Duke is looking to revolutionize health care through community health homes, with the eventual goal of decreasing dependence on hospitals.
The Duke University Health System is among leaders in a national movement based on the establishment of patient-centered medical homes—centers that provide health resources for communities and bridge the gap between a local doctor’s office and a hospital. In six North Carolina counties, Duke operates community health homes that provide a network of services including social workers, dietitians and informational classes, said Dr. Lloyd Michener, chair of the department of community and family medicine. With this network, physicians anticipate that patients will have fewer unnecessary hospital visits.
“There’s a lot of hospital care that’s preventable and that we should be trying to prevent, and that’s pretty radical,” Michener said.
The initiative works to improve the patient experience through organizing care and communication, said Audrey McKinnon, health center administrator for the Division of Community Health.
“A lot of doctor’s offices are moving towards this model to make sure that patient care is more coordinated with more communication to make sure that patients don’t fall through the cracks,” McKinnon said.
The success of these health homes is starting to generate national buzz, Michener said, adding that the idea for community health homes originated in North Carolina about 15 years ago.
“We are the heart of the health home model,” Michener said. “We are now working with just about every state to see how we can do these models with other states.”
In an effort to further this goal, Duke is working with the de Beaumont Foundation on an online tool that will help public health practitioners and public care providers understand some of the strategies that would be useful for effective health care, said Brian Castrucci, program director of the foundation. The service, called Public Health and Primary Care Together: A Practical Playbook, will be universally accessible via the internet.
The idea for community health homes evolved from North Carolina’s desire to save money, Michener said. Hospitals are much more expensive than these community health homes, which are potentially cost-effective because fewer people will need to go to the hospital.
The concept of medical homes for primary care groups was proposed to North Carolina with the explicit goal of reducing preventable admissions to the hospitals—and so far it has been a success, Michener said. Savings have accelerated every year since the homes were implemented, he added.
“A lot of the work you can do on integrating primary care and public health is very cheap,” Michener said. “It’s things like calling your local health care director and working on costs together. It doesn’t cost more than the price of lunch.”
Most of the funding for the community clinics comes from the Health Resources and Services Administration—a federal agency that runs safety net provider networks—Michener said. Durham also contributes, but at a small deficit. Duke pays the difference as a supporter of the community and as a supporter of its employees, many of whom have families in these areas, Michener said.
Although hospitals will still be necessary for traumas and unpredictable diseases, the number of hospitalizations will dramatically decrease if the community health homes become widely used, Michener said. By improving communication and the availability of information, community health homes cut hospital admissions of children with asthma in a rural setting by 70 percent in one year, he added.
The community health homes also provide important information to primary care providers. A group meets quarterly to analyze data and compare Durham against other cities and counties. This allows health care providers to assess areas for improvement. For example, Durham still has a growing rate of obesity, while Chicago now reports a decreasing rate in pediatric obesity, Michener said.
Through the data acquired, Duke has recognized people with serious health conditions who are simply bouncing between community centers and Duke Hospital. One goal is to further tie these people to the medical homes for continual care, Michener said.
In Durham, clinics in Walltown and Lyon Park operate under the community health home model. There is also an initiative to implement clinics in Durham schools, said Eric Nickens, communications manager of Durham County Department of Public Health.
“The school-based clinic initiative will be based on a partnership between Duke and Durham County Department of Public Health, and the details are still being ironed out,” Nickens said.
The theory behind local clinics is that people can choose where they want to go, he added. The clinics are easy and convenient, but they also look and act differently in different communities.
The clinics must be welcoming, especially to areas with minority or disadvantaged communities because those are areas with high rates of preventable illness, Michener said, adding that it is important for the clinics to work with communities that are not based in a geographic locale—like age brackets, sexual orientation or ethnic groups.
He added that rather than opening more clinics, Duke is focusing on making these patient-centered medical homes more effective. In an aging, overweight population, chronic disease is becoming increasingly prominent. Providing longer-term coverage and specialty care is the next step toward effective health care.
The movement is extending beyond national boundaries, Michener said. adding that more than 40 countries—including Singapore, Canada and Australia—are beginning to implement this system of community health homes and more localized health care.
“We want to help form local programs that help people be healthy and build on local community resources, and Durham is our home base for doing that,” Michener said. “So what I hope is that over time Durham will become healthier and happier. We want to evolve from a city of medicine to a community of health.”
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