Tackling Diabetes In South Dallas
People living in one South Dallas neighborhood used to be three times as likely to die from diabetes-related complications than those in Dallas County overall. That grim statistic is changing, thanks to a prevention-focused health center at the Juanita J. Craft Institute.
Diabetes is not a disease that effects all people equally. African Americans are twice as likely to have diabetes as white people, and living in poverty also doubles your risk of developing the disease.
So it’s not much of a surprise that in the predominantly black Frazier neighborhood of South Dallas, where the average income per person is little more than 12,000 dollars, diabetes rates have been off the charts.
“We were seeing way too many patients coming from this particular area,” says Joel Allison, CEO of Baylor White & Scott and one of the creators of the Diabetes Health and Wellness Institute (DHWI). He says after seeing so many South Dallas residents arriving at Baylor’s emergency room, many times too late to save limbs or eye sight, Baylor partnered with the city of Dallas to establish the $15 million facility in 2010.
The goal, he says, was to try an entirely new model of care – outside of the walls of the hospital.
Sick Of Sick Care
DHWI, which now serves around 3,500 people, is focused on prevention instead of sick care. In addition to nurses and doctors, the center has a gym, personal health coaches, and weekly cooking classes.
Of course, learning what to eat is only half the battle – finding fresh ingredients to incorporate into meals is the other obstacle. Recognizing that access to fresh vegetables and fruits in South Dallas can be a challenge, DHWI has a weekly farm stand where ingrediatents are available each Friday.
Dr. FolashadeLester says creating a place where people can take exercise classes, learn about nutrition, and get emotional and financial support removes obstacles to staying healthy. Lester, who is also medical director at DHWI, says when she worked in private practice, there was little time to spend with individual patients talking about diabetes.
“Often times we’re having to deal with generations of dynamics relative to our eating,” she says, “And so unlearning things we grow up learning…And unfortunately we don’t have the time in our visit as a provider to really get into the details of that. So we end up having patients come back.”
Focusing On Patients
Melvin Tuck, a Pleasant Grove resident, has been coming to DHWI for six months.
“They really show they care about you,” he says. “With [my doctor] she sits down and talks with me. She calls, makes sure I’m doing what I need to do.”
Tuck, who’s 57, says has been in and out of the hospital for erratic, high blood sugar. He’s also coping with neuropathy – a constant tingling in his legs. When Tuck lost his health insurance in 2013 and couldn’t afford his medications, DHWI took him in and covered the cost of insulin and pills, he says.
“They helped me, they got me over the hump until we got insurance,” Tuck says. “And I didn’t want to change. I had the option of going back to my doctor but I didn’t, I stayed here.”
Tuck’s blood sugar levels are down from 10 percent to 6.9 percent — just under the optimal blood glucose level of less than 7 percent. And he’s not the only one at DHWI with bragging rights.
A 2012 survey of the institute’s members revealed that nearly half of patients had achieved the optimal blood glucose level of less than 7 percent. CEO Joel Allison says there was also a decrease in emergency room use by 40 percent.
“We are seeing definite improvements,” Allison says, “And we believe this is a model that could be moved around.”
The problem is funding. Giving people this level of care, in what’s called a patient-centered medical home, doesn’t come cheap in today’s system of reimbursement.
Right now, clinics and hospitals are paid when someone is sick, not to help prevent them from getting sick. And while the Affordable Care Act did create incentives for prevention, much of that money won’t come to Texas because the state has refused to expand Medicaid.
“This particular area has a huge uninsured rate, which means right now the patients we see, [are] 85 percent unfunded,” Allison says.
The center relies mostly on grants for innovation and philanthropy. Allison admits this model of care will be hard to replicate across the state until more people have health insurance, and there’s financial incentives to keep people healthy, not treat them when they’re sick.