Diabetes in humboldt park a call to action

DIABETES IN HUMBOLDT PARK:

A Call to Action

December 6, 2006

Prepared by

THE HUMBOLDT PARK DIABETES TASK FORCE

TABLE OF CONTENTS

TASK FORCE MEMBERS…………………………………………………………………………..1

EXECUTIVE SUMMARY.…………………………………………………………………………..2

INTRODUCTION…………………………………………………………………………………...4

MISSION STATEMENT…………………………………………………………………………….6

GUIDING PRINCIPLES……………………………………………………………………………..7

SUMMARY OF RECOMMENDATIONS…...…………………………………………………………10

THE RECOMMENDATIONS

1. INCREASE AWARENESS OF DIABETES AND MAKE DIABETES A COMMUNITY-WIDE PRIORITY……12

2. DEFINE THE SCOPE OF THE PROBLEM WITHIN THE COMMUNITY…………….……………..13

3. PRIMARY PREVENTION: REDUCE THE NUMBER OF PEOPLE WHO DEVELOP

DIABETES IN THE COMMUNITY………………………………………………………...….15

4. IMPROVE MEDICAL CARE FOR PEOPLE WITH DIABETES……...…………………………….18

5. HELP PEOPLE WITH DIABETES TAKE BETTER CARE OF THEIR HEALTH……………………..21

PROJECT COMMUNITY………………………………………………………………………….24

PROJECT TIMETABLE …………………………………………………………………………26

CONCLUSIONS…………………………………………………………………………….……27

A CALL TO ACTION

THE HUMBOLDT PARK DIABETES TASK FORCE MEMBERS

Steve Rothschild, MD, Chair Tiana Kieso, M.B.Ch.B, MPH
Associate Professor, Departments of Medical Services Coordinator
Family Medicine and Preventive Medicine Access Community Health Network
Rush University Medical Center
Willa Iglitzen Lang, MSW
David Baldwin, MD Executive Director
Director, Section of Endocrinology National Kidney Foundation of Illinois
Rush University Medical Center
Miguel Morales
Rhoda Bernstein, MA, MPH Project Coordinator, CO-OP Humboldt Park
Development Coordinator Puerto Rican Cultural Center
Norwegian American Hospital
Martin Nava
Frank M. Castillo, MD Associate Director
Medical Head of Family Medicine Latino Initiatives
Erie Family Health Center American Diabetes Association

Kathy Christoffel, MD, MPH Anita Rico
Katherine Kaufer Christoffel, MD, MPH Community Health Coordinator
Medical & Research Director Centro Sin Fronteras
Consortium to Lower Obesity in Chicago
Children (CLOCC) Daisy Rodriguez, RN
Children's Memorial Research Center Director
Nursing Education
Jaime Delgado Norwegian American Hospital
Services Director
Community Outreach Intervention Projects Laurie Ruggiero, PhD
University of Illinois at Chicago Professor of Community Health Sciences
School of Public Health Institute for Health Research and Policy
Illinois Prevention Research Center
Leon Fogelfeld, MD School of Public Health
Chief Endocrinologist University of Illinois at Chicago
John Stroger Hospital
Abigail Silva, MPH
Pauline Guzman Senior Epidemiologist
Women’s Health Outreach Coordinator Sinai Urban Health Institute
Access Community Health Network Sinai Health System

Kim Hennecke Maripaz Vazquez, RN
Director of Programs Diabetes Nurse Educator
American Diabetes Association Rush University Medical Center

Migdalia Jimenez Steve Whitman, PhD
Health and Nutrition Organizer Director
Healthy Lifestyles Initiative Sinai Urban Health Institute
Association House Sinai Health System

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EXECUTIVE SUMMARY

In "Disproportionate Impact of Diabetes in a Puerto Rican Community in Chicago,” appearing in
the December 2006 issue of the Journal of Community Health, Steve Whitman, Abigail Silva
and Ami Shah, from the Sinai Urban Health Institute, identified the excess burden of illness that
diabetes places on the people of Humboldt Park, most notably the Puerto Ricans. In response to
the findings of that paper, over 20 health professionals and community activists met to develop
an action plan that would significantly reduce diabetes morbidity in Humboldt Park within five
years. Meeting over a three month period, this task force has generated 19 recommendations to
be implemented over the next five years as part of a newly formed Humboldt Park Diabetes
Project. Each recommendation of the task force was based not only on the best available
evidence and research, but also on the principal that community engagement and participation in
the plan will be essential to its success.

The 19 recommendations in the report address five major goals:
1. To increase awareness of diabetes and make it a community-wide priority;
2. To design and implement a screening program to define the scope of the problem within
the community;
3. To reduce the number of people who develop diabetes in the community through a
multifaceted program of education and primary prevention;
4. To improve medical care and access to health services for people with diabetes;
5. To provide people with diabetes with the necessary information and resources to thus
empower them to take better care of their health.

