2006 Community-Campus Partnerships for Health Award Recipient
The REACH 2010: CHARLESTON AND GEORGETOWN DIABETES COALITION
The REACH 2010: Charleston and Georgetown Diabetes Coalition is a partnership between the Charleston and Georgetown communities and the Medical University of South Carolina College of Nursing that is eliminating disparities for African Americans with diabetes. Local community groups, health care professionals and people with diabetes identify assets, and implement and evaluate community actions. The partnership includes 16 agencies, neighborhoods, and people with diabetes and covers more than 1600 square miles, with over 12,000 identified African Americans with diabetes. The actions include 1) community-driven education where people live, worship, work, play, and seek health care; 2) evidence-based health systems change; and 3) coalition power built through trust, collaboration, and sound business planning. The health care professionals bring the science of diabetes while the community determines how to implement the science and together the Coalition works to eliminate disparities.
The Coalition evaluates progress and plans for each year through community surveys, focus groups, chart audits, minutes of meetings, and epidemiological data. Funding is generated by community fundraising, coalition activities, and a cooperative agreement from the Centers for Disease Control and Prevention. Progress in eliminating disparities includes eliminating significant health care disparities in diabetes testing, decreasing emergency room visits, and decreasing amputations in African American men by 50%. The Coalition continues to work on improving diabetes control.
Alpha Kappa Alpha Sorority, Omicron Rho Omega Chapter brings fraternal, professional, and social service organizations, as well as community leaders, into the Coalition and assists as volunteers in REACH activities. The chapter also recruits volunteers to assist with the Summer Youth Program.
Carolinas Center for Medical Excellence is the quality improvement organization for South Carolina and works to improve diabetes care in health care systems using the Institute for Healthcare Improvement model for improvement.
Charleston Diabetes Coalition functions as a coalition for Charleston County and the Tri-county area for consumers, agencies, organizations, volunteers and people with diabetes, and facilitates information and resource sharing and coordinates support for diabetes-related activities.
COMMUNICARE expands the access network in Charleston and Georgetown counties and helps the working poor and those with no health insurance to obtain medications and supplies (including monitoring strips). Communicare also assists with implementation of media plan.
Community Gardening /Harmony Project develops community gardens for growing vegetables and fruits and helps community residents focus on increasing physical activity and healthier eating.
Diabetes Initiative of South Carolina, funded by the South Carolina Legislature and composed of more than 40 organizations and health care agencies, provides the scientific leadership for the Coalition and helps to generate comparison data for evaluating Coalition activities.
East Cooper Community Outreach provides diabetes care, education, community assistance, and linkages to patient assistance programs.
Franklin C. Fetter Family Health Center is a member of the Southeastern Diabetes Collaborative, and provides support and guidance for lay Community Health Advisors working in the Center catchment area. They focus on providing quality care for all with diabetes, regardless of ability to pay.
Georgetown Diabetes CORE Group functions as a grass roots diabetes coalition for Georgetown County and works to generate funding for those unable to obtain diabetes supplies.
Medical University of South Carolina College of Nursing functions as the convener and coordinator for coalition activities and grant writer. The College is home for the Community Health Advisors and houses the community-based participatory research team. College faculty members facilitate community partnerships, actions and evaluation.
South Carolina Department of Health and Environmental Control Diabetes
Prevention and Control Program provides mini grants for Coalition
activities and collaborates with the local coalitions to provide training
to lay and professional groups.
St. James-Santee Family Health Center, Inc. is a rural health care community health center for diabetes care and education and provides support and guidance for the lay Community Health Advisors for Awendaw/McClellanville/East Cooper area and Georgetown County.
Tri-County Black Nurses Association brings health professionals, especially those with ties to the African American communities, into the Coalition, and assists as volunteers. They also provide education for health professionals and the community through Bubblin Brown Sugar.
Trident Health District assists with linkages between community needs and Coalition/Partner actions, and focuses on improving physical activity within communities. They also offer training for community volunteers to increase awareness of diabetes prevention and control.
Trident United Way provides community information (211) and policy
About 40 area churches, community centers, worksites, and libraries provide linkages to people with diabetes in their communities as well as determining what, when, where, and how community members will learn about diabetes self management and ways to improve their health care.
The Medical University of South Carolina (MUSC) College of Nursing and Dr. Carolyn Jenkins have more than a 20 year history of community partnerships for improving health. In 1994, Charlestons Enterprise Community joined with the College of Nursing to link 19 neighborhoods together to conduct a needs assessment and improve health in the community. Lay leaders from each neighborhood were trained to conduct assessments and identify assets in collaboration with Dr. Jenkins and students from MUSC. Identified priorities for action that were identified by community members included lack of access to education and skills for diabetes and hypertension management. The community built and opened a local health center (Enterprise Health Center which is now part of federally qualified health center Franklin C. Fetter Family Health Center) that focused on primary care for hypertension and diabetes care. In 1999 when the Centers for Disease Control issued the call for Racial and Ethnic Approaches to Community Health to reduce racial and ethnic disparities in six different racial and ethnic groups, the community asked Dr. Jenkins to spearhead the development of a Coalition to apply for funding to address diabetes disparities in African Americans. Using the Community-Campus Partnerships for Health principles of partnership and community-based participatory research, Dr. Jenkins joined with community groups to apply for funding. Other groups asked to join the efforts and in September 1999, the Coalition was funded. An assessment of needs and assets, and a community action plan were completed in 1999-2000, and implemented in fall, 2000.
