The purpose of the survey is to 1) understand what types of activities patient navigators do in their daily work, 2) learn about the types of patient navigator programs that exist around the country, and 3) be able to better describe the scope and number of navigation programs in the country. 

IAF would like to invite you to get involved in the survey!  If you are a patient navigator, or know someone who works in the patient navigation field, we would like you to take a few moments to look at the survey at the link below.  You will also find an informational sheet with contact information regarding this important national effort.  The survey is intended for all navigators from around the nation, working with any type of health condition (cancer, diabetes, cardiovascular disease, etc).

www.patientnavigatorsurvey.com

Any additional questions can be addressed to the Principal Investigator for the study, Dr. Elizabeth Calhoun, 312-355-1572 or via email at .  You can also contact the Institute for Alternative Futures, at 206-491-6205 or via email at or Angelina Esparza, Director of the ACS Patient Navigator Program, at 404-329-7776 or via email at . 

PUBLIC HEALTH EFFORTS

1. Refocusing on the Social Determinants of Health:
   The work of the DRA Project has shown the importance of focusing “upstream” on the determinants of health and disparities.  You can see our DRA Project Report on the “most important”? advances here on the DRA website.  The DRA Project has partnered with the Prevention Institute to produce two reports about refocusing on the social determinants of health: The Imperative of Reducing Health Disparities through Prevention: Challenges, Implications, and Opportunities and Laying the Groundwork for a Movement to Reduce Health Disparities.  Using the Prevention Institute reports as a focus, the DRA Project stimulated a national design meeting to press forward the movement forward.  DRA Partners are also creating awareness of the social determinants of health.  For example, the DRA Project is supporting a public impact campaign using the PBS miniseries on health disparities that is currently on the air.  You can find out more about the miniseries and the public impact campaign at Unnatural Causes: Is Inequality Making Us Sick?



2. Lessons from National Healthy Eating and Active Living Programs:
   Healthy eating and active living (HEAL) are the keys to preventing obesity as well as health disparities in diabetes, heart disease and cancer.  The DRA Project worked with The California Endowment’s Healthy Eating Active Communities Program, REACH U.S., Kaiser Permanente’s Community Health Initiatives, The Joint Center’s Health Policy Institute’s program - Place Matters: Addressing the Root Causes of Health Disparities, YMCA Activate America, and the Robert Wood Johnson Foundation’s Active Living by Design to identify and disseminate lessons learned from these programs, particularly in relation to reducing health disparities.  The Report, Using Healthy Eating and Active Living Initiatives to Reduce Health Disparities, identifies five key strategic insights for making these initiatives work with low income communities and communities of color.



3. Obesity Prevention in Schools:
   Schools are an important setting to encourage good health and to prevent obesity.  There are a number of school based efforts working in this area. One is The City Year Detroit Project using teams of AmeriCorps volunteers to work with Detroit’s public schools to enhance their systems for nutrition, physical activity, the health clinic, the physical environment, health of the teachers and staff and involvement of parents.  The DRA Project is working to promote awareness of this type of school based wellness or obesity prevention opportunity.  In 2008, the DRA Project will also release an illustrative survey of over forty school focused programs in this field.



4. REACH U.S. Lessons:
   The Racial and Ethnic Approaches to Community Health (REACH) is CDC’s cornerstone initiative aimed at eliminating disparities in health status experienced by ethnic minority populations.  REACH programs have shown that health disparities can be reduced by engaging local leaders, building community partnerships, recognizing cultural influences, creating sustainable programs, leveraging resources, and empowering individuals and communities.  The DRA Project is working with CDC to develop and promote the lessons from REACH U.S.

HEALTH CARE FOCUSED EFFORTS

5. Expanded Care Model:
   One of the most important ways to reduce health disparities is to have low income and marginalized populations receive quality health care including preventative services.  In US health care, among the most significant quality improving activities have been the Health Disparities Collaboratives in health centers sponsored by the Health Resources and Services Administration (HRSA).  HRSA is evolving the approach of these efforts and the chronic care model they used from a single disease focus (e.g. diabetes, heart disease or cancer) to a focus on the whole person and the whole systems of the centers in the “expanded care model.” The DRA Project is working with HRSA to elaborate and promote the expanded care model, including the integration of social determinants, community conditions and complementary and alternative care.



