OVERVIEW OFCLINICAL DIRECTORS NETWORK

CDN: Past, Present & Future

• An informal network of clinical leaders who practice as primary care providers in low-income and minority communities

• A clinical research and educational organization

• A means to translate clinical research into clinical practice

CDN Corporate Structure

• 501 ( c ) (3) Tax Exempt Non-Profit Corp• Headquarters in NYC with CEO & Staff• Board of Directors consists of 17 volunteers

– Active Clinical Leaders practicing in Low-Income/Minority Practice Settings including Health Centers and Health Plans in NY, NJ, PR,VI

– Physicians, Dentists, Nurses– Elected by the CDN Membership at Annual Meeting

• Linked to a for-profit subsidiary, QPSD Quality Professional Systems Development, Inc.

Why Clinical Networks?

• Target: Clinicians working in community, migrant, homeless and HIV health centers

• Reduce the sense of isolation, stress, burnout

• Update clinicians in latest health improvements & advances

• Collect & share information, skills & technical assistance

• Introduce in the communities latest developments in health care and business practices

Who are the Underserved?

Source: National Association of Community Health Centers

• Poor/Low Income

• Uninsured/Underinsured/Medicaid recipients

• Unemployed

• Women

• Children/Adolescents

• Minorities: African American, Latino, Asian, Pacific Islander,

• Native American/Indian, Native Hawaiian, Native Alaskan

• Migrant/Seasonal Farmworkers

• Homeless

• Drug/Alcohol Users• Rural residents• Refugees• Immigrants (Legal and Illegal)• Persons Living with HIV/AIDS• Gay, Lesbian, Bisexual and

Trans-sexuals• Prisoners/Releasees/Parolees• Mentally Impaired/Mentally Ill• Sex Workers• Disabled/Handicapped• Elderly/Frail Elderly

Who are the Underserved?National Statistics by Age and Gender

Source: NY HRSA (1997)

Total Users

Age Male Female Number Percent

<Age 1 176,676 175,324 352,000 4%

Pediatrics (1-11) 1,035,134 1,034,051 2,069,185 25%

Adolescents (12-19) 391,053 591,153 982,206 12%

Adults (20-64) 1,532,979 2,706,410 4,239,389 52%

Geriatrics (64+) 232,515 378,606 611,121 7%

TOTAL 3,368,354 4,885,544 8,253,898 100%

% of Total 41% 59%

Advantages of Participating in Clinical Research

• Earlier access to new drugs and technologies

• Ongoing Training for Primary Care Providers

• Improved quality of care due to:– expert protocols reviewed by experts, NIH, FDA– more frequent follow-ups– standardized assessments– ongoing quality assurance/quality improvement– external monitoring of data & patient care– feed-back to clinical sites & providers

Financial Benefits to Participants

• Low/No-cost of care to patients• Patient incentives, transportation, enablers• Payments for Provider Time• Covers costs of Visits, Tests, Medications• Improved access to equipment

– diagnostic– therapeutic– data processing– education and training

Where CDN Conducts Research

• New York

• New Jersey

• Puerto Rico, Virgin Islands

• Connecticut

• Florida

• Utah

• California (dental)

• Missouri

• Maine, Massachusetts

• Rhode Island, Vermont

• New Hampshire

• Virginia, West Virginia

• Maryland, Delaware

• Pennsylvania, DC

• Texas

• Oklahoma

CDN’S RESEARCH PORTFOLIO

• HIV/AIDS• Cancer Control• Depression• Stress Management• Hypertension• Diabetes• Immunizations• Migraine/Headache• Anemia• Asthma

• NIAID HRSA NIMH AmFAR BMS DMP Roche

• NCI AHCPR• NIDA SAMHSA• NIMH• NHLBI Pfizer• HRSA• CDC HRSA• Merck• Ortho Biotech• EPA HRSA DEP

Current CDN Research Projects

• FUNDERS: PROJECT TITLE:

• NCI Prevention Care Manager

• NIMH SMART/EST Women’s II

• NHLBI Blood Pressure Adherence

• EPA HRSA Home/Environmental NJDEP Asthma Management

• HRSA CDC Immunizations

NY Prevention Care Manager Project

• Funded by NCI

• PI - Allen Dietrich, MD, Dartmouth

• 8 Health Centers in NYC metro area

• Randomized Controlled Trial (n=1400)