Diabetes is not inevitable or unavoidable. Healthy lifestyles, early and effective medical
treatment, and behavioral self-management for people affected by diabetes can all dramatically
reduce morbidity (complications) and mortality (death). While it will take many years to
eliminate the excess death rate from diabetes, the Humboldt Park Diabetes Project is committed
to working with the community to significantly reduce diabetes morbidity within the next five
years. This is more than a public health challenge – this is a moral imperative for all of us. The
Humboldt Park Diabetes Project calls on the participation of the entire community in this

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challenge: political leaders at the city, state, and federal level; the philanthropic community;
public health authorities from the Illinois and Chicago Departments of Public Health; academic
health centers and universities; hospitals, clinics, and doctors in this community; the media;
community organizations, religious institutions, businesses, and other agencies; and all of the
residents of Humboldt Park.

We further believe that this strategy will not only help the residents of Humboldt Park but will
serve as a model for other communities in Chicago and indeed the United States. To facilitate
this process, we are working with experts in the evaluation of community health projects who
will help us determine just what is most effective in this pursuit.

We must all work together in the fight against diabetes.

We have a plan. The time for action is now.

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INTRODUCTION

The paper entitled "Disproportionate Impact of Diabetes in a Puerto Rican Community in
Chicago” set to appear in the December 2006 issue of the Journal of Community Health was
meant by the authors from the Sinai Urban Health Institute to be a call to action. Indeed,
viewing it any other way would be a disservice to the people of the Humboldt Park community
as well as to people in similar communities across the United States. It is to this call that our
Diabetes Task Force is responding.

As the paper indicates, diabetes is extracting an enormous toll on the people of Humboldt Park,
most notably the Puerto Ricans. The proportion of adults with diabetes (the prevalence) has
increased rapidly in the United States and now stands at about 7%. Among Puerto Ricans in this
community it is 21%, three times higher than the US rate and higher than almost any other
diabetes prevalence that has ever been reported. Even worse, the diabetes mortality rate among
Puerto Ricans in Humboldt Park is 68 per 100,000 people. This may be compared with a rate of
25 for the US and 31 for Chicago. The rate of 68 is so high that if it prevailed for the US, it
would be the second leading cause of death in the country: higher than anything except heart
disease, higher than any cancer, higher than stroke, etc. But the damage extends even further
than this. Once people have diabetes they are at increased risk of kidney disease, (and kidney
failure and dialysis), blindness; amputation; and much more.

Diabetes, however, does not stand immutable and triumphant. We know many ways to prevent
diabetes. In cases where it cannot be prevented, we know many ways to minimize its impact and
certainly to prevent it from killing us. It is to these actions that our Task Force has turned its
attention. The challenge that we pose to ourselves is as follows: What can realistically be done
to turn back the diabetes epidemic in Humboldt Park? Can we create a plan that will do this?
And if we succeed, can we document our efforts so that they can be employed by similar
communities across the country?

When the call went out to concerned people in the city, we never expected such a resounding
response. Without exception, every person we asked to serve on this Task Force agreed,

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attending meetings held at night and reading, writing, and researching the issues long after
official work hours ended. A list of the Task Force members, along with their organizational
affiliations, is detailed on page 1. As can be seen, this report represents the work of a diverse
and highly qualified group.

This document contains recommendations for fighting diabetes in this one community. All of
our recommendations are based on the best-informed evidence that we could locate; all of them
are realistic and can be implemented – starting now. We hope that you will agree that this is
indeed a blueprint for success. We have the knowledge and the capabilities. What we need now
are the resources and the political will to free up those resources for what is literally a matter of
life and death.

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MISSION STATEMENT

Diabetes is not inevitable or unavoidable. Healthy lifestyles, early and effective medical

treatment, and behavioral self-management for people affected by diabetes can all dramatically

reduce morbidity (complications) and mortality (death). While it will take many years to

eliminate the excess death rate from diabetes in the Puerto Rican community, the Humboldt Park

Diabetes Project is committed to working with the community to significantly reduce diabetes

morbidity within the next five years. This is more than a public health challenge – this is a

moral imperative for all of us. The time for action is now.

The Humboldt Park Diabetes Project will:

1) INCREASE AWARENESS OF THE IMPACT OF DIABETES AMONG RESIDENTS OF HUMBOLDT

PARK AND WILL INCREASE UNDERSTANDING THAT DIABETES AND ITS COMPLICATIONS

ARE PREVENTABLE AND TREATABLE.

2) CREATE A SUSTAINED PROGRAM OF CULTURALLY RELEVANT COMMUNITY EDUCATION

TO INCREASE HEALTHY LIFESTYLES AND BEHAVIORS TO REDUCE THE RISK OF

DIABETES.

