Healthcare disparities refer to differences or inequities in access to, and outcomes of, health services.
In the United States, disparities for many chronic health conditions, including diabetes, are a growing national concern. The U.S. Centers for Disease Control and Prevention estimates that nearly 25.8 million people8.3 percent of the U.S. population—are affected by diabetes. Type 2 diabetes accounts for 90 to 95 percent of all diagnosed cases.
To address the growing problem of healthcare disparities related to type 2 diabetes in the United States among low-income and underserved adult populations, The Merck Company Foundation launched The Alliance to Reduce Disparities in Diabetes (Alliance) in 2009 with a commitment of $15 million through 2013.
The Alliance is working to minimize diabetes disparities and enhance the quality of diabetes care by improving prevention and management services. The Alliance is collaborating with national, regional and community partners to develop and implement comprehensive, evidence-based diabetes programs that:
- Apply proven, community-based and collaborative approaches to address healthcare disparities related to type 2 diabetes among low-income and underserved adult populations
- Enhance patient and healthcare provider communication, mobilize community partners and assist healthcare organizations in decreasing disparities in diabetes care
- Disseminate important findings to aid in the development of comprehensive prevention and management programs to help improve the quality of healthcare for adults who have or are at risk for diabetes
- Increase awareness of policy makers at all levels about changes that can help to reduce healthcare disparities in diabetes
- Promote collaboration and information exchanges to strengthen the efforts of interested stakeholders around the country that share the vision and goals of the Alliance
Through grants to five organizations, The Merck Company Foundation is supporting multifaceted, community-based programs that address the key factors that can improve health outcomes for people living with diabetes. The five grantee communities are: Camden, New Jersey; Chicago, Illinois; Dallas, Texas; Memphis, Tennessee; and Wind River Reservation, Wyoming. The University of Michigan's Center for Managing Chronic Disease serves as the Alliance National Program Office.
Alliance programs focus on integrating three core components:
- Patients: Patients who are better educated and empowered may become more engaged in their healthcare overall; they may become better at managing their conditions themselves by adopting behaviors that help prevent health problems and communicating effectively with physicians and other clinicians
- Clinicians: Clinicians who are more skilled in communicating with diverse patient groups-and are aware of cultural beliefs-are more effective in providing care and educating their patients
- System: Healthcare organizations that implement and support clinical systems, policies or practices related to effective disease management can help to reduce disparities in diabetes care
Alliance Program Sites
Camden Coalition of Healthcare Providers (Camden, New Jersey): The Camden Citywide Diabetes Collaborative aims to better coordinate and improve the quality of comprehensive primary care services for city residents with diabetes.
University of Chicago (Chicago, Illinois): The University of Chicago program focuses on redesigning and improving the quality of diabetes management and care provided at community health centers on the South Side of Chicago.
Baylor Health Care System, Office of Health Equity (Dallas, Texas): The Diabetes Equity Project focuses on helping physicians develop strategies that promote effective care and management for low-income, uninsured and underserved people with diabetes in Dallas.
Healthy Memphis Common Table (Memphis, Tennessee): The Diabetes for Life program promotes community outreach and diabetes self-management through local churches in Memphis.
Wind River Reservation (Fort Washakie, Wyoming): An effort led by the Eastern Shoshone Tribe and its collaborating partners seeks to improve access to diabetes care and management among the Eastern Shoshone and Northern Arapaho Tribes of the Wind River Reservation.
Cross-Site Alliance Program Evaluation
The Foundation is working with RTI International to conduct a five-year (2009–2013), cross-site evaluation of the Alliance and its programs. Initial results from the evaluation provide an overview of provider enrollment and participation metrics as well as baseline patient self-reported outcome measures.
In 2011, 45 clinics or practices participated in at least two of the three areas of intervention (i.e., patient, provider, and system). Cumulatively, from 2009 to 2011, 166 individual physicians have been actively engaged in program implementation (e.g., recruiting patients with type 2 diabetes, identifying and implementing systems change in the practice setting). In addition, Alliance sites have served a diverse patient population through their programs. From 2009 to 2011, across the sites, 42 percent of patients were Hispanic or Latino, 36 percent are African American, 9 percent were Native American, 7 percent were white, 2 percent were Asian, and 4 percent were of another racial or ethnic background.
In 2012, clinical outcome metrics will be available, including those for hemoglobin A1c, blood pressure, and cholesterol. Note that the data below are not site-specific, but are aggregated across the five sites, and are coming from an independent evaluation.