Camden New Jersey has significant socioeconomic and health challenges. Dr. Jeffrey Brenner and colleagues have built a national model for improving health outcomes in high-disparity segments of the community, focusing on three key elements:
- Clinic-based Action -- patient education, care management, and system-level coordination
- Community Mobilization -- coalition works with state public health-led program and faith-based partners to promote primary prevention, building on community strengths and resiliency;
coalition also promotes diabetes self-management in community settings.
- Data-Driven Improvement Cycles -- using health data to "hot-spot" specific neighborhoods or buildings with high utilization and monitoring outcomes to drive rapid-cycle improvement of interventions.