3) IDENTIFY 1,000 NEW CASES OF DIABETES IN THE COMMUNITY SO THAT PEOPLE CAN

BEGIN EFFECTIVE TREATMENT BEFORE THE DISEASE CAN DAMAGE THEIR HEALTH.

4) IMPROVE THE CONTROL OF DIABETES, DEMONSTRATED BY OBJECTIVE MEASURES,

WITHIN THE NEXT FIVE YEARS.

5) REDUCE THE RATE OF DIABETES-RELATED HOSPITALIZATIONS AND COMPLICATIONS

WITHIN THE NEXT FIVE YEARS.

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GUIDING PRINCIPLES

In preparing the recommendations in this report, we have observed the following general
principles:

Diabetes is an urgent priority
As shown in the paper by Whitman, Silva, and Shah at the Sinai Urban Health Institute,
diabetes is already so prevalent as to overwhelm existing health resources and recent trends
show that it is rising rapidly in Humboldt Park. Time is of the essence. Our proposals must
be simple and ready to be implemented.
Prevention is preferable to cure. Wherever possible, and supported by research, Primary
Prevention should be emphasized to reduce the occurrence of diabetes – before it can cause
sickness, disability, and death.

Community oversight and cultural sensitivity
The impact of diabetes is felt throughout the community; the response to the problem must
come from the community. Our best hope for both preventing diabetes and providing
optimal care to persons with the disease rests with engaging and involving community
members. Every aspect of the project must be informed by the community, using a
mechanism such as the Centers for Disease Control and Prevention (CDC)’s PATCH
(Planned Approach to Community Health) process; this approach “increases the capacity of
communities to plan, implement, and evaluate comprehensive community-based health
promotion programs.”
All efforts in the project must be culturally relevant; our efforts must go beyond simply
producing materials in Spanish, but must also be sensitive to the values and beliefs of the
residents of Humboldt Park.

Diabetes must be approached at all levels – prevention, early detection, and comprehensive care
A large national prevention study, the Diabetes Prevention Project, has shown that as many
as 60% of at-risk people can prevent diabetes through effective lifestyle interventions.

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Others who are already diagnosed can benefit through self-management training. At the
same time, medications will be needed by many residents to both prevent and treat diabetes
and its complications. As this project will seek to identify persons with diabetes and those at
risk, we must ensure that clinical resources -- and medications for the uninsured – are
available in the community.
Diabetes is a primary care disease – our strategy is not to shift patients from one source of
care in the community to another source. Our proposals will seek to build the infrastructure
to deliver good primary care.
Proposals will be based on best current evidence of effectiveness.

Implementation
The Humboldt Park Diabetes Project will seek immediate funding for a Director with public
health experience and knowledge of the community. Office space and clerical support will
be obtained through funding or in-kind support. This will represent the operational core of
the Project, responsible for outreach and pursuing additional funding to implement the
recommendations.
Recommendations should be rolled out in a carefully thought out series of stages, with each
effort building the infrastructure needed for the next step.
Funding to initiate projects should be from multiple sources, both public and private. This
funding will be considered start-up only; for each proposal, long-term sustainability is a key
consideration.
For each proposal, we will ensure that the benefits to the community can be well
documented, and that information about our progress is shared with the community on a
regular basis.

Evaluation and this Work as an Exemplar
It is essential to note that we view this work as a model to be tested. We are concerned with
diabetes in all communities, not just among Puerto Ricans, not just Humboldt Park, etc.
However, our research has led us to this community and the data suggest that this is a crucial
place to start.

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We will evaluate what we do very carefully, keeping track of our efforts, their impact on
diabetes and related conditions, and cost effectiveness. Our Task Force is very well-qualified
to lead such work.
If our work succeeds and we are able to improve the situation in the project community, then
we will have a well-documented effort that we could extend to other communities in Chicago
and even nationally.

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SUMMARY OF RECOMMENDATIONS

1. INCREASE AWARENESS OF DIABETES AND MAKE DIABETES A COMMUNITY-
WIDE PRIORITY
1.1. Recruit an Oversight Board for the Humboldt Park Diabetes Project.
1.2. Engage community groups in the design and implementation of efforts to increase
awareness of diabetes in the community.
1.3. Identify and train at least two outreach workers to conduct workshops and talk to
individuals and groups about the impact of diabetes in the community.
1.4. Design and implement a social marketing campaign to promote awareness and action on
diabetes in Humboldt Park.

2. DEFINE THE SCOPE OF THE PROBLEM WITHIN THE COMMUNITY
2.1. Design and implement a community-wide screening campaign for diagnosing persons
with diabetes and also for those at risk of developing diabetes.
2.2. Prepare an annual report to the community about findings of the Screening Campaign.

3. PRIMARY PREVENTION: REDUCE THE NUMBER OF PEOPLE WHO DEVELOP
DIABETES IN THE COMMUNITY
3.1. Establish a Diabetes Community Education Center (DCEC) in Humboldt Park.
3.2. Implement an intervention program for children identified as “at risk” through
community screening programs.
3.3. Design and implement multifaceted interventions aimed at diet, physical activity, and
behavior change based in worksites and other settings in the community.
3.4. For persons with pre-diabetes, provide effective early intervention to reduce the risk of
developing diabetes.

