1. 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

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 technologies and 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. Regulatory Affairs Education & Training Biostatistics & Bioinformatics DTRIDCRIDCCR 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)

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

7. 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 CollaborativeAmigas latinas Motivando el Alma Hypertension Project DUKE UNIVERSITY MEDICAL CENTER & HEALTH SYSTEM

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

9. Duke Community-Linked Research Groups Duke School of NursingTerry Sanford Institute - Center for Health Policy, Law, and Management The TRAC Center, SONDuke Primary Care Research Consortium Duke Comprehensive Cancer CenterPrevention 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 StudyClinical Informatics,CFM Epidemiology of Dementia in Cache Co., Utah Chronic Disease Epidemiology, CFM DUKE UNIVERSITY MEDICAL CENTER & HEALTH SYSTEM

10. 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

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. 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

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. 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 DUKE UNIVERSITY MEDICAL CENTER & HEALTH SYSTEM