For a decade, investigators at the National Center for Primary Care at the Morehouse School of Medicine (MSM) have conducted primary care practice-based research in partnership with community health center clinicians. The Southeast Regional Clinicians’ Network (SERCN)/Morehouse School of Medicine practice-based research Network (PBRN) represents health care professionals who work in 171 federally-qualified health center (FQHC) organizations across eight southeastern states, and provides over 3 million patient visits per year to a low-income, high-disparity patient population. From this disenfranchised population, 58 percent are African American and 13 percent are Hispanic /Latino. The majority of patients are medically underserved and living in poverty; 63.2 percent are at or below poverty, and approximately 45 percent of patients served by health centers in the Southeast Region are uninsured.

In 2011, the Carnegie Foundation for the Advancement of Teaching awarded its Community Engagement recognition to MSM, indicating that the medical school and the community are partners. Carnegie specifically defines engagement as a collaboration between a university and its region for the mutually beneficial exchange of knowledge and resources. For example, we developed the A-B-C-D (A - glycosylated hemoglobin [A1c], B - blood pressure, C - cholesterol, and D -depression) community health worker programs, an interactive patient education program delivered by a CHW to improve control of A-B-C-D cardiovascular disease (CVD) risk factors. Recently, MSM researchers added a D-factor, for depression.  

We first pilot tested using Community Health Workers (CHWs) to test the effectiveness of recruiting African Americans in churches. For the intervention group, CHWs participated in a 16-hour training session and delivered a 6-week tailored educational program with counseling sessions and demonstrations. The control group received a weekly lecture by clinical experts. We recently completed the regional dissemination of this project training 30 CHW to work in 10 Federally Qualified Health Centers (FQHCs) to provide self-management support to persons living with diabetes and have multiple, uncontrolled cardiovascular risk factors. 

The SERCN/MSM PBRN has completed 15 studies and currently has 3 in various stages of development. Many of these studies have been published in peer-reviewed journals.  

Selected Preliminary Studies

The NCPC has already established a significant track record relevant to this proposal in two broad categories: 1) community-level practice-based research (T2 translational block); and 2) large data set/population health outcomes research. External funding for the Center has grown to roughly $10 million per year. Staffing and faculty investigators have grown proportionately to support community-based interventions and health outcomes research, and we have added capacity to analyze larger data sets such as Medicaid claims data, state-wide hospital discharge data, and network-generated chart audits

Asthma. We conducted an eight-state, group-randomized, controlled trial of a multi-dimensional quality intervention for community health centers that serve high-disparity, underserved populations (Daniels, Rust, et al. J Asthma, 2005). This intervention included provision of needed resources (peak flow meters, spacers, educational materials, and steroid inhalers), interactive training of all staff and providers, and systems change (standing orders, flow sheets, and feedback loops). 

Diabetes.  We recently pilot-tested the feasibility and impact of protocol-driven point-of-care HbA1c testing on levels of glycemic control and on rates of diabetic regimen intensification, in an urban community health center serving a high-disparity patient population (Rust et al,  International Journal of Health Care Quality, 2007). 

Cancer Screening. In 2005, we completed the “Get Your Tests” study in collaboration with the American Cancer Society to test a patient and provider reminder system for age appropriate cancer screening in federally qualified health centers in Georgia and South Carolina. The reminder system was implemented over three months and targeted adult patients age 40 years and older. In the group that used the educational prompts, we found an increase in documentation that cancer screening was discussed (36 percent improvement), and that age appropriate screening was ordered (10 percent improvement). 

Breast Cancer. We have conducted descriptive research at FQHCs.  For example, the Patient/Provider/System Model surveys were conducted with African-American women (n= 179, x̅ age = 34 years) using the Breast Cancer Perceptions and Knowledge Survey and a demographic questionnaire. Breast cancer pamphlets available at the FQHCs were evaluated on the basis of their readability, and the extent to which they challenged misperceptions.

Colorectal cancer. Focus groups (n = 9) among African Americans (n = 43) in Georgia were conducted to assess their knowledge, attitudes and beliefs towards Colorectal Cancer Screening (CRCS). Most lacked knowledge of CRC, its risks, and available CRCS options. Moreover, most of the participants believed that CRC is largely hereditary or caused by improper diet. The major perceived barriers were fear, cost, and stigma; the major perceived benefits considered CRC preventable when detected early. The major facilitators were doctor recommendations and knowing a family member or friend with CRC. This data was used to develop the situational DVD, which was pilot-tested for acceptability. A Patient-Centered Outcomes Research Institute (PCORI) grant was recently submitted focusing on shared decision making, which involved the use of the culturally-tailored DVD to inform patients of the various screening options.