Programs: Chronic Disease Program,  Battered Women's Program, Prenatal

Chronic Disease Program:
Description - The Migrant Health Service, Inc. (MHSI) Chronic Disease Program exists within the national context of needs to: 1) Reduce the elevated mortality rate and high medical costs associated with diabetes in the Hispanic population. 2) Provide access to quality, culturally sensitive health care services accompanied by effective patient self-management.

Background - In 1998, MHSI piloted a Diabetes Program in six rural, summer-only, nurse-managed health centers.  One year later, the Diabetes Program was revised and expanded to encompass eight nurse-managed health centers and two year-round sites.  In 2000 the Diabetes Lay Educator Program (DLEP) was incorporated into the MHSI Diabetes Program.

Outcomes - The Diabetes Lay Educator Program focuses on outcomes in four areas:  services, education, research, and demonstration.

1.  Direct services to Hispanic farm workers.
     - Diabetes Cluster Clinics: seven evening clinics each summer season,
        serving 100-125 patients each season.
     - Diabetes Prevention Screenings:  three screenings of the Hispanic population
        after Catholic Spanish Masses, serving 270-300 individuals each season.
     - Diabetes Registry:  continual updating of the registry with MHSI diabetic 
        clients, sharing reports with the Executive Director, board members, grant
        partners, nurses, community agencies.
     - Diabetes Lay Educators Support Group Meetings (SGMs): open to the 
        general public with a focus on the Hispanic migrant or seasonal farm worker
        population, held every three weeks, focus is on specific educational topics
        related to diabetes, offer blood pressure and blood sugar testing.

2.  Education of the farm workers, their families, Diabetes Lay Educators (DLEs), 
         health care providers, and university students.
      - Individual and group sessions in English and Spanish for farm workers and
         their families in nurse-managed health centers and communities.
      - DLEs on their responsibilities in their communities in MN, ND, and TX.
      - University students fulfilling course requirements on the culture of the Hispanic
         migrant population.
      - Health care providers and university students through annual conferences.

3.  Widely-disseminated, evidence-based research reporting the processes and 
      outcomes of the program.
       - Presentations: one international, three national, three regional, four state
          and one local.
       - Poster Presentations: one international, three national, six regional, and
         and two local.
       - Refereed Publications: one manuscript published in 2002 and one accepted
          for publication in 2003.
       - Current Research Projects: attitudes and behaviors of Hispanic migrant farm 
          workers toward the self-management of their diabetes, the lived experiences
          of Hispanic migrant farm workers with diabetes, six year trends of diabetes
          cluster clinics (provision of health care and educational services to Hispanic
          farm workers), and knowledge, attitudes, and skills of MHSI nurses who use
          technology in the clinical setting (implementation of PDAs).

4.  Demonstration as a model program in its focus, structure, resource utilization, 
     methods, and results.
        - A model program in focus, structure, resource utilization, methods, and
           results (Hess and Batson, 2003)
        - A model program that can be replicated with other chronic diseases in
          ethnic/cultural groups.
        - A model program that can be transported into other rural settings.

Personal Digital Assistant (PDA) Implementation - in 2003 the Diabetes Program implemented the use of PDAs to track patients with diabetes, cardiovascular disease, and depression.  Each MHSI nurse has been assigned a PDA containing medical records for patients at their site.  Nurses are able to easily enter patient data directly into their PDA.  Each month, PDA flash cards are submitted and all the patient data is uploaded into the main database.  Once the upload of data is complete patient records are consolidated and copied onto each flash card according to the site.  This process allows each nurse to access all the data entered by other nurses at their site.

Program Partnerships -
1.  Altru Diabetes Center: provides training to the Diabetes Lay Educators and services to MHSI clients.
2.  Migrant Clinicians Network: administers Track II program and provides support the Diabetes Lay Educators in Texas. 
3.  Minnesota State University Moorhead:  collaborates and co-sponsors annual
conferences.

Awards and Recognition-  In May 2003, the Diabetes Lay Educator Program was presented with the National Rural Health Association (NRHA) Award for Outstanding Rural Health Program.  The NRHA recognized the Lay Educator Program as an innovative community-based program that meets the health care needs of the rural Hispanic farm population in Minnesota, North Dakota, and Texas.