Reducing Disparities in Diabetes: The Alliance Model for Health Care Improvements

Individuals in specific racial and ethnic groups experience the greatest prevalence and widest disparity in outcome for both type 1 and type 2 diabetes.1 The negative long-term consequences of the disease for these individuals are also higher and can be severe, including amputation, kidney disease, cardiovascular disease, and blindness.2 Better access to and higher quality of health care leads to improved diabetes control and fewer negative outcomes for people at risk of and diagnosed with the condition, especially, in low-income communities.2,3 Particular systems problems associated with poor results for those with diabetes include failure to adequately identify high-risk people, failure to follow recommended clinical treatment guidelines, lack of adequate provider education, inadequacy of patient self-management education, and minimal coordination of care.4 Each of these has been linked to inadequate information systems, insurance and payment options, deployment of clinical personnel, and application of evidence-based strategies for change and similar other deficiencies.5 It is widely agreed that to achieve sustainable change that reduces disparities, new and improved health care policies and systems are needed.6 Achieving such change within and across health care facilities and communities requires participation by key stakeholders in the problem.7 This view posits that solutions are complex (including adaptation of evidence-based strategies to new locales) and require engagement of diverse perspectives (including those of the people who experience the day-to-day burden of the health problem). Recent evidence has shown that collaborative community-wide approaches to enhancing health care delivery can generate far-reaching policy and system changes and improvements in health status.8 To support evidence-based means to reduce inequity in health status, the Alliance to Reduce Disparities in Diabetes was launched by the Merck Company Foundation in 2009. The foundation is providing up to $2 million over 5 years (2009–2013) to …