By Jackie Powder
A $2.5 million federal grant—the largest in the school’s history—will enable researchers to study the impact and effectiveness of a team-based health care delivery system in managing the total cardiovascular health of 500 high-risk patients. Headed by the school’s Associate Dean for Research, Jerilyn K. Allen, RN, ScD, the five-year study will incorporate successful prevention strategies from three earlier research studies. Instead of focusing on a single area of risk, as earlier investigations had done, the new study will address a patient’s combined risks.
“The reality is that very few patients have isolated risk factors, and we need to take a more comprehensive approach to prevent the progression of cardiovascular diseases,” says Allen, who brings 20 years of experience in heart disease prevention to the project, which is funded by the National Heart, Lung and Blood Institute at the NIH.
“What we’re doing is bringing together the best of three models of care to improve outcomes in urban clinics and underserved populations,” she says.
The new team-based project will draw on Dean Martha N. Hill’s research on blood pressure in young African-Americans; Fred Brancati’s work in the School of Medicine on managing diabetes; and Allen’s own research on cholesterol management.
The centerpiece of the research program is the use of a three-person team—comprised of a physician, a nurse practitioner, and a community health worker—to manage the cardiovascular health of the study participants, who will be recruited from clinics operated by Baltimore Medical System (BMS), a non-profit community health center system that provides care to 35,000 medically underserved people in Baltimore’s poorest areas.
The study calls for 50 percent of the patients to be African-American, and 50 percent to be Caucasian. Using a random assignment process, investigators will provide the more comprehensive intervention to half of the patients, and half will receive less intensive treatment.
BMS patients and health providers are to serve on a steering committee. “They will participate in all phases of the project, including helping to refine the intervention so it will be sustainable when the project is complete,” Allen says.
Says BMS president and CEO Jay Wolvovsky: “Any assistance that research could bring to how best to manage, remediate, and prevent cardiovascular disease in our population can only assist us in refining and upgrading treatment options.”
Under the three-person team model, Allen envisions the nurse practitioner as the primary coordinator of care, completing a health assessment, ensuring the patient is on the correct medications, and discussing recommended lifestyle changes. The community health workers will monitor the patients, and help them adhere to prescribed medications and recommended lifestyle changes. The physician will meet regularly with the team and see patients periodically.
The less intensive care model involves providing information on coronary disease and treatment guidelines to the patients and their physicians. It does not include contact with the three-person teams.
In addition to the focus on health outcomes, cost-effectiveness is an important aspect of the research and a key factor in implementing the project on a broader scale. “One of our goals is to communicate to other stakeholders how this model can be effective and cost-effective,” Allen says.