Improving Diabetes Care and Outcomes on the South Side of Chicago is a seven-year project funded by the Merck Company Foundation, through the Alliance to Reduce Disparities in Diabetes, and the National Institute of Health. Spearheaded by Drs. Monica Peek and Marshall Chin of the University of Chicago, the project engages patients, providers, clinics, and community collaborators to improve the health care and outcomes of African-Americans on the South Side of Chicago.

The project is multi-faceted and involves four main components:

1. Patient Education and Empowerment

We educate and empower patients to manage their diabetes and communicate effectively with their doctors. Preliminary results indicate that these classes have significantly improved patients? HbA1c levels, diabetes self-efficacy and diabetes self-management behaviors.

2. Provider Workshops

We work with health care providers to troubleshoot the challenges of communicating with their patients, recognize cultural stereotypes on which they may unknowingly rely, and effectively motivate patients towards health behavior change.

3. Clinic System Redesign

Our team facilitates quality improvement (QI) programs redesigning clinic operations to improve care for diabetes patients. QI initiatives have included instituting group visits, patient medication cards, peer support groups, flow sheets, nurse case management, and patient registries. New initiatives include improving access and tracking of specialists visits, employing community health workers/patient navigators, coordinating care, and implementing other team-based care initiatives.

4. Community Collaborations

We collaborate with existing community resources to create sustainable collaborations that support diabetes patients outside of the health care system. We collaborate with food pantries, the Chicago Park District, prescription discount cards, farmers markets, media channels, grocery stores and other organizations.

We work with six clinics on the South Side of Chicago and are implementing each of the above four components in each clinic.

  • University of Chicago Primary Care Group
  • University of Chicago Kovler Diabetes Center
  • Access Community Health Network: Grand Boulevard Health and Specialty Center
  • Access Community Health Network: Booker Family Health Center
  • Chicago Family Health Center
  • Friend Family Health Center