A Conversation with Elizabeth Ofili, M.D., M.P.H. or Morehouse School of Medicine
What changes will allow community-engaged scholarship to better address health care disparities?
Academic health centers must align institutional priorities with the health of the surrounding community. 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 and faculty, and resource allocation to support research on health care disparities.
An important limitation is that current paper and electronic records or databases that support clinical practice are not readily adaptable to quantitative health services or outcomes research. Community-based primary care practices that serve predominantly minority patients have a less than 10% adoption rate of electronic medical records. Academic community partnerships should seek opportunities to facilitate adoption of electronic records and uniform data standards by community-based practices, as well as the data collection tools that will 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 review 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?
The Morehouse School of Medicine’s (MSM) Community Physician’s Network (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 promote 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. Greater than 130 practices have joined this network with over 350,000 outpatient visits per year across metro-Atlanta and other parts of Georgia.
A Conversation with Bonnie M. Miller, M. D. of Vanderbilt University
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 are needed to explore possible causes, such as poor access, misdistribution 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/ 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 view 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, 5-10 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. While the Emphasis Program is a student-focused activity, the need for faculty mentors has also increased faculty involvement in community-based projects.