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

With a five-year grant from the Merck Company Foundation’s Alliance to Reduce Disparities in Diabetes, the Coalition created the Camden Citywide Diabetes Collaborative in 2009.  The project 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
  • Use data and technology to track patient outcomes and help improve the flow of information for better coordination of care across provider offices

A Multipronged Approach

In order to improve the approach to diabetes care across multiple levels, the Coalition is currently operating several initiatives under the Diabetes Collaborative umbrella:

  • Converting ten community-based, primary care practices in Camden as recognized Patient Centered Medical Homes.  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.
  • Providing additional diabetes self-management education programs throughout the city.  Patients with diabetes need a variety of self-management education options, in order to suit their schedules, locations, languages,  cultures, and comfort levels.  In addition to existing diabetes education programs, which are largely hospital-based, diabetes education is now being offered in two community-based sites — in the Fairview (English) and Cramer Hill (Spanish) neighborhoods.  Additionally, specially created DVDs in English and Spanish are currently being produced for distribution to diabetic patients and their families.
  • Standardizing guidelines for diabetes care.  Standardized guidelines of diabetes care are being developed by the Collaborative to ensure quality and consistency of care for patients across Camden provider offices and clinics.
  • Comprehensive diabetes education for clinicians and care providers.  The Collaborative seeks to improve the capacity of care for patients with diabetes for all health care providers, including physicians, nurses, medical assistants, medical day programs, and others who treat and provide care to these patients on a day to day basis.  This is being done through on-site education in primary care practices, CME opportunities, live and recorded webinars, as well as one-on-one coaching.

For more information about the Camden Citywide Diabetes Collaborative, please contact us.