The mission and goals of the Coalition were determined through a democratic process where all members of the Coalition had input into identifying community strengths and needs. All met numerous times to develop the principles of operation, as well as mission, goals, and objectives. Each collected community data and identified resources. Other community groups were invited to join as the partnership developed. The mission is to Reduce and eliminate disparities for African Americans with diabetes through community action, health systems change, and collaboration. The specific goals and objectives are revised and prioritized by the Coalition each year. The goals and objectives for 2005-2006 are:
Goal 1 Improved Health Outcomes
Goal 2 Increased Access to Care
Goal 3 Generate Funding for Continuation of Coalition Activities
Goal 4 Empower the Coalition
Goal 5 Increase Community Awareness
This figure shows the model of action for how the Coalition pursues its goals and objectives:
The Coalitions community is defined as the geopolitical community of Charleston and Georgetown counties, and its focus is on African Americans with diabetes and their support systems. Mission, goals, and activities are focused on individuals, community agencies and organizations. Any group or individual has input either through the REACH 2010: Charleston and Georgetown Diabetes Coalition (groups) or through local Coalitions in either of the two counties (individuals and groups).
Decisions are made through a democratic process with each group getting one vote. Local Coalitions in each county are governed by a Board and bylaws. At each meeting (quarterly or monthly), they assess some aspect of their progress, and use continuous quality improvement processes to move toward their mission and goals. They celebrate successes and identify changes that are needed to move closer toward their goals. Their principles of operation state that we will be generous in our relationships and put the issues on the table rather than have meetings before or after the meeting to discuss issues or to talk about problem partners.
When issues arise, they use their identified principles to guide a decision that is made through discussion and majority vote.
Each partner brings their expertise and all work together to reduce disparities. For example, the health systems provide care but lack the resources for quality diabetes education and outreach. The MUSC College of Nursing has faculty who are Certified Diabetes Educators and the community centers, churches and libraries offer services to people in their communities. Working together, weekly diabetes self management education is offered in 8 community sites where people congregate. The local librarians, in collaboration with MUSC librarians and diabetes educators, teach people how to use the Internet to find credible diabetes information, while local health providers work with people to improve diabetes control. Together, they work to evaluate progress and integrate health professional students into the programs while they learn about communities, people with chronic diseases, health care, and civic responsibilities.
The Coalition works to decrease disparities through community-based participatory research. The expertise of faculty at higher educational institutions work with the community to build broad-based partnerships for leveraging resources and for reaching goals.
The Coalition also works to decrease disparities through service-learning. Over 200 students from the Medical University of South Carolina Colleges of Nursing, Pharmacy, Health Professions, Medicine, and Graduate Studies, as well as dietetic interns and interns from other universities (51) and from local high schools (5), engage in service-learning to assist the communities in meeting their goals. Four students have completed their doctoral dissertations while working with the Coalition. The students learn about communities and CBPR, while assisting the Coalition to meet its goals and objectives.
Students raise funds for two local diabetes coalitions, the Georgetown Diabetes CORE Group and the Charleston Diabetes Coalition, to assist needy patients with diabetes supplies.
The Coalition has focused on building trust and collaboration with partners while working on specific outcomes. The Coalition has been recognized by the Office of Minority Health, South Carolina Department of Health and Environmental Control, and Centers for Disease Control and Prevention, as well as local community governments, for accomplishments in decreasing disparities. The Coalition documents outcomes using a logic model:
These graphs illustrate the progress of the Coalition in improving care and reducing disparities:
The Coalition attributes its success in part to a clear articulation of the principles of community-campus partnerships and of community-based participatory research, as well as working toward open and honest communication and issue identification. Identifying these principles early in the Coalition history has helped to resolve issues and to work toward success. When conflicts arise, the Coalition works to resolve the issues, while remaining focused on the overarching goal of eliminating disparities. The partners appear to be committed to listening to the issues from all points of view and seeking to really understand each partners needs. When anger and frustration arises, partners continue to work to resolve issues without compromising principles.
Another factor that has supported the Coalitions success is clearly identified and prioritized goals and objectives and community support for reaching the identified milestones. The community interests and national objectives in Healthy People 2010 are closely aligned. The support of state and national organizations such as South Carolina Department of Health and Environmental Control and Centers for Disease Control and Prevention has financially supported the community efforts.
