Alliance to Reduce Disparities in Diabetes

NPO at the Minority Health and Health Disparities Grantees' Conference

Changing Health System Policies and Practices to Reduce Disparities

2014 Minority Health and Health Disparities Grantees' Conference
December 1-3, 2014
National Harbor, MD

Authors
J.A Dodge, M. Quinn, & B.W. Nelson

Abstract
Purpose: Eliminating health disparities requires system and policy changes that evolve from the real-life experiences of vulnerable individuals. While introducing innovative interventions for African-American, Native American, and Latino low-income people living with diabetes, the five community-based sites of the Alliance to Reduce Disparities in Diabetes recognized that policy changes were essential to sustain promising efforts.

Design Methods: To ascertain the nature and extent of Alliance policy and system change efforts, between 2011 and 2013 data were collected at 3 different time points from more than 60 individuals (project team members, physicians, clinic staff, diabetes educators, health system leaders, community collaborators) across the Alliance sites. Confirmed policy changes were categorized by level of change (organizational to national) and stage of accomplishment (beginning to full maintenance).

Results: Collectively the Alliance sites pursued a total of 53 system and policy changes. The majority (n=28) were at the multi-organizational level (i.e., change was happening in several organizations or clinics but not citywide).   Three strategies emerged as the most promising for addressing disparities: data sharing and organizing data-driven services for high utilizers; embedding community health workers in the care team; and integrating clinic and community services.  Examples of Alliance interventions in these areas will be presented.

Discussion/Conclusion: Policies informed by experiences “on the ground” hold the most promise for reducing health disparities. Models emerging from the Alliance have created momentum and new opportunities for improving diabetes outcomes and quality of care in vulnerable under-served populations.