Integrating Practice and Community Programs to Improve

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Integrating Practice and Community Programs to
Improve Health

• J. Lloyd Michener, MD
• Professor and Chair
• Department of Community and Family Medicine
• Director, Duke Center for Community Research
• Duke University School of Medicine
• AcademyHealth Annual Research Meeting
• June 9, 2008
• Washington, DC

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Community Engagement - Takes StructureThe Duke
Center for Community Research (DCCR)

• Moving the Community from Subject to
  Collaborative Partner
• Goal
• Improve the health of the community through
• Community engagement in research
• Integration of practices into research
  structure
• Linking communities, practices, researchers
• Components
• 1. Community Research Liaison Center
• 2. Community Health Research Training Center
• 3. Electronic Health Record

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Leading Causes of Death in Durham, NC
Published in the 2007 Durham County Health
Assessment, Data source NC State Center for
Health Statistics, County Health Data Book
(http//www.schs.state.nc.us/SCHS/data/databook/)
Note The US rates were measured differently
than NC state data, therefore interpret with
caution.
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Community Engagement

• Takes time and persistence

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Community Engagement - a Diversity of Partners

• Lincoln Community Health Center (subsidized by
  DUHS)
• Durham County Health Department
• Wake CapitalCare Collaborative
• Durham County Department of Social Services
• The Durham Center
• Senior PharmAssist
• Durham Housing Authority
• Durham Public Schools
• El Centro Hispano
• Durham CAARES
• Faith-based organizations

• Duke University Hospital and Health System
• Duke University School of Nursing
• Duke Dept of Community and Family Medicine
• Duke Dept of Pediatrics
• Duke Dept of OB-GYN
• Duke Dept of Psychiatry
• Durham Regional Hospital
• Duke Center on Aging
• Duke Department of Medicine
• Duke Department of Ophthalmology

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Community Engagement - a Diversity of Programs
and Sites
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Clinical Networks Duke Sites
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Primary Care Research Network

• The Primary Care Research Consortium is
• a primary care research network for academic,
  community, Veteran's Affairs (VA), and
  managed-care practices within the Duke Health
  System and surrounding communities.
• includes 25 practices in 8 counties in North
  Carolina
• represents more than 150 primary-care clinicians
  caring for more than 250,000 patients, with
  access to a total population of 1.2 million.
• since 1997, the PCRC has conducted over 50
  studies enrolling more than 3000 patients.

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Integrating Community Programs and Practices

• Bring in all who serve the same population
• Analyze populations, practices, and neighborhood
  data
• Go to patients home and listen asking open
  ended questions
• Measure impact quality
• Adjust, ask for feedback on a continuing basis

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Durham Community Health Network and 5 County
Community Care

• 35,000 Medicaid patients, Durham (DCHN), Vance,
  Granville, Warren and Person Counties (5 County)
  in 31 primary care practices
• primarily women and children, largely
  African-American, growing Latino population

• Practice Partners
• 8 primary care practices in Durham County
• Local hospitals, EDs and urgent care
• Duke CFM, Peds, OB-GYN, DUH, DRH,
• DHTS

• Community Partners
• County health departments
• State of NC
• County departments of social services

• Clinical Outcomes (State)
• 34 lower hospital admission rates
• 8 lower ED rate

• Financial Outcomes (State)
• 24 lower average episode cost for children (687
  v 853)
• 3.5 million/yr for asthma management
• 2.1 million/yr for diabetes management
• 60 million in SFY03
• 124 million in SFY04

Total
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Just for Us

• Since 2000, serving 350 patients, average age 70
  who have multiple chronic conditions
• 44 have mental illness
• All are home bound
• 84 are African-American many with low to no
  family support
• Low literacy illiterate

• Outcomes
• Ambulance costs ? 49
• ER costs ? 41
• Inpatient costs ? 68
• Prescription costs ? 25
• Home health costs ? 52

All patients with hypertension 79
140/90 Diabetics with hypertension 84 140/90
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LATCH

• Durham County Uninsured Latinos
• Newly immigrated, from Mexico and Central America
• No knowledge of health system high risk
  behaviors
• Community-based, bicultural support
• Medicaid outreach
• 10,800 enrolled to date 5,500 active

• Practice Partners
• Planned Parenthood of Central NC
• City of Durham, Parks and Recreation
• DUH
• DRH
• CFM
• SON

• Community Partners
• El Centro Hispano
• Durham County Health Department
• Durham County Department of Social Services
• Lincoln Community Health Center
• Catholic Charities

Decreased ED costs
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Community-Wide IntegrationA Work in Progress
Private MDs
Research IRB
NE Physician Network
Cabarrus Family Medicine
IT (EMR)
IT (EMR)
Research IRB
Cabarrus County Kannapolis Schools
Disease Management
CMC Northeast
Carolinas Health Care System
Local Employers
Castle Cooke Murdock
Carolina Physicians Network
Pastoral Care
Churches
Cabarrus Health Alliance
Community Registry
Research IRB
Rotary
Novant Healthcare
Presbyterian Novant Medical Group
Healthy Cabarrus
Community Free Clinic
Community Care Plan
FQHCs (McGill Logan)
IT (EMR)
United Way
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Durham County Projects

• Pilot projects to see if teams of community
  groups, clinicians, and researchers can improve
  health
• 1 million for planning
• RFA for pilot projects to be released Summer
  2008. Requirements

• 1. Input, support, and commitment from community
• 2. Well-integrated design for prevention/care
• 3. Budget that demonstrates effective use of
  resources
• 4. Evaluation plan that establishes measurable
  markers

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A new role for academic health centers Improving
the health of communities
Community
Medical Care
Analysis and Redesign
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The Duke Center for Community Research (DCCR)

• Goal Improve the health of the community through
• Community engagement in research
• Integration of practices into research structure
• Linking communities, practices, researchers
• Components
• 1. Community Research Liaison Center
• 23 grants funded, submitted or under development
  14 community-wide health committees staffed
• 2. Community Health Research Training Center
• Required training for clinicians and researchers
  launched (initial module completed by almost 700
  individuals to date) two more in preparation
• 3. Electronic Health Record
• 4. Demonstration Projects

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