At Duke University, an experiment in community health care

Durham -- the "City of Medicine" -- was not living up to its reputation for health-care excellence, so the Duke medical school reached out to lend a hand.
By Darryl Fears
Washington Post Staff Writer
Saturday, November 6, 2010; 5:27 PM

DURHAM, N.C. - This so-called City of Medicine has long represented the highs and lows of the U.S. medical system: It has a private medical school with a proud and profitable tradition of producing experts in such specialties as neurology and gynecology - and a population riven by diabetes, obesity and other chronic illnesses.

But in a turnabout, Duke University has been focusing closer attention on the neighborhood that surrounds it by forming a partnership with Durham's Federally Qualified Health Center. It's an experiment in community care that began well before health care became a heated political battle. It's one that has been closely watched by the Obama administration as a model for its vision of widespread reform. And perhaps most significantly, it's one that could survive and even thrive if the new law is never fully implemented or is ultimately repealed, as some newly elected Republican members of Congress advocate.

The project's aim is simple: reduce chronic illnesses that plague the uninsured to keep them from making expensive visits to hospital emergency rooms. The most immediate beneficiaries are poor men, women and children such as Jasmine Bond, 24, and her son Antayvion, 4, who wailed in protest recently as his mother held him down for routine immunizations at a clinic opened a year ago under Duke's partnership with the Lincoln Community Health Center.

Patients like Bond said in surveys that they would have gone to hospital emergency rooms if the three clinics built by the partnership over the past seven years had not been there, generating pricey and often unnecessary bills that Duke pays because the patients cannot.

In the longer term, experts say, such experiments in delivering community care - as well as medical schools and federally qualified clinics in at least eight other cities - have the potential to reduce overall health-care costs and even help heal other festering wounds such as race relations.

The universities "see the problems in their neighborhoods and they feel a new sense of urgency to go out and attack that problem," said Darrell G. Kirch, president and chief executive of the Association of American Medical Colleges.

"I think people realize the Affordable Care Act will be limited in how much change it can make in the delivery system," Kirch said. "They're showing us how you make new delivery models that will improve health status."

The chancellor of Duke's health affairs, Victor J. Dzau, and the chairman of its department of community and family health, J. Lloyd Michener, said they meet frequently with officials in Washington.

"If you look at this country, the best medical centers sit in places with the worst health statistics," Dzau said he told the officials. "We can't be an ivory tower. We can't just wait for sick people to come to us."

Michener said Durham wasn't living up to its lofty City of Medicine moniker.

"Let me be blunt: Durham has more doctors per capita than any place and our community isn't as healthy as it should be," Michener said.

Non-acute emergencies

At the Holton Wellness Center, which celebrated its first anniversary in August, Jasmine Bond was the face of the problem - and its solution.

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