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4. IMPROVE MEDICAL CARE FOR PEOPLE WITH DIABETES
4.1. Engage health care providers serving Humboldt Park in a diabetes collaborative network
to improve diabetes care.
4.2. Develop and implement an intensive diabetes quality care education project for health
care providers.
4.3. Design and implement quality improvement projects across all of the members of the
Humboldt Park diabetes collaborative network.
4.4. Conduct an annual clinical needs assessment to ensure adequate health system resources.
4.5. Implement diabetes clinical services at the Diabetes Community Education Center.
4.6. Implement a case management program for all persons with diabetes in Humboldt Park.

5. HELP PEOPLE WITH DIABETES TAKE BETTER CARE OF THEIR HEALTH
5.1. Implement a “diabetes information clearing house” within the DCEC to provide
educational materials and referrals to community agencies
5.2. Provide free diabetes self-management education and resources for people diagnosed
with diabetes.
5.3. Provide community-based resources to healthy decision-making regarding nutrition and
physical activity for persons with diabetes and their families.

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THE RECOMMENDATIONS

1. INCREASE AWARENESS OF DIABETES AND MAKE DIABETES A COMMUNITY-WIDE PRIORITY
The report of the Sinai Urban Health Institute has shown that diabetes takes a
disproportionate toll on the Humboldt Park neighborhood. In order to correct this
situation, residents must be aware of the problem, and must believe that they can correct
this problem by taking action as individuals, as families, and as a community. The success
of our campaign will depend upon a major effort to front-load awareness within the
community and engage as many individuals as possible in the design and implementation
of the Humboldt Park Diabetes Project.

1.1. Recruit an Oversight Board for the Humboldt Park Diabetes Project.
The Board should include a wide range of representatives, including residents of the
neighborhood, community based organizations (CBOs), representatives of the
business community in Humboldt Park, health professionals and services, and public
health officials to oversee the development and implementation of the project.

1.2. Engage community groups in the design and implementation of efforts to increase
awareness of diabetes in the community
HPDP will utilize a coalition of community partners that do valuable work in the
Humboldt Park community and are already engaged in organizing around health
issues. These include (but are not limited to) the Puerto Rican Cultural Center,
Centro Sin Fronteras, Centro San Bonifacio, Association House, Bickerdike
Redevelopment Corporation, Erie Neighborhood House, Miguel Barreto Union
League Boys and Girls Club, the McCormick Tribune YMCA, the Chicago Park
District (Humboldt Park), San Lucas Church, the Community of Wellness-
HPEP/NNNN (Humboldt Park Empowerment Partnership-Near Northwest
Neighborhood Network) Committee, CLOCC (Consortium to Lower Obesity in
Chicago Children), and Community Organizing for Obesity Prevention in Humboldt

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Park (CO-OP HP). These organizations compose part of the Humboldt Park
community infrastructure needed to address diabetes.

1.3. Identify and train at least two Outreach Workers to conduct workshops and talk to
individuals and groups about the impact of diabetes in the community.
Outreach Workers should be recruited from the neighborhood, be bilingual, be
effective communicators and display enthusiasm about the HPDP. In this phase of
the project, the Outreach Workers will be responsible for disseminating information
about the HPDP and making neighbors aware of efforts underway. In particular, they
will prepare the community for the Screening Campaign (recommendation 2.0);
beginning in the second year of the project, they will be actually conducting the
screenings in the community.

1.4. Design and implement a Social Marketing Campaign to promote awareness and
action on diabetes in Humboldt Park.
Businesses use marketing to influence the behaviors of potential customers; social
marketing has been described as the planning and implementation of programs
designed to bring about social change using concepts from commercial marketing
with the ultimate aim of influencing action. An organized campaign will further
increase awareness of diabetes within the community by promoting the project via
radio and television stations in both English and Spanish. Additional efforts could
include a poster campaign, in stores, schools—school council parent meetings,
churches, community centers, unemployment centers, as well as other centers such as
WIC, YMCA etc. Business partners must be identified who will provide in-kind
contribution of creative talent and grants will be pursued to develop effective
materials and strategies for the social marketing campaign.

2. DEFINE THE SCOPE OF THE PROBLEM WITHIN THE COMMUNITY
Although the Sinai study indicates dramatic rates of individuals who are aware that they
have diabetes, published national data indicate that there is also a substantial population of

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undiagnosed diabetics. Using the widely quoted statistic of 33% undiagnosed, we estimate
that if 20% of the adult Puerto Rican population of Humboldt Park already know that they
have diabetes, there is another 10% (or approximately 2,000 people) with undiagnosed
disease. A still larger number have “Pre-Diabetes” or Metabolic Syndrome, putting them at
risk of diabetes. Early detection and action can avoid the damage to the body that can occur
when people have uncontrolled diabetes.

