DURHAM, NC -- What if, instead of waiting until you were diagnosed with a chronic illness or life-threatening disease, you actively worked with your doctor to figure out ways in which you could become your healthiest self today and avoid the onset of a difficult illness tomorrow? Would it be all that different from what hundreds of athletes do each day as they prepare their bodies and minds for an important game or season?

Not really, if you think about the idea behind a new study launched last week at Duke University Medical Center.

A Strategic Approach to Health

Researchers from the Center for Health Services Research in Primary Care and the Duke Center for Integrative Medicine (DCIM) have designed a study to determine if patients who work closely with a health care provider to develop a "strategic health plan" (and adhere to it) can significantly reduce their risk for life-threatening diseases, including cardiovascular disease, stroke, diabetes, and cancer. The plan's design offers a test model for a new approach to medicine-an approach researchers believe would offer better care for patients and could eventually ease the overtaxed system of health care in the United States.

The randomized, controlled study, which is currently recruiting Duke employees aged 45 and older who have one or more risk factors (such as diabetes, hypertension, high cholesterol, or cigarette smoking), will have two groups of participants. One group will receive a health screening and then continue to receive usual care with their primary care physician. The second group also will receive health screenings but will meet with a doctor to talk about their results-with an added caveat. They also will begin a strategic health planning program that will assign them to a health care coach-a trained provider who will work with participants individually and in groups to develop a plan consisting of strategies and goals for achieving optimum health.

"The study is designed to create a whole new model of health care that we think would be much better for patients than the current model of disease-based care," says Tracy Gaudet, MD, director of the DCIM and a lead investigator on the trial. "Our goal is to help patients by giving them the tools they need to make lifestyle changes that will ultimately optimize their health and wellness."

Previous studies at Duke and elsewhere have concluded that making certain lifestyle modifications can lead to better health, but many people have difficulty making lifestyle changes because of a lack of motivation or support.

What is Health Anyway?

It has been stated that today's health care system is reactive rather than proactive, disease-based rather than health enhancing, and physician-directed rather than patient-centered.

"In the United States today, health care is generally directed to treating disease once it occurs. It is reactive," says Ralph Snyderman M.D., chancellor for Health Affairs and president and CEO of Duke University Health System. "When someone is hurt or becomes ill, we react quickly to make them better. In our everyday lives and businesses we try to plan for the best possible outcome. Why don't we do that with our health? It's amongst our most valued possessions.

"What has been missing in America is a health system designed to facilitate disease prevention and the ability of individuals to promote their health. People need to be more involved in their care, and we need to help them focus on preventing those illnesses they are most at risk for. We need to get health care providers and health care systems to think and act prospectively. Designing individualized health plans for patients and providing the means for preventing disease is an important start," says Snyderman.

In the field of integrative medicine, providers strive to give medical care within the framework of a developing partnership with their patients.

According to researchers, that partnership goes beyond acute medical interventions to seek the patient's optimal health and healing, even when a cure is not possible. All factors that affect health, wellness, and disease are considered, including the psychosocial and spiritual dimensions of a person's life.

"The combination of resources from the DCIM and the division of general medicine offers a rich opportunity to conduct this type of research," says Eugene Oddone, M.D., associate professor of general medicine and a lead investigator on the study.

Proactive Planning for Health

Duke is well known for its research advances in the field of genetics, an area that will continue to grow and impact our lives.

"Each of us is born with a genetic profile, which, based on what we are exposed to over a lifetime, makes us more or less susceptible to certain diseases," Snyderman says. "The ability to predict an individual's risk will give us the ability to prevent and/or minimize serious illnesses. When disease occurs, we need to intervene at the earliest time possible and work with the individual to minimize negative outcomes.

"We currently spend $1.4 trillion a year on health care, but we aren't getting our money's worth," says Snyderman. "Our health care system is inefficient and needs to be fixed. Thanks to scientific breakthroughs and medical discoveries that are taking place more rapidly than ever, we can improve health care in ways that could not have been imagined even ten years ago. We have opportunities to prevent serious illnesses like heart disease, stroke, certain forms of cancer, and diabetes. We need to develop new models of health care delivery as possible solutions to the looming health care crisis.

"We are convinced that a prospective health care revolution will make everyone a winner. Patients will be healthier, avoiding these preventable diseases that erode their quality of life. Health care providers will provide more effective care while reducing unneeded expenses; and employers and private and government insurers will find each dollar spent for health going further."

Special Delivery: Health Care Coach

While preventive medicine is not a new concept, the idea of planning strategically for our health is new and makes a great deal of sense, the researchers say.

"Helping to create a written plan with a patient isn't going to be effective if all we do is give them a piece of paper with the plan and say 'go to it'," says Gaudet. "We need to help people figure out ways for them to make the plan a reality in their lives. It's going to be very important for us to figure out, through this study, how we can facilitate and motivate people to live healthier lives."

For the participants receiving the strategic intervention, the emphasis will be on group support and education, as well as health care coaches. Two arms of education will be provided. The first will encompass traditional patient education in which three basic skill sets will be taught: diet, movement/exercise, and self-education. The second will consist of integrative medicine approaches such as mindfulness or relaxation, communication, and spirituality.

The researchers believe this new model of care would eventually offer cost savings for society, ease the strained provider system, and offer a way to give people the tools they need to create the healthiest life possible for themselves.

"If we could engage each individual and assist them in developing a comprehensive plan for their health," says Snyderman, "we could empower that individual with knowledge and the tools they need from the health care system in order to minimize their risk of developing serious illnesses down the road and improve their health and quality of life today."

Employees wanted for study Duke researchers are recruiting Duke employees for the Strategic Health Planning Study. You may be eligible to participate in this randomized, controlled study if you are:

• A Duke employee
• 
  
  
• Aged 45 or older
• 
  
  
• Have diabetes, hypertension, high cholesterol, or are a smoker.
• 
  
  

Everyone who participates will receive a health screening and have a meeting with a primary care physician to discuss how to cope with risk factors for life-threatening diseases such as heart disease, stroke, diabetes, and cancer. Some of the participants also will receive a health care coach--a trained provider who will work with the participant individually or in groups to develop a plan for achieving optimum health. If you are interested in participating in the Strategic Health Planning study or would like more information, call 681-2160. The study is funded by the Centers for Medicare and Medicaid Services. Related LinksDuke University Health SystemCenters for Medicaid and Medicaid ServicesDuke Center for Integrative Medicine

For more information, contact: Tracey Koepke | (919)660-1301 | koepk002@mc.duke.edu