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$10.1M grant to support  health of African Americans Five-year project will improve health outcomes of people with hypertension, diabetes and AIDS African Americans in South Carolina have more hypertension, diabetes and AIDS and poorer health outcomes with these diseases than the population as a whole.  Nationally, life expectancy for African American men born in 1997 is 66 years compared to 74 years for Caucasian men.  For African American women life expectancy is 74 versus 80 years for Caucasian women.  Dr. Barbara Tilley confers with Daniel Hoskins, head of the advisory committee. “Clearly there are major problems and hurdles to the improvement of the health status of African Americans in general and particularly African Americans in South Carolina,” said Barbara C. Tilley, Ph.D., professor and chair of MUSC's Department of Biometry and Epidemiology, College of Medicine, and principal investigator for the project.  The funding for the project comes from the Agency for Healthcare Research and Quality (AHRQ), an agency of the U.S. Department of Health and Human Services charged with supporting research designed to improve the quality of health care, reduce its cost, improve patient safety, decrease medical errors, and broaden access to essential services.  Under the grant, a multi-disciplinary team will analyze causes and contributing factors for inequalities related to the delivery and practice of health care, and identify and implement strategies to improve the process. Tilley said that the project is far more than a research protocol. “Our intention is not to come in, introduce a program and then leave,” she said.  “We want to make permanent changes that will truly improve the health of African Americans in South Carolina.  If we find that our interventions work, we are prepared to deliver the new program to those in communities who didn't receive the intervention initially.  In addition, we will be working with state policymakers and state agencies to insure a continuation of our efforts.” But the project doesn't stop there. Tilley anticipates that information gained from this comprehensive project will be applicable to areas outside the state and extend beyond the African American community.  The study emphasizes the roles and activities of providers of health care. For example, one project investigates expanding the role of the pharmacist. Instead of merely filling a prescription and providing drug counseling to the patient, the pharmacist will actually call patients who have not renewed  prescriptions for medications for chronic conditions such as hypertension and diabetes. The pharmacist will determine why the patient has not renewed the prescription and take appropriate action to see that the patient receives the medication. If it is a matter of cost, the pharmacist might work with the physician to identify a lower cost generic substitute. Or the pharmacist might help the patient find sources of funding. “Since the planned interventions will have an impact on both patients and providers, the satisfaction of both groups is important to the success of the endeavor,” said Tilley. “For this reason, we have assembled a community advisory group for the project to help assure that proposed interventions are acceptable to the communities where the projects will be implemented.” The major components of the MUSC project are:  reducing the racial disparity in cardiovascular disease by working with community providers to achieve better blood pressure control in their patients. (Project leaders—Brent Egan, M.D., departments of Cell and Molecular Pharmacology and Experimental Therapeutics and Medicine and Deanna Cheek, Department of Medicine,); improving economic access to antiretroviral prescription drugs and adherence to antiretroviral guidelines for African American Medicaid enrollees with HIV disease in South Carolina. (Project leader—Kit M. Simpson, Ph.D., Department of Pharmacy Practice, College of Pharmacy and the Center for Health Care Research); exploring racial difference in the provision of end-of-life care for cancer and congestive heart failure patients in South Carolina (Project leaders— Jerome Kurent, M.D., departments of Neurology and Medicine, College of Medicine, and Susan DesHarnais, Ph.D. American College of Surgeons); and performing a randomized trial of a pharmacist-intervention to increase prescription refills. (Project leader— Deborah Carson, Pharm. D., Department of Pharmacy Practice, College of Pharmacy). Co-investigators on these projects include Barbara Powe, Ph.D., Department of Health Management Outcomes, College of Nursing, and Walter Jones, Ph.D., Department of Health Administration and Policy, College of Health Professions.  “Investigators represent numerous departments and colleges of the Medical University, making it truly a cross-university effort,” said Tilley.  The grant also provides a core of support for data collection, data management, and data analysis led by Stuart Lipsitz, Ph.D., Department and Epidemiology, College of Medicine. The Biostatistical Core includes funding for the Office of Research and Statistics (ORS) at the State Budget and Control Board led by Walter P. Bailey.  Data from ORS will help to document improvements brought about by the project through use of statewide statistics. The Core also includes support for Thomas Brown, Ph.D., a health services researcher at Richland Memorial Hospital who will provide a link to other researchers in the Columbia area and to a consultant at Johns Hopkins who is an expert in assessing patient and provider satisfaction. Gardinia Ruff, Office of Minority Health, Department of Health and Environmental Control, will serve as a scientific advisor to the project. Funding also supports the development of new investigators, particularly minority investigators with an interest in research to reduce disparities in minority health. New investigators receive funding for pilot studies, 25 percent salary support and mentoring from senior investigators. The pilot programs are evaluating new models for health care delivery.  Pilot projects include: implementing successful managed care models of healthcare delivery in a medically underserved African American patient population with Type 2 diabetes. (Pilot leader—Dawn Clancy, Department of Medicine, College of Medicine); implementing ARQ guidelines concordant care to African American with Type 2 diabetes mellitus and depression (Pilot leader—Leonard Egede, M.D., Department of Medicine, College of Medicine and Center for Health Care Research); and improving the evaluation of therapist adherence to multisystemic therapy with ethnically diverse, adolescent drug offenders (Pilot leader— Stanley J. Huey, Ph.D., Department of Psychiatry, College of Medicine). Tilley hopes to join with the many other ongoing activities in the state to form a broad-based, collaborative, state-wide initiative focused on eliminating minority health disparities. Community Advisory Committee Daniel Hoskins, director, Disease Prevention and Control Network Program, Hollings Cancer Center Patricia Nelson, public housing director, Charleston County Housing and Redevelopment Authority, 722-1942 Rev. Willis T. Goodwin, Pastor, New Frances Brown and Washington United Methodist Churches, 747-7090 Delbert Dubois, community organizer, College of Nursing, MUSC Everlena Lance, board member, Mental Health Association, Georgetown County, 843-527-1435 Florence Linnen, Waccamaw EOC Community Action Agency, Georgetown County, 843-546-6161 or 546-3615 Sabra C. Slaughter, Ph.D., executive assistant to the president, MUSC Ida Spruill, R.N.,  study coordinator for Project SUGAR, Endocrinology, Diabetes, and Medical Genetics, MUSC Tammy Butler, DHEC, 803-898-0553 Maxine Martin, Ph.D., president/CEO, Trident Urban League, 965-4037