Bull’s eye: Diabetes

By Kate Spies
09:26 AM
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Two universities take aim at diabetes in the Southeast

Officials at Duke University and the University of Michigan have their figurative arrows fletched – and the aim is to target diabetes in a serious way.

Leaders from Duke and the University of Michigan National Center for Geospatial Medicine will begin work on a $9.8 million innovation project on July 1 to reduce death and disability from Type 2 diabetes among 57,000 people in the Southeast.

The award is one of the 26 grants announced by the department of Health and Human Services on May 8. The project, titled “From Clinic to Community: Achieving Health Equity in the Southern United States,” is slated to span three years and save nearly $20.8 million.

The project hinges on a detailed IT program. Researchers will use predictive and geospatial medicine to regenerate four southeastern counties that are struggling with the expensive and debilitating spread of diabetes.

The project will incorporate four site partners spanning several states: Durham County Health Department (Durham County, N.C.), Cabarrus Health Alliance (Cabarrus County, N.C.), Mississippi Public Health Institute (Quitman County, N.C.), and Mingo County Health Department (Mingo County, W.V.).

“Geographically, diabetes is rooted most apparently in the southeastern U.S.,” said Marie Lynn Miranda, director of the University of Michigan National Center for Geospatial Medicine ¬– hence the project’s focus.
Population statistics of each site reflect this; approximately 27,000 citizens in Cabarrus County alone are at risk or have Type 2 diabetes, said Barbara Sheppard, senior director of Health and Community Initiatives at Cabarrus Health Alliance.

“We have an opportunity to create a healthier community and reduce burdensome costs associated with Type 2 diabetes morbidity and mortality,” she said.

To that end, the project will extract, transfer, and load patient record data from across site EHRs. Pairing patient information with publicly available socioeconomic information will generate risk algorithms on area neighborhoods, explained Ashley Dunham, project leader at the Duke Translational Medicine Institute.

“We can actually develop a risk algorithm which tells you, based on the healthcare that someone is receiving, how high or low risk they are, using a variety of indicators from their electronic health record,” she said.

The geospatial technology will allow for two kinds of interventions.

“We have a plan for a sophisticated information technology system that will feed into decision support,” said Miranda. This decision support will provide patient focus on high-risk individuals, as well as community-based interventions.

In addition to streamlining IT, the grant money will be used to train 88 healthcare workers and create 31 new positions throughout the area. “In essence, it adds community health workers, community pharmacists and a coordinator to serve as the ‘quarterback’ for diabetes services in the county,” said Ellen Jones, executive director of the Mississippi Public Health Institute.

New and existing personnel will use the spatially enabled informatics to monitor and treat patients with Type 2 diabetes. The intervention focus is on improving patient care, says Sheppard, but also reducing costs.

“Diabetes-related complications include cardiovascular disease, blindness, renal disease, and lower extremity amputations, which imposes a significant financial and emotional toll on families and the community,” she said. “In North Carolina, the cost of diabetes is approximately $5.3 billion per year.”

Similar expenditure rates characterize other areas grappling with this disease. The nation’s average spending on diabetes hovered at $174 billion in 2007, according the 2011 Diabetes Fact Sheet issued by the Centers for Disease Control.

If the grant program meets the expected savings rate in the target communities, said Miranda, Duke University and the University of Michigan are looking to expand their work.

The initial arrows are aimed at the southeast, but the eventual target could be much larger; Miranda and Dunham hope the model will be extended on a national scale.

“Addressing the diabetes epidemic is an enormous challenge but this grant provides us with an enormous opportunity to fundamentally rethink how we deploy healthcare resources in country,” said Miranda.

“So if it works in Mississippi, could it work in Alabama? Could it work in Louisiana? Could it work in Kentucky?” said Dunham. Answering these questions, and leveraging geospatial technologies to lessen the effects of diabetes, she said: “That’s the goal.”