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INTRODUCTION   Program Overview   Black Population in 2000   Black Poverty in 1999   Annual Reports   Other Exceed Centers  PROJECTS   Treating Hypertension   Treating HIV/AIDS   End-Of-Life Care   Refilling Prescriptions  PILOT PROJECTS   Group Visits for Diabetes   Diabetes & Depression   Adherence to MST   Pain Management  CORES   Administrative Core   Biostatistics Core   Investigator Dev. Core  PUBLIC NEWS ROOM   Seminar Announcement   News   Fundings & Resources   Conferences and Call for Paper   Other Information  STAFF INFO CENTER   Secure Login   MUSC Boilerplate   GCRC at MUSC   Staff Directory   ORS Request Procedure   Healthcare Privacy Rule (PDF)  MEDTEP APPENDIX  LINKS	AHRQ EXCEED: The South Carolina Excellence Initiative for Understanding and Eliminating Disparities in Health Care in Blacks ANNUAL REPORT 10/1/2000 – 4/30/2001 PDF CONTENTS Knowledge Acquisition Funded Projects Submitted Projects Measurement Tools Evaluated Soliciting Community Opinion/ Learning About The Community Examples of recruitment flyers and other approaches to recruitment Major Project/Core status report Knowledge Application Knowledge Dissemination Scientific Publications/Presentations Technical Reports/Manuals Press Releases Community Outreach Activities Continuing Education/ Course Titles Planning Documents/Policy Testimony/Other Dissemination Monthly EXCEED Seminar Series Capacity Building Investigator Development Pilot Study Status Collaborative Networks Developed Technical Assistance Accomplishments Curriculum Development/Teaching KNOWLEDGE ACQUISITION -Identifying factors that reduce health status differentials; increase access to health care; enhance identification, recruitment, and retention; and affect assessment of status, access and functioning. Funded Projects 2000 Brady, K, PI; Tilley, BC (Advisory Committee). Southeastern Node of the Clinical Trials Networks. Funding: $2.2 million (5 yrs). Funding Agencies: NIH, NIDA. Funding Period: 2001. Abstract: There is a disconnect between research concerning effective treatments for substance use disorders and drug abuse treatment in community based settings. The NIDA Clinical Trial Network (CTN) proposes to bridge this gap by the partnering of academic medical centers and community treatment programs in designing and implementing clinical trials and health service research in sites spread throughout the United States. In the Southeastern Node we have assembled an experienced group of investigators with a variety of research experiences. This group has conducted single and multi-site trials in collaboration with members of existing CTN. The participating community treatment programs are experienced, well-established programs serving diverse patient populations. The specific aims of this proposal are: 1.) To develop an infrastructure to allow for the conduct of substance abuse research trials in the Southeastern region of the United States through a partnership with the Medical University of South Carolina and a network of community treatment programs. 2.) To work collaboratively with the NIDA and the other CTN NODEs in: a.) directing at least one research trial per year investigating medications, psychosocial treatment, health services or practice research in the drug abuse area; b.) participating in at least two additional research studies per year. 3.) To work collaboratively with the NIDA and the other CTN NODEs through the Network Steering Committee to develop and maintain the framework for the CTN including the development of operating policies and procedures, and the formation and participation of subcommittees. Wager, KA, *Clancy, D. The Impact of Direct Entry into the EMR on the Physician-Patient Relationship. Funding: $48,850. Funding Agencies: American Health Information Management Association. Funding Period: 2001. Abstract: The purpose of this study is to determine whether direct entry into the electronic medical record (EMR) alters physician-patient relationships at the Adult Primary Care Clinic (APCC) at the Medical University of South Carolina (MUSC) as perceived by the patients. APCC fellows and residents will be randomly assigned to three groups, those using direct entry in front of the patient in the exam room, those using a structured interview process modeled after the templates used in direct EMR entry and those using neither the structured interview nor direct EMR entry. Patients seen by each group will be interviewed, using a valid survey instrument, about their perceptions of the care provided by the resident or fellow. These interviews will be conducted by trained student interviewers and will occur immediately following each patient visit. The hypothesis for this study is that direct entry into the EMR in front of patients in the exam room at APCC will have no measurable impact the physician-patient relationships. 2001 Cope, D, *Clancy, D, Tilley, BC, Magruder, K. Testing a Managed Care Approach, Group Visits, in Disadvantaged Patient with Type 2 Diabetes. Funding: $266,913 for Year 1 pilot project. Funding Agencies: Robert Wood Johnson Foundation. Funding Period: 2001. Abstract: The principal objective of this project is to test a promising model of outpatient group visits in caring for disadvantaged patients with type 2 diabetes. This is an approach that in managed care settings has been shown to be at least as effective as but more efficient than usual care for both geriatric patients with high health services use patterns (Beck et al., 1997) and patients with diabetes (Sadur et al., 1999). This project seeks to test the effectiveness of the group visit model in a disadvantaged, uninsured or underinsured, predominantly African American patient population with type 2 diabetes. We plan for a one-year pilot study, which will inform a more definitive full study in years two and three. The specific hypotheses are that patients receiving group visits will have improved quality of care, better control of their diabetes, improved health services use patterns, and greater satisfaction with their health care. *Egede, L. Improving Diabetes Outcomes in Poor Blacks: a SocioCultural Approach. Funding: $372,176. Funding Agencies: American Diabetes Association. Funding Period: 2001-2004. *Huey, S. A Pilot Comparison of Two Approaches for Treating Gang-Affiliated, Delinquent