Transcript Slide 1

COMMUNITY HEALTH
ENGAGEMENT PROGRAM
(CHEP)
DIRECTORS:
RONALD T. ACKERMANN, MD, MPH
DAVID G. MARRERO, PHD
Aims
1. Engage the Community in Research
A. Community residents
B. Community organizations
C. Community healthcare providers
2. Foster Communication Among CTSI
Stakeholders
A. Scientists
B. Healthcare providers
C. Broad community
CHEP
Figure 1. Organization of the CTSI Community Health Engagement Program (CHEP)
Community Health Engagement Program
Administrative oversight and management of community
engagement, practice & community data integration,
communications, technical assistance, training in community
CHEP Executive Committee
Mayor’s
Action
Council
Health
Dept.
Offices
Indiana
Minority
Health
Coalition
Purdue
Extension
Partners
Purdue CHEP
Extension
Public
Schools
Systems
Faithbased
Orgs
Community
Advisory
Board
Parks &
Recreation
Depts
Community
Provider
Groups
Project Coordination Teams
Communication Action Team
Community Population Engagement
Community
Organizations
(4H, YMCA)
Professional
Societies
Network
Coordinator
Community Provider Engagement
Advancing Community Research Methods
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

Community Advisory Group
– Community Executive Board
– Community Advisory Counsel
Purdue Extension
 Department of Communication – IUPUI

Engaging Healthcare Community Goals
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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

Existing Practice Based Research Networks
– INET, ResNet, PResNet
– Director, coordinator, and research staff
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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
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
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
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A Real World Example
The Diabetes Prevention Program
Study Interventions
Eligible participants
Randomized
Standard lifestyle recommendations
Intensive Metformin Placebo Troglitazone
Discontinued 6/98
Lifestyle
(n = 585)
(n = 1079) (n = 1073) (n = 1082)
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
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
Mean Weight Change from Baseline
Weight Change (Kg)
+1
Placebo
0
-1
-2
-3
-4
-5
-6
-7
-8
Metformin
Lifestyle
0
6
12
18 24 30
Months
36
42
48
Leisure physical activity change
Mean Change in Leisure Physical
Activity (Met hours per week)
8
Lifestyl
e
7
6
5
4
3
Metformi
n
Placebo
2
1
0
0
1
2
3
Years from randomization
4
Development of Diabetes
Placebo
Metformin Life-style
Development of diabetes
(percent per year)
11.0%
7.8%
Reduction of diabetes
compared with placebo
----
31%
Number needed to treat ---to prevent 1 case in 3 yrs
13.9
4.8%
58%
6.9
So What do we Need
to do to Prevent
Diabetes in the “Real
World?”
DPP Translation
PopulationLevel Diabetes
Prevention
Evidence-base
Worth the investment
Health Payers
Employers
Individuals
Real-World
Implementation
Linked to
healthcare
Adaptable to
different settings
Factor access
issues
Scalable nationally
Evidence-based Diabetes
Prevention
Evidence / goal
Target adults with pre-diabetes
(blood test)
Provide structured lifestyle
intervention to achieve 5-7%
weight loss
Link to health plan / employer
payment (physician initiated)
Provide ongoing behavior
support at least monthly
Healthcare
Community
X
X
X
X
Partnered Approach for
Prevention
Community
Healthcare
Population Resources
Environment
Education by Schools & Media
Risk assessment opportunities
Reciprocal
Interactions
Glucose testing
Risk/benefit assessment (safe?)
Prescriptive advice (role for meds?)
Gateway to reimbursement
Formal
Programs
Personnel
Experience
Facilities
Contact
The YMCA model
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?
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)
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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
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The DEPLOY Study
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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
Brief
Advice
DPP
(N = 38)
(N = 39)
pvalue*
-2.0%
-6.0%
<0.001
Change SBP (mmHg)
-2.3
-1.9
0.88
Change A1c (%)
-0.1
-0.1
0.96
Change TChol (mg/dL)
+6.0
-21.6
<0.001
Change HDL (mg/dL)
+2.1
+1.1
0.68
Weight (%reduction)
* Adjusted for sex and baseline value of outcome variable
Results after 12-14
months
Brief
Advice
DPP
(N = 33)
(N = 29)
pvalue*
-1.8%
-6.0%
0.008
-2.7
-1.6
0.78
Change A1c (%)
+0.03
-0.1
0.28
Change TChol (mg/dL)
+11.8
-13.5
0.002
-1.4
+1.9
0.10
Weight (%reduction)
Change SBP (mmHg)
Change HDL (mg/dL)
* Adjusted for sex and baseline value of outcome variable