2.1. Design and implement a community wide screening campaign for diagnosing
persons with diabetes and also for those at risk of developing diabetes
Over a two-year period, the HPDP will provide free screenings in a wide variety of
settings to ensure the widest possible participation within the community. Examples
of such settings include CBOs, churches, grocery stores, libraries, and other public
places. In addition, the HPDP screening could be conducted by current project
partners such as Rush University Medical Center, Erie Family Health Center, the
Cook County Bureau of Health Services, the National Kidney Foundation of Illinois
(through its KidneyMobile), the American Diabetes Association, St. Elizabeth
Hospital, Norwegian-American Hospital, and the Access Community Health
Network. By participating, these health partners would also agree to provide access
to care to their respective health centers and hospitals for persons identified with
diabetes that are in need of direct services. Screening should consist of simple health
history, height/weight/ waist circumference / blood pressure measurement, and
glucose measurement. These can be conducted in virtually any location at any time,
without extensive preparation.

Community residents who are screened will receive immediate results and
information about their personal risk for diabetes. Depending upon their risk, they
will receive targeted culturally relevant health education materials. In addition, they
will be encouraged to participate in education and early intervention programs, as
described under recommendation 3.0.

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2.2. Prepare an annual report to the community about findings of the Screening
Campaign.
It is essential that the information gathered by the Screening Campaign be returned to
the community. HPDP will work with the Illinois Department of Public Health and
the Chicago Department of Public Health to explore the creation of an annual
community health report summarizing diabetes statistics about the community to
allow monitoring health of the community and provide feedback to the community as
a whole.

3. PRIMARY PREVENTION: REDUCE THE NUMBER OF PEOPLE WHO
DEVELOP DIABETES IN THE COMMUNITY

3.1. Establish a Diabetes Community Education Center (DCEC) in Humboldt Park
The Diabetes Community Education Center will be a visible sign of the commitment
to addressing the problem of diabetes. Its placement in a prominent and accessible
location will provide a center for education, screening, and self-management training.
The DCEC can house the project as well as a wide range of educational programming
to intervene with children and families at risk for the development of diabetes.

During the first year of the project, the DCEC should offer general programs on
diabetes education as part of the awareness efforts (Recommendation 1.0). When the
Screening Campaign is put into place (Recommendation 2.0), screenings can be
conducted at this site as well. In subsequent years, the DCEC will provide more
intensive education and follow-up for persons who have been identified as being at
risk for developing diabetes and who seek to reduce their risk of progressing to the
disease.

(Although not directly part of the primary prevention effort, the DCEC will also
develop a role as a full service center for assisting persons diagnosed with diabetes,
providing referral, self-management support, and intensive interventions to improve
care. These efforts are described in Recommendations 4 and 5.)

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3.2. Implement an intervention program for children identified as “at risk” through
community screening programs
CO-OP Humboldt Park, working in collaboration with CLOCC, has already begun
efforts to identify and intervene with children at or before they enter elementary
school. We recommend that these efforts be expanded, with the objective of reducing
the rate of obesity by the time children enter high school.

All children identified as “at risk” due to elevated BMI measurements in community
screening or because of family history will receive a referral to their physicians with
information about the risk of diabetes and information about available lifestyle
promotion programs. We will also work with after-school and other physical activity
programs within the community to expand capacity and availability, to ensure that
children have access to a range of safe and acceptable physical activities.

3.3. Design and implement multifaceted interventions aimed at diet, physical activity,
and behavior change based in worksites and other settings in the community.
The CDC’s Guide to Community Preventive Services (6/30/2005) recommends such
interventions for overweight and obese individuals because of evidence of cost
effectiveness of such programs in reducing weight.

Pilot interventions to promote healthier lifestyles are already underway in Humboldt
Park. Such projects should be funded to promote their expansion to include all at-risk
members of the community.

Examples of interventions that provide affordable nutrition education, fresh food
access, and activity opportunities for residents of all ages include: the PRCC-CO-OP
Humboldt Park Market Basket program; the various Producemobile operations in
Humboldt Park and the HomeGrown Farmers Market, all of which address local and
affordable access to fresh produce; Bickerbikes, a program of Bickerdike
Redevelopment Corporation; TASK (Travel that is Active and Safe for Kids);

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Muevete, Girls in the Game and other physical activity available in Humboldt Park;
peer education through the Promotoras program of Centro San Bonifacio; nutrition
education through the EFNEP (Expanded Food and Nutrition Education Program)-
University of Illinois Extension; and the Chicago Partnership for Health Promotion
(CPHP).

Targeted efforts, including direct mail and personal contact by outreach workers will
engage “at risk” adults and children to promote their participation in these programs.
General information about these programs will also be disseminated through an
informational campaign (Recommendation 1.4), and physicians’ offices and clinics
(Recommendation 4.2).

