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Aims

Community Health Engagement Program (CHEP) Directors: Ronald T. Ackermann, MD, MPH David G. Marrero, PhD. Aims. Engage the Community in Research Community residents Community organizations Community healthcare providers Foster Communication Among CTSI Stakeholders Scientists

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Aims

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  1. Community Health Engagement Program (CHEP)Directors: Ronald T. Ackermann, MD, MPHDavid G. Marrero, PhD

  2. Aims • Engage the Community in Research • Community residents • Community organizations • Community healthcare providers • Foster Communication Among CTSI Stakeholders • Scientists • Healthcare providers • Broad community

  3. CHEP

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

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

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

  7. Engaging Healthcare Community - Who • Existing Practice Based Research Networks • INET, ResNet, PResNet • Director, coordinator, and research staff • 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

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

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

  10. A Real World Example The Diabetes Prevention Program

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

  12. Lifestyle Intervention An intensive program with the following specific goals: • > 7% loss of body weight and maintenance of weight loss • Fat gram goal -- 25% of calories from fat • Calorie intake goal -- 1200-1800 kcal/day • > 150 minutes per week of physical activity

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

  14. Mean Weight Change from Baseline + Placebo Metformin Lifestyle 0 6 12 18 24 30 36 42 48 Months

  15. Mean Change in Leisure Physical Activity (Met hours per week) Lifestyle Metformin Placebo 0 1 2 3 4 Years from randomization

  16. Development of Diabetes PlaceboMetforminLife-style Development of diabetes 11.0% 7.8% 4.8% (percent per year) Reduction of diabetes ---- 31% 58% compared with placebo Number needed to treat ---- 13.9 6.9 to prevent 1 case in 3 yrs

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

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

  19. Evidence-based Diabetes Prevention

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

  21. The YMCA model

  22. What is the YMCA? • Community-based organization • Started in 1800’s in the United Kingdom • Found in 98 countries • Focus on developing mind, body and spirit: • Place for social, health and athletic activities • Largest provider of child care in the United States

  23. Why the YMCA? • 2,600 YMCAs in the U.S. • 42M U.S. families within 3 miles of a Y • Strong history of disseminating structured clinical interventions nationally • Operate to achieve cost recovery only • Policy to turn no person away for inability to pay for a program (financial assistance)

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

  25. The DEPLOY Study • 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

  26. Results after 4-6 months * Adjusted for sex and baseline value of outcome variable

  27. Results after 12-14 months * Adjusted for sex and baseline value of outcome variable

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