Duke-Durham Partnership: Informatics Improves Health

To remedy the situation, Duke put teaching assistants and nurse practitioners armed with laptops into elderly apartment buildings to conduct door-to-door health visits. The laptops allowed them to communicate with a patient's primary care provider.

According to Michener, inpatient utilization dropped 68% in one year as a result.

"Every one of these folks had doctors," says Michener. "But they couldn't get to the office."

The project did not save money, because the elderly patients started getting their medications refilled. But, Michener says that for the same amount of money, they now have people who are much healthier and not visiting the ER nearly as often.

A true partnership
According to Michener, the project is unique in that team members include members from the Duke health system and members of the Durham community. His theory is that they can be more successful together than they can be separately. Each team has one project manager, nurses, health administrators, primary care providers, researchers, health department members, social services representatives, and community members.

"We tried to include a spectrum of folks from our wonderfully diverse county," says Michener.

Both Duke and non-Duke physicians have embraced the project and some serve on the project teams as members. "There are very few doctors who don't want to see their patients get better care," says Michener. "And there are very few patients who don't think the system couldn't be improved."

"A difference can be made if you can get people behind it."
Sharon Elliott-Bynum, RN, PhD is a Durham resident and co-founder of CAARE, Inc., a community-based service organization. She volunteers with several groups to work to diminish health disparities in Durham. The organization offers education as well as prevention, screening, and treatment through their newly-opened free clinic, which is staffed by volunteer nurses and physicians.

"What I've done is created a community model that has everything under one roof," she says. "My goal was to enhance the services available and to fill in gaps—sort of become a safety net provider."

The DHI steering committee invited Elliott-Bynum to participate in their project based on her experience working on healthcare issues in the Durham community. She is contributing her talents to the cardiovascular, cancer, HIV, diabetes, and maternal and child teams.

The partnership will allow project team members from Duke and the community to work together to share best practices and learn from one another. For example, Elliott-Bynum says she looks forward to the research data that she will have access to during the project. Before, volunteers for non-profit organizations have relied on their instincts and what they have seen in the community in order to pinpoint their interventions.

"We see what poverty is and we've seen what it looks like," she says. "We've never been able to truly see it from a geo-spatial standpoint. If you have the ability to retrieve the data, you could paint a full picture. You have a broader sense of what it really looks like. Community partners have always done good work, they've always been very passionate, but they've never been able to put in a research based, evidence-based model so that people could really respect it."

At the same time, she says that Duke will also learn a great deal from the community members involved in the project. While their research teams have had access to money for their projects, she says that they have accomplished a great deal with little or no money.

"I think there is a seasonal change happening in Durham where the institutions realize that in order for them to perform effective research, they have to connect with the community," she says. "That's a totally new approach to doing things. I think the outcomes are going to be so much better because you've got the buy in at the front end."

According to Elliott-Bynum, when the research money comes and goes, the community must be able to sustain the interventions put in place. She also believes that institutions should disseminate outcomes from their research findings so that communities can use them to improve their health.

"I think it's going to be a paradigm shift," she says. "A difference can be made if you can get the people behind it. We'll make it work, especially if it's going to benefit our community as a whole."

Planning a new model to help Durham battle obesity
David Reese, MBA is the chief operating officer of the Inter-Faith Food Shuttle. He also vice-chairs the Partnership for a Healthy Durham and co-chairs their obesity and chronic illness committee.

Reese describes the partnership between Duke and the community as "very significant." He says Duke is looking to create a healthier community, not just a healthier demographic of patients that they want to serve. He believes this attitude will improve the relationship between Duke and the community as a whole.

He is a member of the DHI obesity team. His team is using a socio-ecological framework and focusing on the chronic care model. By helping Durham residents reduce obesity, Reese believes the team will be able to affect a lot of the chronic illnesses that are associated with it, particularly diabetes.