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

Aims

  • Engage the Community in Research

    • Community residents

    • Community organizations

    • Community healthcare providers

  • Foster Communication Among CTSI Stakeholders

    • Scientists

    • Healthcare providers

    • Broad community


Aims

CHEP


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


Aims

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


Aims

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


Aims

Mean Weight Change from Baseline

+

Placebo

Metformin

Lifestyle

0 6 12 18 24 30 36 42 48

Months


Aims

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

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


So what do we need to do to prevent diabetes in the real world

So What do we Need to do to Prevent Diabetes in the “Real World?”


Dpp translation

DPP Translation

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


Evidence based diabetes prevention

Evidence-based Diabetes Prevention


Partnered approach for prevention

Partnered Approach for Prevention

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


What is the ymca

What is the YMCA?

  • 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?

  • 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

  • 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

  • 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

* Adjusted for sex and baseline value of outcome variable


Results after 12 14 months

Results after 12-14 months

* Adjusted for sex and baseline value of outcome variable


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