Wednesday, December 9, 2009

Innovative Projects Helping Counties

Durham Health Innovations (DHI), a partnership between Duke Medicine and Durham County in North Carolina, has set up ten projects to address specific health issues affecting the culturally diverse residents of Durham County. The grant money released earlier this year came from a major grant from NIH that created the Duke Translational Medicine Institute which in turn, created the Duke Center for Community Research to manage the funding. Each of the projects will receive up to $100,000 to be used by the end of the year.

Robert Califf, M.D., Director of the Duke Translational Medicine Institute and Co-Chair of the Duke Health Innovation oversight committee said, “There are many community organizations that are already hard at work to improve healthcare in Durham, but we know that is not enough. However, the solution is not going to be to only work with more money but the solution needs to come from coordinating healthcare better by using more effective information technology.”

“Plans are to house all of the information in an institutional data warehouse and share the information with the community,” according to Lloyd Michener, M.D., Chair of Duke’s Department of Community and Family Medicine.

The projects in the community cover adolescent health, asthma, chronic obstructive pulmonary disease, cancer, cardiovascular disease, diabetes, HIV and sexually transmitted diseases, maternal health, obesity, pain management, substance abuse, and seniors’ health. These health issues affect many communities, but local health officials are not satisfied with the current methods being used to treat these issues.

Some of the projects will involve the design of a medical home model of care for adolescents to help with physical and mental health services, develop a model to coordinate community healthcare teams, develop a chronic disease registry to help improve care for asthma and COPD, provide for a specific coordinated care model for individuals with cardiovascular and chronic kidney disease, and examine how to provide an innovative coordinated care model for adults aged 60 years and older.

In other counties in North Carolina such in Kabbaoikus and Cabarrus Counties, residents have started enrolling in the MURDOCK study community registry and biorepository. The MURDOCK study funded by a gift from David H. Murdock is using modern genomic technologies to identify molecular predictors of outcomes across major chronic diseases and disorders.

The MURDOCK study is organized into a multi-tiered approach known as “Horizons”. The initial phase in one of the Horizon projects is focusing on osteoarthritis, obesity, liver disease, and cardiovascular disease. The study team has scheduled visits with participants to review their situation, have them sign a consent form, and then discuss their medical histories and medications. At that point, their vital signs are obtained along with their blood and urine.

By partnering with a wide range of healthcare providers, the MURDOCK study is able to reach a diverse population of residents including the uninsured and underserved. This enables the study designers to create a population-based registry and biorepository that accurately represents all the residents of the counties rather than just those who have access to healthcare.

After the visit, the staff processes the samples for long term storage and then the data will be analyzed for novel patterns and signatures that may predict risk or response to therapy and hopefully reveal underlying pathways with therapeutic potential. The investigators will eventually validate their findings in prospective trials using the registry and biorepository. The data will available and mined for decades to come to answer questions related to the epidemiology and genomics of disease.