© 2010 College of Medicine Welcome! ¡Bienvenidos!

© 2010 College of Medicine

Welcome!

¡Bienvenidos!


U.S. - Mexico BorderCenter of Excellence Consortium:

Current and Future Directions

Ana Maria Lopez, MD, MPH, FACPAssociate Dean for Outreach and Multicultural Affairs

Professor of Medicine and Pathology

Medical Director, Arizona Telemedicine Program

University of Arizona College of Medicine


California

New Mexico

Texas

Arizona

U.S. - Mexico BorderCenter of Excellence Consortium


Acknowledgement


US Mexico Border Center of Excellence Consortium

Who are we?What is our overarching goal?What have we accomplished?What is our current focus?


United States-Mexico Border Center of Excellence Consortium

Developed with the purpose of more clearly defining the needs of health professionals, especially physicians, dentists, pharmacists and nurses in the border region.

Encouraged partnerships via communication, collaboration and coordination with various health professional schools, organizations, HRSA funded programs, and international collaboratives


Who are we?

• Consortium formed by the existing Centers of Excellence (COEs) along the border states in 2002

• Efforts to date have focused on:

- Direct health service workforce- Research workforce capacity- Model programs- Community service learning health curriculum- Community engagement programs


COE Consortium Members• University of Arizona• University of California, San Diego• University of California, San Francisco• University of California, Los Angeles• University of New Mexico, School of Medicine• University of Texas at Austin-(Pharmacy)• University of Texas at Houston HSC• University of Texas Medical Branch at Galveston• University of Texas at San Antonio (Medical and

Dental)• Texas Tech University HSC at El Paso


National and Regional Partners• Hispanic Association of

Colleges and Universities

• Hispanic Serving Health Professions Schools and Schools of Public Health

• US Mexico Border Health Commission

• US Mexico Health Association

• Pan American Health Organization

• Minority Faculty Fellowship Program

• Centers of Excellence Program• Area Health Education Ctrs• Community Health Centers• US Mexico Border Health

Association• Border Health Office• HRSA Regional Office• TX Department of Health• Health Careers Opportunity

Program


Consortium Goals

• To develop and implement a strategic plan to reduce the health professional workforce shortages along the U.S. - Mexico border.

• To eliminate health disparities within our border community by addressing workforce capacity and their education and training needs


Specific Goals

Assess the needs and resources related to health professions research workforce capacity and diversity of HRSA funded programs;

Address research education and training along the U.S.-México Border States;

Serve as a resource for other research programs and institutions with an interest in increasing the health research workforce in the region.


Defining Needs

Consortium core members selected two reports to help conceptualize needs and goals along the US-México Border:

• Healthy Border 2010 (US-México Border Health Commission, HRSA, 2003)

• Border Health Research Agenda Council Meeting Report (PAHO, 2002).


Direct Health Service Workforce2002-03

• Defined the health workforce pool

• Determined demographics and health status of the border population

• Identified gaps in workforce

• Established collaboration efforts


Next Area of Focus and Direction

As the next step in addressing workforce shortage: research Develop an inventory and database of

completed and existing research along the U.S.-México Border


Research Workforce Capacity2004-05

• Defined the extent of shortages in health research workforce

• Identified barriers to achieving research parity with the rest of the region and the nation by developing the following databases:

- Current research programs on the U.S.-Mexico border- Latino research training programs in our own institutions- Currently funded research projects that target health disparities along the border


Research Database Project

Main Objective: identify border health disparities research

projects• Cancer• Cardiovascular Disease• Infant Mortality• Immunizations• Diabetes• HIV/AIDS


Model Programs2005-06

• Identified model programs related to health promotion and service, health disparities research and workforce training activities:

- Developed a resource guidebook of model programs

• Exposed health professions students and faculty to border primary health, environmental, and public health concerns through:

- Clinical rotations- Internships- Border health training- Collaborations among agencies and programs along border


Community Service Learning 2006-07

Developed a community service learning health curriculum: - Culturally and linguistically competent

- Gender sensitive and specific- Incorporates community service learning

- Utilizes promotoras as lay teachers for health profession students


Community Service Learning 2006-07

• Service learning in clinical education: Balance between service and learning

objectives Emphasis on reciprocal learning Integrating the role of community

partners Emphasis on self-reflective practice


Community Engagement2007-08

“Community-Based Programs to Create Community-Responsive Health Professional Workforce” keeping connected to our communities teaching students to become future leaders

Sub-themes community engagement community service health literacy


How Does Research Translate into Best Practices?

