Incorporating Community Engagement in Primary Care Research Training: Eleven-Year Outcomes.

BACKGROUND: In response to a local workforce need for community-engaged scholars, a community-based participatory research (CBPR) curriculum was incorporated into an established primary care research fellowship. The program prepares researchers to partner with at-risk communities to address root causes and cultural, linguistic, and systems barriers that contribute to health disparities. OBJECTIVES: To describe the context, design, implementation and evaluation of the Academic Fellowship in Primary Care and Community-Engaged Research. METHODS: The traditional primary care research curriculum was enhanced with expanded enrollment, including social scientists with complementary expertise to physician fellows; a structured CBPR seminar series; involvement of fellows in mentored community-academic partnership projects with progression to independence; and relevant teaching and mentoring experiences. EVALUATION: Between 2007 and 2016, 22 fellows enrolled, with 16 in the CBPR track. Fellows demonstrated significant prepost gain in self-assessed competency in CBPR. During their 2- to 3-year training period, each CBPR fellow developed at least one community-academic partnership project, and they collectively produced more than 50 articles and 70 regional or national presentations, and mentored 29 medical student projects. Graduates have assumed leadership positions in academia, and have improved institutional capacity for community-engaged research, teaching, and practice. CONCLUSIONS: Important factors related to success and feasibility of CBPR training within a 2- to 3-year timeframe were having dedicated, experienced faculty mentors with existing authentic, trusted community partners, and dedicated funding for new community-academic partnership projects. This model can prepare primary care researchers and teachers to genuinely collaborate with vulnerable communities to address important health priorities and advance health equity.

Medical Student Views of the Affordable Care Act.

INTRODUCTION: With new insurance coverage under the Affordable Care Act (ACA) beginning in 2014 and the ever-changing practice of medicine, it is important to understand medical students' recent perspectives on health policy and reform. OBJECTIVE: This study describes the opinions, perceptions, and comprehension of the ACA and health care reform by a cross-section of medical students in Wisconsin. METHODS: A total of 578 students (35%) completed an original survey developed from previous surveys. RESULTS: Of those sampled, one-half identified as liberal or very liberal and 20% as conservative or very conservative. Respondents were split equally in their opinions of whether the United States or other nations had the highest quality care. One-half felt that faculty physicians and the media influenced their opinion of the ACA, while two-thirds felt that coursework and peers had no influence on their views. The vast majority sampled thought everyone is entitled to adequate medical care regardless of ability to pay and that physicians have a major responsibility to help reduce health care costs. A majority of liberal students and a minority of conservative students, supported the ACA. Personal and family experience as a patient influenced most liberals to support and most conservatives to oppose the ACA. One-half felt that medical school spent adequate time on health care policy education.

The urban and community health pathway: preparing socially responsive physicians through community-engaged learning.

One of five options for the new required Medical College of Wisconsin Pathways program, the Urban and Community Health Pathway (UCHP), links training with community needs and assets to prepare students with the knowledge, skills, and attitudes to provide effective care in urban, underserved settings; promote community health; and reduce health disparities. Students spend at least 10 hours per month on pathway activities: 4 hours of core material delivered through readings, didactics, case discussions, and site visits; and at least 6 hours of experiential noncore activities applying core competencies, guided by an Individualized Learning Plan and faculty advisor. Noncore activities include community-engaged research, service-learning activities or other relevant experiences, and submission of a synthesis paper addressing pathway competencies. The first cohort of students began their pathways in January 2010. Of 560 participating students, 95 (of which 48 were first-year, 21 second-year, and 26 third-year students) selected UCHP. Core sessions focused on public health, social determinants, cultural humility, poverty, the local healthcare system, and safety net. During noncore time, students engaged in projects addressing homelessness, obesity, advocacy, Hmong and Latino health, HIV, asthma, and violence prevention. Students enjoyed working with peers across classes and favored interactive, community-based sessions over didactics in the classroom. Students' papers reflected a range of service and scholarly activities and a deepened appreciation of social and economic influences on health. The UCHP enriches the traditional curriculum with individualized, community-based experiences to build knowledge about health determinants and skills in partnering with communities to improve health.

Coding for asthma patient education in the primary care setting.

Counseling and education for chronic diseases is a common service provided by primary care physicians. By not using and understanding the basic concepts in documentation and coding, primary care providers deny themselves proper reimbursement for the quality care they provide. Although we have used asthma as an example, concepts discussed here can be applied to other chronic diseases that require patient self-management. We review coding strategies that should be used when counseling and education are the main focus of the patient visit. We review additional procedures and techniques to make office flow, documentation, and coding proceed more smoothly.

Pediatric asthma case management: a review of evidence and an experimental study design.

Asthma is a complex disease that involves physiological, environmental, and psychosocial factors. This paper reviews childhood asthma case management by social service professionals, lay health workers, and nurses, and it presents a new randomized controlled study using nurse case management in a local community coalition. Evidence suggests the common factor for success involves case managers spending time contacting and patiently and persistently working with the family, thus building a trusting relationship. Although case management time is an expense for a health care payer, provider, and the child and family, the positive outcomes achieved can demonstrate the benefit of these interventions to all parties involved. The described experimental study assesses the cost and effectiveness of home-based nurse case management by a community coalition for children visiting an emergency department for asthma care.

Factors associated with physician interventions to address adolescent smoking.

OBJECTIVE: To determine the percent of adolescent Medicaid patients with medical record documentation about tobacco use status and cessation assistance; and factors associated with providers documenting and intervening with adolescent smokers. DATA SOURCE: Secondary analysis of data collected in 1999 from medical records of Wisconsin Medicaid health maintenance organization (HMO) recipients 11 to 21 years old. STUDY DESIGN: Random reviews and data collection were related to visits from January 1997 to January 1999. Data collected included patient demographics, provider type, number of visits, and whether smoking status and cessation interventions were documented. DATA EXTRACTION METHODS: Medical charts were reviewed and a database was created using a data abstraction tool developed and approved by a committee to address tobacco use in Medicaid managed care participants. PRINCIPAL FINDINGS: Among adolescents seen by a physician from 1997 to 1999, tobacco use status was documented in 55 percent of patient charts. Most often tobacco use status was documented on history and physical or prenatal forms. Of identified adolescent smokers, 50 percent were advised to quit, 42 percent assisted, and 16 percent followed for smoking cessation. Pregnant patients were more likely to have tobacco use documented than nonpregnant patients (OR=10.8, 95 percent CI=4.9 to 24). The odds of documentation increased 21 percent for every one-year increase in patient age. CONCLUSIONS: Providers miss opportunities to intervene with adolescents who may be using tobacco. Medical record prompts, similar to the tobacco use question on prenatal forms and the tobacco use vital sign stamp, are essential for reminding providers to consistently document and address tobacco use among adolescents.