Any gaps left by currently available services will be identified through on-going
evaluation, and the HPDP will work to fill these in collaboration with the Park
District, Chicago Public Schools, YMCA, Illinois Extension Service, and others.

3.4. For persons with pre-diabetes, provide effective early intervention to reduce the risk
of progressing to develop diabetes.
The Diabetes Prevention Program (DPP), the DREAM study, and other research trials
have effectively demonstrated that for persons at risk of developing diabetes, the use
of medications or behavioral interventions can significantly reduce the rate of
incident diabetes.

All persons identified with pre-diabetes will receive information about strategies to
reduce their risk of progression to diabetes, as well as facilitated referrals to
community services. Enhanced, culturally relevant lifestyle education programs will
be developed in year 3 - 5 of the project, based at the Community Diabetes Education
Center.

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Most experts now recommend medication to reduce the rate of progression from pre-
diabetes to diabetes in adults. For uninsured and under-insured individuals, a
program to provide these medications (such as Metformin or Rosiglitazone) will be
needed. HPDP will seek funding to ensure that all adults with pre-diabetes who are
appropriate candidates for medication intervention and who wish to use such
medications will have access to them.

4. IMPROVE MEDICAL CARE FOR PEOPLE WITH DIABETES

4.1. Engage health care providers serving Humboldt Park in a diabetes collaborative
network to improve diabetes care.
Across the US, collaborative provider networks have served to improve diabetes care.
HPDP will bring together the “safety net” providers within the community (Cook
County Bureau of Health Services, Erie Family Health Center, Access Community
Health Network, Near North Health Services) along with community hospitals and
academic health partners to address quality of care and access to services.

4.2. Develop and implement an intensive diabetes quality care education project for
health care providers.

4.3. Design and implement quality improvement projects across all of the members of
the Humboldt Park diabetes collaborative network.
The prevalence of diabetes requires management be carried out in the primary care
settings. “Best practice” protocols have been shown to improve diabetes care. A
program to reach all providers with on-going education and quality measures for
follow-up is needed to enhance care on the front lines. This type of intensive
provider education has had demonstrated benefit in the national Chronic Care
Collaboration model; a local example has been the partnership of an academic
medical center (Rush University Medical Center) with a community hospital (St.
Anthony’s Hospital) under the leadership of Dr. David Baldwin.

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Working together with community partners in the HPDP, culturally-relevant, low
literacy education and referral resources will be made available to providers to
enhance care for newly identified persons with diabetes and at-risk adults and
children.

Sharing of data among members of the collaborative network and publication of that
data within the community will create a visible commitment to improving care of
diabetes. Such data can include information about adherence to published practice
guidelines and rates of diabetes control (as measured by readily available tests such as
Hemoglobin A1c). This will identify opportunities for continued improvement in
existing services, and sharing of “best practices” among members of the collaborative
network.

4.4. Conduct an annual clinical needs assessment to ensure adequate health system
resources
We cannot simply improve diabetes awareness and diagnosis in the community
without ensuring that the resources exist to treat these new cases. Safety net
providers in Humboldt Park are already at – or past – capacity to deliver needed
services to the current population of known persons with diabetes. As this project
identifies up to 1,000 additional individuals with diabetes, as well as a significantly
larger number with pre-diabetes, it is essential that the health system be monitored,
and additional providers be sought to provide care.

We estimate that over the course of this project, an additional 2 to 3 primary care
physicians and 3 full time nurse practitioners may be needed to meet demand. Hiring
of these new providers would occur in a staged process over five years; state and
federal funding should be sought to hire additional primary care providers within the
diabetes collaborative network, as indicated by the annual needs assessment.

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4.5. Implement diabetes clinical services at the Diabetes Community Education Center
(DCEC)
A freestanding diabetes care center with links to Cook County Bureau of Health
Services, Erie Family Health Center, Access Community Health Network, Near
North Health Services, and other primary care providers in the community would
offer significant advantages:

Linking patient care to education and screening initiatives
Adding the value of Certified Diabetes Educators and Community Health Workers
to patient care – which is more difficult to implement if services are decentralized
across multiple centers.
Avoiding overwhelming any one provider with uncompensated care
Focusing on diabetes creates environment for best quality of care
Having a single source for diabetes specialty services within the community
Having potential ability to control medication costs through bulk purchases, strict
generic formulary

Critical to the success of this approach is that community providers will be engaged
in the development of the CDEC and kept informed of plans for its operation. Health
care providers must see the CDEC as a resource and a benefit to them and their
patients, and NOT as a threat. Providers must receive timely electronic reports of
patient progress, medications, and educational interventions.

Resources needed to implement this program would include: Certified Diabetes
Educators and Community Health Workers (Recommendation 5); social worker; and
a pharmacist. A simple fingerstick A1c monitor should be available to provide
patients with immediate feedback on their progress towards diabetes control.