Youth. Funding: $23,780. Funding Agencies: Individual Zumberge Research Grant. Funding Period: 2001 . Abstract: Interventions to suppress antisocial behavior among gang-affiliated youth in the U.S. have met with little success. Although research suggests that antisocial behavior is multidetermined, most existing approaches for treating antisocial behavior fail to target these multiple risk factors. Multisystemic Therapy (MST) is a multifaceted, context-sensitive treatment that shows considerable promise as an effective intervention for gang-affiliated, antisocial youth. However, previous studies of MST have been limited to predominantly European-American and African-American antisocial youth with little apparent gang involvement. The proposed study will extend the validity of MST by evaluating the feasibility of this approach in the treatment of adjudicated, gang-affiliated youth who are predominantly Latino and African-American. This study has 3 primary aims related to the effective treatment of gang-affiliated, antisocial youth. The first aim is to test whether MST, relative to a control condition, is effective in improving family and peer functioning, and decreasing rates of antisocial behavior. A second aim is to examine whether MST is more effective at reducing the frequency and duration of youth arrests and other out-of-home placements. Finally, if MST is shown to be an effective treatment with this population, a third aim will be to develop and submit a grant proposal to fund a more extensive clinical trial that extends the validity of MST to the treatment of gang-affiliated and Latino youth. *Mazyk, J, Simpson, K. Analysis and Modeling of Clinical Impacts of Complex Chronic Diseases. Funding Agencies: MUSC Summer Research Award Program. Funding Period: 2001. *Egede, L. Collaborative Management of Diabetes in Blacks. Funding Agencies: AHRQ. Funding Period: 2001. Submitted Projects – (Exceed investigators are indicated with bold text, pilot or new investigators indicated with *) 2000 Cope, D, *Clancy, D, Tilley, BC, Magruder, K. Testing a Managed Care Approach, Group Visits, in Disadvantaged Patient with Type 2 Diabetes. Funding: $266,913. Funding Agencies: Robert Wood Johnson Foundation. Funding Period: 2002 . Abstract: The principal objective of this project is to test a promising model of outpatient group visits in caring for disadvantaged patients with type 2 diabetes. This is an approach that in managed care settings has been shown to be at least as effective as but more efficient than usual care for both geriatric patients with high health services use patterns (Beck et al., 1997) and patients with diabetes (Sadur et al., 1999). This project seeks to test the effectiveness of the group visit model in a disadvantaged, uninsured or underinsured, predominantly African American patient population with type 2 diabetes. We plan for a one-year pilot study, which will inform a more definitive full study in years two and three. The specific hypotheses are that patients receiving group visits will have improved quality of care, better control of their diabetes, improved health services use patterns, and greater satisfaction with their health care. Henggeler, PI, Schoenwald, SK, *Halliday-Boykins, C, *Liao, J, *Aibalese-Crawford, M, *Indurkhya, A. Evaluation of MST-Based Continua of Care, R01. Funding Requested: $2,797,889. Funding Agencies: NIMH. Kurent, JE, PI; Tilley, BC(Advisory Committee). Innovations in Interdisciplinary Geriatrics Medical Education at the Medical University of South Carolina. Funding Requested: $2 million (4 yrs.) Funding Agencies: Donald W. Reynolds Foundation. London, S, PI; Tilley, BC (Steering Committee). Interdisciplinary Care to Reduce Oral Health Disparities. Funding Requested: $11.4M (7 yrs.). Funding Agencies: NIH. 2001 Blue, AV, Mainous, AG, III, Gilbert, G, Carson, D. Assessing Medical Student's Attitudes Toward Cultural Competency in Health Care. Funding Agencies: National Patient Safety Foundation. Funding Period: 2001. *Clancy, D, Smith, J. Eliminating Prescribing Errors Through the Use of an Ambulatory Computerized Record in the Hospital Setting. Funding: $555,555. Funding Agencies: The Duke Endowment. Funding Period: 2001. Magruder, K. Improving Minority Veterans' Health. Funding: $500,000. Funding Agencies: VA Center of Excellence. Funding Period: 07/2001. Simpson, K. Pilot project to assess preferences for colon cancer screening methods for Veterans attending clinics at the Charleston VA. Funding Period: 2001. Note: This proposal was part of a Center of Excellence application to establish a Research Center at the VA in Charleston focused on disparities in the care process and health outcomes for minority veteran groups. Tilley, BC. Minority supplement to RCMAR Coordinating Center grant to support *Christopher Mathis, a faculty member at South Carolina State University, to study cultural competence of community pharmacists. Funding: $50,000 Funding Agency: National Institute on Aging. Funding Period: 2001-2002. Tilley, BC. Administrative supplement to RCMAR Coordinating Center grant for pilot study to pool SF-36 data across RCMAR sites and do analyses of data with respect to applicability to diverse populations. Funding: $75,000. Funding Agency: National Institute on Aging. Funding Period: 2001-2002. Measurement Tools evaluated 2000 S. DesHarnais evaluated a variety of Quality of Life Measurement tools, with particular focus on those most suitable for terminally ill patients. 2001 *D. Clancy and K. Lorig evaluated tools regarding health care utilization, illness intrusiveness, and patient satisfaction for the ambulatory setting. Visual analogue scales for general health, quality of life, and fatigue are being evaluated by randomly selected patient in the Adult Primary Care Center for the level of understanding of these tools in a patient population with limited education. Questions regarding communication with physicians, ability to get information about a disease, ability to get help from community, family, and friends, and ability to communicate with physicians are also being evaluated. These tools are proposed for use with the RWJF project immediately and with the EXCEED project. Soliciting Community Opinion/ Learning About The Community (Focus Groups /Speak-Out Forums Held) April 2001. K. Simpson met one-on-one with HIV-infected members to learn more about the role of black churches’ in HIV-disease in SC. Community Advisory Committee Meeting, September 4, 2000, 12:30-2:30 p.m., MUSC, Wickliffe House. This meeting provided an excellent forum for the project leaders to better understand community issues and concerns and ways in which the goals of the project could be more effectively achieved through bilateral collaboration. Attending: Daniel Hoskins, M.S.,Chair Tammy Butler, MPH Reverend Willis T. Goodwinb Everlena Lance Florence Linnen Maxine S. Martin, Ed.D. Patricia Nelson, PHM Ida Spruill, RN,MSN Delbert Dubois Sabra C. Slaughter, Ph.D. Based on comments from the community, the Black Alumni of MUSC, and project needs, additional members were added to the Community Advisory Committee: Bambi Sumpter-Gaddist, Ph.D. (HIV/AIDS community activist) Louis A. Hassell, DDS Sabra C. Slaughter, Ph.D. was moved to the Scientific Advisory Committee. Scientific Advisory Committee March 2001. Project leaders from the PPG made brief presentations to the Scientific Advisory Committee, followed by extensive discussion. It was decided that a second meeting would be useful and is planned for May 2001. The agenda will include a more in depth discussion of health education methods and a more in depth discussion of approaches to increasing cultural competence of providers. Attending the 3/2001 meeting: William T. Garvey, M.D. Carolyn Jenkins, Dr.PH Marilyn Laken, Ph.D., R.N. Stephen Mcleod-Bryant, M.D. Alberto B. Santos, M.D. Jan Z. Temple, Ph.D. Jane Zapka, Sc.D. Examples of recruitment flyers and other approaches to recruitment 2001 D. Carson: Programming of the MUSC Pharmacy QS 1 to identify potential study patients has been initiated and is being beta-tested. *D. Clancy: Both the funded RWJF pilot project described above under “Funded Projects) and the EXCEED Pilot Project 1 will operate under the same acronym, DIG IT, Diabetes In Groups, Improving Together. A recruitment flyer has been developed and is pending IRB approval. See Appendix 1. B. Egan: A flyer was created to list the highlights of project 1. The flyer is being pilot tested for use instead of a letter to physicians, since the key points of the study can be grasped more quickly. See Appendix 1. Major Project/Core status report (See Investigator Development for status of Pilot Projects) Four Major Projects Include: Reducing the Racial Disparity in Cardiovascular Disease Through Better Blood Pressure Control – B. Egan, MD, D. Cheek, MD, D. Lackland, PhD Update: Protocol and data collection instruments have been developed. Sheryl Mack, Field Program Coordinator was hired and began creating a resource list of the primary care providers, clinics, health centers, and health care professionals. S. Mack worked on a draft of written and oral potential presentations, materials, and a variety of informational tools to be utilized in recruitment physicians and clinics to participate in Project 1. A candidate for the Office Data Manager and Project Assistant was interviewed. S. Lipsitz developed a schedule for randomizing providers who agreed to participate to one of the 3 interventions, i.e, expert, feedback, and expert with feedback. B. Egan, S. Mack, P. Ferguson (student) and Mr. Bercik (computer programmer) met to discuss progress in preparing the feedback reports to physicians randomized to those two arms of the study. B. Egan, S. Mack, D. Cheek, and D. Lackland have been meeting with community physicians. To date over 50 primary care physicians have been contacted for possible participation. A common concern of doctors is the increased workload on already overworked staff members, should they be randomized to the feedback group. Project investigators are working with physicians to develop approaches to feedback compatible with their mode of practice that will minimize staff time. For example, a pilot test of the feedback is ongoing in a physician’s office in Beaufort. Orientation and training has begun with those doctors who have agreed to participate. In that setting the chosen method of feedback was a card on which they note blood pressure and a few other pieces of information when the patient comes for a visit. Where computerized medical records exist with recorded blood pressure, the project programmer will develop a way to download the information. Based on the success in Beaufort, enrollment of practices for the randomized trial has begun with Low Country Family Medicine in Mt. Pleasant, SC (Eleanor Alford-Jenkins, M.D.) being the first practice to agree to participate in the study. Economic Access to Antiretroviral (ARV) Prescription Drugs & Adherence to ARV Guidelines for African American Medicaid Enrollees with AIDs or HIV-Disease in South Carolina- K. Simpson, PhD. Update: Protocol drafted. Hired D'Jaris Whipper-Lewis, MHA, as research coordinator and Pamela Mazyk, Pharm.D as consulting clinical pharmacist; specified data extraction protocol for Medicaid data set and submitted request to the Office of Research Services (ORS); evaluated and selected economic model for estimating local outcomes; developed process and initiated data collection on effective interventions for HIV disease and culturally appropriate intervention methods; initiated process for identifying community stakeholders and leaders in HIV-disease in South Carolina. Hired statistician/statistical programmer to perform merges of the Medicaid billing data. An Exploration of Racial Differences in End-of-Life Care Preferences Among Cancer & Congestive Heart Failure Patients in South Carolina – S. DesHarnais, PhD, J. Kurent, MD, W. Jones, PhD Update: Protocol drafted. Dr. DesHarnais developed a detailed request for historical data on disparities in use of end-of-life options from the Office of Research and Statistics in Columbia; developed a state-wide sampling frame for physicians and their patients; and began the recruitment of interviewers. Geneva Levey and Vickie Ott were hired as project interviewers. Frank Brescia and Winnefred Hennessy were hired as medical consultants. A literature review on end-of-life care with emphasis on what is known regarding preferences of African Americans was completed. A change will be made in key personnel. Daniel Hoskins, MPH, leader of the Community Advisory Committee and on the Steering Committee for EXCEED will take over the project coordination from