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
slide2
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
slide10
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
slide13

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

slide14

Mean Weight Change from Baseline

+

Placebo

Metformin

Lifestyle

0 6 12 18 24 30 36 42 48

Months

slide15

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

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

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

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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