6. Integrative Primary Care:
   Many low income and minority communities use complementary or alternative approaches (CAM).  Many community health centers do provide some CAM services.  It is likely that the inclusion of evidence based methods of complementary and alternative care could reduce health disparities by making care more accessible, culturally appropriate and affordable.  The DRA Project is working with the Samueli Institute, HRSA and other DRA Partners to look for ways to integrate complementary and alternative methods of care into primary care for low income and minority populations.  A major focus will be the role that evidence based CAM options can play in the Expanded Care Model.  A Scoping meeting was held in partnership with the Samueli Institute on April 28, 2008.



7. Patient Navigation:
   One source of health disparities is the inability of patients to navigate and appropriately access health care treatment, particularly for diseases with complex treatment regimens, such as cancer.  In recent years there have been many significant experiments with “navigators” for patients.  The DRA Project is working with the many DRA Partners and others currently running patient navigation projects to focus on ways to understand current navigator activity and outcomes, make navigation more sustainable, and consider how emerging information technology, particularly “virtual navigation” can assist patients and navigators to be more effective.  The DRA Project has published a Patient Navigation Program Overview.



8. Biomonitoring:
   New technology for monitoring patients in their homes and in their daily routines offers promise in conducting research, preventing disease, screening for risk factors and monitoring treatment or progression of disease.  Such monitoring, combined with coaching, has been shown to be effective in some low income populations in managing and improving outcomes of chronic disease, including diabetes, heart disease and asthma.  The DRA Project will work with community health centers and other providers interested in developing these applications to spread knowledge and increase the usability and effectiveness of these biomonitoring approaches for low income communities and their health care providers.  With funding from the Robert Wood Johnson Foundation, forecasts were developed for biomonitoring potentials as well as recommendations for making these advances disparity reducing, often by shortening their diffusion time into low income populations and their health care providers (see the BFP Final Report).  The DRA Project is working with the Commission to End Health Care Disparities to summarize and promote this technology strategy.

In addition to the eight working efforts listed above, the DRA Project will continue to monitor and promote other disparity reducing advances including tobacco control, and advances in modeling and mapping; and holding Disparities Foresight Briefings on Capitol Hill to inform the policy community of key developments.  See the results of our Briefing on Reducing Health Disparities Faster.

DRA Foresight Briefing Presentations
Introduction to the DRA Foresight Briefing by Clem Bezold
Health and Equity in All Policies by Larry Cohen
Building Stronger Communities for Better Health by Brian Smedley
Beyond Health Reform:Aligning Federal Policy with Good Health Policy by Adolph Falcon



Health Equity: Focusing on Health in All Policies: The DRA Project in conjunction with the Congressional Black Congress Health Brain Trust held its third DRA Foresight Briefing on February 25th, 2009 in Washington, D.C. You can also read the Hill Briefing Summary.

DRA Foresight Briefing Handouts
Speaker Biographies
Most Important Disparity Reducing Advances
Toward A Policy-Relevant Analysis Of Geographic And Racial/Ethnic Disparities In Child Health
Reducing Inequities in Health and Safety through Prevention

DRA Foresight Briefing Presentations
Introduction to the DRA Foresight Briefing by Clem Bezold
CBC Health Braintrust Priorities and Benchmarks by Congresswoman Donna Christensen
Promoting Health Equity: Taking 2 Steps Back to the Social Determinants of Health by Larry Cohen
Commission to Build a Healthier America by David Williams
Housing and Health Disparities by Dolores Acevedo-Garcia
Building Stronger Communities for Better Health by Brian D. Smedley



The Health Disparities Collaboratives: Enhancing Quality and Reducing Disparities: The DRA Project in conjunction with the Congressional Hispanic Congress held its second DRA Foresight Briefing on November 24th, 2008 in Washington, D.C. More than 100 Congressional staff, NGO representatives and academics attended the standing room only event.