W. Jones. D. Hoskinshas experience both in working with the community and will overseeing studies, given his experience working with the Hollings Cancer Center at MUSC. Improving Care for High Risk Minority Patients with Chronic Illness by Using Pharmacist Consultations to follow up on Missed Prescription refills. (Previous title- A Randomized Trial of a Pharmacist-intervention to increase prescription refills) – D. Carson, PharmD, K. Simpson, PhD Update: D. Carson developed protocol for patient identification, recruitment, intervention and data collection. Study pharmacists are being identified and counseling training is ongoing. Protocol for telephone contact is being finalized taking into consideration the advice of the Scientific Advisory Committee. A system has been designed for the automation of patient selection, randomization, and follow-up in which the QS/1 pharmacy computer system is the primary data source. This Patient Identification Program (PIP) allows for the identification of patients who are not compliant with refill schedules; merges ethnicity information from secondary sources; randomizes patients to intervention or control; generates mailing labels and personalized reminder letters; contains an interactive phone follow-up system which prompts pharmacists with the information necessary to complete a phone consolation, including medication and disease history; and exports data for analysis, identifying patients only by EXCEED ID. Pharmacists are also provided with a trans-theoretical model so that they can assess the stage of change of the patient if appropriate in providing counseling. Cores: Administrative Core The Steering Committee structure has been expanded to include key staff members from all projects. The Steering Committee meets twice a month, joined at one meeting per month by all investigators. A monthly seminar series has been organized. Biostatistics Core The Biostatistics Core has successfully assisted in the design of all of the projects of the Exceed grant. The Biostatistics Core has met with each investigator about the data collection forms necessary for the given project, the data management aspect of the projects, as well as the analysis (statistical and economic) plan. Because data for planned studies are not yet available, preliminary disparity studies on secondary State and National data are being planned and performed. This core has set up a cordial relationship with the South Carolina Office of Research and Statistics, State Budget and Control Board in order to provide access to state data for Exceed Investigators. The analysis of the state data will be performed as soon as the data are received. However, the Core currently has National data (NHANES) on hand (through the world wide web and other sources). The Core has performed the statistical analyses of the national data for papers that have already been submitted to medical journals and abstracts that have been submitted to conferences. In analyzing the national secondary data, the Core has also come across data that needs new statistical methodology in order to be correctly analyzed; a paper has been submitted to a statistical methodology journal discussing these new methods. Subcontract/Consulting Relationship with T. Brown and L. Shi. The Core has had conference calls with Dr. Leiyu Shi of Johns Hopkins University and Dr. Thomas Brown, University of South Carolina to discuss Patient/Provider Satisfaction surveys for the various projects. Project 1 and Pilot 1 will be incorporating satisfaction surveys into their projects. TCIG Sub-contract: W. Zhao set up a web page for Multisystemic Therapy Institute (Pilot Project 3) to: collect data for Therapist Adherence Measure, collect data for Supervisor Adherence Measure, generate Web-based reports for TAM and SAM, and permit database downloading from the web. Also, for Pilot Project 3, W. Zhao set up a database for Charleston County Juvenile Drug Court to maintain information on juvenile drug cases. B. Egan and M. Giese, Executive Director for The Hypertension Initiative, met with W. Zhao about designing a website for the hypertension project (Project 1) that would enhance an existing website already developed by Dr. Egan for other hypertension-related projects. W. Zhao has been working with *L. Egede on setting up the database for Pilot Project 3. W. Zhao has set up a web site for the EXCEED grant to be used by EXCEED investigators and to provide information to the public. EXCEED investigators have full access to the site, using a password for protected areas. The web address is http://tcig.musc.edu/exceed. See more discussion under Knowledge Dissemination. The State Budget and Control Board, Office of Research and Statistics (ORS) In March 2001, ORS hired Lisa Haney to work as the ORS Statistician in the Biostatistics Core. L. Haney is researching the Medicare data system in preparation for requesting Medicare data from HCFA that will be needed to complete future projects. During the quarter, ORS has assisted K. Simpson in the completion of the Application for Medicaid Data for Project 2. ORS has developed the data for K. Simpson’s request and will be prepared to provide this to her with any necessary modifications upon approval of her application by the state agency that oversees Medicaid. The ORS is helping to obtain this approval. ORS has also assisted S. DesHarnais in the development of her request and is preparing to retrieve the data for her project. KNOWLEDGE APPLICATION - Information on measurement tools put into practice (i.e. posted on web with web reference), recruitment/retention efforts, changes made to organization or delivery of care, development of health care policy, participation in national workshops to set policy. Given the early stage of EXCEED, there are currently no entries for knowledge application. KNOWLEDGE DISSEMINATION - continuing education; public awareness campaigns; planning documents; policy testimony; scientific publications. Scientific Publications/Presentations Manuscripts Published/In Press (See Appendix 2 for reprint) 2000 Egan BM, Lackland DT, Williams B, Gunter N, Tocharoen A, Beardon L: Health improvement and cost-avoidance opportunities in hypertensive Medicaid beneficiaries. J Clin Hypertension (in press). Lackland DT, Egan BM, Fan J: Low birth weight contributes to the excess prevalence of hypertension