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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

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durham and duke a story of community engagement

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

leading causes of death in durham nc
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.

community engagement takes 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

Community Engagement - Takes a Diversity of Partners
creating community programs
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

just for us
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%
latch
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

community engagement increases self efficacy
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

patient registry stakeholders a work in progress

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

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

The Duke Center for Community Research (DCCR)

www.aamc.org/mededportalgo to “Find Resources”; enter keyword: community engaged research

dissemination
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