Current Research Pilots
A network approach to facilitating continuity of care for chronic diseases in the aftermath of a natural disaster
Principal Investigator: Martha I. Arrieta, MD, MPH, PhD
Disaster preparations usually focus on the provision of shelter for vulnerable individuals, and/or evacuation planning and support. However, in the aftermath of Katrina, the need to provide for continuity of care for populations whose health was already compromised became painfully evident. Common chronic medical conditions among Hurricane Katrina Evacuees in Colorado surveyed immediately after the disaster were: hypertension (28.4%), depression or other psychiatric illness (23.2%), asthma or chronic lung disease (21.1%), cardiovascular disease (17.9%), and diabetes (13.7%). Among the households represented, 60.2% had one or more family members requiring prescription medication, and 38.8% of those were lacking them.
Uninsured and underinsured individuals, many of them African American, rely on the federally supported primary care infrastructure for health needs in general, and the management of chronic diseases in particular. We hypothesize that a strategy to provide for continuity of care for patients with chronic diseases in the aftermath of a disaster will need to rely heavily on the community health centers that constitute the area’s safety net. Moreover, such strategy will require the development/strengthening of avenues and processes for communication between the distinct federally funded organizations that serve specific geographic units in the Gulf Coast. Additionally, mechanisms should be in place to facilitate the flow of patients across organizations. Finally, links between community health centers, other health care institutions (hospitals, pharmacies) and community based organizations are a critical component in the provision of continuity of care, especially in the event of a disaster. Therefore, our network approach to preparing for and providing care to patients with chronic diseases in the wake of a disaster.
We propose to build the capacity of the primary care infrastructure in the Gulf Coast by fostering the development of a network of primary care providers that would function seamlessly across the Mississippi – Alabama - Florida state boundaries, to provide continuity of care to patients with chronic diseases affected by a disaster.
The present proposal aims at facilitating a structured dialogue among community health centers, hospitals, commercial and not-for-profit pharmacies, and community based organizations in order to: a) identify the critical chronic disease management needs in the immediate aftermath of a natural disaster, both from the provider and the patient perspectives, b) identify the elements of a community based network that would be ready to cover such needs, and c) define the resources required to make such a network functional. We will focus on the management of major chronic diseases and of HIV/AIDS.
In addition, we will foster the integration of the network across state boundaries, and its sustainability.
Pilot Project 8 under 5 P20 MD002314-05; Errol D. Crook, PI ; University of South Alabama
Title of the Project: Family Meal Barriers and Strategies that Promote Healthy Frequent Family Meals in African-American Families
Principal Investigator: Sharon M. Fruh, PhD, RN, FNP-BC
The overall goal of this project is to improve the health of minority populations through the promotion of healthy family meals. The project focuses on the effect of a family meal intervention program tailored to minority and disadvantaged individuals. The program will first be piloted with Community Health Advocates (CHAs) who are representative of a health disparate population of African American descent. Initially, two focus groups will be done with the CHAs in order to identify barriers to frequent healthy family meals and to effective communication around the table. Next, the intervention program: “Family Meal Challenge” will be presented to the CHAs, and their feedback will be used to refine the program so that it is effective and culturally relevant. Finally, the “Family Meal Challenge” intervention will be implemented at two African-American churches located in health disparity zip codes, with a third similarly located church serving as control site. The latter church will also receive the intervention in a sequential format, once the program has been fully implemented and evaluated in the first two sites. This intervention is also being implemented at several other sites that reach out to minority populations. It is anticipated that the findings from this project will be supportive of the benefit of the “Family Meal Challenge “ intervention, and can be used to further refine the program with the goal of expanding it to other church congregations in health disparity areas.
Pilot Project 7 under 5 P20 MD002314-03; Errol D. Crook, PI; University of South Alabama
Title of the Project: Heat shock protein 27 (HSP27) as a marker of atherosclerosis
Principal Investigator: William T. Gerthoffer, Ph.D.
We are conducting a pilot study to test the hypothesis that low plasma levels of small heat shock protein 27 (HSP27) is a risk factor in medically underserved populations of patients who are at high risk for cardiovascular disease. HSP27 is considered an “anti-atherogenic” protein because it has antiproliferative and anti-inflammatory effects in vascular smooth muscle and endothelial cells. HSP27 is secreted into the blood in non-diseased individuals, and in one clinical study patients with coronary artery disease had much lower plasma levels of HSP27 compared to non-diseased patients. Unstable atherosclerotic plaques also contain much less HSP27 than non-diseased arterial tissue. Based on these observations low plasma levels of HSP27 has been proposed as a blood-borne biomarker of plaque instability. Our hypothesis is that plasma HSP27 levels vary with the incidence and severity of coronary artery disease in a high risk, diverse patient population. This idea is being tested by measuring HSP27 levels in blood from a cross-section of pateints being cared for at the USA Heart Center.
1. Control volunteers with one or no major risk factors for cardiovascular disease (50 subjects).
2. Patients with multiple risk factors undergoing outpatient cardiovascular stress testing (180 subjects).
3. Patients who undergo elective cardiac catheterization (180 subjects).
Each patient population will represent differing degrees of risk of cardiovascular disease. By comparing plasma HSP27 levels in these three clinically distinct groups we will test for a correlation between low plasma levels of HSP27 and clinical evidence of coronary artery disease. We have used the results of this pilot project as preliminary data to support a larger, longitudinal study of at-risk populations.