Project Turning Point

The intent of Project Turning Point disease management program is to improve the overall health of clients, and to reduce their likelihood of visiting a hospital or emergency room.   To achieve these goals, Project Turning Point disease managers work directly with clients to help increase their personal understanding of their health status and how to affect it; and to encourage them to actively participate in managing their own health and care plan(s).

Who is Eligible?

Eligible clients must meet all of the following criteria:

  • Legal resident of Baker, Bradford, Clay, Nassau or Union County
  • 18-64 years old
  • Not insured and not eligible for Medicaid, Medicare, VA, or other coverage
  • Enrolled or eligible to be enrolled in primary care with the County Health Department
  • Family Income  <150% Federal Poverty Level (FPL)
  • Diagnosed with diabetes by a licensed healthcare professional

Disease management services are provided by qualified Project Turning Point staff.   Services begin with an initial patient assessment, and client progress is tracked through periodic reassessments at least every six months.   An Individual plan of care is developed with each client that includes personal goals that the client helps set for him/herself, and that are based on guidelines from the American Diabetes Association.   Project Turning Point disease managers utilize motivational interviewing and a variety of evidence-based interventions to help “coach” patients regarding desired lifestyle changes.   The disease managers establish and maintain contact with the client, the primary care provider, and the clinic support staff at the client’s home County Health Department (CHD) throughout the client’s enrollment period; and serve as the care coordination center-point for disease-related treatment, screenings, and other services.

Project Turning Point disease managers also assist the client and Primary Care Physician in authorizing and obtaining needed specialty and pharmaceutical services related to their diabetes (Eye Care and Foot Care).

 Project Turning Point utilizes the Diabetes Master Clinician Project (DMCP) to track clients’ clinical progress and actively manage the project’s overall success in its goals of improving health and reducing hospital utilization.   This electronic data-management tool includes tracking functions that:  1) assist the clinician in managing individual patients; 2) provide a basis for patient education; and 3) provide individual provider and aggregate clinic reports to enhance overall project quality management and evaluation.

Project Turning Point offers at least two separate and accredited educational curriculums including: 1) Diabetes Conversation Maps – a set of five large table maps developed under guidance from the American Diabetes Association to guide group discussion through a variety of educational topics; and 2) Take Charge of Your Diabetes – a 12 session (usually 1 two-hour session per week) curriculum developed by the U.S. Centers for Disease Control and Prevention (CDC) promoting self-management and outlining potential complications related to diabetes.

Project Turning Point disease managers are also certified to teach the highly accredited Stanford University chronic disease self-management curriculum known as Living Healthy.   Classes for this 6 week course can be scheduled in a participating county on request for clients as well as any residents who are living with a chronic disease.


Diabetes Master Clinician Program

This program currently is available at no charge. The program includes the use of an internet based diabetes registry, training for all clinicians and office staff on how to use the registry and standards of diabetes care as well as training for group visits. The user's manual that describes how to enter data and use the program can be obtained by clicking here. This manual has screen shots and instructions for most reports that can be obtained from the registry. For more information


Diabetes University

Diabetes University is creation of the Diabetes Master Clinician Program and the NF SG chapter of the American Diabetes Association. The program goal is to help staff in Primary Care Offices, ADA volunteers, patients and their families increase their  knowledge and understanding about Diabetes.
For more information: