Elizabeth Ofili, MD, MPH, FACC
Associate Dean, Clinical Research and
Director, Clinical Research
Center
Morehouse School of Medicine
eofili@msm.edu
What changes will allow community-engaged scholarship to better address health care disparities?
Academic health centers must align institutional priorities
with the health of their surrounding communities. Community-based
scholarship is well-suited to address health care disparities
when the following strategies are actively pursued: partnership
with minority communities and institutions, recruitment of
a diverse student body and faculty, and resource allocation
to support research on health care disparities.
Less than 10 percent of community-based primary care practices
use electronic medical records and many record systems and
databases that support clinical practice are not readily adaptable
to quantitative health services or outcomes research. Adoption
of electronic records and uniform data standards by community-based
practices, as well as the data collection tools, would better
support longitudinal practice-based outcome studies.
What are the challenges that hinder faculty participation in community-based research?
Faculty interested in community-based research face a number
of challenges: lack of an existing infrastructure to support
community-based research; lack of structured training and
preparation for community-based research; significant hurdles
with the scientific peer-review process for funding; and limited
quantity and quality of scientific peer-reviewed journals
with a strong interest in community-based research.
Furthermore, appointment and promotion committees are also less familiar with the scientific rigors of community-based research that is outside the field of epidemiology.
How is your institution supporting community-based scholarship?
Morehouse School of Medicine has a long-standing education
and research partnership with the community. One such example
that focuses on community-based physicians is the Communty
Physicians' Network (CPN). The CPN is an academic community
partnership that is transforming health through scientific
discovery and collaboration. The CPN consortium of primary
care and multi-specialty community-based health care practitioners
in partnership with MSM aims to reduce health disparities
through innovative educational programs, clinical research
participation, and practice-based interventions.
The mission and focus of the consortium promotes equity in
health care by expanding the African-American, Hispanic, and
other minority practitioner base in clinical research and
by increasing participation of African-American and other
ethnic minority patients in clinical trials and community-based
research. More than 130 practices have joined this network
with over 350,000 outpatient visits per year across metro-Atlanta
and other parts of Georgia.
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Bonnie M. Miller, MD
Associate Dean, Undergraduate Medical Education
Vanderbilt University
bonnie.miller@vanderbilt.edu
What must community-based research address in order to make
an impact on health care disparities?
To make an impact on the disparities in health care and outcomes, research must address potential causes as well as potential interventions. The community must see academic health centers as dedicated and trusted partners in the mission to improve community health.
This direct involvement and trust is needed to explore possible
causes, such as poor access, maldistribution of resources,
biases, and problems with patients' adherence, as well as
targeted interventions such as improved prevention, screening,
and safety net programs. This trust is also critical to secure
the participation of community members in clinical and translational
research projects. The outcomes of these projects might elucidate
potential biological causes for disparities.
What changes, infrastructure, and support do institutions need to make to encourage faculty to engage in community-based scholarship?
Ideally, community-based scholarship should be aligned with institutional goals to improve the health of the surrounding community.
Interested faculty must have the support of their department
and/or division leaders. Faculty members need to be assured
that the promotions and tenure process views this area of
scholarship as legitimate and worthwhile. The platforms for
dissemination of such scholarship may not be familiar to promotions
committees, so this may require education for the committee's
membership.
How is your institution supporting community-based scholarship?
In 2003, Vanderbilt initiated a new required program for
our first- and second-year students called the Emphasis
Program. Students carry out a two-year mentored scholarly
project in one of nine areas related to medicine.
One of the areas, Community Health Initiatives, allows self-selected students to carry out a community-based project under the supervision of both a faculty and a community mentor. Students in this group meet regularly with the faculty Area Head, who provides core knowledge and skills about such topics as grant writing, needs assessments, and community relationships.
So far, five to ten students each year have chosen this
Emphasis Program area, and their projects have been extremely
successful. Students have had abstracts selected for national
presentation. One project led to changes in the way psychiatric
medications are prescribed in the local women's prison. Although
the Emphasis Program is a student-focused activity, the need
for faculty mentors has also increased faculty involvement
in community-based projects.
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