Focusing on Basic Patient Needs to Fight Diabetes

Spotlight Feature

nancy herman

Nancy Herman

Vice President of Development, Chief Philanthropy Officer

Norwegian American Hospital, Chicago

Background: The statistics were alarming. Knowing that diabetes was surging throughout the community it serves, Norwegian American Hospital on Chicago’s West Side came up with a new approach to address the disparities it was seeing. Through REaL data collection, the hospital discovered that nearly 70% of its patients with diabetes were Black, 63% were Hispanic/Latinx while 46% were non-Hispanic white patients. Data also revealed that food insecurity was a significant issue among many. Hospital leaders decided that a diabetes prevention community outreach plan, focusing on nutrition and education, was the best path to address this disparity.

With help from the health equity grant collaboration between the American Hospital Association’s Institute for Diversity and Health Equity (IFDHE) and Blue Cross Blue Shield of Illinois (BCBSIL), the hospital launched a new program called Comida for Health to address disparities in diabetes through food access and education. The plan calls for enrolling 135 patients with diabetes who are also struggling with food insecurities. Providing greater access to nutritious foods as well as group and one-on-one diabetes education sessions are program core components. In this month’s Spotlight Feature interview, Nancy Herman, vice president of development and chief philanthropy officer at Norwegian American Hospital, talks more about her program’s efforts to extend diabetes education and care into the community.

Why did your hospital decide to move forward with this new initiative?

In the communities we serve on Chicago’s West Side, access to food is a major challenge. Even before the current pandemic, 46% of our Humboldt Park neighborhood households were food insecure – that’s compared with about 13% nationwide. Many in our community aren’t getting fruits and vegetables.

Simultaneously, Latinx and African-American members of these local communities experience significant chronic disease disparities, particularly related to diabetes. Diabetes prevalence in Humboldt Park is more than three times that of many other Chicago neighborhoods – in two of our served zip codes, more than 11% of adults have diabetes, putting it in the top 25th percentile of zip codes nationwide. Racial disparities in diabetes mortality rates are even more striking, with diabetes mortality among Humboldt Park’s Latinx population almost double the overall rate of diabetes mortality in Chicago.

With such significant diabetes morbidity and mortality rates among our Latinx and African-American community members and patients, the hospital felt it had to do something to address some of the social determinants of health that contribute most to these rates: access to healthy, affordable food and access to culturally-and linguistically-competent diabetes education.

“Our hope is that by identifying and supporting patients with diabetes who are also food insecure, we will be able to tackle one of the biggest barriers many of our patients of color face...”

What is the goal of your program and how do you anticipate your efforts will impact patients?

The goal of our project is to provide diabetes education to the underserved population.

In 2019, we began screening patients for food insecurity and also launched a monthly food pantry for our patients and community members. Our new Comida for Health program builds upon this work. It provides healthy, culturally-relevant food and culturally- and linguistically-responsive health education specifically tailored to food insecure patients with diabetes, with the goal of improving their diabetes outcomes.

Our diabetes center team identifies and reaches out to patients who are both food insecure and have diagnosed diabetes to provide them with tailored support. Patients participate in small group health education and medical nutrition therapy in their preferred language. They also receive supplies from the food pantry as well as utensils, a Crock-Pot slow cooker, and other essentials to help facilitate healthy cooking. Furthermore, they are provided with other supports like transportation as needed. We are tracking outcomes like A1c levels and patients’ perceived diabetes self-management.

Our hope is that by identifying and supporting patients with diabetes who are also food insecure, we will be able to tackle one of the biggest barriers many of our patients of color face in improving their diabetes outcomes and their quality of life.

Does a clearer understanding of socioeconomic conditions impacting patients and other barriers to health equity help you build a better program? How?

Absolutely. It was through trying to understand the socioeconomic conditions and barriers our patients were facing that we decided to focus on food insecurity in the first place, as it has been one of the most prevalent social needs among our patients. We’ve seen that only become more prevalent over recent months. Among community members tested at our COVID-19 drive through testing, who are screened for various different social needs, food has been far and away the most common resource needed.

We do want to keep learning more about the other barriers our patients with diabetes are facing. Program staff will provide individual wraparound support to patients to identify and resolve other health needs they may have, including vision care, podiatry or behavioral health, or whether they have needs like transportation, insurance, or housing. We hope to reduce socioeconomic disparities in outcomes and learn more about what types of targeted support our community most needs.

“We hope to reduce disparities in outcomes and learn more about what types of targeted support our community most needs.”

What information would you share with others about advancing health care equity within their organization?

Having a health equity approach to care in a safety net hospital comes naturally because we see the issues every day. We’ve spent the last century listening to our community about the social needs that affect their health. We’ve worked to integrate equity into everything that we do and incorporate supports like transportation and outreach into ongoing routine care.

We also continue to learn and improve. For instance, when we first launched our food pantry, we noticed that some patients were leaving their food behind. We asked them about it, thinking that maybe they didn’t like something, but they told us that some of the food required a microwave or a stove, neither of which they had. In response, we’ve added a Crock-Pot to our current program to address this need.

I’d be remiss if I failed to mention the importance of having culturally-relevant staff, speaking to patients in their preferred language, as well collecting data to share about the needs of the patients.

When we first talked to some of our patients about COVID early on in the pandemic, one patient summed up what many were feeling in the community: “I have survived serious drug abuse, gunshot wounds, prison, and abuse of every kind. I will be able to survive the virus.” Our community faces many needs, and we try to listen to our patients and meet them and their needs right where they are.