One of the biggest challenges will likely be providing access to medications for the
many uninsured and under-insured persons in the community. In addition to oral

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A CALL TO ACTION

medicines to control blood sugar, the prevention of complications for persons with
diabetes also requires medicines to control blood pressure and cholesterol, as well as
less costly medicine such as baby aspirin. In collaboration with the Cook County
Bureau of Health Services, a formulary of generic medications with demonstrated
benefit for preventing diabetes complications should be developed.

4.6. A case management program should be developed for all persons with diabetes in
Humboldt Park
The CDC’s Guide to Community Preventive Services (1/17/2003) recommends
disease management and case management services because of strong evidence of
cost effectiveness. It is not uncommon for persons with chronic diseases such as
diabetes to miss doctors appointments, run out of medicines, or forget to get needed
tests. Case managers can help people with diabetes organize their care, get regular
follow-up, and avoid falling through the cracks of the health care system. Five to six
case managers will be needed for the estimated 1,000 new cases of diabetes to be
identified, as well as for the people who have already been diagnosed but who are not
receiving care on a regular basis. Case Managers will engage people by phone and
will help them receive services through reminders, information, and referrals.

5. HELP PEOPLE WITH DIABETES TAKE BETTER CARE OF THEIR HEALTH

5.1. Implement a “diabetes information clearing house” within the DCEC to provide
educational materials and referrals to community agencies
Almost from its inception, the DCEC can begin to serve as a resource directory for
persons with diabetes. Beyond providing a site for literature, video education, access
to effective websites (such as that of the American Diabetes Association), the DCEC
should maintain a directory of resources available in Humboldt Park to help persons
with diabetes. In addition to health care providers, this would include exercise
programs, food and nutrition services, social services, and CBOs. This
recommendation can be rapidly implemented at relatively low cost.

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A CALL TO ACTION

5.2. Provide free diabetes self-management education and resources for people
diagnosed with diabetes
The CDC’s Guide to Community Preventive Services (1/17/2003) recommends Self-
Management education in community gathering places based on evidence of cost
effectiveness. We recommend hiring three full time Spanish-speaking Certified
Diabetes Educators to work in the CDEC and provide diabetes self-management
classes and one-on-one counseling. In addition, up to six full time Spanish-speaking
Community Health Workers (promotoras) should be hired to follow up with newly
diagnosed diabetics in their homes and in community settings to ensure understanding
and behavior changes.

Self-monitoring of blood sugar is recommended for all persons with diabetes, but it is
absolutely essential to the approximately 30% of adults who must use insulin to
control their sugar. The CDEC should provide free glucose meters and test strips to
diabetics in the community who use insulin, and should provide the needed education
to allow those individuals to use their meters effectively.

5.3. Provide community-based resources to healthy decision-making regarding
nutrition and physical activity for persons with diabetes and their families.
Persons living with diabetes must make dozens of decisions each day that will affect
their illness – decisions about what to eat, whether to walk or drive, what physical
activity to engage in, buying and taking their medicine, and many more. Simple
interventions such as signs encouraging people to take the stairs rather than waiting
for an elevator have been shown to improve rates of diabetes control in community
settings. In addition, such supports benefit everyone in the community by promoting
healthier lifestyle choices.

The HPDP will work with community leaders and businesses to implement such
health-promoting resources. These efforts could include a voluntary nutrition
labeling program at markets and restaurants in the community, or widely

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A CALL TO ACTION

disseminated flyers publicizing existing exercise programs at community centers,
park district field houses, and senior centers.

When needed resources do not currently exist in the community (for example, a lack
of ready affordable fresh fruits and vegetables), the HPDP will work with community
based organizations to help obtain them, or to develop them within the community.

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A CALL TO ACTION

PROJECT COMMUNITY

We would like to help everyone in Chicago and even the United States who has diabetes, or who
might get diabetes. Since this is, of course, an impossible position to start with, we thought that
it would be good to select a comparatively small, well-defined geographical area, run a “pilot
project” there for five years, and carefully evaluate what happens. (We are particularly well
suited for such an effort due to the remarkably varied talents of members of the Task Force.) If
our efforts are successful, then we will argue with great energy that they be replicated throughout
Chicago and even beyond. As the slogan for universal health care says, “Everybody In, Nobody
Out.” That is our eventual goal. Starting with this one small project area is our strategy.

We thus have decided to that we will use the geographic boundaries of Chicago Avenue (south)
to Armitage Avenue (north), and Western Avenue (east) to Kedzie Avenue (West). This area is
commonly known as Humboldt Park. Note that this overlaps with (but does not correspond
exactly to) the officially designated community area of Humboldt Park.

