Northwestern University Clinical and Translational Sciences Institute CommunityEngaged Research Cent

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Northwestern University Clinical and
Translational Sciences Institute
Community-Engaged Research Center

• Katherine Kaufer Christoffel, MD, MPH
• Director, Community-Engaged Research Center
• Jen Kauper-Brown, MPH
• Co-Director, Community-Based Participatory
  Research Program
• March 12, 2008

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Statement on Conflicts of Interest

• We have no conflicts to declare.

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(No Transcript)
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Our Mission
The Community-Engaged Research Center is
committed to improving community health by
facilitating collaborative research partnerships
that include Chicago-area organizations,
community-based clinicians and Northwestern
University academic partners.
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Starting Points for NUCATS Work With Community

• To understand improve health
• Must work in community setting, where people live
• Resident health influences include
• Health care of community residents
• Life outside the health care system
• Points of contact with residents include
• Primary care settings
• Non health care delivery settings
• Churches, schools, prisons

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CERC Organization
NUCATS Administration
NU Community Engagement Council

• Other NUCATS Centers
• Translational Innovation
• Clinical Research
• Biomedical Informatics
• Clinical Research Education

Community-Engaged Research Center (CERC)
CERC External Advisory Committee
Practice-Based Research Program
Community-Based Participatory Research Program
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CERC Programs and Activities

• Programs
• Practice-Based Research Program
• Community-Based Participatory Research Program
• Activities
• Northwestern University Community Engagement
  Council
• Seminar Series
• Visiting Professorships
• Research Workshops
• Seed Grants

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Northwestern University Community Engagement
Council

• Open to anyone who works at NU on anything
  related to community
• Faculty, trainees, staff
• Information sharing, maybe more
• Quarterly meetings
• Has met once so far
• Next meeting in April

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Education

• Seminar series
• On CBPR and PBR topics
• One held so far
• Kushner on Chronic Care Model
• Will occur q 1-2 months
• Visiting Professorships
• None scheduled yet

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Research Workshops

• Designed for
• Faculty, fellows, others
• Community physicians
• Community organizations
• More than one of the above
• So far
• CBPR for community orgs (Jen will discuss)
• Geospatial analysis 3/14 at CNT
• Others in planning stages

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Seed Grants

• Goals
• Support community-campus relationship building
• Collect pilot data
• Upcoming calls for proposals soon
• PBR
• CBPR

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PBRP
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Why PBR?

• Primary Care pts
• Unselected, common conditions
• Range of severity
• Avoid Berksons Bias re chronic conditions
• Pts stop coming to the mecca
• Unique research topics, e.g.,
• Delivery of primary care
• Preventive care, chronic disease management
• Primary care pts and provider characteristics
• Educational needs of primary care pts

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Practice-Based Research Program
NU Clinical and Translational Researchers

• Other NUCATS Elements
• Regulatory Support
• Biomedical informatics
• Career Development
• Clinical Research Center

CERC
Helen Binns, MD, MPH and Adolfo Ariza,
MD Interim Co-Directors

Practice-Based Research Program
Executive Director Practice-Based Research Program
REACH/NMH Hospital Network David Baker, MD, MPH,
Director
Evanston Northwestern Healthcare Network Thomas
Gavagan, MD Director
Pediatric Practice Research Group Helen Binns,
MD, MPH, Director
Practice
Practice
Practice
Practice
Practice
Practice
Practice
Practice
Research projects are encouraged between practice
networks
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Some Examples of Adult PBR Research at NU-Thanks
to Dave Baker
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UPQUAL Utilizing Precision Performance
Measurement to Improve Quality

• Develop test new EMR tools to help MDs order
  recommended tests or meds
• Allow easy documentation of reasons for not
  ordering tests or prescribing meds
• Improve quality measurement
• ID of pts w gaps in care for outreach
• Being conducted in two of our PBRNs

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Documentation of Patient Reasons Used to Improve
Care

• Information recorded by MD is automatically sent
  to care manager
• i.e., Patient declines care (e.g., cancer
  screening, vaccination)
• Care manager provide further education and
  outreach if physician desires
• i.e., Patient cannot afford care
• Care manager contacts patient to find ways to
  afford care (eg, free med programs)

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UPQUAL Study Sites and Team

• REACH NMFF GIM clinic
• (NMFF) Dave Baker, Steve Persell, Nancy Dolan
• (IT) Darren Kaiser, Dale Sanders, Jason Thompson
• ENH 2 FM and 2 IM clinics
• (IM) Janu Khandekar
• (FM) Russell Robertson, Tom Gavagan,
• (IT) Tom Smith, Steve Smith, Sue Levi

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Pediatric Practice Research Group
Examples-Thanks to Helen Binns and Adolfo Ariza
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Seconds for Care Frequency of Discussions

• Healthy Families Healthy Children Study
• N185, 2-10 y
• 6 practices
• Well child visits
• Events and actions timed by observers on handheld
  computers

Martin et al, J Pediatr 2008, in press
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Seconds for Care Time on Topic
Martin L, et al, J Pediatr 2008, in press
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Typical Pediatric Visit Observation of Visit
Content

• Children 2-10 years
• 4 practices
• Well child visits
• n174 visits with child ?5th BMI percentile
• Events and actions timed by observers collecting
  data on handheld computers

Ariza et al. PPRG
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Typical Pediatric Visit Observation of Visit
Seconds by Content
Seconds
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Ariza et al. PPRG
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CBPR-P
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Background

• Why CBPR?
• What is CBPR?- definition, principles, spectrum
  of engagement
• Benefits of CBPR
• Description of NU CBPR Program
• Resources/opportunities for academic partners

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Why are we here?

• Persistence of health disparities
• Limitations of current research approaches
• Growing appreciation of the value of
  partnerships, Community engaged research movement
• Greater demand by communities for equity and
  research relevance

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Defining Community-Based Participatory Research
(CBPR)

• A collaborative approach to research that
  equitably involves all partners in the research
  process and recognizes the unique strengths that
  each brings.  CBPR begins with a research topic
  of importance to the community and has the aim of
  combining knowledge with action and achieving
  social change...
• W K Kellogg Community Health Scholars Program

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CBPR Key Principles

• Recognizes community as a unit of identity
• Builds on strengths resources within community
• Facilitates collaboration in all phases of
  research
• Integrates knowledge action for mutual benefit
  of all partners

Israel BA, EngE, Schulz AJ, and Parker EA eds.
(2005) Methods in community-based participatory
research for health. Jossey-Bass San Francisco,
CA.
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CBPR Key Principles (contd)

• Promotes co-learning empowering process
• Involves a cyclical and iterative process
• Addresses health from positive ecological
  perspectives
• Disseminates findings knowledge gained to all
  partners

Israel BA, EngE, Schulz AJ, and Parker EA eds.
(2005) Methods in community-based participatory
research for health. Jossey-Bass San Francisco,
CA.
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What is the difference?

• Traditional
• PI-generated/ initiated
• Research on
• PI in control
• Limited sharing of resources
• Researcher is expert
• Project ends when data are analyzed

• CBPR
• Collaboratively generated/designed
• Research with
• Shared governance/ ownership
• Shared resources/
• Honors comm knowledge
• Makes sure what is learned is used

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Benefits/Value Added of CBPR Approach

• Enhances relevance and quality of data
• Strengthens intervention design/implementation,
  Recruitment and Retention
• Knowledge gained/interventions/resources benefit
  community
• Increases trust between partners
• Potential to translate findings to guide further
  interventions policy change

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Growing Legitimacy Current Reality

• Increasing funding, diversity of study,
  publishing, training/resources
• But
• Predominant model NOT partnership
• Relationships based on individuals/funding
• Communities realizing their power
• Big differences btwn mature early partnerships

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CBPR Case Example Detroit Urban Research Center
Project Community Action Against Asthma Goal To
understand and address environmental triggers of
childhood asthma Funder NIEHS Partners
Multiple CBOs, community members at large,
Detroit Health Dept, Henry Ford Health System,
UM-Schools of Medicine Public Health
http//www.sph.umich.edu/urc/
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CAAA Background/ Research Components

• Epidemiological Outdoor air quality _at_ community
  schools, indoor at schools/ house-holds, health
  outcome data for enrolled children
• Household-level intervention Home visits w/
  edn- staggered randomized design. Household
  assessment/questionnaires w/caregivers kids
• Neighborhood-level intervention Community
  organizing w/residents to reduce
  neighborhood-level environmental stressors

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CAAA Partnership Components

• Formation/Mobilization
• Identifying the Problem
• Research Design and Project Start-up
• Implementation
• Recruitment of Participants Development of Data
  Collection Methods
• Baseline Data Collection Intervention
  Implementation
• Ongoing evaluation/reflection/sustainability

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CBPR Program _at_ NU

• Goal Supports promotes engaged research
  between Chicago community organizations and
  Northwestern academic partners that respects
  community input and builds upon strengths of
  involving community partners in all aspects of
  research
• Long-term relationships with community groups
• Lead to action/improvements in health
• Programs goals/objectives jointly defined by
  steering committee  

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CBPR-P Steering Committee
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CBPR-P Activities/ Programs

• Seed Grants- 1st RFP in March
• Partnership building
• CBPR implementation
• Capacity Building/Training
• For NU faculty/staff/students and community
  partners
• Collaborative research partnerships, Basics of
  Research, Methods, Dissemination
• Partnership Facilitation
• Networking events, Individual brokering

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CBPR-P Activities/ Programs

• Info Clearinghouse
• Website, CERC Connections newsletter
• Technical Assistance
• Proposal preparation
• Partnership design/support
• Community Networkers
• Liaisons for bi-directional communication

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Resources _at_ www.ccph.info

• Online Clearinghouse Sample CBPR course syllabi,
  publications, related projects/events
• CBPR Partnership Curriculum
• Faculty Promotion and Tenure Tools Online
  toolkit for faculty, sample policies
• IRB Resources
• CBPR, PT, Ethics/IRB Listservs

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CERC Contact Information

• CERC
• Michelle Melin-Rogovin
• m-melin-rogovin_at_northwestern.edu
• 312-503-5050
• CBPR Questions
• Jen Kauper-Brown
• j-kauper-brown_at_northwestern.edu
• 312-503-2942
• http//www.nucats.northwestern.edu/centers/cerc/in
  dex.html
• Located in Rubloff moving to 11th floor in May
  2008