improving diabetes care and outcomes on the south side of chicago

www.alliancefordiabetes.org

University of Chicago

Improving Diabetes Care and Outcomes on the South

Side of Chicago

Improving Diabetes Care and Outcomes

on the South Side of Chicago

Alliance to Reduce Disparities in Diabetes

Diabetes Mellitus Death Rates (per 100,000) -by Community Area

Community Areas with the Lowest Median Household Income

At least 33% below the citywide average

PSA: 8 of 10

8 of Chicago’s 10

lowest income

communities are in

UCH’s primary

service area. Community Location

Median Household

Income

Oakland PSA $10,739

Riverdale PSA $13,178

Grand Boulevard PSA $14,178

Washington Park PSA $15,160

Woodlawn PSA $18,266

North Lawndale Other $18,342

Fuller Park PSA $18,412

Englewood PSA $18,955

Armour Square PSA $22,756

West Garfield Park Other $23,121

East Garfield Park Other $24,216

Douglas PSA $24,835

New City PSA $25,647

$38,625

$46,435

Chicago Average

Illinois Average

H

Project Goals

• Short-term goals:

– Improve access to care

– Improve quality of care

– Improve clinical outcomes

• Long-term goals:

– Strengthen partnerships among HCs, CBOs and University of

Chicago

– Empower communities to address diabetes

– Be sustainable

6 Participating Health Centers

– ACCESS Booker Family Health Center

– ACCESS Grand Boulevard Health Center

– Chicago Family Health Center

– Friend Family Health Center

– University of Chicago Kovler Diabetes Center

– University of Chicago Primary Care Group

Intervention

• Six health centers – 2 academic clinics

– 4 FQHCs

• Patient activation/ communication training

• Provider communication training

• Clinic Redesign

• Community Connections

Intervention

• Six health centers – 2 academic clinics

– 4 FQHCs

• Patient activation/ communication training

• Provider communication training

• Clinic Redesign

• Community Connections

Patient Intervention

• Patient communication training – Patient empowerment

– Culturally tailored diabetes education

– Shared decision-making

• Discuss (Information-Sharing)

• Debate (Deliberation)

• Decide (Decision-Making)

• 2-3 hr classes x 10 weeks

• Pilot (n=21):

– 86% attended > 70% classes

– Improved self-efficacy, self-mgnt

Changes in Self-Efficacy

Survey Question Number of Patients (n =21)

Baseline Post-Intervention P-value

I feel confident in my ability to

manage my diabetes

3.9 4.5 0.04

I feel capable of handling my

diabetes

3.8 4.5 0.01

I am able to do my own routine

diabetes care now

3.9 4.6 0.02

I am able to meet the challenge

of controlling my diabetes

3.9 4.2 0.28

Changes in Self-Efficacy: 3-month follow-up

Survey Question Number of Patients (n =21)

Baseline Post-Intervention P-value

I feel confident in my ability to

manage my diabetes

3.9 4.4 0.04

I feel capable of handling my

diabetes

3.8 4.6 0.02

I am able to do my own routine

diabetes care now

3.9 4.6 0.02

I am able to meet the challenge

of controlling my diabetes

3.9 4.4 0.16

Changes in Self-Care Behaviors

Survey Question Number of Patients (n =21)

Baseline Post-Intervention P-value

Healthful eating plan

3.4 5.1 0.002

Self-Foot Care 4.1 6.0 0.001

Self-Glucose Monitoring 4.4

6.2 0.04

Exercise 2.9 3.1 0.09

Changes in Self-Care Behaviors (3 mo f/u)

Survey Question Number of Patients (n =21)

Baseline Post-Intervention P-value

Healthful eating plan

5.9 5.9 0.08

Self-Foot Care 4.1 6.2 0.51

Self-Glucose Monitoring 4.4

5.6 0.28

Exercise 2.9 2.9 0.13

Patient Intervention: Mobile Phone Pilot

• 4 week pilot at PCG (n=18)

• Text message reminders re:

diabetes self-management

• Improvements in:

– Diabetes self-efficacy

– Self-foot examinations

– Medication adherence

Results: User Experience

Strongly Agree Moderately or

Slightly Agree

Disagree

It was easy to receive and read the

text messages from the research team.

94 6 0

It was easy to send text messages to

the research team.

72 28 0

I found the text message reminders to

be helpful at decreasing the number of

pills I missed.

89 11 0

I found the text message reminders to

be helpful at increasing the number of

times I checked my feet.

89 11 0

I found the text message reminders to

be helpful at decreasing the number of

doctor visits that I missed.

87 13 0

I would be willing to use a cell phone

reminder system in the future to help

me manage my diabetes.

78 22 0

I would recommend a cell phone

reminder system to my friends/family

that have diabetes.

94 6 0

Changes in Self-Efficacy

Pre During Post

Series1 14.0 18.8 17.8

0.0

5.0

10.0

15.0

20.0

P<0.01

P<0.01

Intervention

• Provider communication training – Shared Decision-Making

• Clinic Redesign – Community Health Workers

– Peer educators

– Group visits

• Community Connections – Education

– Resources

Our Project Team

• Marshall Chin

• Monica Peek

• Abigail Wilkes

• Tonya Roberson

• Kristine Bordenave

• Michael Quinn

• Doriane Miller

• Lisa Vinci

• Andrew Davis

• Elbert Huang

• Jonathan Birnberg

• Keisha Bishop

• Jonathan Dick

• Shantanu Nundy

• Melinda Drum

• Hui Tang

• Shannon Wilson

• Deborah Burnet

• Karen Kim

• Dawnavan Davis

• Thomas Fisher

• Quin Golden

• Eric Whitaker

• Asim Mishra

• Laura Derks

• Mickey Eder

• Peggy Hasenauer

• Louis Philipson

• Rick Kittles

• Marla Soloman

• Rebecca Lipton

• Tiffany White

• Donald Goens

• Melishia Bansa

Funding/ Support

• Merck Company Foundation

• NIDDK R18 DK083946-01A1

• NIDDK P60 DK20595 (DRTC)

• NIDDK K23 DK075006

• NIDDK K24 DK071933

• University of Chicago CTSA Pilot and Collaborative

Translational and Clinical Studies Award