On the latest episode of The Huddle, we’re joined by Jay Shubrook, DO, BC-ADM, FACOFP, FAAFP, Anne Lee, MEd, RDN, CDCES, and Clipper Young, PharmD, MPH, as they talk about Touro University’s unique Mobile Diabetes Education Center (MOBEC). They explain how the center was formed, the services MOBEC provides, and how others can replicate this work to serve and educate a greater population of people with and at risk for diabetes. Learn more about MOBEC here: Touro University California https://diabetesjournals.org/clinical/article/42/1/125/153645/Community-Based-Diabetes-Awareness-Strategy-With
On the latest episode of The Huddle, we’re joined by Jay Shubrook, DO, BC-ADM, FACOFP, FAAFP, Anne Lee, MEd, RDN, CDCES, and Clipper Young, PharmD, MPH, as they talk about Touro University’s unique Mobile Diabetes Education Center (MOBEC). They explain how the center was formed, the services MOBEC provides, and how others can replicate this work to serve and educate a greater population of people with and at risk for diabetes.
Learn more about MOBEC here: Touro University California
Jodi Lavin-Tompkins
Hello and welcome to ADCES's podcast, “The Huddle: Conversations with the diabetes care team”. In each episode, we speak with guests from across the diabetes care space to bring you perspectives, issues, and updates that elevate your role, inform your practice, and ignite your passion. I'm Jodi Lavin-Tompkins, the Director of Accreditation and Content Development at the Association of Diabetes Care & Education Specialists.
My guests today are Dr. Jay Shubrook, Anne Lee and Dr. Clipper Young. We're going to have a conversation about a unique program they're doing that's helping to deliver personalized diabetes education to residents of Solano County in California. So welcome to the three of you. And I know this is a unique program for delivering diabetes care. So I want to start out with asking each of you to describe your role to our listeners. Jay, why don't you go first, introduce yourself and talk about your role.
Jay Shubrook
I'm Jay Shubrook a family physician and a primary care diabetologist. I serve as the director of diabetes services at Touro University of California, and MOBEC is one of those services we provide.
Anne Lee
Hello, my name is Anne Lee. I'm a registered dietitian, CDCES. I've been working with Dr. Shubrook, Dr. Young, and the rest of the team since 2017 when MOBEC, the Mobile Diabetes Education Center, started providing services in the community. I help with designing and managing the various community education programs we have. That includes the screenings and education that we provide to our visitors.
Clipper Young
And hello, good morning, everyone. I'm Clipper Young. And as a clinical pharmacist and a CDCES with a public health background, my role has evolved over time, specifically with MOBEC. And I remember that I was initially at the forefront of program design and implementation and also attending community events and with Anne vividly. Since then, I've shift my focus to concentrating on behind the scenes data analysis and disseminating outcomes. And also, I've explored ways to integrate MOBEC with other programs for potential funding opportunities.
Jodi
Okay, thank you. Now, each of you has used the term MOBEC, and we didn't really introduce that. So I want to spell it out for our listeners. Jay, I know you're wearing the official MOBEC polo shirt for the podcast, so can you just tell us what does MOBEC, M-O-B-E-C, stand for? And then when we say it throughout the podcast, people will know what we're talking about.
Jay
Absolutely. So, you know, every program needs a good acronym, right?
Jodi
Right!
Jay
So MOBEC is Mobile Diabetes Education Center. And I realize it's not MODEC, it's MOBEC, partially because we knew that we would have something that should be easy to come off the tongue and also something that wasn't already declared in another space.
Jodi
That makes sense. So Jay, I want to continue with you. Can you describe for our listeners, where did the idea to create this mobile education center come from and how has it evolved into a fully functioning program?
Jay
So as someone that treats patients with diabetes really is a focus of my practice. And seeing certainly ways that we can improve care, I always feel like there's more we should be doing upstream, right? We know that at least type 2 diabetes is largely preventable and entirely treatable, and that we really could reduce complications. And part of that is finding people earlier in the process and giving them actionable information to allow them to be engaged and activated in their self-care. And so the university was given an opportunity to have essentially a vehicle that could be used for research or other things. Knowing that we wanted to do something that was community-focused and knowing that we wanted to be able to offer services in the community, we received the mobile unit and then retrofitted it so that we could do diabetes screening. And so when we first started, we were really just kind of learning about the process. So one of the things that it makes MOBEC unique is that we are really focused on screening, health awareness, and education. We do not actually provide clinical care. And that was done purposely so that one, we're meeting an unmet need because there are many places that people can get care. And we wanted to be a connector from the community to the existing health systems. And there are ample health systems that we can get people connected to, but it's building that first step, that first bridge to engagement and involvement.
Dr. Young had a brilliant idea to say, why don't we assess our community and really see what they need? And so we went to the seven metropolitan areas of the county and did surveys reaching out to say, what kind of services could we provide if we did a mobile clinic? And I think that was such an important step for our success because we were able to one, meet the community and then two, help them with services that are desired by them rather than offered by us alone. And then the second part of that is really making sure that we're not just going into the community as a freestanding independent institution, but really making sure that we partner with community partners who are the host that we come and visit because we want to be embedded in the community and seen as a resource in the community. And I think those were two very important steps early on.
Jodi
You said you surveyed the community. So did you survey people in the community directly, or did you go through clinics or some other way of doing that?
Jay
So we partnered with the Solano Department of Public Health, as well as the major insurer, public insurer there, which was Partnership Health Plan. And they helped to develop a critical network of representative leaders in each of the communities. And so we really started with that as a part. So we were screening community members and asking them what they wanted from us.
Jodi
Okay, so partnerships are very important.
Jay
What we've learned is communities are important. They're units and often medical teams are seen as outside. And so part of our growth was growing from a medical unit to a really community focused unit. And so we had an advisory board that helped to redesign the look of MOBEC and we became a trusted partner over time. And we really saw that in COVID where some organizational activities asked for MOBEC to come because we were seen as a trusted partner. And that was really an eye-opening moment for me to say, “oh, people see us now as a key part of the community”. And that's exactly what we want. We want people to be familiar with us. We want to know that it's safe to come see us and that we're there to provide, not to take. And so now we've grown a lot. And I know that Anne and Dr. Young are going to talk more about this, but we offer multiple services now and really provide key community-based screening with timely educational interventions that allow people to act on these findings and seek the right level of care or education.
Jodi
Thank you for that great description. I mean, this sounds like a really innovative program that is meeting so many needs. So I want to move on to ask Anne, I understand, Anne, that you spend about 50% of your time on the Mobile Education Center. You're handling logistics and training students. So can you tell us more about how the center works, how it's funded, and anything else you think we should know?
Anne
The Mobile Diabetes Education Center has gotten funding from a few very generous funders since 2017. The funders include Sutter Health, California Department of Public Health, Solano County Public Health, Janssen Pharmaceuticals, and Kaiser Permanente. They saw the benefits of reaching individuals in their own communities. We operate in sort of a pop-up format. We just bring all of our equipment to set up at a location. And we drive to the truck and trailer unit, the MOBEC unit itself, to offer services. And we offer inside the truck and trailer unit. We have scheduled times that we show up to provide blood glucose and A1C testing, blood pressure monitoring, and cholesterol screening at a location in Solano and Napa County. Some of the locations include places of worship, community or senior centers, schools and housing complexes. MOBEC has a variety of visitors that come for different interests. Some may want to get screened just out of curiosity of our process. And some find us very convenient to get additional testing outside of their doctor's offices. Other people may lack comprehensive health coverage or they may have felt frustrated navigating their health systems that they belong to and they find it very convenient to come to us and ask questions about blood glucose or blood pressure or cholesterol. And since we offer testing to anyone who is interested, regardless of their health insurance coverage or health status, visitors often feel very comfortable sharing their health stories which is really an asset for our medical students because the medical students, when they come to volunteer with us, they get to hear about these real health struggles of individuals, especially from those with limited resources in our county. It truly is a program that raises awareness among those who may not have prioritized their long-term health, a community program that is designed to provide free diabetes education and a learning center for medical students.
Jodi
That part is really great that you're involving the medical students and they get to be on the ground hearing from these folks and their challenges. That's an awesome training opportunity. So, glad to hear you're taking advantage of that with the program. Clipper, I think our listeners would be interested in learning about, now that we know about the program, how it started, how it's set up, how it works. What have you heard as far as feedback and what outcomes have you seen? So how well is this mobile education center working?
