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

Engaging Non-healthcare Community - Goals Learn and communicate CTSI needs and resources Learn and communicate CTSI needs and resources Seek active community participation Seek active community participation Match community priorities with CTSI funding opportunities Match community priorities with CTSI funding opportunities Collaborate about strategies for engaging all population groups in research Collaborate about strategies for engaging all population groups in research

Engaging Non-Healthcare Community - Who Community Advisory Group Community Advisory Group –Community Executive Board –Community Advisory Counsel Purdue Extension Purdue Extension Department of Communication – IUPUI Department of Communication – IUPUI

Engaging Healthcare Community - Goals Integrate a network of practice networks Integrate a network of practice networks Define a basic operating structure for involving practices / providers in research Define a basic operating structure for involving practices / providers in research Assess the characteristics and preferences of practices / providers / patients for research Assess the characteristics and preferences of practices / providers / patients for research Expand / enhance the network over time Expand / enhance the network over time Match community healthcare priorities with CTSI funding opportunities Match community healthcare priorities with CTSI funding opportunities

Engaging Healthcare Community - Who Existing Practice Based Research Networks Existing Practice Based Research Networks –INET, ResNet, PResNet –Director, coordinator, and research staff Practices “at large” 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 Polis Center – mapping of practices and nearby resources

Fostering Communication Communication Action Team Communication Action Team Division of CME Division of CME Identify effective communication channels Identify effective communication channels Study the relative impact of different communication channels over time Study the relative impact of different communication channels over time Bridge dialogue among stakeholders Bridge dialogue among stakeholders

Synergies CTSI Hub – match scientific funding opportunities with community preferences CTSI Hub – match scientific funding opportunities with community preferences Recruitment core – integrate information about all CTSI recruitment channels Recruitment core – integrate information about all CTSI recruitment channels Bio-informatics - expedite recruitment in healthcare settings and enhance provider role Bio-informatics - expedite recruitment in healthcare settings and enhance provider role

A Real World Example The Diabetes Prevention Program

Study Interventions Eligible participants Randomized Standard lifestyle recommendations IntensiveLifestyle (n = 1079) Metformin (n = 1073) Placebo (n = 1082) Troglitazone Discontinued 6/98 Discontinued 6/98 (n = 585) (n = 585)

Lifestyle Intervention An intensive program with the following specific goals: > 7% loss of body weight and maintenance of weight loss> 7% loss of body weight and maintenance of weight loss –Fat gram goal -- 25% of calories from fat –Calorie intake goal kcal/day > 150 minutes per week of physical activity> 150 minutes per week of physical activity

- 850 mg per day escalating after Metformin- 850 mg per day escalating after 4 weeks to 850 mg twice per day 4 weeks to 850 mg twice per day Metformin placebo adjusted in Placebo- Metformin placebo adjusted in parallel with active drugs parallel with active drugs Medication Intervention

Mean Weight Change from Baseline Months Lifestyle Metformin + Placebo

Years from randomization Mean Change in Leisure Physical Activity (Met hours per week) Lifestyl e Metformi n Placebo

Development of Diabetes Placebo Metformin Life-style Placebo Metformin Life-style Development of diabetes 11.0% 7.8% 4.8% (percent per year) Reduction of diabetes % 58% compared with placebo Number needed to treat to prevent 1 case in 3 yrs

So What do we Need to do to Prevent Diabetes in the “Real World?”

DPP Translation Population- Level Diabetes Prevention Evidence-base Real-World Implementation Linked to healthcare Adaptable to different settings Factor access issues Scalable nationally Worth the investment Health Payers Employers Individuals

Evidence-based Diabetes Prevention Evidence / goal HealthcareCommunity Target adults with pre-diabetes (blood test) X Provide structured lifestyle intervention to achieve 5-7% weight loss X Link to health plan / employer payment (physician initiated) X Provide ongoing behavior support at least monthly X

Partnered Approach for Prevention Healthcare Glucose testing Risk/benefit assessment (safe?) Prescriptive advice (role for meds?) Gateway to reimbursement Formal Programs Community Population Resources Environment Education by Schools & Media Risk assessment opportunities Reciprocal Interactions PersonnelExperienceFacilitiesContact

The YMCA model

What is the YMCA? Community-based organization Community-based organization Started in 1800’s in the United Kingdom Started in 1800’s in the United Kingdom Found in 98 countries Found in 98 countries Focus on developing mind, body and spirit: 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. 2,600 YMCAs in the U.S. 42M U.S. families within 3 miles of a Y 42M U.S. families within 3 miles of a Y Strong history of disseminating structured clinical interventions nationally Strong history of disseminating structured clinical interventions nationally Operate to achieve cost recovery only Operate to achieve cost recovery only Policy to turn no person away for inability to pay for a program (financial assistance) Policy to turn no person away for inability to pay for a program (financial assistance)

Group Delivery of DPP Offer program to a group of 10 – 12 led by trained lay persons Offer program to a group of 10 – 12 led by trained lay persons Enhances social support and accountability Enhances social support and accountability Lowers direct intervention costs by >75% Lowers direct intervention costs by >75% Cost-saving for a health plan that shares 45-50% of intervention fees with other payers/purchasers Cost-saving for a health plan that shares 45-50% of intervention fees with other payers/purchasers

The DEPLOY Study Community-based pilot RCT 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 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 (N = 38) DPP (N = 39) p- value* Weight (%reduction)-2.0%-6.0%<0.001 Change SBP (mmHg) Change A1c (%) Change TChol (mg/dL) <0.001 Change HDL (mg/dL) * Adjusted for sex and baseline value of outcome variable

Results after months Brief Advice (N = 33) DPP (N = 29) p- value* Weight (%reduction)-1.8%-6.0%0.008 Change SBP (mmHg) Change A1c (%) Change TChol (mg/dL) Change HDL (mg/dL) * Adjusted for sex and baseline value of outcome variable