Basic scientific research takes place in the laboratory. At the University of Tennessee Health Sciences Center, the work of Dr. Jim Bailey and his team is at the other end of the research spectrum, that is, in the community.
Dr. Bailey, Robert S. Pearce Endowed Chair in Internal Medicine, is the Principal Investigator of the Tennessee Heart Health Networka statewide initiative to test interventions to improve the cardiovascular health of Tennesseans.
In 2021, UTHSC and Dr. Bailey received a $4.5 million grant from the Agency for Healthcare Research and Quality (AHRQ) to create a network of primary care providers across the and equip them with effective, patient-centered methods to encourage better management of blood pressure and smoking cessation, two major risk factors for cardiovascular disease. The goal is to reduce strokes and heart attacks in the state which ranks third in the United States for cardiovascular events, sixth in deaths from cardiovascular disease and fifth in deaths from stroke. Tennessee is one of only four states in the country chosen by the AHRQ to receive this grant.
Dr Bailey, also executive director of the Tennessee Population Health Consortium and the director of UTHSC Center for Health Systems Improvement, asserts that this “real-world” research sits at the intersection of implementation science and population health. “What we’re really doing through this work is testing the impact of UTHSC’s large statewide service delivery program,” he explains. “We work to replicate evidence from academic efficacy trials into large community efficacy trials, and then deploy proven approaches to improve care through even larger implementation and dissemination initiatives like the Tennessee Heart Health Network, where we see if we can have an impact on the population as a whole.
First research
In 2016, Dr. Bailey received a $5.2 million award from the Patient-Centered Outcomes Research Institute to study the effectiveness of patient-centered approaches to improving health care for African Americans who lived in underserved areas and suffered from uncontrolled diabetes. He brought together a coalition of Memphis primary care providers to test whether motivational text messaging, health coaching and patient-approved educational materials improved patient medication taking and better care decisions. personal. All three approaches helped patients.
Building on this research, the Tennessee Heart Health Network will help participating medical practices learn how to deliver health coaching and motivational text messages, proven to help people eat better, move more, take regular medication and quitting smoking, which has an impact on cardiovascular health. The network offers toolkits, learning collaborations, newsletters and practice support to help participating healthcare providers across the state.
The Tennessee Heart Health Network is the flagship enterprise of the Tennessee Population Health Consortium, a collaboration of leading academic institutions, health care providers, and other stakeholders aimed at improving health throughout Tennessee.
“The overall goals of our Chancellor and UT are to help move our health rankings in Tennessee from where they are now (near the bottom),” Dr. Bailey says. “The only way to have a chance of doing this is to scale up interventions that have been proven in smaller studies and scale them up. This is research that focuses on outcomes that patients care about and that is centered on their most essential needs.
The Path to Population Health Research
As an undergraduate at St. John’s College in Annapolis, Maryland, Dr. Bailey studied in The Great Books program, which challenges students to think about questions through texts from Homer to Thomas Aquinas and Dante Alighieri to Fyodor Dostoyevsky. This time spent answering life’s big questions may have set him on the path to his work answering the big questions of population health.
“I never thought about becoming a doctor until almost a year and a half after graduating from college,” he says. Interested in international health, a mentor convinced him to join a Ford Foundation-funded child survival project in rural Alabama to train health coaches and community lay people to work with mothers for the first times to help improve childbirth outcomes.
“So my entry was, hey, how can we take community knowledge and use community health workers to really change the trajectory of people’s lives?”
He entered medical school and during his clinical years discovered what he describes as “a knack for caring for individuals, as well as larger populations.”
“I found that I really enjoyed caring for individual patients and I especially enjoyed doing these tips that can help people choose a different path in their own lives where they are their own best doctors,” says Bailey. , who practices internal medicine.
Make the difference
The Tennessee Heart Health Network now includes 65 primary care practices across the state, about 20 in each major division.
“We did what’s called practice facilitation to help them learn and sustainably implement these proven interventions in the primary care setting,” says Dr. Bailey. “We share our information and also try to help in our newsletters with hundreds of health practices and systems and others across the state.”
The network has also worked with health insurance companies across the state, particularly organizations run by TennCare, so practices can charge for providing health coaching services.
Under the direction of Susan Butterworth, a nationally recognized health coach trainer in evidence-based motivational interviewing techniques, UTHSC now offers an online training program for health coaches.
“We train health coaches and help practices deploy these workers into their practice, and then show them how to bill for health coach services so they can sustain those services over time,” says Dr. Bailey .
Brenda Riddle, a certified health coach trained by UTHSC in 2019, has worked at the Methodist internal medicine practice Le Bonheur Healthcare in Stanley Dowell, MD, for decades. Now, Dr. Dowell’s practice works with the Tennessee Heart Health Network, and Riddle runs shared or group medical appointments, where multiple patients can come together and receive counseling and support on issues such as diabetes. , high blood pressure, cholesterol and other health problems.
“I love working with people,” Riddle says. “I’m looking at it through their eyes because it’s not just about them, it’s about me, and it’s really about my family. I have a whole family with all these comorbid issues. We’re just working to make them better.
Building the future
Midway through the AHRQ grant, Dr. Bailey and his team continue to build network infrastructure and communicate with primary care practices across the state. The eventual results of this action research will be measured to determine the success of large-scale interventions.
“There is no phase two of this grant, at least not yet announced,” says Dr. Bailey. “But we are continuing our work. We expect the Heart Health Network to continue for at least the next 10 years, as heart health issues are not going away in Tennessee.
Using a model that has been successful in New Mexico, the network wants to build support for primary care in collaboration with UT Extension, potentially expanding its reach to every county in Tennessee, especially in rural areas.
“We are investing all of this money in health care, and every primary care clinic can be an outpost to provide the most vital population health services, like blood pressure control,” says Dr. Bailey . “We know how to do much better, but it takes primary care activities beyond the walls of the clinic, reaching into the community.”
This story first appeared in the Spring 2023 issue of Our Tennessee magazine.