Robust partnerships between rural community health education centers and academic health care institutions can make substantial strides toward addressing race-, income- and geographically-based health disparities in underserved communities by empowering both the community and leading University institutions, according to newly published research from the University of Maryland School of Medicine.
University of Maryland Medical Researcher Claudia R. Baquet, MD, MPH, and her team examined 17 years of a partnership between the University of Maryland School of Medicine and a rural health education non-profit on Maryland's Eastern Shore, the Eastern Shore Area Health Education Center (ESAHEC). The research team found that rural communities were more willing to participate in clinical trials and biospecimen donations when long-term partnerships were established between University Medical Centers in cooperation with local community health educational centers. The paper was published in the most recent issue of Progress in Community Health Partnerships: Research, Education and Action, a journal published by Johns Hopkins University Press.
"Maryland's Eastern Shore has a rich history of ethnic, racial and cultural diversity in their communities," says Dr. Baquet, professor and associate dean for policy and planning and director of the Center for Health Disparities at the University of Maryland School of Medicine. "The Eastern Shore represents populations with unique health disparities that are amenable to targeted interventions, " she says.
But like many rural regions in the state, the Eastern shore has unique needs when it comes to health care.
"Its residents have higher rates of cancer and chronic disease than those who live in urban areas," she says. Furthermore, the area lacks public transportation systems to take patients to and from health care. It also has a growing number of older residents who are Medicare-eligible yet are not aware of the services available to them."
The researchers, who formed this partnership, envision that the partnership will become a model for other programs throughout the country, fostering community-engaged research, particularly among rural communities. The partnership between the ESAHEC and the School of Medicine is funded by grants from the National Cancer Institute's (NCI) Center to Reduce Cancer Health Disparities (CRCHD) and the NIH National Institute on Minority Health and Health Disparities (NIMHD).
"Dr. Baquet's research is representative of the kind of study the NCI Center to Reduce Cancer Health Disparities has been promoting since the Center's inception over a decade ago," says Sanya A. Springfield, PhD, CRCHD's director.
"It's gratifying to see Dr. Baquet's research reflect how a model of mutual respect and trust can lead to community empowerment, a refocus on healthy lifestyle behaviors, and increased willingness to participate in clinical trials and biospecimen donation among our underserved communities. These are all essential components to building greater capacity, eliminating disparities, and advancing the science of cancer health disparities.," Dr. Springfield said.
The researchers describe the relationship between the School of Medicine's Office of Policy and Planning and the ESAHEC, a nonprofit funded by the Health Resources Services Administration and the Maryland health department. The goal of the ESAHEC is to use educational partnerships to help address shortages in primary care and specialty health professionals in the nine rural counties that make up the Eastern Shore of Maryland.
"This ongoing research partnership with the ESAHEC is special in its truly bi-directional nature, in which both partners participate fully in the research process and each benefits from the other's expertise," says Dr. Baquet.
ESAHEC's educational programs include a Bioethics Mini-Medical School for the public and other research and health-topic training for the rural community, as well as continuing education for established health care professionals and a health career education track for children from Grade 8 through Grade 12.
The Eastern Shore ESAHEC is one of three partnerships in Maryland and 255 in the nation.
Outreach that educates the community and community health professionals about health care and research is core to the issue of improving health care outcomes, increasing access and addressing health disparities, says Baquet.
Increasing public trust in research is another major benefit of the program. Examples of types of research jointly conducted by the partners includes: research on barriers to clinical trial participation, strategies to address biospecimen donation for future research purposes, telehealth training, bioethics barriers to research participation, patient navigation to cancer screening for rural and urban communities.
"We are hoping that our outreach will encourage greater community trust in academic researchers and greater participation in research, allowing academics to better understand and address the issues facing rural communities," Baquet says. "In turn, we hope that academic health center faculty will become more culturally competent, responsive to community needs and expertise and will learn to include community organizations as meaningful partners in their research. This model has a higher potential for sustainability than the approach that we call 'helicopter research,' where academics conduct studies but do not share their results or return any benefit to the community."
"We do have a truly bidirectional partnership," says Jeanne Bromwell, co-author of the article and deputy director and continuing education coordinator at the ESAHEC. "Dr. Baquet respects our role in the community and we very much respect her knowledge and contacts through the School of Medicine. People here often look at academics as outsiders. With our contacts down here, we are able to bring Dr. Baquet's expertise to the community in a way that does not make them feel threatened. It is a phenomenal relationship."
The research results are used to develop new programs to educate community members about bioethics and the benefits of clinical research, easing their concerns and suspicions about such studies. Community members have participated in research examining the use of community health workers as patient navigators for cancer screening for African-American patients. They also participated in research that found that telehome care patient monitoring of home health patients with certain chronic diseases improves outcomes. The partnership with the medical school also has provided the ESAHEC access to critical funding for which it would not otherwise be eligible.
The program continues to form bonds between the School of Medicine and its students and the residents and health professionals on the Eastern Shore, in keeping with the School's mission, says E. Albert Reece, MD, PhD, MBA, vice president for medical affairs of the University of Maryland and John Z. and Akiko K. Bowers Distinguished Professor and dean of the School of Medicine. "The School of Medicine's mission reaches well beyond Baltimore, throughout the state of Maryland, the nation and, indeed, the world," says Dr. Reece. "We hope that our incredibly valuable partnership with our colleagues on the Eastern Shore will serve as a model for other academic medical institutions across the country, creating a new future for the health of America's rural residents."