DUKE UNIVERSITY MEDICAL CENTER & HEALTH SYSTEM

Duke Center for Community Research

J. Lloyd Michener, MD

Professor and Chair

Dept of Community & Family Medicine

October 16, 2006

North American Primary Care Research Group

Tucson, Arizona

Vision of Transformation: What has to be done?

Healthcare transformation will involve several bold moves:

National mandate on extensive reformation of

healthcare delivery & financing systems Campaign on Prevention, Health & Wellness

and Prospective Health Innovation that leads to transformative/

disruptive technologies and approaches

(V.J. Dzau 2006)

Bold Reform of Care Delivery Systems

Develop true integrated care delivery systems from community to medical centers (national or state systems)

Increase investment in Primary Care (vs Focused Factories)

Replacing Physician Centered model with novel models of care-providers (physician extenders, laypersons)

Use of Innovative IT technology for clinical information capture, connectivity, remote monitoring and decision support

(V.J. Dzau 2006)

Duke Model of Bench to Bedside to Population: Two Interrelated,

Signature Initiatives

Translational and Clinical Research Institute (TCRI)

- Duke Translational Research Institute (DTRI):

- Duke Clinical Research Institute (DCRI)

- Duke Center for Community Research (DCCR)

Global Health Institute (GHI)

- Policy & Research

- Education

- Service Delivery

(V.J. Dzau 2006)

Regulatory Affairs

Education & Training

Biostatistics & Bioinformatics

DTRI DCRI DCCR

Core Laboratories

New Molecule

Pre-clinical Development First in Human

Phase II/III

Application in the Community

TCRI Administration

Project Leaders and the Portal Office

Duke Translational and Clinical Research Institute Structure

(V.J. Dzau 2006)

CFM Durham Clinical Sites

DUKE UNIVERSITY MEDICAL CENTER & HEALTH SYSTEM

Duke Community & Family Medicine Care Coordination

Northern Piedmont Community Care Durham Community Health Network 4County Community Care

African American Health Improvement Partnership

Academic Chronic Care Collaborative Amigas latinas Motivando el Alma

Hypertension Project

DUKE UNIVERSITY MEDICAL CENTER & HEALTH SYSTEM

State-wide ProgramsKBR and NCHWTF Community Nutrition

Network

Occupational Health Services

DUKE UNIVERSITY MEDICAL CENTER & HEALTH SYSTEM

CFM State-Wide

...Across the U.S. and beyond

Duke Community-Linked Research GroupsDuke School of Nursing Terry Sanford Institute - Center for

Health Policy, Law, and Management

The TRAC Center, SON Duke Primary Care Research Consortium

Duke Comprehensive Cancer Center Prevention Research, CFM and CCC

Center for Clinical Health Policy Research

Community Health, CFM

Center for Clinical and Genetic Economics

Occupational and Environmental Medicine, CFM

Great Smoky Mountain Study Clinical Informatics,CFM

Epidemiology of Dementia in

Cache Co., Utah

Chronic Disease Epidemiology, CFM

DUKE UNIVERSITY MEDICAL CENTER & HEALTH SYSTEM

The Duke Center for Community Research (DCCR)

DUKE UNIVERSITY MEDICAL CENTER & HEALTH SYSTEM

Governance: Community Research Advisory Board

Moving the Community from Subject to Collaborative Partner

Components: Community Research Liaison Center Community Health Research Training Center

Electronic Health Record

Community Research Liaison Center

The connection between CTSI and local communities and organizations A virtual library:

for researchers to learn about communities for community groups to learn about themselves

Outreach and training to assist communities with data and to connect communities with researchers

Community Health Research Training Center

Train and prepare researchers to work successfully with communities Train and prepare learners/trainees for

research with communities Conduct formal regulatory training and testing

for community engagement IRB Consent process

DCCR Electronic Health Record

• Covers citizens of Durham County• Captures data for Durham County• Develop analytic techniques using data from the

DSR• Dealing with co-variates• Meshing advanced laboratory data with long

term outcomes• Produce rapid & measurable improvement of

community health status• Can perform rapid turn-around intervention studies

(V.J. Dzau 2006)

And after that…

World peace

Subtext – be careful what you ask for!

General Comments and Advice

Be bold - try to make a difference Be inclusive – more than one network,

discipline, department Embrace diversity – there is no one right

way Give back – how will your communities

and networks be better for the project?

CFM Vision/Mission

The Department’s mission is: to advance understanding of health and

illness in the community, workplace and family;

to design innovative interventions to promote health and prevent disease; and

to teach others what we have learned

DUKE UNIVERSITY MEDICAL CENTER & HEALTH SYSTEM

Emphasis on Health and Prevention

Prevention Health and Wellness Prospective Health Personalized Medicine Integrative Medicine

Biomarkers Genomics, ‘omics Risk Assessment Informational Technology Driven by Innovation

(V.J. Dzau 2006)

Principles of Community Engagement Proposed projects should be based on a need identified by the

community that is beneficial to the community. Scope and time-frame of project should be clear to the community.

Partners must be willing to commit time and resources to the project, be good stewards of project data, and include the community in outcome reporting activities.

Partners must trust each other and build mutual respect for each other while learning from each other’s perspectives.

A diverse range of community members and agencies need to participate to ensure that proposed activities meet the needs of a diverse citizenry. All participants are considered experts.

A safe environment exists for all participants of all backgrounds to share ideas without fear of ridicule or criticism. No blaming or judgments. Keep lines of communication open.

Created by: Principles of Engagement Workgroup 9/20/05DUKE UNIVERSITY MEDICAL CENTER & HEALTH SYSTEM