OVERVIEW OF CLINICAL DIRECTORS NETWORK

1. OVERVIEW OFCLINICAL DIRECTORS NETWORK

2. CDN: Past, Present & Future • An informal network of clinical leaders who practice as primary care providers in low-income and minority communities • A clinical research and educational organization • A means to translate clinical research into clinical practice

3. CDN Corporate Structure • 501 ( c ) (3) Tax Exempt Non-Profit Corp • Headquarters in NYC with CEO & Staff • Board of Directors consists of 17 volunteers • Active Clinical Leaders practicing in Low-Income/Minority Practice Settings including Health Centers and Health Plans in NY, NJ, PR,VI • Physicians, Dentists, Nurses • Elected by the CDN Membership at Annual Meeting • Linked to a for-profit subsidiary, QPSD Quality Professional Systems Development, Inc.

4. Why Clinical Networks? • Target: Clinicians working in community, migrant, homeless and HIV health centers • Reduce the sense of isolation, stress, burnout • Update clinicians in latest health improvements & advances • Collect & share information, skills & technical assistance • Introduce in the communities latest developments in health care and business practices

5. Poor/Low Income Uninsured/Underinsured/Medicaid recipients Unemployed Women Children/Adolescents Minorities: African American, Latino, Asian, Pacific Islander, Native American/Indian, Native Hawaiian, Native Alaskan Migrant/Seasonal Farmworkers Homeless Drug/Alcohol Users Rural residents Refugees Immigrants (Legal and Illegal) Persons Living with HIV/AIDS Gay, Lesbian, Bisexual and Trans-sexuals Prisoners/Releasees/Parolees Mentally Impaired/Mentally Ill Sex Workers Disabled/Handicapped Elderly/Frail Elderly Who are the Underserved? Source: National Association of Community Health Centers

6. Who are the Underserved?National Statistics by Age and Gender Source: NY HRSA (1997)

7. Advantages of Participating in Clinical Research • Earlier access to new drugs and technologies • Ongoing Training for Primary Care Providers • Improved quality of care due to: • expert protocols reviewed by experts, NIH, FDA • more frequent follow-ups • standardized assessments • ongoing quality assurance/quality improvement • external monitoring of data & patient care • feed-back to clinical sites & providers

8. Financial Benefits to Participants • Low/No-cost of care to patients • Patient incentives, transportation, enablers • Payments for Provider Time • Covers costs of Visits, Tests, Medications • Improved access to equipment • diagnostic • therapeutic • data processing • education and training

9. New York New Jersey Puerto Rico, Virgin Islands Connecticut Florida Utah California (dental) Missouri Maine, Massachusetts Rhode Island, Vermont New Hampshire Virginia, West Virginia Maryland, Delaware Pennsylvania, DC Texas Oklahoma Where CDN Conducts Research

10. HIV/AIDS Cancer Control Depression Stress Management Hypertension Diabetes Immunizations Migraine/Headache Anemia Asthma NIAID HRSA NIMH AmFAR BMS DMP Roche NCI AHCPR NIDA SAMHSA NIMH NHLBI Pfizer HRSA CDC HRSA Merck Ortho Biotech EPA HRSA DEP CDN’S RESEARCH PORTFOLIO

11. Current CDN Research Projects • FUNDERS: PROJECT TITLE: • NCI Prevention Care Manager • NIMH SMART/EST Women’s II • NHLBI Blood Pressure Adherence • EPA HRSA Home/Environmental NJDEP Asthma Management • HRSA CDC Immunizations

12. NY Prevention Care Manager Project • Funded by NCI • PI - Allen Dietrich, MD, Dartmouth • 8 Health Centers in NYC metro area • Randomized Controlled Trial (n=1400) • To test case management strategies to improve breast, cervical and colorectal cancer early detection services for women

13. SMART/EST Women’s Project II • Funded by NIMH • PIs - Stephen Weiss, PhD MPH- U Miami & Jonathan N. Tobin, PhD - CDN • 12 Health Centers in NYC,NJ, Miami • Randomized Controlled Trial (n=450) • To test cognitive behavioral stress management training and health education to reduce distress and improve medication adherence for adult women with HIV/AIDS