and end-stage renal disease in African Americans. J Clin Hypertension (in press). (The grant was unfortunately not acknowledged in this paper which is related to the PPG.) *Huey, S. J., Jr., Henggeler, S. W., Brondino, M. J., & Pickrel, S. G. (2000). Mechanisms of change in multisystemic therapy: Reducing delinquent behavior through therapist adherence and improved family and peer functioning. Journal of Consulting and Clinical Psychology, 68, 451-467. Cunningham, P. B., Henggeler, S. W., Limber, S. P., Melton, G. B., & Nation, M. A. (2000). Patterns and correlates of gun ownership among nonmetropolitan and rural middle school students. Journal of Clinical Child Psychology, 29, 432-442. Swenson, C. C., Randall, J., Henggeler, S. W., & Ward, D. (2000). Meeting the needs of maltreated children taken into custody: Outcomes and costs of an interagency partnership. Children’s Services: Social Policy, Research, and Practice, 3, 191-209. Wagner, E. F., Swenson, C. C., & Henggeler, S. W. (2000). Practical and methodological challenges in validating community-based interventions. Children’s Services: Social Policy, Research, and Practice, 3, 211-231. 2001 Brown, TL, Borduin, CM, Hennggeler, SW. Treating juvenile offenders with mental disorders in community settings. 2001. 445-464. Ashford, JB, Sales, BD, Reid, WH (eds.) Treating adult and juvenile offenders with special needs. American Psychological Association, Washington, DC. Book Chapter. Cunningham, PB, Hennggeler, SW. Healthy children through healthy schools: Implementing an empirically-based drug and violence prevention and intervention program in public school settings. Journal of Clinical Child Psychology. In Press. Hennggeler, SW. Multisystemic therapy. Residential Treatment for Children & Youth. In Press. Hennggeler, SW, Hoyt, SW. Multisystemic treatment with serious juvenile offenders and their families. 2001. 115-131. Richman, JM, Fraser, MW (eds.) The context of youth violence: Resilence, risk, and protection. Praeger, Westport, CT. Book Chapter. *Huey, SJ, Jr., Hennggeler, SW. Effective community-based interventions for antisocial and delinquent adolescents. 2001. 301-322. Hughes, JN, La Greca, AM, Conoley, JC (eds.) Handbook of psychological services for children and adolescents. Oxford University Press, Oxford, UK. Book Chapter. Simpson, KN, Voit, EO, Goodman, R, Chumney, ECG. Estimating the social and economic benefits of pharmaceutical innovations: Modeling clinical trial results in HIV-disease. Research in Human Capital and Development 2001. Special issue on "Investing in Health: the Social and Economic Benefits of Pharmaceutical Innovation" (in press). Swenson, CC, Hennggeler, SW, Schoenwald, SK. Family-Based Treatments. 2001. 205-220. Hollin, CR (ed.) Handbook of offender assessment and treatment. John Wiley & Sons, Chichester, England. Book Chapter. Manuscripts Submitted 2000 Natarajana S, Lipsitz SR; Kleckleyc TV; Nietert PJ. Self-Report of High Cholesterol- Determinants of Validity in US Adults. Submitted to The Annals of Internal Medicine. Lipsitz S.; Parzen M.; Ibrahim, J.; Fitzmaurice, G.. General Linear Models with a coarsened covariate. Submitted to Biometrics. Presentations/Accepted Abstracts and Posters 2000 Egan, BM. Presentation: Community and Faith-based Approaches to Cardiovascular Risk factor Reduction in the Elderly and Minorities. Date: 10/2000. Center for Aging, University of Alabama. Note: Grand Rounds Lecturer. Egan, BM, Lackland, DT. Presentation Date: 11/2000. Jackson Cardiorenal Meeting, Jackson, MS. Note: This meeting included experts in the epidemiological, clinical, and basic aspects of hypertension and other risk factors. The meeting emanated from recent start-up activities of the Jackson Heart Study which is designed to better understand racial disparities in cardiovascular health. *Egede, L. Presentation: Diabetes and Comorbid Depression: an evolving Dilemma. Date: 11/2000. Division of General Internal Medicine Noon Conference, Medical University of South Carolina. Henggeler, SW. Presentation: Multisystemic therapy. Presentation Date: 2000. Connecticut Department of Children and Families, Middleton, CT. Note: Invited workshop. Henggeler, SW, Swenson, CC. Presentation: Multisystemic therapy workshop: An intensive community and outcome based treatment for victims of child abuse. Presentation Date:2000. Child Advocacy Project, Gloucester, VA. Note: Invited workshop. Henggeler, SW. Presentation: Roots and buds. Presentation Date: 2000. First International MST Conference, Savannah, GA. Note: Keynote address. Henggeler, SW, Swenson, CC. Presentation: Multisystemic therapy and its implications for adolescent treatment, services, and prevention. Presentation Date: 2000. Administration for Children's Services, New York, New York. Note: Invited Address. Henggeler, SW. Presentation: Multisystemic therapy for juvenile offenders. Presentation Date: 2000. The 13th Annual Idaho Conference on Health Care, Pocatello, Idaho. Note: Invited Workshop. Henggeler, SW. Presentation: Key components of effective services for juvenile offenders. Presentation Date: 2000. Lost in the Shuffle: Treating the Mental Health Needs of Young Offenders, Coalition for Juvenile Justice, Tampa, FL. Note: Keynote address. Henggeler, SW. Presentation: An overview of MST outcomes and clinical procedures. Presentation Date: 2000. Ponce School of Medicine, Puerto Rico. Note: Invited Workshop. Henggeler, SW. Presentation: Components of effective treatments of juvenile offenders. Presentation Date: 2000. Juvenile Law Center and Mental Health Association of Pennsylvania, Harrisburg. Note: Invited Address. Henggeler, SW. Presentation: Multisystemic therapy clinical and service outcomes: Bases of success. Presentation Date: 2000. Grand rounds, New York University Child Study Center. *Huey,SJ, Jr. Presentation: Effective community-based interventions for delinquent youth: The state of the art. Presentation Date: 11/2000. 