Research and Evaluation

The Research and Evaluation unit of the Division of Community Health evaluates division programs and collaborations, conducts externally-funded evaluation and research, and disseminates what is learned in multiple ways.

Researchers participate in the division’s teaching and advising mission, including developing new curricula and teaching materials. In addition to participating in the division’s educational program, researchers teach medical students and family medicine residents in the Department of Family Medicine and Community Health, among others.

Evaluation of Division Programs

As a learning organization, the Division of Community Health continually evaluates our programs and collaborations. Evaluations range from assessment of program implementation to collection of client and patient perspectives to documenting program outcomes, such as improved access to care, changes in health management and health status, and reductions in emergency room use. Decisions about evaluation questions and methods are made together with those who make these programs happen. Our goal is to enhance the relevance of evaluation and reduce the burden on program staff.

Partner Evaluation Survey

To enhance its efforts to contribute to the health of Durham and other communities, the Duke Division of Community Health surveys its partners about their satisfaction with and perception of the outcomes of the Division’s work.  Survey questions addressed satisfaction with Division collaborations, the impact of these collaborations on the health of the community, and related issues. Read the most recent survey results.

Externally-Funded Research and Evaluation

The division conducts and collaborates on externally-funded research and evaluation related to the division’s mission of finding new ways to improve population health, especially for the underserved.

See the video/transcript of Mina Silberberg, PhD, Vice Chief for Research and Evaluation, Duke Division of Community Health, discussing the difference between research and monitoring & evaluation and how it plays an integral role in improving population health and all the multiple factors that we know affect health.

The following are other current or ongoing projects:

Increasing Housing Stability: Assessing Promising Tenancy Support Models to Inform Local, State, and National Policy and Practice

PIs: Mina Silberberg, Emily Carmody, Donna J. Biederman

Homelessness and poor health are inextricably linked, making homelessness and housing public health issues. People who are homeless are subject to conditions that directly and adversely impact mental and physical health and create significant challenges to accessing health care. Securing stable housing is therefore a crucial resource for individuals with physical and mental health issues and an integral part of treatment and recovery. However, obtaining housing is only the first step to ending homelessness. Those who are newly housed can face a number of challenges maintaining housing. Experts in the field increasingly favor supportive housing models. This approach combines affordable housing with tenancy support services (TSS) — ranging from assistance with housing applications to help with self-care and socialization once housed — and is associated with increased housing stability and decreases in homelessness over time. Supportive housing also creates the possibility for individuals currently living in institutionalized settings to safely transition to living independently in the community. Moreover, in addition to housing stability’s indirect effects on health, TSS can directly impact health by supporting individuals with self-care and accessing health services.

To support beneficiaries in obtaining and remaining in stable community-based housing, the Center for Medicare and Medicaid Services (CMS) is encouraging states to use Medicaid to fund TSS. North Carolina (NC) is joining the ranks of those states using this opportunity to support housing for people with disabilities. However, there is significant work to be done to see this opportunity fully realized. Ensuring that services provided are effective for diverse populations while being widely available requires a clear definition of TSS, effective practice guidelines and training protocols, quality assurance protocols and regulations, appropriate integration of TSS with other services, and robust contracting and reimbursement systems. Developing these policies and practices in turn requires research on what TSS are needed, who can effectively provide TSS, the training necessary for effective service provision, appropriate outcomes for assessing TSS effectiveness, and the contextual and organizational factors that will support widespread availability of services for diverse populations.

To help identify effective service provider, funding and regulatory/oversight practices, we are studying: 1) two NC agencies considered to be in the vanguard of efforts to house the homeless: Homeward Bound and the UNC Center for Excellence in Community Mental Health, 2) the perspectives of NC state officials and housing specialists at the Local Management Entities that oversee safety net mental health, disability, and substance abuse services, and 3)experiences in the State of Louisiana (LA), which is a forerunner in the use of Medicaid funds for TSS. Using a mix of qualitative and quantitative methods, our research answers the following questions: 1. What constitutes effectiveness (i.e., what do providers and clients perceive to be the key outcomes of supportive housing)? To what extent is improved health considered to be one of those outcomes? 2. What are the practices of effective TSS providers? 3.Which aspects of provider agency context support effective TSS that is responsive to client needs and accessible to a diverse population? Which create challenges? 4.Which aspects of local, state, and federal regulation support delivery of effective TSS that is responsive to client needs and accessible to a diverse population? Which create challenges? What specific challenges do provider agencies foresee for agencies that might participate in provider networks? What types of support would facilitate network participation? Practice implications of study findings will be explored through a stakeholder symposium. This project is funded by the Robert Wood Johnson Foundation through its Interdisciplinary Research Leaders program.

Addressing Barriers to Adult Hearing Healthcare

PIs: Debara Tucci and David Witsell, Dept. of Surgery

The goals of this project are to: 1) determine what level of involvement by the primary care practitioner (PCP) is required to inform and encourage adults age 65-75 to follow through with routine hearing screening; 2) develop a model of effective adult hearing screening, based on resource utilization and screening compliance in each intervention group, that maximizes identification of hearing loss in affected patients and minimizes burden to the PCP and patient; 3) determine what factors are important to adults 65-75 in making decisions about hearing screening and interventions and develop strategies to optimize appropriate intervention; and 4) provide data on the ability of patients, audiologists and primary care providers to identify significant medical conditions that should be evaluated by an ear specialist prior to hearing aid procurement.  

Community Engaged Research

Community Engaged Research (CEnR) “begins with a research topic of importance to the community, has the aim of combining knowledge with action and achieving social change to improve health outcomes and eliminate health disparities" (WK Kellogg Foundation Community Health Scholars Program (2012)).

The Research and Evaluation unit conducts community engaged research projects and provides guidance, resources and training to other researchers using this approach.

Key aspects of our work in CEnR include:

  • Working on projects of importance to the community.
  • The presence of community stakeholders on project steering committees and other deliberative and decision-making bodies
  • Community advisory boards
  • Compensation for the community’s time and other contributions
  • Dissemination of results back to the community

Disseminate Models, Lessons Learned, and other Research/Evaluation Findings

The Research and Evaluation unit of the Division of Community Health seeks to share what we have learned about improving population health with a wide variety of stakeholders. Modes of dissemination include: