The Kate B. Reynolds Foundation has provided funding to Community Care, through the NCFAHP (North Carolina Foundation for Advanced Health Programs, Inc.) to develop and implement a two-pronged prevention initiative. One prong of the initiative is targeting stroke prevention and the other is targeting childhood obesity. Three Community Care networks (Carolina Collaborative Community Care, Northwest Community Care and Sandhills Community Care Network) are participating in a stroke prevention initiative. There are four networks participating in the childhood obesity initiative (Access II Care of Western N.C., Carolina Community Health Partnership, Partnership for Health Management and Community Care of Wake and Johnston Counties).

In the stroke prevention initiative the networks are targeting Medicaid enrolled patients with hypertension and defining two subgroups to receive more intensive interventions - patients who have a primary care provider within one of the 18 'target practices' and patients whose pharmacy claims history indicates that they are not taking their blood pressure medication regularly. The 18 large target practices receive provider education, chart audits and performance feedback. Each network has developed a plan for physician and practice education based on local resources and practice preferences. A quick-reference physician guide to evidence-based clinical guidelines pertinent to stroke prevention / cardiovascular risk reduction had been developed and disseminated (also available on the Community Care web site). Between 800 and 1,200 high-risk patients will be invited to participate in a telephonic program for patient education and tailored self-management support, using a model developed by Dr. Hayden Bosworth and colleagues from Duke University and the Durham VA Medical Center. Objectives are to demonstrate a 10 percent improvement over baseline clinical performance metrics (such as blood pressure control, cardiovascular risk factor assessment, cholesterol management, and appropriate use of aspirin) in target practices; and increased awareness of treatment goals and adherence to blood pressure medications among high-risk patients. Early accomplishments include the following: high rates of provider and practice participation in educational programs and performance review, improved clinical flow processes, and successful recruitment and retention of patients into the self-management program.

The childhood obesity initiative is targeting Medicaid enrolled patients between the ages 2 and 18 in 113 practices. Providers and primary care practices are aiming to increase BMI (body mass index) screening and improve self-efficacy in assessing patients for overweight and obesity. In partnership with the N.C. Division of Public Health, provider toolkits based on evidence-based guidelines were developed and distributed. In addition, family education messages about healthy eating and physical activity were included in the pilot. Accomplishments to date include training practices in the use of obesity screening tools (practice re-design workshops); assisting practices in designing and implementing co-location models with nutritionists; establishing links to community resources for patient and family education; and increasing the use of BMI screening and completing an initial needs assessment.

The pilot networks will be able to develop a model that can be replicated in other networks and communities and will help Community Care in the development and implementation of meaningful preventive measures.