1. Using Healthy Heart Data by Rick Frey, PhD Toiyabe Indian Health Project, Inc. A collection of PowerPoint slides that have been used in grant applications, Diabetes grant narratives, and Board of Directors’ reports over the past three years by the Preventive Medicine Department at Toiyabe. Using program data Toiyabe Indian Health Project, Inc. *The clinical measures listed on these documents were used by the programs over the past 10 years and were current at their time of use. However, these example documents are not intended to serve as current clinical guidelines. Programs using these documents will need to ensure the clinical measures are current for their intended use.

2. Toiyabe Indian Health Project, Inc. Board of Directors Presentation July 25, 2008 Bridgeport Indian Colony Preventive Medicine

3. Current Toiyabe Participant Data Individuals in the HHP registry116 Number of consented participants 80 Number with completed baseline assessments 64 Number with completed annual assessments 30 Number with completed 2-year assessments 16

4. How Are We Doing? As of January 1, 2008: National AverageToiyabe Average Weight loss.6%2.2% BMI decrease.6%2.2% Waist decrease.6%5.1% Hips decrease.6%4.1% LDL decrease1.8%18.7% HDL increase2.7%9.2% Triglyc. decrease2.4%4.9% Tot. Chol. decrease 3.6%9.2% HbA1C decrease.3%10.5%

5. Perspective A one point drop in HbA1C reduces diabetes-related complications by 40%. Over a period of nine years, the 333 community- directed grants dropped their national average by 1 point. In one year Toiyabe’s HHP participants dropped their average HbA1C level by.9 point.

6. Toiyabe Indian Health Project, Inc. Board of Directors Presentation July 31, 2009 Bridgeport Indian Colony Preventive Medicine Department

7. Toiyabe Participant Data Last yearToday Individuals in the HHP registry116149 Number of consented participants 80103 Number with completed baseline assessments 6490 Number with completed annual assessments 3050 Number with completed 2-year assessments 1631 Number with completed 3-year assessments 014

8. How Are We Doing? Selected Goal Attainment National Mean Toiyabe Mean Systolic BP (< 130 mm Hg)63%71% LDL (<100 mg/dl)66%76% Aspirin Use85%94% Physical Activity (>150 min./wk) 45%52% As of January 1, 2009

9. How Are We Doing? Selected Clinical Characteristics National MeanToiyabe Mean Weight loss1.7%3.0% HDL increase1.6%2.5% Triglycerides decrease8.5%13.0% Total Cholesterol decrease 3.6%9.2% HbA1C decrease6.4%10.0% As of January 1, 2009

10. Just a Reminder A one point drop in HbA1C reduces diabetes-related complications by 40%. Over a period of nine years, the 333 community- directed grants dropped their national average by 1 point. In two years Toiyabe’s HHP participants dropped their average HbA1C level by.8 point.

11. Toiyabe Indian Health Project, Inc. Board of Directors Presentation July 30, 2010 Bridgeport Indian Colony Preventive Medicine Department

12. Toiyabe Participant Data 2008 2009 Today Individuals in the HHP registry116 149 182 Consented participants80 103 115 Completed baseline assessments 64 90 106 Completed annual assessments 30 50 63 Completed 2-year assessments 16 31 46 Completed 3-year assessments --- 14 30 Completed 4-year assessments --- --- 12

13. How Are We Doing? Selected Goal Attainment Through Second Year of Participation National Mean (1107) Toiyabe Mean (35) Systolic BP (< 130 mm Hg)61%78% Diastolic BP (<80 mm Hg)70%75% HbA1C (<7%)49%43% LDL (<100mg/dl)65%61% HDL (>40 mg/dl-m, >50mg/dl - w)36%33% Aspirin Use89%97% As of January 1, 2010

14. How Are We Doing? Selected Clinical Characteristics Change from Baseline through Second Year National MeanToiyabe Mean Weight loss1.5%5.4% BMI decrease.8%3.0% Systolic BP decrease1.5%3.2% Diastolic BP decrease2.5%3.7% As of January 1, 2010