DRA Foresight Briefing Handouts
Speaker Biographies
A Comprehensive Health Home - Using the Expanded Care Model of The Collaboratives
America’s Health Centers
Health Disparities Fact Sheet

DRA Foresight Briefing Presentations
Introduction to the Health Disparities Collaborative Briefing by Clem Bezold
National Association of Community Health Centers by David Stevens
The Urban Health Plan by Paloma Hernandez
Beaufort Jasper Hampton CHS by Roland Gardner



Reducing Health Disparities Faster: Addressing Social Determinants of Health: The DRA Project in conjunction with the Congressional Hispanic Congress held its first DRA Foresight Briefing on December 6th, 2007 in Washington, D.C. The Henry J. Kaiser Family Foundation has graciously hosted a webcast video, slides and a transcript of the DRA Foresight Briefing here on their website. The handouts at the briefing can be found below.

DRA Foresight Briefing Handouts
DRA Project Short Description
Biographies of Briefing Speakers
Promoting Healthy Eating and Active Living Programs
Laying the Groundwork for a Movement to Reduce Health Disparities
Voices from REACH Communities
Reducing Health Disparities Through Prevention
Most Important Disparity Reducing Advances

DRA Foresight Briefing Presentations
Introduction to the DRA Project by Clem Bezold
Changing Public Health Practice by Rosemarie Henson
A Look at the Chicago Southeast Diabetes Community Action Coalition by Amparo Castillo
Addressing the Social Determinants of Health by Larry Cohen
The Healthy Black Family Project by Stephen Thomas

Public Health/Community Based Prevention
1. Focus on Social Determinants of Health
2. Draw Lessons from National Healthy Eating and Active Living Programs
3. Obesity Prevention in Schools
4. REACH U.S. (Racial and Ethnic Approaches to Public Health) Lessons

Health Care Focused Efforts
5. Care Model
6. Integrative Primary Care
7. Consumer-Patient Navigation
8. Continuous Passive Biomonitoring

In addition to the general principle of greater equity or fairness, many health organizations serving the poor have real incentives to reduce health disparities: community health centers, hospitals losing money on needless readmissions, funding agencies and insurers paying for preventable or avoidable events and related services. The DRA Project is involving a wide range of these organizations as sponsors providing funding or as partners providing in-kind participation and support. The DRA Project gathers together representatives and experts from across healthcare including community health centers, health systems, government agencies, health technology companies, research centers and public policy and advocacy organizations. 

The DRA Project is extending an open invitation to your organization to become involved reducing health disparities. In 2009, the DRA project will work to accelerate appropriate advances and consolidate the learning from its partner network. Organizations committed to reducing health disparities are welcome to join.

For more information or to join the DRA Project contact us at IAF at .

The Health Resources and Services Administration defines health disparities as “population-specific differences in the presence of disease, health outcomes, or access to health care.” The last century has seen major advances in public health, health technology, economic wealth and prosperity.  While these advances have translated into increased health status for Americans there are many underserved communities that have been left behind. 

The next decade will see a myriad of advances in prevention and treatment that will yield significant health gains.  Notable advances are likely in the recognition of the role of social determinants, community approaches to prevention, early cancer detection, patient navigation, chronic disease management, and complementary and alternative medicine.

Typically the poor and underserved are among the last to benefit from such advances. Health disparities in the US are significant. African-Americans are 23 percent more likely to die from all types of cancer than whites, and in 2001 the death rate from diabetes in Hispanics was 40 percent higher than the death rate of whites. Slow diffusion of advances plays a role in these disparities. 

The DRA Project works to overcome this reality by targeting the advances with the highest potential for reducing health disparities and then creating a network of organizations committed to accelerating the development and deployment of those advances. The DRA Partner Network includes health care systems and local providers, major Federal government agencies, technology developers, and consumer and patient organizations.

Founding Sponsors: National Cancer Institute, Agency for Healthcare Research and Quality (AHRQ)

Sponsors: Robert Wood Johnson Foundation, Centers for Disease Control and Prevention (CDC), American Cancer Society, Novo Nordisk, The University of Texas Medical Branch, Florida Hospital

*This project has been funded in whole or in part with Federal Funds from the National Cancer Institute, National Institutes of Health, under Contract No. NO1-CO-12400 and the Agency for Health Research and Quality, under Contract No. GS-10F-0322R.

*The DRA Project would also like to thank our DRA Project Partner Unnatural Causes for allowing us to use images from their documentary series for this website.