durham health innovations: city of medicine, community of health michelle j. lyn, mba, mha assistant...
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Durham Health Innovations:City of Medicine, Community of Health
Michelle J. Lyn, MBA, MHAAssistant ProfessorChief, Division of Community HealthDepartment of Community and Family MedicineAssociate Director, Duke Center for Community Research
Our Context: A History of Collaboration and an Opportunity to Lead…
Duke and Durham Collaboration: A Few Examples…
Community clinics
School-based clinics
Home care for elderly and/or disabled
Care management teams
Specialty Care Access
What we must address… Access, Cost, Quality
What we know….— Most illness related to health behaviors— Disease burden and practice patterns vary
What we believe….Everyone deserves access to simple, proven measures to reduce the risk of dying or losing function.
It is time to rethink the work, redesign the system…
An Opportunity to Lead…
Our Support
Clinical and Translational Science Awards (CTSA) of the National Institutes of Health (NIH)
Duke Medicine
Duke Translational Medicine Institute
Duke Center for Community Research
Durham Health Innovations
The Fundamental Question…
What does it take to move the health indicators for our ENTIRE community?
Co-chairs: Rob Califf, MD, Director, DTMI and Vice Chancellor for Clinical Research, Duke MedicineGayle B. Harris, MPH, Director, Durham County Health Department
MaryAnn Black, MSW, LCSW, Associate Vice President, Office of Community Relations, DUHS
Jackie Brown, Community Advocate
William Fulkerson, MD, Senior Vice President, Clinical Affairs, DUHS
Catherine L. Gilliss, DNSc, RN, FAAN, Dean, Duke University School of Nursing and Vice Chancellor for Nursing Affairs
Ellen Holliman, Director, The Durham Center
J. Lloyd Michener, MD, Chairman, Department of Community & Family Medicine and Director, Duke Center for Community Research
Marie Lynn Miranda, PhD, Director, Children’s Environmental Health Initiative, Duke University Nicholas School of the Environment
Earl Phillips, Assistant Director, Community Engagement, City of Durham
Gerri Robinson, Director, Durham County Department of Social Services
Pilar Rocha-Goldberg, Executive Director, El Centro Hispano
Oversight Committee
Requirements:
Planning Grants
An Interdisciplinary Duke-Durham Team
Relevant Health Issue
Engage Population Most Affected/Most At-Risk
Alternative model of service/care
Institutional Resources in Planning Activities
Financial Model
Evaluation Plan
Dissemination Plan
Stage 1 by the numbers…
22 Duke-Durham teams submitted Stage I Brief Proposals
413 team members –
237 representing Duke and
176 community partners (representing 90 community agencies/organizations and businesses)
19 Duke-Durham teams moved to Stage II
Stage II applications required teams…
Select co-team leaders from Duke and the community
Identify a project manager
Propose, describe, and present evidence for an innovative model of care (i.e., changes in the structure or function of a service, system, or care delivery setting).
Detail how community partnerships would be central to the planning process
Project Areas
Adolescent Health
Asthma and Chronic Obstructive Pulmonary Disease (COPD)
Cancer
Cardiovascular Disease
Diabetes
HIV/STD/Hepatitis
Maternal Health
Obesity
Pain Management and Substance Abuse
Seniors Health
Adolescent Health
Adolescent Health Initiative (AHI)
Team Co-Leads: Kristin Ito, MD, MPH, Duke Department of Pediatrics
Nancy Kent, LCSW, The Durham Center
C. Nicole Swiner, MD, UNC Family Medicine
Yvonne Wasilewski, PhD, MPH, Center for Child and Family Policy
Project Managers:
May Alexander & Wendy Tonker, How’s that working?
Asthma and COPD
Innovative Approaches to Better Detect and Treat Asthma and Chronic Obstructive Pulmonary Disease in Durham (Breathe Easy Team)
Team Co-Leads:
Monica Kraft, M.D., Duke Asthma, Allergy and Airway Center
Betty Masten, M.D., Lincoln Community Health Center
Project Manager:
Rhonda Webb, M.S., Duke Asthma, Allergy and Airway Center
A Partnership for Community Wellness in Durham, NC
Cancer Prevention and Early Detection
Team Co-Leads:
Victoria Seewaldt, M.D., Duke Pharmacology and Cancer Biology, Cancer Control and Prevention
Sharon Elliot Bynum, RN, BSN, MA, Ph.D., Healing with CAARE, Inc.