• To test case management strategies to improve breast, cervical and colorectal cancer early detection services for women

SMART/EST Women’s Project II

• Funded by NIMH• PIs - Stephen Weiss, PhD MPH- U Miami

& Jonathan N. Tobin, PhD - CDN• 12 Health Centers in NYC,NJ, Miami• Randomized Controlled Trial (n=450)• To test cognitive behavioral stress

management training and health education to reduce distress and improve medication adherence for adult women with HIV/AIDS

Antihypertensive & Lipid Lowering to Prevent Heart Attack Trial (ALLHAT)

• Funded by NHLBI• PI - Jonathan N. Tobin, PhD - CDN • 3 Health Centers in NY & NJ [Nationally: 623 sites]

• Randomized Controlled Trial (n=126) [42,450 pts]

• To compare 4 classes of blood pressure drugs against each other without a placebo to improve blood pressure control, lipids and outcome for hi-risk hypertensive adults

Improving Blood Pressure Medication Adherence and BP Control

• Funded by NHLBI• PI - William Gerin, PhD - Mt Sinai • 12 Health Centers in NYC & upstate• Randomized Controlled Trial (n=450)• To test home blood pressure monitoring and

telephone nurse case management to improve medication adherence and blood pressure control for poorly controlled hypertensive adults

Improving Home/Environmental Asthma Management

• Funded by EPA, HRSA Reg II, NJ DEP• PI - Jonathan N. Tobin, PhD - CDN • 12 Health Centers in NY,NJ,PR,VI,PA,MO• Randomized Controlled Trial (n=250)• To test home visits and telephone nurse case

management for health education and support to improve asthma control for pediatric asthmatics

Improving Immunization Rates

• Funded by HRSA & CDC• PI - Jonathan N. Tobin, PhD - CDN • 20+ Health Centers in NY,NJ• CQI/Observational Studies (n=18,050)• To test assessment and feedback of immunization

rates, individualized Technical Assistance, Office Systems Development and Follow-up Support on Immunization Completion Rates (4-3-1-3-3)

STUDY LINK

• Funded by Title I Ryan White CARE Act • HIV/AIDS Research Coordinators Network• Database of all enrolling HIV/AIDS clinical

research in NYC • Warmline/Single phone number for access to

information and referrals to research studies• Marketing clinical research to clinicians, case

managers, AIDS service organizations

CDN’s Educational Activities

• Annual Clinical Leadership Conference

• Information Management for Clinical Leaders

• Community Health Center Rounds

• Dental Quality Assurance Peer Review

• Customized Training & Office Systems Consultation

• eCME: Video-teleconferences & Webcasts http://CDN.horizonlive./com ON-SITE AND ON-LINE

Community Health Center Rounds

• Detection of HIV/AIDS & Oral Cavity Cancer• Cancer Control, Early Detection & Prevention• Screening for Colo-rectal Cancer in Primary Care• Reducing Perinatal Transmission of HIV/AIDS• Detection of Depression in Primary Care• Quality Improvement in Immunizations• Detection & Prevention of Domestic Violence• Basics in Fundraising & Grant Writing• Internet Access: How to Surf & Search the Web

CDN’s Educational Activities

• eCME: Video-teleconferences & Webcasts http://CDN.horizonlive./com

• Bringing the latest in clinical and management information and technology to Health Center Clinicians both On-siteOn-site and On-lineOn-line– Live at Health Centers

– Live Webcasts

– Archived Webcasts available 24 x 7

Long-term Goal: Clinical Research to Set

Standards for Clinical Practice

To recruit every practice,

every provider and every patient

to participate

in at least one clinical trial

CDN’S FUTURE DIRECTIONS

• Develop & Market Products to strengthen links between Patient Care, Education, Training, Research and Business Practices – Electronic Medical Publishing– Distance Education/Web-based Training– Electronic Medical Records– Clinical Decision Support Tools

• Patient Recruitment/Medical Marketing

• Industry-sponsored Clinical Trials

CLINICAL DIRECTORS NETWORK Jonathan N. Tobin, PhD

President/CEO

CDN

Clinical Directors Network, Inc.

54 West 39th Street - 11th Floor

New York City NY 10018 USA

Tel (212) 382-06-99 ext 34

Fax (212) 382-06-69

Email: jntobin@CDNetwork.org

Web Site: www.CDNetwork.org