Community-Based Participatory
Research: Working with
Community Health Centers
Michelle Proser
Director of Policy Research
National Association of Community Health Centers
mproser@nachc.com ~ (202) 296-1960
2007 Academy Health Annual Research Meeting
“Enhancing Research Through Collaborative Community-Higher Education
Partnerships: Models of Community-Based Participatory Research”
Health Centers 101
 Over 16 million patients, of whom:
 40% are uninsured
 36% have Medicaid
 92% are low income
 64% are minority
(2005 Uniform Data System, BPHC, HRSA, HHS)
 Over 1,100 organizations, 6,000 sites
 Located in Medically Underserved Areas
 Open to all
Source: See www.nachc.com/research
National Association of Community Health Centers
June 4, 2007
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Health Centers Patients
 Account for roughly:
 1 in 9 Medicaid beneficiaries
 1 in 7 uninsured persons
 1 in 4 people in poverty
 1 in 10 racial/ethnic minorities
 1 in 9 rural Americans
 Patients are sicker than general public
 Number of uninsured, low income, and
Medicaid patients rising faster than
counterparts nationally
Source: See www.nachc.com/research
Figure 1
Uninsured Ambulatory Care Visits by
Provider Type, 2004
Health **
Centers
22%
Hospital ER
20%
Private
Physicians*
52%
Hospital
Outpatient
Departments
7%
*Includes all non-federally employed physicians outside hospitals and federally-run facilities.
** Assumes the proportion of visits for the uninsured equals the proportion of patients that are uninsured.
Sources: Private Physicians from 2004 NAMCS (CDC National Center for Health Statistics, 2006). Hospital Outpatient and ER from 2004
NHAMCS (CDC National Center for Health Statistics, 2006). Health Center from 2004 Uniform Data System, BPHC, HRSA, HHS.
Figure 2
Health Center Patient Visits
by Type of Service
Behavioral Health
5%
Medical
Care
76%
Dental
10%
Enabling
Services*
7%
Other
2%
Total = 60 million encounters** in 2005
* Encounters for enabling services include visits to case managers and health educators.
** Estimate includes both federally funded and non-federally funded health centers.
Source: NACHC, 2006. Based on 2000-2005 Uniform Data System, Bureau of Primary Health Care, HRSA, HHS.
Why do CBPR with Health Centers?
 Community-focused
 Patient-majority governing boards
 Focus on community health
 Knowledge of specific community needs
 Diverse patient population, in terms of:
 Chronic illness and case mix
 Age
 Insurance Status
 Serve populations traditionally excluded from
research
 History of Quality Improvement Initiatives
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Why do CBPR with Health Centers?
 History of data reporting and growing use
of Health Information Technology
 In 2006, 26% reported some EMR capacity,
and nearly 90% maintain at least one disease
registry
 Participation in networks (vertical and
horizontal)
 Infrastructure that speeds dissemination
 Growing numbers already participating in
research or want to
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June 4, 2007
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Health Centers and
the Medically Underserved:
Building a Research Agenda
National Association of Community Health Centers
June 4, 2007
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Why a Research Meeting?
 Purpose: To lay out immediate and future
research priorities for health centers and the
medically underserved
 Goal: To develop a consensus-driven
research agenda by engaging a diverse group
of stakeholders
 Focus on 3 research domains
 Health Information Technology (HIT)
 Quality and Quality Improvement
 Cost Effectiveness and Value
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Quality & Quality Improvement
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How we improve quality from where we are
now
Identifying and implementing features
linked to quality improvement
Better defining quality
Staffing and services
Community impacts
Incentives for quality improvement
Disseminating best practices
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Health Information
Technology
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Articulating a business case for HIT adoption
Identifying the continuum of HIT use at health
centers
Identifying HIT functions and technology
issues
Identifying barriers to adoption
Determining impact of financial incentives for
HIT adoption
Determining the impact on care delivery
Determining and measuring indicators of
success
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Cost Effectiveness & Value
 Value compared to other providers or lack
thereof
 Identifying features linked to cost
effectiveness
 Determining return on investment
(especially for Medicaid)
 Identifying long-term and downstream
cost savings
 Community impact
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Where Do We Go From Here?
 Disseminate meeting proceedings
and research agenda
 Future meetings to monitor progress
on agenda and additional research
needs
 Research agenda should address the
core mission of health centers
 Research agenda should be flexible
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Reaching Out to Health Centers
 Let NACHC or state Primary Care Associations help
 Email me or see www.nachc.com/primcare/srpcalist.asp
 Join CCPH listserv
http://depts.washington.edu/ccph/index.html
 For more info on health centers, visit
www.nachc.com/research
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National, State-level and other data
Summaries of literature
Reports, fact sheets
Chartbook
Info on health center research meetings
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