14. Antihypertensive & Lipid Lowering to Prevent Heart Attack Trial (ALLHAT) • Funded by NHLBI • PI - Jonathan N. Tobin, PhD - CDN • 3 Health Centers in NY & NJ [Nationally: 623 sites] • Randomized Controlled Trial (n=126) [42,450 pts] • To compare 4 classes of blood pressure drugs against each other without a placebo to improve blood pressure control, lipids and outcome for hi-risk hypertensive adults

15. Improving Blood Pressure Medication Adherence and BP Control • Funded by NHLBI • PI - William Gerin, PhD - Mt Sinai • 12 Health Centers in NYC & upstate • Randomized Controlled Trial (n=450) • To test home blood pressure monitoring and telephone nurse case management to improve medication adherence and blood pressure control for poorly controlled hypertensive adults

16. Improving Home/Environmental Asthma Management • Funded by EPA, HRSA Reg II, NJ DEP • PI - Jonathan N. Tobin, PhD - CDN • 12 Health Centers in NY,NJ,PR,VI,PA,MO • Randomized Controlled Trial (n=250) • To test home visits and telephone nurse case management for health education and support to improve asthma control for pediatric asthmatics

17. Improving Immunization Rates • Funded by HRSA & CDC • PI - Jonathan N. Tobin, PhD - CDN • 20+ Health Centers in NY,NJ • CQI/Observational Studies (n=18,050) • To test assessment and feedback of immunization rates, individualized Technical Assistance, Office Systems Development and Follow-up Support on Immunization Completion Rates (4-3-1-3-3)

18. STUDY LINK • Funded by Title I Ryan White CARE Act • HIV/AIDS Research Coordinators Network • Database of all enrolling HIV/AIDS clinical research in NYC • Warmline/Single phone number for access to information and referrals to research studies • Marketing clinical research to clinicians, case managers, AIDS service organizations

19. CDN’s Educational Activities • Annual Clinical Leadership Conference • Information Management for Clinical Leaders • Community Health Center Rounds • Dental Quality Assurance Peer Review • Customized Training & Office Systems Consultation • eCME: Video-teleconferences & Webcasts http://CDN.horizonlive./com ON-SITE AND ON-LINE

20. Community Health Center Rounds • Detection of HIV/AIDS & Oral Cavity Cancer • Cancer Control, Early Detection & Prevention • Screening for Colo-rectal Cancer in Primary Care • Reducing Perinatal Transmission of HIV/AIDS • Detection of Depression in Primary Care • Quality Improvement in Immunizations • Detection & Prevention of Domestic Violence • Basics in Fundraising & Grant Writing • Internet Access: How to Surf & Search the Web

21. CDN’s Educational Activities • eCME: Video-teleconferences & Webcasts http://CDN.horizonlive./com • Bringing the latest in clinical and management information and technology to Health Center Clinicians both On-site and On-line • Live at Health Centers • Live Webcasts • Archived Webcasts available 24 x 7

22. Long-term Goal: Clinical Research to Set Standards for Clinical Practice To recruit every practice, every provider and every patient to participate in at least one clinical trial

23. CDN’S FUTURE DIRECTIONS • Develop & Market Products to strengthen links between Patient Care, Education, Training, Research and Business Practices • Electronic Medical Publishing • Distance Education/Web-based Training • Electronic Medical Records • Clinical Decision Support Tools • Patient Recruitment/Medical Marketing • Industry-sponsored Clinical Trials

24. CLINICAL DIRECTORS NETWORK Jonathan N. Tobin, PhD President/CEO CDN Clinical Directors Network, Inc. 54 West 39th Street - 11th Floor New York City NY 10018 USA Tel (212) 382-06-99 ext 34 Fax (212) 382-06-69 Email: jntobin@CDNetwork.org Web Site: www.CDNetwork.org