The Coalition shares these lessons learned about community-campus partnerships:
For a complete list, visit http://reach.musc.edu/awards.html
Emerging Nursing Star in Health Disparities Research, Howard University,
Washington DC, March 2004
Best Student Poster, 9th Annual Diabetes Symposium, Charleston, SC,
First Place Coalition Poster, 9th Annual Diabetes Symposium, Charleston,
SC, September 2003
First Place Award for Outstanding Poster Presentation in Community
Interventions category at the CDC Diabetes Translation Conference, Boston,
MA, April 2003
First Place Award for Outstanding Poster Presentation in the Health
Systems Category at the CDC Diabetes Translation Conference, Boston, MA,
King MG, Jenkins C, Hossler C, Carlson B, Magwood G, Hendrix K. People
with diabetes: knowledge, perceptions, and applications of recommendations
for diabetes management.
Abstract: The purpose of this paper is to report results of the People with Diabetes survey conducted as part of the REACH 2010: Charleston and Georgetown Diabetes Coalition. The pilot data revealed that African Americans (AAs) (N=80) reported fewer A1c, lipid, and kidney testing, feet and eye exams, and less nutrition and diabetes self-management counseling during 1999-2000 than did Caucasians (Cs) (N=23). The survey was repeated in 2002 when data were collected from a convenience sample of 160 AAs and 150 Cs using the revised self-reported survey instrument. African Americans (AAs) were significantly likely to report that their understanding of results for the kidney function test were good as compared to Cs (P<.001) and were more likely to report receiving nutrition education (P=.003). Otherwise, there were no significant differences between AAs and Cs on the remaining items in the survey. Since REACH 2010 was actively involved in the AA community for 2 years between the pilot survey and the repeated survey, these results were anticipated and are also reflected in results of chart audits conducted within healthcare systems used by the same AA population.
Jenkins C, McNary S, Carlson BA, King MG, Hossler CL, Magwood G, Zheng
D, Henrix K, Beck LS, Linnen F, Thomas V, Powell S, Maat I. Reducing
disparities for African Americans with diabetes: progress made by the
REACH 2010 Charleston and Georgetown Diabetes Coalition.
Abstract: Racial and Ethnic Approaches to Community Health (REACH 2010) is a U.S.Centers for Disease Control and Prevention demonstration program that responds to the U.S. Department of Health and Human Services' goal to eliminate racial and ethnic disparities in health status by the year 2010. As part of REACH 2010, community projects were funded to develop, implement, and evaluate community action plans to improve health care and outcomes for racial and ethnic populations. This article describes the program and details the progress of the REACH 2010: Charleston and Georgetown Diabetes Coalition in reducing disparities in care. Approaches employed by the Coalition included community development, empowerment, and education related to diabetes; health systems change associated with access, care, and education; and coalition advocacy. Racial disparities were identified for 12,000 African Americans with diabetes in this urban/rural South Carolina community. After 24 months, significant differences that initially ranged from 11% to 28% in African Americans (when compared with whites/others) were not observed on 270 chart audits for A1C, lipid and kidney testing, eye examinations, and blood pressure control. Future efforts will focus on maintaining progress, eliminating other disparities, and identifying the contributions of each intervention in eliminating racial disparities.
Jenkins C, Magwood G, Carlson B, Neal D, Hossler C, King M, REACH Team and Partners. REACH 2010: Charleston and Georgetown Diabetes Coalition--A Community-Campus Partnership for Eliminating Health Disparities. College of Health Professions Community Collaborations. Medical University of South Carolina, Charleston, SC, April 25, 2005.
Moody M, Hill R, Williams J, Todd-Heckel E, Colwell J, Jenkins C. Improving Diabetes Prevention and Control through Community-Based Coalitions. National Diabetes Translation Conference, Miami, FL, May 4, 2005.
Carlson B, Highland B, Linnen F, Odom K, Lance-Robb M, Moore G, Matthews S, Turner R, Jackson D. [poster] Diabetes Information and Internet Skills in the Community-Based Participatory Library Program of the REACH 2010 Charleston and Georgetown Diabetes Coalition. MLA, San Antonio, TX, May 16, 2005.
Magwood G, Shipp V, Ward-Murray EM. Disparities in Health Care and Outcomes: Diversity, Culturally Competent Care, and Research. SC AHEC and REACH 2010 Pre-Nursing Academy. Charleston, SC, May, 2005.
Jenkins C, Neal D, Magwood G., and Community Partners. REACH 2010: Charleston and Georgetown Diabetes Coalitions Efforts to Decrease Amputations in African American Males. EXCEED Seminar, Medical University of South Carolina, Charleston, SC, September 16, 2005.
Accepting the award on behalf of the Coalition at the award ceremony on Saturday June 3 in Minneapolis were:
Visit the Coalition website at http://reach.musc.edu