6th Annual "A New Beginning for Partnership for Children and Families in Los Angeles County" Conference, Los Angeles, CA. Jones, WJ, DesHarnais, SI, Kurent, J. Presentation: Developing innovative community plans for reducing racial disparities in access to end-of-life care. Presentation Date: 11/2000. Presented at the 128th Annual Meeting of the American Public Health Association, Boston, MA. Tilley, BC. Presentation: Research in Minority Aging: Achieving Health Equity. Presentation Date: 09/2000. USDA, Center for Nutrition Policy and Promotion, Millennium Series Symposium, Nutrition and Aging Leading a Health., Washington, DC. Website:http://www.usda.gov/cnpp/Seminars/Aging/Proceedings 2001 *Clancy, D, Cope, D. Poster Presentation: Testing a Managed Care Approach, Group Visits, in Disadvantaged Patient with Type 2 Diabetes. Presentation Date: 3/2001. Improving Chronic Illness Care grantee meeting, St. Louis, MO. Henggeler, SW, Rowland, MD. Presentation: Multisystemic therapy (MST): Bases of success in treating serious clinical problems. Presentation Date: 2001. Invited workshop at Helping Families Change Conference, 2001: From theory into practice, Melbourne, Australia. Henggeler, SW. Presentation: Multisystemic treatment of serious clinical problems in children and adolescents. Presentation Date: 2001. Keynote address at Helping Families Change Conference, 2001: From theory into practice, Melbourne, Australia. Henggeler, SW. Presentation: Multisystemic therapy outcomes: Bases of success. Presentation Date: 2001. Invited workshop, Norfolk Interagency Consortium, Norfolk, VA. Henggeler, SW, Rowland, MD. Presentation: Multisystemic therapy: An exceptional evidence-based, effective treatment program for antisocial behaviour in children and adolescents. Presentation Date: 2001. Invited address, Faculty of Child and Adolescent Psychiatry, University of Queensland, Brisbane, Australia. Henggeler, SW. Presentation: Using evidence-based treatments for improving drug abuse services for youth. Presentation Date: 2001. Keynote address at Youth in Turmoil: 2001, Adolescent Treatment Conference, St. Petersburg, FL. Henggeler, SW. Presentation: An integrated system for children with behavior disorders: Multisystemic therapy. Presentation Date: 2001. Invited address at Best Practice in Hawaii: Choosing Effective Strategies for Serving and Supporting Children and Families, Honolulu, HI. Kurent, J. Presentation: Challenges in End of Life Care. Presentation Date: 03/2001. Keynote speaker, Lexington, SC. Note: Discussed impact of ethnic and cultural diversity on palliative and end-of-life care needs, with specific reference to needs of the African-American community. Kurent, J. Presentation: Death and Dying in America: Overcoming Barriers in End-of-Life Care. Presentation Date: 03/2001. Spiritual Care Symposium, sponsored by Health Care Alliance. Kurent, J. Presentation: Presented "End of Life Care" workshop. Presentation Date: 03/2001. South Carolina Bioethics Network, Furman University. Bailey, W. P. Presentation: Using Statewide Data to Plan and Evaluate Efforts to Reduce Racial and Ethnic Health Disparities. Presentation Date: 4/2001. AHRQ sponsored workshop for State Departments of Health on “Strategies to Reduce Health Disparities”, Arizona. Technical Reports/Manuals - All EXCEED projects are developing Procedure Manuals. Press Releases – (See Appendix 3) Community Outreach Activities (Public Awareness Campaigns, Speak-outs, other) 2000 D. Lackland and B. Egan were both session chairs and participants at the annual Consortium for Southeastern Hypertension Control (COSEHC) meeting in Savannah, GA. This meeting addresses the excess burden of cardiovascular disease in the Southeast with special attention to racial disparities including cultural issues. October 2000. B. Tilley met with W. Robinson, principal investigator of the South Carolina health project Partners in Wellness to explain the EXCEED grant. November 2000. B. Egan discussed evaluation of the hypertensive patient including special populations at a Southern Medical Association continuing medical education meeting in Orlando, FL. November 2000. The Hypertension Initiative held a continuing medical education conference in Columbia, SC, on the elderly hypertensive patient. Approximately 50 primary care providers attended. During panel discussions, the topic of racial disparities in hypertension control and potential solutions was extensively discussed. Several physicians expressed an interest in participating in the Hypertension Initiative and Project 1 (B. Egan). November 2000. Experts in hypertension educational series, “The diabetic, dyslipidemic, hypertensive patient.” Beaufort, SC. Approximately 30 primary care providers were active participants in this CME program. Several expressed an interest in participating in the monitoring and feedback program as well as the Hypertension Specialist certification which are included in project 1 of the PPG. December 2000. Tilley, BC. Presentation on EXCEED to MUSC Board of Trustees, Charleston, South Carolina. April 2001. J. Kurent participated in leading a discussion at MUSC with Enterprise Community Advisory Board on End-of-Life Care on the development of a curriculum in end-of-life care for African-American ministers. He will submit a grant application to support development of this curriculum. 2001 January 2001. Executive Committee and Board meeting of Commun-I-Care was held in Columbia, SC. B. Egan presented data on hypertensive and diabetic hypertensive Medicaid beneficiaries which document very high costs from hospitalizations. Medicaid beneficiaries are approximately 60% African American and 75 % women. The demographic characteristics of CIC clients are similar and many of these individuals are also diabetic and/or hypertensive. The health care costs associated with complications are substantial and in large part avoidable with adherence to evidence-based goals of therapy. The potential savings that could be achieved through implementing these guidelines in CIC patients were discussed. January 2001. Tilley, BC. Presentation: Understanding and Eliminating Health Disparities in Black Americans. Medical University of South Carolina, Disease Prevention and Control, Access Network Program Advisory Group, Executive Committee Meeting. February 2001. Tilley, BC. Presentation: Understanding and Eliminating Health Disparities in Blacks. Black Alumni Council Annual Meeting, Medical University of SC, Gazes Research Institute Conference Room. February 2001. B. Egan. A cardiovascular risk assessment was performed on 225 State legislators and their office staff to highlight the importance of cardiovascular risk. Opportunities for improving the health of all South Carolinians were emphasized in one-on-one