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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