1. Engaging Our Neighbors To Transform Care
The Community and Duke:
Engaging Our Neighbors To Transform Care
A Story of Durham and Duke
J. Lloyd Michener, MD
Professor and Chair
Department of Community and Family Medicine
Director, Duke Center for Community Research
Duke University Health System
AAMC Annual Meeting
November 6, 2011 1

2. 20 years of improving outcomes, lowering costs for diverse NC communities

3. Building On A Long History...

4. To Be A Community of Health, Not Only A “City of Medicine”
Our Goal:
To Be A Community of Health,
Not Only A “City of Medicine”

5. We Care For Most Of Durham
All patients seen at Duke,
215,731 unique patients
~80% of Durham County population

6. Walltown and Lyon Park Clinic
We Plan Together:

7. We Develop Programs Together
Just For Us

8. Just For Us

9. Envisioning The Future: Durham Health Innovations

10. The Burden Of Disease Is Uneven: Hypertension

11. Conclusion: Durham Needs Care That Is...

12. Implementation: Building Capacity in Our Neighborhoods
Health Ambassador Sites
Health ambassador sites serve multiple functions:
Hubs for community conversations around health improvement
Neighborhood centers for health activities
Hubs for health information and resource distribution
DHI Community Health Organizers work with Health Ambassador Sites to facilitate a capacity-building process that involves neighborhood leaders, stakeholders, business owners, and residents. With DHI Teams, they pilot health strategies with these sites. 
Assessing the services, capacity and wish lists of each physical location allows us to identify potential synergies and collaboration opportunities between neighborhood sites.
Interest and momentum in SWCD is building most rapidly around the areas of healthy eating and exercise and health information/access.
Lyon Park Community Center will serve as the hub for SWCD organizing strategies.
We continue to identify assets and build partnerships with potential health ambassador sites in SWCD. We will bring SWCD stakeholders together in Oct. for a reporting out session about what we have heard and implemented thus far and will get feedback on next steps.
CHOs are working on connecting Ambassador Sites in SWCD in ways that can leverage resources and work already being done around health. Compare the example “tags” above that describe Teen Center and Lyon Park Community Center programs and wish lists. There are clear areas of commonalities, particularly in relation to serving the community’s youth and seniors, and focusing on improved nutrition. We are connecting ambassador sites through this type of information gathering as part of the capacity building process. We will develop a strategic plan this fall that takes into account the priorities named by residents, neighborhood assets, and the potential for new DHI strategies to help address neighborhood health issues.
At this point, the key health priorities that we have identified in SWCD focus on access to care, healthy eating and exercise, and diabetes. We will be looking at the specific elements of these issues within the neighborhood context and listening to residents to determine specific strategies. In the meantime, DHI teams and CHOs are implementing small-scale pilot projects with ambassador sites. For example, a partnership between the Adolescent Health Team, Health Dept., and Planned Parenthood led to a series of health programs that were piloted over the summer.

13. The Future: Integrated Care
Neighborhood Health Ambassador Sites
Neighbor-hood Health Navigators
Clinical Hubs: Lyon Park & Holton
Connected Care: Employer- & Practice-Based Efforts
Integrating social and medical resources, neighborhood assets, and community activism to pave the way for a healthier Durham.
Integration is pivotal to this model: Integration of social and medical resources; integration of neighborhood activism and assets; and integration of efforts to improve health in the home, community, and workplace.
Note that Connected Care encompasses Durham County Health Department and County Employees.

14. Conclusions Health requires more than medicine
Health care requires more than physicians
Improving health requires teams in the office and in the community
Community partners add expertise and resources
Needs vary; one size does not fit all

15. Principles of Community Engagement
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