A five-year multi-site initiative focused on disparities in diabetes care found that care systems designed to address individual medical and social care needs — along with policy changes that affect community resources and payment systems can improve health outcomes for many marginalized patient populations.
In a new supplemental issue of the Journal of General Internal Medicine released March 28, physicians at the University of Chicago Medicine and colleagues nationwide published the results of the Bridging the Gap: Reducing Disparities in Diabetes Care Initiative, a five-year multisite initiative funded by the Merck Foundation.
UChicago was selected by the Merck Foundation in 2017 as the National Program Office for the initiative. It collaborates with eight grantees, the grantees’ partner organizations, and the Merck Foundation to develop innovative ways to address disparities in diabetes care and outcomes. Beyond UChicago Medicine, other participating institutions included:
- Alameda County Public Health Department – Oakland, CA
- La Clínica del Pueblo – Washington, DC
- Marshall University – Huntington, WV
- Minneapolis Health Department – Minneapolis MN
- Providence Health & Services – Portland, OR
- Trenton Health Team – Trenton, NJ
- St. Mary’s Health and Clearwater Valley Health – Orofino, ID
- UPMC Western Maryland – Cumberland, MD
This cooperative system allowed healthcare organizations, community partners, public health leaders, researchers, clinicians and other healthcare professionals at the various institutions to work together toward shared solutions.
Collaborators have built evidence-based holistic care systems to address diabetes care on a population level. This includes programs and partnerships to address challenges faced by marginalized communities that can increase risk of diabetes complications, such as access to healthy food and secure housing, in addition to addressing healthcare challenges for individual patients.
“Diabetes is a poster child for chronic illness,” said Marshall Chin, M.D., M.P.H., Richard Parrillo Family Distinguished Service Professor of Medicine at UChicago Medicine, in a statement. “The principles we have identified and developed with this project apply to many other diseases, and could have a dramatic effect on population health and healthcare costs.”
“This project has essentially been a learning collaborative,” said Monical Peek, M.D., M.P.H., Ellen H. Block Professor for Health Justice in the Department of Medicine, in a statement. “Rather than the traditional funding model where a team would receive a grant and go off on their own to do the project, instead, we’re doing everything we can to help the grantees succeed. We’ve provided coaching and organized group calls to share lessons learned and discuss challenges. Each site is working on the same problem but for their unique population in their unique region.”
The team shared what has been the most successful for improving outcomes. First, holistic, team-based care that bridges clinic treatment to community resources. This builds a trust-based relationship between clinicians and their patients and is tailored according to a patient’s severity and needs.
Second, healthcare organizations that partner with community groups to address social factors such as food insecurity. This can expand care beyond the walls of a medical clinic and empower patients to better manage their own symptoms with community support. And finally, adjusting policy and payment systems to support and incentivize prevention and addressing unmet social needs like food access or housing improves outcomes. This reduces complications and improves overall care for patients.
The group said it hopes these results and perspectives will inform ongoing and new initiatives to improve care access and diabetes management for patients nationwide. Already, they are seeing some rippling changes.
“When we started this project five years ago, many stakeholders weren’t quite ready to make the leap to changes in the payment structure, and so forth,” Chin added. “But the COVID-19 pandemic has raised public awareness of health equity issues. We have a real window of opportunity to leverage our results and conversations to change policy, and we hope that these findings and lessons can guide those policies.”
What has been key, the team says, is empowering the individual healthcare organizations to tailor their programs to the needs of their patients and recognize the importance of building personal, trusting relationships. “You can’t just force a one-size-fits-all shortcut on this problem,” Peek added. “You need to understand the local drivers and trust issues, and you need to combine the technical parts of the solution — like changing the payment system — with the cultural ones.”
