Community health engagement program chep directors ronald t ackermann md mph david g marrero phd
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Community Health Engagement Program (CHEP) Directors: Ronald T. Ackermann, MD, MPH David G. Marrero, PhD. Aims. Engage the Community in Research Community residents Community organizations Community healthcare providers Foster Communication Among CTSI Stakeholders Scientists

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Community health engagement program chep directors ronald t ackermann md mph david g marrero phd
Community Health Engagement Program (CHEP)Directors: Ronald T. Ackermann, MD, MPHDavid G. Marrero, PhD


Aims

  • Engage the Community in Research

    • Community residents

    • Community organizations

    • Community healthcare providers

  • Foster Communication Among CTSI Stakeholders

    • Scientists

    • Healthcare providers

    • Broad community



Engaging non healthcare community goals
Engaging Non-healthcare Community - Goals

  • Learn and communicate CTSI needs and resources

  • Seek active community participation

  • Match community priorities with CTSI funding opportunities

  • Collaborate about strategies for engaging all population groups in research


Engaging non healthcare community who
Engaging Non-Healthcare Community - Who

  • Community Advisory Group

    • Community Executive Board

    • Community Advisory Counsel

  • Purdue Extension

  • Department of Communication – IUPUI


Engaging healthcare community goals
Engaging Healthcare Community - Goals

  • Integrate a network of practice networks

  • Define a basic operating structure for involving practices / providers in research

  • Assess the characteristics and preferences of practices / providers / patients for research

  • Expand / enhance the network over time

  • Match community healthcare priorities with CTSI funding opportunities


Engaging healthcare community who
Engaging Healthcare Community - Who

  • Existing Practice Based Research Networks

    • INET, ResNet, PResNet

    • Director, coordinator, and research staff

  • Practices “at large”

    • In INPC – facilitates recruitment and data collection

    • In other interested delivery systems – MMG, St. V…

    • Truly at large? – incorporated into existing networks

  • Polis Center – mapping of practices and nearby resources


Fostering communication
Fostering Communication

  • Communication Action Team

  • Division of CME

  • Identify effective communication channels

  • Study the relative impact of different communication channels over time

  • Bridge dialogue among stakeholders


Synergies
Synergies

  • CTSI Hub – match scientific funding opportunities with community preferences

  • Recruitment core – integrate information about all CTSI recruitment channels

  • Bio-informatics - expedite recruitment in healthcare settings and enhance provider role


A Real World Example

The Diabetes Prevention Program


Study interventions
Study Interventions

Troglitazone

Discontinued 6/98

(n = 585)

Eligible participants

Randomized

Standard lifestyle recommendations

Intensive

Lifestyle

(n = 1079)

Metformin

(n = 1073)

Placebo

(n = 1082)


Lifestyle intervention
Lifestyle Intervention

An intensive program with the following specific goals:

  • > 7% loss of body weight and maintenance of weight loss

    • Fat gram goal -- 25% of calories from fat

    • Calorie intake goal -- 1200-1800 kcal/day

  • > 150 minutes per week of physical activity


Medication Intervention

Metformin- 850 mg per day escalating after

4 weeks to 850 mg twice per day

Placebo- Metformin placebo adjusted in

parallel with active drugs


Mean Weight Change from Baseline

+

Placebo

Metformin

Lifestyle

0 6 12 18 24 30 36 42 48

Months


Mean Change in Leisure Physical Activity (Met hours per week)

Lifestyle

Metformin

Placebo

0 1 2 3 4

Years from randomization


Development of diabetes
Development of Diabetes week)

PlaceboMetforminLife-style

Development of diabetes 11.0% 7.8% 4.8%

(percent per year)

Reduction of diabetes ---- 31% 58%

compared with placebo

Number needed to treat ---- 13.9 6.9

to prevent 1 case in 3 yrs



Dpp translation
DPP Translation World?”

Evidence-base

Population-Level Diabetes Prevention

Linked to healthcare

Adaptable to different settings

Factor access issues

Scalable nationally

  • Worth the investment

    • Health Payers

    • Employers

    • Individuals

Real-World Implementation



Partnered approach for prevention
Partnered Approach for Prevention World?”

Community

Healthcare

Population Resources

Environment

Education by Schools & Media

Risk assessment opportunities

Reciprocal Interactions

Personnel

Experience

Facilities

Contact

Formal Programs

Glucose testing

Risk/benefit assessment (safe?)

Prescriptive advice (role for meds?)

Gateway to reimbursement


The ymca model

The YMCA model World?”


What is the ymca
What is the YMCA? World?”

  • Community-based organization

  • Started in 1800’s in the United Kingdom

  • Found in 98 countries

  • Focus on developing mind, body and spirit:

    • Place for social, health and athletic activities

    • Largest provider of child care in the United States


Why the ymca
Why the YMCA? World?”

  • 2,600 YMCAs in the U.S.

  • 42M U.S. families within 3 miles of a Y

  • Strong history of disseminating structured clinical interventions nationally

  • Operate to achieve cost recovery only

  • Policy to turn no person away for inability to pay for a program (financial assistance)


Group delivery of dpp
Group Delivery of DPP World?”

  • Offer program to a group of 10 – 12 led by trained lay persons

  • Enhances social support and accountability

  • Lowers direct intervention costs by >75%

  • Cost-saving for a health plan that shares 45-50% of intervention fees with other payers/purchasers


The deploy study
The DEPLOY Study World?”

  • Community-based pilot RCT

  • Test the feasibility and effectiveness of training YMCA employees to deliver a group-based version of the DPP lifestyle intervention in YMCA branch facilities


Results after 4 6 months
Results after 4-6 months World?”

* Adjusted for sex and baseline value of outcome variable


Results after 12 14 months
Results after 12-14 months World?”

* Adjusted for sex and baseline value of outcome variable


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