To beat back diabetes, we're the ones
The following was written by leaders of five Boston community health centers: Recent media attention to the rising tide of diabetes in our nation's urban centers has produced understandable concern which those of us who provide healthcare to Boston's poorest neighborhoods share. In recent years, within our five community health centers alone, we have seen the incidence of Type II diabetes in our communities mushroom to a point where we are serving over 3,800 diabetic patients collectively, and thousands more who are at risk. Yet even in the midst of widespread suffering, much of it unnecessary, there are reasons for optimism.
With proper education and support, our patients can make the diet and lifestyle changes that can prevent the onset of diabetes and avoid or delay its most dangerous and costly complications. Studies have shown this to be the case, and we know it first hand, because when we have been able to engage patients in their own care by teaching them how to check their own blood sugar, eat healthier foods, get more exercise, and come in for regular care, they generally do better. If these services were the norm for our patients, and people like them across the country, we are confident that many more could live healthier and longer lives than the media have portrayed.
Common sense argues for such preventive care and chronic disease management, yet the financial incentives embedded in our health systems seem to have it backwards. Reimbursement to providers for diabetes care has typically favored hospitalization, costly procedures, and diagnostic tests over primary care, even though investing in community-based care would save money in the long run.
A February 2006
But Boston has something going for it that other cities do not; we are fortunate to have an extensive and strong network of community health centers that provide quality primary and specialty care in the neighborhoods most burdened by diabetes.
We know what it takes to get our patients engaged in improving their own health. We believe that, for many of our patients , we can provide these services better and more cost-effectively than hospitals. One simple reason for this is that we are part of the communities we serve. Another is that we provide excellent care.
Of course our participation in the life of our communities does not alone provide us with the expertise to help our patients avoid or manage this very complex disease. It does , however , allow us to provide our care consistent with the cultural and linguistic needs of our patients. This goes a long way toward building the trust needed to engage our patients in the often challenging array of services and self-care needed to address the challenges of diabetes. Further, the standards we set for the quality of our care are among the highest in the healthcare industry.
The result is that our doctors, nurses, and support staff are experts in their respective primary and specialty care fields -- as any of our patients can attest. In applying that expertise to diabetes care prevention and management, we believe that we will offer a model of such care to others, and debunk the myth that this disease cannot be managed well.
This rather bold contention -- that we can serve as a model for effective chronic disease management in low-income, urban communities -- is about to be put to the test. The Richard and Susan Smith Family Foundation and the Paul and Phyllis Fireman Charitable Foundation recently partnered to award our five health centers a combined $5.05 million over five years to pay for the case management, diabetes education, lifestyle coaching, and community outreach programs that we have not been able to adopt on the scale needed -- until now, that is.
At the end of the five years, an independent evaluator will determine not only whether these patient supports worked, but also whether they were worth the investment in terms of cost savings. We already know the price of failure in diabetes care : The latest figure from the Centers for Disease Control is $132 billion per year in medical costs and reduced worker productivity.
Stay tuned while we measure success.
Joel Abrams, Dorchester House Multi-Service Center
Adela Margules, Bowdoin Street Health Center
Bill Walczak, Codman Square Health Center
Frederica Williams, Whittier Street Health Center
Azzie Young, MattapanCommunity Health Center 