15. How Are We Doing? Selected Clinical Characteristics Change from Baseline through Second Year National MeanToiyabe Mean LDL decrease8.3%1.6% HDL increase2.5%5.9% Triglycerides decrease10.1%9.4% Total Cholesterol decrease5.2%3.0% HbA1C decrease3.8%2.5% As of January 1, 2010

16. How Are We Doing? Outcomes at Second Annual Assessment National (1107)Toiyabe (36) Weight218.8210.2 BMI36.235.5 Systolic BP126.8118.6 Diastolic BP74.373.8 As of January 1, 2010

17. How Are We Doing? Outcomes at Second Annual Assessment National (1107)Toiyabe (36) LDL90.288.2 HDL44.746.6 Triglycerides177207 Total Cholesterol167.4165.2 HbA1C7.57.7 As of January 1, 2010

18. Toiyabe Indian Health Project, Inc. Healthy Heart Program California Area IHS Medical Conference Sacramento, CA 2010

19. Toiyabe Participant Data Last yearToday Individuals in the HHP registry149175 Consented participants103114 Number who have completed: baseline assessment 90105 annual assessment 50 60 2-year assessment 31 40 3-year assessment 14 22 4-year assessment 0 9

20. Clinical Characteristics Comparison National and Toiyabe Healthy Heart Participants through Second Year National Toiyabe Base2 nd Base2 nd (%) Change from Baseline (3331)(1107)(91)(36) National Toiyabe Weight 222.2218.8222.2210.2 1.5 5.4 BMI36.536.236.635.5.8 3.0 Waist45.644.944.643.7 1.5 2.0 Systolic128.7126.8122.5118.6 1.5 3.2 Diastolic76.274.376.673.8 2.5 3.7 Cholesterol176.5167.4170.3165.2 5.2 3.0 LDL98.490.289.688.2 8.3 1.6 HDL ↑ 43.644.744.046.6 2.5 5.9 Triglycerides196.9177.0228.8207.4 10.1 9.4 HbA1C7.87.57.97.7 3.8 2.5 Data from SDPI HH Progress Report – 12/31/09

21. Toiyabe Indian Health Project, Inc. Comparison of Healthy Heart Participants and DM patients (not in HH Program) September 2009 DM Group (%) HH Group (%) n=188 n=66 A1C < 8.03350 BP < 130/802658 Cholesterol <200 mg/dl3370 LDL < 100 mg/dl1747 HDL > 55 mg/dl 515 Triglycerides < 150 mg/dl1948 Foot Exam4392 Eye Exam2550 Dental Exam4064 Diet Education3691 Exercise Education3280 Depression Screening3674

22. Application to CDC for Community Transformation Grant July 15, 2011

23. Excerpt from Community-Directed Grant Application FY 2010 (in response to a question about diabetes-related health issues) “Diabetes has a prevalence rate of over 14% in the TIHP service area. This is a unique challenge because diabetes is associated with a number of comorbidities. Fortunately there is hard baseline data on the participants in the TIHP Healthy Heart Program (HH), which is a competitive Special Diabetes Program for Indians (SDPI) program designed to reduce the risk of cardiovascular disease in Native American DM patients. The HH sample size represents approximately 33% of the TIHP 2009 DM audit cohort. It is believed that this sample characterizes the morbidity percentages for all TIHP DM patients. The following data is taken from the September, 2009 progress report from the SDPI Demonstration Projects Coordinating Center at the University of Colorado, Denver:”

24. Gender All FemaleMale N%N%N% Heart Disease 6016.72119.08117.3 High blood pressure 6149.22268.28354.2 Ulcer/stomach disease 6010.0210.0817.4 Anemia or other blood disease 608.3210.0816.2 Cancer 611.6210.0821.2 Depression 6216.12119.08316.9 Osteoarthritis, degenerative arthritis 6121.3219.58218.3 Back pain 6033.32250.08237.8 Rheumatoid Arthritis 6113.1214.88211.0 Rates of Comorbidities of Diabetes Patients at Toiyabe Indian Health Project The top five DM-related health issues at TIHP, in rank order, are hypertension, back pain, arthritis, heart disease, and depression.