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