Anne Ford, M.D., Duke Department of OB/Gyn
Gustavo Montana, M.D. Duke Radiation Oncology
Vladirir Mouraviev, M.D., Ph.D., Duke Department of Surgery
Marva Price, DrPH, RN, FAAN, Duke University School of Nursing
Stephanie Robertson, Duke University Comprehensive Cancer Center
Valarie Worthy, R.N., Sister Network, Durham/Triangle Chapter
Project Manager:
Jeff Birnbaum, B.S.E., Duke Department of Medical Oncology
Cardiovascular Disease
Vascular Intervention Project (VIP)
Team Co-Leads:
Kevin L. Thomas, M.D., FACC, FAAC, Duke Division of Cardiovascular Disease/Duke Clinical Research Institute
Sharon Elliott-Bynum, RN, MSN, Ph.D., Healing with CAARE Inc., Jeanne Lucas Education and Wellness Center
Project Manager:
Kristin Dossary, Duke Clinical Research Institute
Diabetes
Partnership IMPACTS Diabetes Outcomes
Team Co-Leads:
Gloria Trujillo, M.D., Duke Department of Community and Family Medicine
Kathryn Trotter, MSN, CNM, FNP, Duke University School of Nursing
Michele Easterling, MPH, RD, Durham County Health Department
Nichole Weedon, MSW, P-LCSW, Durham County Dept. of Social Services
Project Manager:
Rachel Kuliani, MPH, Durham Health Innovations
HIV, STD and Hepatitis Prevention and Care
Prevention and Treatment of HIV,STDs, and Hepatitis in Durham County
Team Co-Leads:
John Bartlett, MD, Duke Global Health Institute / Infectious Disease Clinic
Arlene Sena, MD, MPH, Durham County Health Department, UNC-CH Division of Infectious Diseases
Project Managers:
Mary DeCoster, MPH, Durham County Health Department
Marc Kolman, MSPH, Piedmont Health Care Consortium
Maternal and Child HealthThe Maternal and Child Health Intervention Group (MCH Group)
Team Co-Leads:
Monique Chireau, M.D., MPH, Duke Department of Obstetrics and Gynecology
Tamera Coyne-Beasley, MD, MPH, Community Health Coalition / UNC-CH Dept. of Pediatrics and Internal Medicine
Sue McLaurin, M.Ed., PT, Community Health Coalition
Maria Small, MD, MPH, Duke Department of Obstetrics and Gynecology
Project Managers:
Tammy Bishop, RNC, MSN, Duke Department of Obstetrics and Gynecology
Lottie Barnes, MPH, CHES, Community Health Coalition
Obesity
Achieving Healthy Bodies for a Lifetime (AHL)
Team Co-Leads:
David Reese, MBA, Chief Operating Officer, Inter-Faith Food Shuttle
William Yancey, Jr. MD, MHS, Duke Department of Medicine
Project Manager:
Jennifer McDuffie, PhD, General Internal Medicine, Durham VAMC
Pain Management and Substance AbuseRethinking Pain: Collaborative Approaches to Address the
Relationship of Pain, Substance Abuse, and Psychiatric Illness
Team Co-Leads:
Fred Johnson, MBA, Duke Division of Community Health
Cathleen Melton, MD, Lincoln Community Health Center
Project Manager:
Sarah Weaver, MPH, Duke Division of Community Health
SeniorsSeniors Healthy in Place "HIP Seniors"
Team Co-Leads:
Robin Ali, MD, PharmD, Duke Dept. of Community and Family Medicine
Brenda Jamerson, PharmD, Duke Psychiatry and Behavioral Sciences, Campbell University School of Pharmacy
Ellie McConnell, RN, PhD, GCNS, BC, Duke School of Nursing
Joan Pellettier, Triangle J Area Agency on Aging
Gina Upchurch, RPh, MPH, Senior PharmAssist
Project Manager:
Carolyn Kroll, MA, CK Kroll & Associates. Inc.
Technical Assistance CoresCommunity Engagement
Data and Analysis Plan Development
Co-Chairs:Michelle Lyn
Earl Phillips (City of Durham Housing and Development)
Co-Chairs:Marie Lynn Miranda
Becky Freeman (Durham County Health Department)
Co-Chairs: Krishna Udayakumar
Casey Steinbacher (Durham County Chamber of Commerce)
Data confidentiality issues
Analysis
Modeling
engagement
Facilitating
conversations
Connecting to other
teams
DSR and other linked data
Business data
Data from teams
Geospatial mapping
Alternative models
of care
Business plan
development
Finding Common Ground
Elements of a Connected Care Model
1. Population Analysis and Risk Stratification
2. Metrics and Accountability
3. Care Management/Care Coordination
4. Communication
Common Elements Across Teams
1. Population Analysis and Risk Stratification
People with or at high risk for health problems
Risk stratification that accounts for health status, socio-economic and environmental factors
Assess neighborhood- and community-wide health status and identify opportunities for health improvement
Common Elements Across Teams
2. Metrics and Accountability
Collaboratively identify key measures to:
- determine extent of the health problems
- track progress
- inform decision-making and resource allocation
Common Elements Across Teams
3. Care Management / Care Coordination
Community health advocates
Optimal use of all providers including specialist and primary care physicians
Care closer to people’s homes and neighborhoods
Tight coordination of clinical services, home health, hospice, pharmacists, respiratory therapy, etc.
Opportunities for group visits, home visits, and use of internet technology for health care strategies
Common Elements Across Teams4.Communication
Engage community input throughout the entire process
Leverage information technology and informatics capabilities to facilitate improved communication
— across community and providers — improve decision-making (via availability of
critical information, decision support tools, risk-stratification tools)
— information & referral
Care designed with communities and providers that optimizes the use of non-traditional and traditional providers so that it is:
—Close
To home, neighborhood, school, workplace…
—Connected
Individuals to health providers
Health providers to each other
—Accountable
Measurable performance with consequences
It is a fundamental redesign, not a substitution model, not a “lesser” model
Combining team efforts results in…
Challenges and Lessons Learned
Each step of the way
Through every process
In each relational group
Next Steps…
What we have:
A shared understanding that we ALL have a role to play in improving the health of our community
What we need:
An open commitment by ALL of us that improved health outcomes is a shared goal and that ALL of us are willing to be held accountable for our work toward that goal
Next Steps…
What we must do:– Continue to focus on engagement – Achieve consensus on our expected outcomes
and how we will measure them– Recognize this is not and should never be a
“one intervention fits all” approach– Set realistic expectations of time – this is NOT
a short-term effort - it will require phases of implementation
– Demonstrate the positive economic impact of health-related activities
Our First Steps…– Finish synthesizing the work of the teams
and incorporate YOUR input– Expand the DHI Oversight Committee – Provide project management, quantitative
support, and grant writing support to the teams
– Appoint an Informatics and Information Technology Committee
– Appoint Implementation Team to operationalize strategies and ensure coordination of effort across the work of the teams
Poster Session: A Discussion with DHI Participants
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