Clipper
Yeah, at least two key observations come to my mind. So first, I feel MOBEC has shown a powerful way to help people manage their health and specifically in screening and also education. But it is not just about checking their blood sugar or blood pressure, but it's about creating that safe space to talk, to build that trust that Dr. Shubrook mentioned earlier, and also understand their health in real time. And also I feel that this simple act can boost their self-confidence and end up to personalize consultation and setting goals. And also since we're mobile and community-based, the setting feels friendly and also approachable, not like somebody is in a clinic and also at a hospital that feels intimidating. And the second point would be, I see MOBEC, it's making a dual impact on both the communities that we serve and also the students that we teach and as Anne mentioned earlier. And on the community side, we have seen measurable outcomes like participant learning about their A1C levels for the first time or increasing access to diabetes and pre-diabetes education and also a rise in health literacy. But beyond the numbers is really about that trust that Dr. Shubrook mentioned. Community members, they return, they bring their friends, their families, and also engage more deeply in their own health and also ways to take care of themselves. And on the student side, MOBEC functions as a real-world classroom. Students from pharmacy, osteopathic medicine, physician assistant, nursing, public health programs, they gain firsthand experience addressing health disparities. Also learning to practice with cultural humility and also structural competency and the concepts that they have all learned and heard in classrooms or nowadays in virtual classrooms. But many of them would tell us that MOBEC has been a transformative moment in their training at Touro because they see what it means to deliver care that is truly person-centered and also community-based. In that sense, MOBEC isn't just delivering screenings and education. And I really like to see that as it's also shaping the future of health care one student at a time, at least at Touro, and by providing that environment for students to cultivate their own paths in health care.
Jodi
Thank you. Well, this question is for all three of you. I would like you to help our listeners with a few takeaways that you would like to highlight from our conversation today, or maybe something we haven't touched on yet you think is important.
Clipper
I think trust is the most valuable currency. I see when we deliver services and care with humility, respect, and consistency in a community, and the trust will come naturally. And with that trust, what comes after it's better outcomes, better engagement, and also stronger bond between communities and the health care team. And secondly, we have an interprofessional team. So I think interprofessional education is very powerful. And training students in this setting helps create a more caring and also community-focused healthcare team. And MOBEC isn't just enlightening participants' health care journeys. We also want to set a standard for how health care professional students learn and also help others. And lastly, the mobile platform is a viable and scalable model. Throughout the years, I've seen firsthand that mobile and community-based care like MOBEC, it's not just a nice-to-have thing. It's a real and effective way to screen for chronic diseases, especially for those who don't have easy access to health care.
Anne
And to piggyback on what Dr. Young was talking about, you know, the people that we see on MOBEC face many challenges managing their health. From people with very hectic work/home schedules, and life struggles, many put their long-term health as a low priority item until it becomes a problem. So with social media and entertainment being so easily accessible on their phones, people may seek and actually trust health information from an influencer more than health care providers. So being the trusted source and raising awareness of preventing chronic diseases or their complications remain important goals of MOBEC. And we wanna be the one that our community can trust.
Jodi
Absolutely.
Jay
Yeah, I think these are really important points and I would highlight that we're so grateful that we have a diversity of funders who have been really supporting us. And I think it shows that we all have a shared common goal, which is really to improve the public health. I think that there's still a lot of stigma as it relates to diabetes and taking it into the community and taking it so it's kind of embedded, not medicalized. This is allowing us to have an open conversation. And I love that we have an opportunity to train future health care professionals in a service learning opportunity where one, they maybe see a very different view of someone's life and challenges. And two, they see the importance of moving upstream. And we're just very grateful to have this opportunity. We have an amazing team. And as Dr. Young had mentioned, interprofessional team doing interprofessional education. I think everybody wins in the long run there. So, we're grateful the opportunity and we hope to keep growing. And if anyone else wants to build their own MOBEC, reach out to us. We'd be happy to help you with that blueprint.
Jodi
When I hear about MOBEC, I think the other mobile program that became sort of the standard almost, I can go to my local hospital and there's a mobile mammography van that drives around. So I'm really hoping for you that this model for diabetes care also becomes that standard. That would be awesome.
Anne
We sure hope so.
Jodi
Also, what's very encouraging is that you talked about the multidisciplinary aspect of the care provided, and I think it's a great opportunity to show what diabetes care and education specialists can do as a multidisciplinary specialty.
Jay
I'll just reiterate that having Anne on MOBEC is really, all our team members are very important, but we want people to have access to quality education at a teachable moment when they find screening and we want it to be in a safe environment. So having Anne and the team there, including the other health professional students, are critical to our success.
Jodi
Well, thank you so much, Jay, Anne, and Clipper for sharing your expertise on this topic with us. Our listeners appreciate hearing about innovative delivery of diabetes care and can use the benefits of your hard work as ideas to implement in their own settings.
Thank you for listening to this episode of The Huddle. Make sure to download the resources discussed on today's episode. You can find them linked in the show notes. And remember, being an ADCES member gets you access to many resources, education, and networking opportunities. Learn about the many benefits of ADCES membership at adces.org/join. The information in this podcast is for informational purposes only and may not be appropriate or applicable for your individual circumstances. This podcast does not provide medical or professional advice and is not a substitute for consultation with a health care professional. Please consult your health care professional for any medical questions.