discussions. After the health screen, four MUSC faculty, including Dr. Egan, met with Sen. Giese to discuss specific programs which could be implemented. February 2001. B. Egan discussed hypertension, racial disparities in cardiovascular health, and programs for addressing those disparities with students at Morris College in Sumter. This presentation was part of the seminar series organized by Mr. William Robinson and colleagues for historically black colleges and universities (HBCUs) throughout the State. February 2001. *L. Egede was guest speaker on a community outreach program for African American men entitled “The Invincible Man”. The focus was on diabetes, colon cancer, and prostate cancer in African American men. March 2001. B. Egan participated in an “Experts in Hypertension Seminar Series: Focus on the complicated hypertensive patient,” held in Greenville, SC. April 2001. K. Simpson provided information on Project 2 to a local black church. April 2001. Our Health: Bridging the Disparity Divide television program aired on South Carolina Educational Television. Eight panelists discussed ways to reducing health disparities. Program panelists included F. Linnen and G. Ruff, members of the EXCEED Advisory Committees. EXCEED was a co-sponsor. See flyer in Appendix 1. 2001. W. Zhao set up the EXCEED Website including following sections: Introduction to the SC EXCEED program. Information about the four Projects and three Pilot projects. A Newsroom containing information on seminars, funding, jobs, conferences, and call for papers. Exceed Staff contact information. Links to related websites. Web-based information update. Continuing Education/ Course Titles Learning experiences for EXCEED investigators. 2000 B. Tilley taught a course in grant development for clinical research (students included one pilot investigator). 2001 K. Simpson was a visiting speaker for MUSC Policy Analysis class with 25 Masters degree students. She presented Project 2 objectives and an analysis of potential policy change options that we have identified to-date to improve outcomes for HIV-patients in SC. B. Tilley was a visiting speaker for MUSC Policy Analysis class. She presented the EXCEED project and its implications for policy. S. Huey taught an undergraduate course on minority mental health. Planning Documents/Policy Testimony/Other Dissemination - October 2000. B. Tilley and project leaders met with the State legislative Black Caucus to discuss the program objectives and community interactions. November 2000. B. Egan and D. Lackland met with State Representative David Mack to discuss health disparities and opportunities for collaboration between the State and MUSC (PPG) in an effort to reduce those disparities. 2001. W.P. Bailey and K. Willert attended the State Office of Rural Health Legislative breakfast. 2000-2001 ORS provided information to the Legislators to increase knowledge about health care disparities and encourage awareness. Monthly EXCEED Seminar Series - (Audience included students, faculty, and staff at MUSC and other state institutions, as well as community members.) January 2001. “Eliminating Health Disparities, the EXCEED Initiative for South Carolina” Presenters: B. Tilley, Introduction; B. Egan, K. Simpson, S. DesHarnais, D. Carson February 2001. “Cultural Competence” Organizer: B. Powe, Presenters: A. Blue, I. Spruill, and D. Hoskins March 2001. No Seminar- Spring Break. April 2001. “Opportunities to Reduce Disparities in Cardiovascular Health among Hypertensive Medicaid Beneficiaries” presented by B. Egan and D. Lackland CAPACITY BUILDING- Investigator Development: mid-career scientists, junior faculty, graduate faculty, undergraduate students; Collaborative Networks: inter-institutional, intra-institutional, public-academic liaisons Investigator Development - 2000 *L. Egede took the following classes: Design and Conduct of Clinical Trials Measurement in Research *L. Egede is mentoring Tricia Howard, Master’s thesis on diabetes outcomes. D. Carson recruited Pam Mazyck, PharmD (minority) for Outcomes Research Fellowship position beginning July 1, 2001 whose primary responsibilities will be working with EXCEED Projects 2 and 4. 2001 *L. Egede took the following classes: Grant Development for Clinical Research Introduction to Health Services Research *D. Clancy: Attended the Institute for Healthcare Improvement National Congress for Improving Care for People with Chronic Conditions with special focus on Asthma and Depression in St. Louis, MO. K. Simpson. Funding support was approved for *J. F. Mazyck, Pharm.D. student, (minority) for an outcomes research project titled: “Analysis and Modeling of Clinical Impacts of Complex Chronic Diseases”. Funded by MUSC Summer Research Award Program for Health Professional Students. B. Tilley identified two potential new minority investigators to work with EXCEED (C. Mathus, P. Cunningham). Pilot Study Status The three Pilot Projects to develop new minority investigators and engage new non-minority investigators into minority health research include: Implementing Successful Managed Care Models of Healthcare Delivery in a Low Income Underserved African American Patient Population with Type 2 Diabetes – *D Clancy, MD (K Magruder, PhD, mentor). Update: The Protocol and the Manual of Procedures are almost completed. Project personnel have adapted the moderator guide for African American patients with diabetes focus groups developed and reported upon in November/December 1999 issue of The Diabetes Educator by Mary Blanchard, RN in her article “Using a Focus Group to Design a Diabetes Education Program for an African American Population.” Plans to acquire rooms for the focus groups for the patients and restaurants for the physicians, arrange for audio-taping equipment and personnel, as well as focus group moderators, is underway. Recruitment of potential focus group participants will begin immediately upon IRG approval of the recruitment flyer. Potential patient participants are being identified by staff members at the Adult Primary Care Center. W. Zhao designed Case Report forms for the project. In April 2001, D. Clancy went to Denver, Colorado to observe group visits in action and receive training. Aleatha Fields was hired as a research assistant. A Pilot Program To Provide AHRQ Guidelines Concordant Care To African Americans With Type 2 Diabetes Mellitus