Diabetes Management for the Homeless: Sojourner Clinic

Sojourner Health Clinic (SHC) is a free health clinic run by medical students at the University of Missouri-Kansas City School of Medicine under the direction of attending physicians from the Truman Medical Center. SHC helps the adult homeless and medically indigent in Kansas City, Missouri maintain their health and avoid expensive emergency room visits and hospital stays by providing routine safety-net medical services through a location accessible to two-thirds of the city's uninsured and medically under-served.

Three-quarters of SHC's patient population suffer from conditions such as asthma/COPD (26%), hypertension (36%), diabetes, gastrovesophageal reflux disease (15%), and upper respiratory infections (40%).

In addition to providing patient outreach and healthcare, the SHC provides a practical, real-life learning experience to its medical student volunteers. The next step planned by attending physicians is to partner with other student-run free clinics across the nation to be part of a multi-institutional longitudinal study demonstrating patient outcomes for diabetes and hypertension and to continue implementing regular lab services, patient care flow sheets to track outcomes, and patient education on lifestyle changes. This initiative will continue to prepare young physicians to provide quality care, taking special care to address the specific challenges faced by the poor and underserved.

The goal of Sojourner Health Clinic is to pick up where the current medical system leaves off by providing free acute and ongoing healthcare to patients who do not have access--or are reluctant to access—traditional routes to a doctor or medicine.

During 2012, the Sojourner Health Clinic managed to increase the number of diabetic patients with A1C levels below 9 percent from 15% to 83%, reducing the average blood glucose level of patients and giving them a better sense of control over their diabetes.

SHC provides free medical care to approximately 350 medically indigent homeless annually. During 2012, the clinic evaluated the progress of the health of its diabetic patients. The indicator for this goal was to raise the percentage of diabetic patients with A1C levels below 9 percent from an estimated 15% to 50%. New point of care machines enabled SHC to begin to monitor the A1C levels of diabetic patients. At the end of the grant cycle, 83% of diabetic patients had an A1C level below 9 percent. The clinic now has a process in place for regular monitoring and plans to improve protocol by collaborating with other clinics doing similar work.