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Durham and Duke: A Story of Community Engagement

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  1. Durham and Duke: A Story of Community Engagement J. Lloyd Michener, MD Professor and Chair Department of Community and Family Medicine Director, Duke Center for Community Research Duke University School of Medicine National Advisory Research Resources Council May 14, 2008 Bethesda, Maryland

  2. 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.

  3. Takes time and persistence Community Engagement

  4. 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 Community Engagement - Takes a Diversity of Partners

  5. Community Engagement - Takes a Diversity of Programs and Sites

  6. Creating Community Programs Bring in all who serve the same population Analyze population and neighborhood data Go to patient’s homes and listen; asking open ended questions Measure impact & quality Adjust, ask for feedback on a continuing basis 6

  7. Just for Us Community Engagement – Powerful Outcomes • 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%

  8. LATCH Community Engagement – Powerful Outcomes • 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 Decreased ED costs

  9. Research Team Duke University Department of Community and Family Medicine Community Health Coalition NCCU 11 Churches Antioch Baptist Covenant Presbyterian Faith Assembly Christina Center First Calvary Baptist Mt. Calvary United Church of Christ Mt. Level Missionary Baptist St. John Baptist St. Joseph’s AME Church St. Mark AME Zion Union Baptist Community Engagement – Increases Self-Efficacy AAHIP Partners R24 MD001655 NCMHHD Goal: Assess barriers to diabetes control in low income African American population Empowerment Changes in Health from Start to Six Months HbA1c

  10. Private MDs Patient Registry Stakeholders:A Work in Progress 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 Community Registry Cabarrus Health Alliance Research IRB Rotary Novant Healthcare Presbyterian Novant Medical Group Healthy Cabarrus Community Free Clinic FQHCs (McGill & Logan) Community Care Plan IT (EMR) United Way

  11. 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 The Duke Center for Community Research (DCCR) www.aamc.org/mededportalgo to “Find Resources”; enter keyword: community engaged research

  12. Dissemination • Council of Academic Societies of the AAMC - March 8, 2008 • GRAND (Research Deans, with NCRR) - April 17, 2008 • “Accelerating the Dissemination and Translation of Clinical Research into Practice” (a full day session with NIH, CDC, AHRQ, APTR) - May 9, 2008 • Academy Health (with NCRR) - June 9, 2008 • An additional set of 5 regional workshops in planning, with support from APTR/CDC. Goal to link CTSA sites with each other and encourage regional collaboration. The regions are: • Oregon, California, Washington • Texas, North Carolina, Georgia, Tennessee, Missouri • Pennsylvania, Maryland, Ohio • Minnesota, Iowa, Illinois, Wisconsin, Michigan • Connecticut, New York Monograph of best practices in development