Duke Center for Community Research

1. 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

2. 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 technologiesand approaches (V.J. Dzau 2006)

3. 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)

4. 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)

5. Duke Translational and Clinical Research Institute Structure TCRI Administration Education & Training Biostatistics & Bioinformatics Core Laboratories Regulatory Affairs Project Leaders and the Portal Office DTRI DCRI DCCR New Molecule Pre-clinical Development First in Human Phase II/III Application in the Community (V.J. Dzau 2006)

6. DUKE UNIVERSITY MEDICAL CENTER & HEALTH SYSTEM CFM Durham Clinical Sites

7. DUKE UNIVERSITY MEDICAL CENTER & HEALTH SYSTEM Duke Community & Family Medicine Care Coordination

8. DUKE UNIVERSITY MEDICAL CENTER & HEALTH SYSTEM State-wide Programs Community Nutrition Network KBR and NCHWTF Occupational Health Services CFM State-Wide ...Across the U.S. and beyond

9. DUKE UNIVERSITY MEDICAL CENTER & HEALTH SYSTEM Duke Community-Linked Research Groups

10. DUKE UNIVERSITY MEDICAL CENTER & HEALTH SYSTEM The Duke Center for Community Research (DCCR) Moving the Community from Subject to Collaborative Partner Governance:Community Research Advisory Board Components:Community Research Liaison Center Community Health Research Training Center Electronic Health Record

11. 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

12. 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

13. 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)

14. And after that… • World peace • Subtext – be careful what you ask for!

15. 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?

17. DUKE UNIVERSITY MEDICAL CENTER & HEALTH SYSTEM 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

18. 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)

19. DUKE UNIVERSITY MEDICAL CENTER & HEALTH SYSTEM 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 9/20/05