Wake Forest School of Medicine has received $2.8 million from The Duke Endowment to support five projects that will examine the role social determinants play in access to health care for people in North Carolina.
According to the World Health Organization, social determinants of health are the non-medical factors that influence health outcomes.
The projects supported by this funding are:
The Department of Internal Medicine received $919,000 over three years to conduct a randomized controlled trial to increase access to virtual care, sometimes referred to as telemedicine, for vulnerable populations, such as rural and older patients, lower income groups and racial and ethnic minorities.
This project, called the Super-Supporter Program, is a joint effort with Atrium Health to evaluate and support the necessary infrastructure for virtual care. Principal investigators of the program are Thomas K. Houston, M.D., professor of internal medicine at Wake Forest School of Medicine, and Anthony J. Caprio, M.D., internal medicine, Atrium Health.
The program will use a centralized team of patient navigators specially trained to reach out to patients and their families to provide help in accessing and using virtual technology. A pilot program developed by Houston’s team during the COVID-19 pandemic that utilized patient navigators helped increase the rate of successful clinical video visits and served as a foundation for this project.
“Nowadays, access to the best care means both in-person and virtual care. We hope this new program will help vulnerable groups to access all the care they need,” Houston said.
The Division of Public Health Sciences received $630,000 to conduct a randomized controlled trial to test the effectiveness of a home-based monitoring system for new mothers, who can sometimes develop serious high blood pressure complications following delivery.
Hypertensive disorders of pregnancy are often undiagnosed or inadequately managed and are a leading cause of perinatal morbidity and mortality due to substantial racial and socioeconomic disparities.
The three-year trial, which will be led by principal investigators Elizabeth Jensen, Ph.D., associate professor of public health sciences, and Emily Bunce, M.D., assistant professor of obstetrics and gynecology, both of Wake Forest School of Medicine, will be available to all women in Forsyth County who give birth at Wake Forest Baptist Health. Study participants will be randomized to remote blood pressure monitoring or usual standard of care. The goal is to reduce and prevent serious complications from undetected hypertension by determining who is at greatest risk.
Participants in the program will receive a blood pressure cuff for home monitoring with Bluetooth capability to feed readings directly to the patient’s doctor via a smart phone app that will be installed before leaving the hospital. The doctor then will be able to monitor blood pressure in real time and provide guidance on whether or not the woman needs to be seen before serious complications can occur.
The Section of Gerontology and Geriatric Medicine received $530,000 over three years to establish and conduct a randomized controlled trial to test the effectiveness of a community health worker program for frail older adults. The program is led by Kathryn Callahan, M.D., associate professor of geriatrics and geriatric medicine, and Deepak Palakshappa, M.D., assistant professor of internal medicine, both at Wake Forest School of Medicine.
“People who are frail are more likely to get very sick from a routine illness and more likely to then lose the ability to handle daily activities – bathing, dressing, preparing food,” Callahan said. “If they do get sick, they are likely to require hospitalization, and it may take longer to recover their baseline if at all.”
Traditional primary care focuses on chronic disease management and often does not include functional impairment and frailty assessments despite their predictive value for high-cost healthcare, disability, nursing home admission and mortality, Callahan said. In addition, clinicians often lack the tools to address health-related social needs.
Callahan’s team first identifies people who are considered frail through an electronic frailty index (EFI) that uses data routinely collected as part of primary care to assign a score to indicate the level of frailty. Community health workers then will contact those people to determine unmet social and functional needs and connect them with appropriate medical and community resources.
The Department of Pharmacy at Wilkes Medical Center received $450,000 over two years to improve access to care for uninsured adults in Wilkes County who are at 200% or below federal poverty level.
People without health insurance are often the least likely to seek or to be able to access necessary health care, said Arlen Rash, pharmacy director at Wake Forest Baptist Health – Wilkes Medical Center, who leads the program. The effort was originally funded by the Duke Endowment in 2018 and renewed earlier this year.
The program focuses on linking patients to primary care providers and has reduced hospital readmission rates by providing access to appropriate medications and improving health outcomes through an evidence-based management program for patients with diabetes, hypertension and mental health issues.
Value-based Care and Population Health received $311,000 over two years in support of its new paramedicine program.
This funding will allow the program to add registered nurse navigation and community paramedic support to work with complex chronic and recently discharged patients to identify and resolve ongoing medical or social needs to aid in their recovery. Some of the services paramedics will provide are home wellness visits, technology support for virtual medical monitoring or video doctor visits, and guidance on available community resources.
The goal is to improve health and reduce costs from preventable hospital admissions and readmissions via a combination of navigation, remote patient management and paramedics’ intervention with a strong linkage back to primary care, according to Jennifer Houlihan, vice president of value-based care and population health, who co-leads the program with Richard Lord, M.D., chair of family and community medicine, both at Wake Forest School of Medicine.
Based in Charlotte and established in 1924 by industrialist and philanthropist James B. Duke, The Duke Endowment is a private foundation that strengthens communities in North Carolina and South Carolina by nurturing children, promoting health, educating minds and enriching spirits. Since its founding, it has distributed more than $4 billion in grants. The Endowment shares a name with Duke University and Duke Energy, but all are separate organizations.