Camden Citywide Diabetes Collaborative
The Coalition has identified 7,041 residents in Camden living with Diabetes Mellitus or Type 2 Diabetes. In a six year period (2002-2008), these patients accounted for over 62,000 visits to Camden EDs/hospitals accumulating charges of over $1.2 billion…
Citywide Coordination of Services and Care for Camden Patients With Diabetes
There are over 7,000 residents in Camden living with Diabetes Mellitus or Type 2 Diabetes. In a six-year period (2002-2008), these patients accounted for over 62,000 visits to Camden EDs and hospitals accumulating millions of dollars of charges.
Camden, like many underserved communities in the United States, is home to a diabetic population that far exceeds the national averages. Many of these individuals also suffer from other diseases that require treatment. The total cost of care for this small number of patients is staggering.
With the support from Merck Company Foundation’s Alliance to Reduce Disparities in Diabetes and Bristol-Myers Squibb Foundation, the Coalition seeks to fundamentally change how providers, office staff, hospitals, and community agencies in Camden care for city residents with diabetes by building an accessible, high-quality, coordinated and data-driven health care delivery system with a strong primary care base.
Broadly, the objectives of the Citywide Diabetes Collaborative are:
- Increase the capacity of community-based, primary care practices to provide comprehensive, proactive care to their patients with diabetes
- Increase diabetes self-management education for residents of Camden with diabetes
- Improve the coordination of care for patients with diabetes across health provider practices, hospitals, and health systems in Camden
The Diabetes Program is part of an overarching objective to convert community-based primary care practices to Patient Centered Medical Homes. The goal is to keep patients out of the ED and hospital by increasing the quality of care at primary care offices. For the past 3 years, the Coalition’s Camden Citywide Diabetes Collaborative has worked with Camden primary care providers to improve diabetes health outcomes through practice transformation efforts. With recent funding from the Bristol-Myers Squibb Foundation, the Coalition has developed an Integrated Diabetes Care Program. Through this program, the Coalition will be working very closely with two of Camden’s primary care practices to add nurse care coordination, community support, provider and staff education, health information technology, organizational development, social work, behavioral health and wellness, and financial resources.
The Coalition recognizes that ongoing long-term care for diabetes, as well as other chronic illnesses, needs to occur within the primary care setting. Coalition staff are assisting practices in capacity building projects, including implementing electronic health records (EHR), utilizing the Camden Health Information Exchange (HIE) in routine patient care, creating diabetes registries, and on-site patient nutrition and diabetes self management education. The Coalition is also providing on-site education, Diabetes Mentor Educator (DME) opportunities, as well as one-on-one coaching.
