OVERVIEW OF CLINICAL DIRECTORS NETWORK

1
OVERVIEW OFCLINICAL DIRECTORS NETWORK
2
CDN Past, Present Future

• An informal network of clinical leaders who
  practice as primary care providers in
• low-income and minority communities
• A clinical research and educational
  organization
• A means to translate clinical research into
  clinical practice

3
CDN Corporate Structure

• 501 ( c ) (3) Tax Exempt Non-Profit Corp
• Headquarters in NYC with CEO Staff
• Board of Directors consists of 17 volunteers
• Active Clinical Leaders practicing in
  Low-Income/Minority Practice Settings including
  Health Centers and Health Plans in NY, NJ, PR,VI
• Physicians, Dentists, Nurses
• Elected by the CDN Membership at Annual Meeting
• Linked to a for-profit subsidiary, QPSD Quality
  Professional Systems Development, Inc.

4
Why Clinical Networks?

• Target Clinicians working in community, migrant,
  homeless and HIV health centers
• Reduce the sense of isolation, stress, burnout
• Update clinicians in latest health improvements
  advances
• Collect share information, skills technical
  assistance
• Introduce in the communities latest developments
  in health care and business practices

5
Who are the Underserved?

• Poor/Low Income
• Uninsured/Underinsured/Medicaid recipients
• Unemployed
• Women
• Children/Adolescents
• Minorities African American, Latino, Asian,
  Pacific Islander,
• Native American/Indian, Native Hawaiian, Native
  Alaskan
• Migrant/Seasonal Farmworkers
• Homeless

• Drug/Alcohol Users
• Rural residents
• Refugees
• Immigrants (Legal and Illegal)
• Persons Living with HIV/AIDS
• Gay, Lesbian, Bisexual and Trans-sexuals
• Prisoners/Releasees/Parolees
• Mentally Impaired/Mentally Ill
• Sex Workers
• Disabled/Handicapped
• Elderly/Frail Elderly

Source National Association of Community Health
Centers
6
Who are the Underserved?National Statistics by
Age and Gender
Source NY HRSA (1997)
7
Advantages of Participating in Clinical Research

• Earlier access to new drugs and technologies
• Ongoing Training for Primary Care Providers
• Improved quality of care due to
• expert protocols reviewed by experts, NIH, FDA
• more frequent follow-ups
• standardized assessments
• ongoing quality assurance/quality improvement
• external monitoring of data patient care
• feed-back to clinical sites providers

8
Financial Benefits to Participants

• Low/No-cost of care to patients
• Patient incentives, transportation, enablers
• Payments for Provider Time
• Covers costs of Visits, Tests, Medications
• Improved access to equipment
• diagnostic
• therapeutic
• data processing
• education and training

9
Where CDN Conducts Research

• New York
• New Jersey
• Puerto Rico, Virgin Islands
• Connecticut
• Florida
• Utah
• California (dental)
• Missouri

• Maine, Massachusetts
• Rhode Island, Vermont
• New Hampshire
• Virginia, West Virginia
• Maryland, Delaware
• Pennsylvania, DC
• Texas
• Oklahoma

10
CDNS RESEARCH PORTFOLIO

• HIV/AIDS
• Cancer Control
• Depression
• Stress Management
• Hypertension
• Diabetes
• Immunizations
• Migraine/Headache
• Anemia
• Asthma

• NIAID HRSA NIMH AmFAR BMS DMP Roche
• NCI AHCPR
• NIDA SAMHSA
• NIMH
• NHLBI Pfizer
• HRSA
• CDC HRSA
• Merck
• Ortho Biotech
• EPA HRSA DEP

11
Current CDN Research Projects

• FUNDERS PROJECT TITLE
• NCI Prevention Care Manager
• NIMH SMART/EST Womens II
• NHLBI Blood Pressure Adherence
• EPA HRSA Home/Environmental NJDEP Asthma
  Management
• HRSA CDC Immunizations

12
NY Prevention Care Manager Project

• Funded by NCI
• PI - Allen Dietrich, MD, Dartmouth
• 8 Health Centers in NYC metro area
• Randomized Controlled Trial (n1400)
• To test case management strategies to improve
  breast, cervical and colorectal cancer early
  detection services for women