MAP OF PROJECT COMMUNITY IN CHICAGO The 2000 census counted
37,166 people in this area. Of
these 33% were Puerto Rican,
Western

Armitage 27% were Mexican, 16% were
White, 13% were Black and the
Kedzie

Chicago
rest were "Other," many of
these "Hispanic other."

If we use the prevalence of
(non-gestational) diabetes for
each of these four groups,
derived from our community
study (and presented in the
Sinai Urban Health Institute

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A CALL TO ACTION

paper cited above), and apply these to the number of people 18+, then we wind up with an
estimate of 2,469 people in the project area who have been given a diagnosis of diabetes. The
literature suggests that one third of people with diabetes have not been given a diagnosis. This
implies that 1,235 such people also live in the project area. Thus, altogether we estimate that
3,704 people 18+ in the project area have diabetes.

Page 25

HUMBOLDT PARK DIABETES PROJECT TIMETABLE
YEAR Qtr Operations Awareness Screening Prevention Healthcare Self care
1 1 Hire Staff, Establish office 1.1 Oversight Board
Recruit HPDP partners 1.2 Commnty Mtgs;
2 (Public and private sectors, 2.1 Design Screening 3.1 Establish Diabetes 4.1 Create Diabetes
health care, business)
Engage CBOs
3 1.3 Outreach Wkrs Campaign Commun Ed Cntr DCEC Collaborative network 5.1 DCEC serves as
Publicize screening campaign 3.2 Childhood 4.2 Educational & information clearing
4 Intervention Program Referral Resources house / referral ctr
2 1
1.4 Implement Social 2.1 Implement Screening 4.3 Shared data on 5.2 Self-management
2 Marketing Campaign Campaign education programs
3.3 Multifaceted quality of care
3 workplace and (CDEs, Community
community interventions Health Workers)
4 4.4 Needs
assessment
3 1
5.3 Community-wide
2 3.4 Intervene with 4.5 Clinical services
“Pre-Diabetes” campaign of support
@ DCEC for healthful decision
3 group
making
4 4.6 Case
Management
4 1
Complete 2 year
2 Screening Campaign
3
4 Annual Reports to Community Evaluation of All Interventions and
5 1 about Progress of the HPDP Continuous Quality Improvement
2
3
4
Over 90% of surveyed Residents will be aware Persons at risk of Persons with diabetes Persons with diabetes
residents of HP will be of their own risk of developing diabetes will have improved will know what they
aware of the impact of diabetes or that they will have ready access quality of care, and will need to do to manage
DM in their community, have the diagnosis. to culturally relevant have measurable their diabetes and will
OUTCOME and the work of the Over 1,000 new cases education & improvement in the have ready access to
HPDP. of DM will be identified. intervention programs control of their the tools needed to
designed to reduce disease.. help them manage their
their risk disease.
REDUCE THE ADVERSE IMPACT OF DIABETES ON THE RESIDENTS OF HUMBOLDT PARK
REDUCE THE RATE OF DIABETES-RELATED HOSPTIALIZATIONS AND COMPLICATIONS
WITHIN FIVE YEARS

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A CALL TO ACTION

CONCLUSION

Over the next five years, hundreds of people with diabetes in Humboldt Park will suffer
potentially avoidable blindness, kidney failure and dialysis, heart attacks, strokes, amputations
and other complications; dozens will be killed by the disease. The evidence is clear that
diabetes and its complications are taking a disproportionate toll on this community.

The community residents, activists, and health professionals who have come together to prepare
this report refuse to accept this as just another unfortunate set of statistics. This document
contains recommendations for fighting diabetes in a Chicago community that is being devastated
by the disease. The 19 recommendations listed have been assembled based on the best informed
evidence that we could locate and that we believe can be practically implemented in Humboldt
Park over the next five years. If successful in reducing the adverse impact of diabetes, we will
have helped not only this neighborhood but also established an effective community model to be
implemented elsewhere in Chicago and the nation.

We call upon political leaders at the city, county, state, and federal level to recognize the
magnitude of the problem and work to ensure funding for these efforts;

We call upon the philanthropic community to provide additional support for the
development of innovative new programs to reduce the impact of diabetes in this
neighborhood;

We call upon public health authorities to focus attention and resources on this problem;

We call upon academic health centers and universities in our area to provide needed
technical support and clinical services;

We call upon the hospitals, clinics, and doctors in this community to work together to
improve care for everyone with diabetes or who is at risk;

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A CALL TO ACTION

We call upon the media to increase awareness of diabetes, and to help get the message
out to the community that diabetes is not inevitable nor are its complications
unavoidable;

We call upon community organizations, religious institutions, businesses, and other
agencies in Humboldt Park to consider how they can help in the fight against diabetes;

We call upon residents of Humboldt Park to join with us to address the challenge of
diabetes, and to hold all of us accountable for taking action to solve this problem.

WE HAVE A PLAN. THE TIME FOR ACTION IS NOW.

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Diabetes in humboldt park a call to action

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