And Depression – *L Egede, MD (M Johnson, PhD, K Magruder, PhD, mentors) Update: L. Egede recruited and trained the research assistant, trained the diabetes educators, developed collaboration with clinic providers, completed study protocols. The development of training manual and the development of process measures is in progress. He has identified sites where the study will be conducted. Improving the Evaluation of Therapist Adherence to Multisystemic Therapy with Ethnically Diverse, Adolescent Drug Offenders – *S Huey, PhD (S Henggeler, PhD, mentor). Update: Questionnaires were developed; a draft of Protocol was completed; and therapist adherence data has been collected from 50 families and their therapists. Collaborative Networks Developed (Intra-institutional/Inter-institutional/Public-academic liaisons) Oct-Dec, 2000. J. Colwell continued to chair the Diabetes Initiative of SC (See executive summary for 2000 Annual report in Appendix 3). October 2000. B. Tilley went to Columbia to meet with Office of Minority Health, State of South Carolina to discuss EXCEED project. December 2000. B. Tilley went to Orangeburg and Denmark, SC to meet with representatives of the South Carolina State University 1890 Project, with the President of Vorhees College, and with the Orangeburg Community Health Center Director. March 2001. B. Tilley went to Orangeburg and Denmark for a second meeting with the 1890 Project to develop community liaisons and to meet with the chair of the science programs at Vorhees College. December 2000. B. Egan met with J. Colwell to discuss ways in which the Diabetes and Hypertension Initiatives could work together to improve outcomes and reduce racial disparities. December 2000. B. Egan and D. Lackland met in Columbia with Ken Trogdon, Executive Director for Commun-I-Care and Pete Bailey and Beth Corley with Carolina Medical Review to discuss analysis of health care data for low-income patients with hypertension and diabetes. The possibility of merging the two databases (Commun-I-Care and State Medicaid) was discussed and appears feasible. Everyone agreed it would be useful to continue discussions on areas for collaboration. December 2000. D. Lackland chaired the quarterly Stroke Task Force Meeting of the AHA. B. Egan, a member of this Task Force, also attended the meeting. Project 1 of the Health Disparities PPG was briefly presented and implications for reducing stroke discussed. December 2000. B. Egan and D. Lackland participated in a conference call with Drs. Brown (Columbia) and Hsui (John Hopkins) to discuss tools for assessing patient and provider satisfaction in the hypertension component of the PPG on health disparities. 2001. K. Magruder, in preparation for Center of Excellence application, has contacted a number of other VAs and academic institutions (University of Alabama, Birmingham; Duke; USC; SC State; VA, Columbia; VA, Little Rock; VA, Durham; VA, San Antonio) concerning collaboration. 2001. *D. Clancy formed Intra-institutional Liaisons with Dr. Paul Bush, Director of Pharmacy Service, for the Duke Endowment letter of intent submitted to President’s Council. She has made Inter-institutional Liaisons by networking at the Improving Chronic Illness Care Grantee Session and at the Institute for Healthcare Improvement National Congress for Improving Care for People with Chronic Conditions with special focus on Asthma and Depression in St. Louis, MO. She has made Public-academic Liaisons through her involvement with Tri-County Project Care. January 2001. B. Egan met with Mr. George Rogers, former Heisman Trophy winner at USC, who is interested in conveying the message of cardiovascular risk reduction to men. 2001. D. Carson identified Dr. Stephanie Taylor, an African American pharmacist/researcher at the University of Michigan, as a consultant because of her expertise in the area of racial disparity research. D. Carson initiated dialog with Dr. Dorothy Smith of Consumer Health Corp. regarding development of the “toolbox” for practitioners during year 2 of the project. Technical Assistance Accomplishments (Includes Committee Work/ Leadership Positions in other settings that include research on aging) 2000 *D. Clancy was appointed the Chair of the MUSC Medical Records Committee allowing her to have input in documentation standards across campus. Further, being appointed Chair of the Health and Public Policy Committee of the SC Chapter of the American College of Physicians allows her access to new information regarding health care related issues in Washington by mass fax as well as e-mail. With her meeting annually with governmental representatives in Washington she have access to those people in Washington who make public policy. March 2001. K. Simpson performed an analysis of SC hospital-discharge data and of MEDSTAT data on 396,000 commercially insured beneficiaries to develop two sets of estimates of the numbers of black and white patients with renal impairment (but not end-stage renal disease) living in SC counties in 1998. This estimate was used as the basis for a response to a NIH RFA for a prospective epidemiology study of renal disease. 2001 *D. Clancy was asked to join the community advisory board of the new safety network in development in the Tri-county region, Tri-County Project Care. As such she has attended the first community advisory board meeting, and has had extensive involvement with the Tri-County Project Care personnel through her involvement in the designing and authorship of grants for potential funding sources. October 2000. B. Tilley served on AHRQ- Health Care Quality as Effectiveness Study Section Review. November 2000. B. Tilley served on NHLBI special study section to review health promotion projects. November 2000. B. Tilley served on AHRQ planning committee with a group of researchers and Federal officials to plan the agenda for a national workshop to be held in April to assist State and local health policymakers develop successful strategies for eliminating health care disparities. Curriculum Development/Teaching 2001 K. Simpson developed course in health services research for Masters in Clinical Research Program. B. Tilley developed course in grant writing for Masters in Clinical Research Program. Evaluation of mentoring program (semi-annual) To be completed in May, 2001.
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