13
SMART/EST Womens Project II

• Funded by NIMH
• PIs - Stephen Weiss, PhD MPH- U Miami
  Jonathan N. Tobin, PhD - CDN
• 12 Health Centers in NYC,NJ, Miami
• Randomized Controlled Trial (n450)
• To test cognitive behavioral stress management
  training and health education to reduce distress
  and improve medication adherence for adult women
  with HIV/AIDS

14
Antihypertensive Lipid Lowering to Prevent
Heart Attack Trial (ALLHAT)

• Funded by NHLBI
• PI - Jonathan N. Tobin, PhD - CDN
• 3 Health Centers in NY NJ Nationally 623
  sites
• Randomized Controlled Trial (n126) 42,450 pts
• To compare 4 classes of blood pressure drugs
  against each other without a placebo to improve
  blood pressure control, lipids and outcome for
  hi-risk hypertensive adults

15
Improving Blood Pressure Medication Adherence and
BP Control

• Funded by NHLBI
• PI - William Gerin, PhD - Mt Sinai
• 12 Health Centers in NYC upstate
• Randomized Controlled Trial (n450)
• To test home blood pressure monitoring and
  telephone nurse case management to improve
  medication adherence and blood pressure control
  for poorly controlled hypertensive adults

16
Improving Home/Environmental Asthma Management

• Funded by EPA, HRSA Reg II, NJ DEP
• PI - Jonathan N. Tobin, PhD - CDN
• 12 Health Centers in NY,NJ,PR,VI,PA,MO
• Randomized Controlled Trial (n250)
• To test home visits and telephone nurse case
  management for health education and support to
  improve asthma control for pediatric asthmatics

17
Improving Immunization Rates

• Funded by HRSA CDC
• PI - Jonathan N. Tobin, PhD - CDN
• 20 Health Centers in NY,NJ
• CQI/Observational Studies (n18,050)
• To test assessment and feedback of immunization
  rates, individualized Technical Assistance,
  Office Systems Development and Follow-up Support
  on Immunization Completion Rates (4-3-1-3-3)

18
STUDY LINK

• Funded by Title I Ryan White CARE Act
• HIV/AIDS Research Coordinators Network
• Database of all enrolling HIV/AIDS clinical
  research in NYC
• Warmline/Single phone number for access to
  information and referrals to research studies
• Marketing clinical research to clinicians, case
  managers, AIDS service organizations

19
CDNs Educational Activities

• Annual Clinical Leadership Conference
• Information Management for Clinical Leaders
• Community Health Center Rounds
• Dental Quality Assurance Peer Review
• Customized Training Office Systems
  Consultation
• eCME Video-teleconferences Webcasts
  http//CDN.horizonlive./com ON-SITE AND
  ON-LINE

20
Community Health Center Rounds

• Detection of HIV/AIDS Oral Cavity Cancer
• Cancer Control, Early Detection Prevention
• Screening for Colo-rectal Cancer in Primary Care
• Reducing Perinatal Transmission of HIV/AIDS
• Detection of Depression in Primary Care
• Quality Improvement in Immunizations
• Detection Prevention of Domestic Violence
• Basics in Fundraising Grant Writing
• Internet Access How to Surf Search the Web

21
CDNs Educational Activities

• eCME Video-teleconferences Webcasts
  http//CDN.horizonlive./com
• Bringing the latest in clinical and management
  information and technology to Health Center
  Clinicians both On-site and On-line
• Live at Health Centers
• Live Webcasts
• Archived Webcasts available 24 x 7

22
Long-term Goal Clinical Research to Set
Standards for Clinical Practice

• To recruit every practice,
• every provider and every patient
• to participate
• in at least one clinical trial

23
CDNS FUTURE DIRECTIONS

• Develop Market Products to strengthen links
  between Patient Care, Education, Training,
  Research and Business Practices
• Electronic Medical Publishing
• Distance Education/Web-based Training
• Electronic Medical Records
• Clinical Decision Support Tools
• Patient Recruitment/Medical Marketing
• Industry-sponsored Clinical Trials

24
CLINICAL DIRECTORS NETWORK

• Jonathan N. Tobin, PhD
• President/CEO
• CDN
• Clinical Directors Network, Inc.
• 54 West 39th Street - 11th Floor
• New York City NY 10018 USA
• Tel [phone] ext 34
• Fax [phone]
• Email jntobin_at_CDNetwork.org
• Web Site www.CDNetwork.org