Healthy Community Access Program (Health Resources and Services Administration)
In order to develop a patient-based research infrastructure at Charles Drew University, this faculty development project grant proposed to implement disease registries in a safety net primary-care environment to assess whether these interventions might have an impact on depression and diabetes management.
Mohsen Bazargan, Ph.D., Drew PI (firstname.lastname@example.org
Charles Drew University of Medicine and Science (CDU) proposes to partner with the University of California, Los Angeles (UCLA) and two primary care clinical sites (HCAP providers), Hubert H. Humphrey Comprehensive Health Center (HHCHC) and MidValley Comprehensive Health Center (MVCHC) to develop the CDU/UCLA Healthy Community Access Program (CDU/UCLA HCAP). The program’s overarching goal is to strengthen an integrated community healthcare delivery system that services the underserved minority community of Los Angeles County (LAC) through the development of a patient-centered research infrastructure. To this end, the CDU/UCLA HCAP proposes three projects that collectively contribute to the Demonstration proposal by focusing on three areas of infrastructure development: 1) primary care research; 2) faculty development; and 3) clinical information systems. The CDU/UCLA HCAP proposes to: 1) develop a patient-based research infrastructure at CDU, one of only four historically black medical schools in the nation, and the only one west of the Mississippi; and 2) establish collaborative medical research programs with UCLA and two primary care clinical sites, HHCHC and MVCHC.
CDU was founded to provide training to committed physicians to service underserved communities. While in recent years CDU has made strides to develop much-needed research infrastructure, the CDU Department of Family Medicine (DFM) has not been able to extend its clinical mission to encompass research needed to serve its community. The CDU/UCLA HCAP not only supports this extension by enhancing a mutually beneficial partnership between CDU, UCLA, and the LAC Department of Health Services (DHS), but also supports critical infrastructure at the CDU DFM necessary to sustain high quality research.
The Chronic Care Model - The Chronic Care Model is a population-based model that relies on knowing which patients have a particular illness, assuring that they receive evidence-based care, and actively aiding them to participate in their own care. It is recommended that a sub-group of the entire population be the focus of change in practice for the duration of the Collaborative. The model as shown in figure 1 has six components: 1) the health care organization, 2) community resources and policies, 3) self-management support, 4) decision support, 5) delivery system design, and 6) clinical information systems.
The CDU/UCLA HCAP is dedicated to supporting the Chronic Care Model implementation at the two HCAP provider sites, HHCHC and MVCHC, for depression and diabetes. The treatment of chronic conditions at these two HCAP providers is presently under the traditional medical model of one-on-one patient/provider encounters in which providers monitor clinical information, make medical decisions, and conduct health education within a limited timeframe and without a specific support system to accomplish the tasks at hand. Staff physicians at the clinic are evaluated on a sporadic basis. Education for providers regarding the appropriateness of care, including identification and treatment of common chronic conditions such as diabetes and depression, is piecemeal at best.
CDU/UCLA HCAP proposes three projects that collectively contribute to the Demonstration proposal by focusing on three areas of infrastructure development: 1) primary care research 2) faculty development; and 3) clinical information systems. The thematic focus is depression and diabetes.
Project One - Depression Management: Depressive disorders are leading causes of disability worldwide. Efficacious treatments exist, but many persons, especially Latinos and African Americans, do not receive evidence-based care for depression. In primary care settings, rates of detection of depression and use of evidence-based treatments are low to moderate. Disease management interventions can improve outcomes for depressed patients. Depressed patients who are Latino or African American have poorer outcomes than whites under usual care, but practice interventions can show greater improved outcomes among African Americans and Latinos. The CDU/UCLA HCAP proposes to adapt the chronic care model of depression management using interventions that have shown to be effective. The intervention will be implemented and evaluated for the underserved ethnic minority patient population at HHCHC and MVCHC.
Project Two – Faculty Development:The faculty development project will facilitate interdisciplinary junior and senior faculty development among CDU/UCLA project teams and affiliated providers at HHCHC and MVCHC. The implementation of the chronic care model will have the desired effect of “facilitating interdisciplinary junior and senior faculty development around a patient-centered care model”. The DFM faculty (CDU and UCLA) will be engaged in the decision support efforts of the model such as embedding evidence-based guidelines in the care delivery system and providing skill-oriented interactive training programs for all staff in depression and diabetes care, as well as training on how to help an ethnically diverse patient population with depression and diabetic self-management goals.
Project Three - Clinical Information Systems: This component of the HCAP Demonstration project will implement three interrelated activities designed to enhance the capacity of existing data systems at HHCHC and MVCHC. The goals of these efforts are to support and improve primary care research; to improve data sharing between CDU and HCAP providers; and to improve patient care outcomes for persons with depression and diabetes. The project will A) establish electronic depression and diabetes registries at the two HCAP sites, B) link a Geographic Information System (GIS) to the registries to enable community-level analyses of health determinants, and C) evaluate the use of telemedicine technology for point of care diabetic retinopathy screening and clinical decision support.
The findings from the above three collaborative projects will advance and help to sustain a patient-based research infrastructure at CDU.
Existing Partnerships – CDU currently has a number of existing collaborative partnerships with research-intensive institutions. The CDU/UCLA Project EXPORT, funded by National Center for Minority Health Disparities, is designed to promote the conduct of methodologically rigorous research aimed at reducing disparities in diabetes- and depression-related health of low-income African Americans and Latinos. The NIH-funded Center of Urban Research and Education in Diabetes and Metabolism (CUREDM) aims to improve diabetes and metabolic disorder patient outcomes in the context of methodologically rigorous clinical research. The UCLA/CDU Center for Health Improvement for Minority Elders (CHIME), funded by National Institute on Aging /NIH (RCMAR), is a research and mentoring program that ultimately contributes to the reduction in health disparities for African American and Latino Elders.
Many of these research infrastructure programs have built support for community and/or diabetes and depression research at CDU; the proposed collaborative program has emerged from this support. While, the institution has proven to effectively implement research infrastructure programs, this will be the first opportunity for the department of family medicine to enhance its research capacity. The CDU/UCLA HCAP leadership team has obtained committed in-kind support from Project EXPORT for a statistician, a project leader, and the HCAP coordinating council and advisory committee chair.