2008-09

Outlined approach to new questions How can research effectively and practically be

translated into clinical practice? How can practice inform research? Are both questions equally important?


Identified Emerging Collaborators

Considered collaborative activities with:

National Institute of Health

Agency for Health Research and Quality (AHRQ),

The National Library of Medicine (NLM)

Continuing Education (CE/CME) Providers


National Institute of Health

Excellence in Partnerships for Community Outreach, Research on Health Disparities and Training (Project EXPORT) at University of Arizona University of California at San Diego University of Texas at El Paso

Clinical and Translational Science Awards (CTSA)


EXPORT Model research programs addressing health

disparities along the US-Mexico Border selected for inclusion in the Consortium Research Database Project.

Funded by National Institutes of Health, National Center on Minority Health and Health Disparities (NCMHD)

NCMHD supports basic, clinical, and behavioral research, promotes research infrastructure and training, advocates for outreach to underserved


EXPORT Goals

Rigorous population and epidemiologic research to: build research capacity for health disparities research in

minority-serving and other designated institutions;

promote the participation of health disparity groups in biomedical and behavioral research and prevention and intervention activities; and,

promote planning for the conduct of minority health and/or other health disparities research.


Clinical and Translational Science Awards (CTSA)

Purpose: narrow time between bench and bedside “enable institutions to engage in innovative and

transformative efforts appropriate to their own environment that will develop and advance clinical and translational science as a distinct discipline within a definable academic home.”

Current funded CTSAs within the Border States: The University of California at San Diego The University of California at San Francisco The University of Texas Health Science Center at San Antonio


Agency for Health Quality ResearchImplement health services research into

practice AHRQ has devoted funds to support primary care

Practice-Based Research Networks (PBRNs).

PBRNs draw on the experience and insight of practicing clinicians to identify and frame research questions whose answers can improve the practice of primary care.

Since 2000, AHRQ has funded over 52 PBRNs through targeted grant programs.


PBRNs in Border States California (6):

The USCF/Stanford Collaborative Research Network , San Francisco; Community Health Center Network, Alameda; Pediatric Diagnostic Center PBRN, Ventura; UCSF Collaborative Research Network, San Francisco; San Diego Unified Research in Family Medicine Network, San Diego; UCLA Primary Care Research Network, Los Angeles

New Mexico: RIOSnet, University School of Medicine, Albuquerque

Texas (5): Central Texas Primary Care Research Network, Temple; The

Southern Primary-Care Urban Research Network, Houston; Residency Research Network of Texas , San Antonio; North Texas Primary Care Practice Based Research Network, Fort Worth; South Texas Ambulatory Research Network, San Antonio


National Network of Libraries of Medicine (NN/LM)

Mission: to advance the progress of medicine and

improve the public health by providing all U.S. health professionals equal access to biomedical information and by improving the public's access to information to enable them to make informed decisions about their health


National Network of Libraries of Medicine (NN/LM)

In 2006, NN/LM awarded 5Y Regional Medical Library (RML) contracts

Houston Academy of Medicine – Texas Medical Center Library

University of California Los Angeles

RMLs focus their efforts on reaching underserved health professionals in rural and inner city areas


MedLine Go LocalNational initiative complementing

MedlinePlus develop and maintain databases of health

service providers in specific geographic areas

27 “MedlinePlus Go Local” projects in 24 states:• University of Arizona• UT Health Science Center, San Antonio• University of New Mexico.


MedLine Go Local Opportunities

Development and evaluation of a Spanish interface for MedlinePlus Go Local

Evaluation of Go Local directories from the perspective of community members living in the Border region, including promotoras

Sharing best practices for maintaining Go Local Border region projects


Continuing Education Programs

The Accreditation Council of Continuing Medical Education (ACCME) 2006: Updated accreditation criteria to link CME to

quality improvement and more effectively address current and emerging public health concerns


CE/CME Evolving Criteria

Practice-based learning and improvement the content of CME matches the scope of the

learner’s practice

learning activities are linked to practice-based needs

changes in competence, performance, or patient outcomes are measured

opportunity for interprofessional CE/CME

CE/CME: building a bridge between translational research and clinical practice.


How clinicians in border practices access evidence-based information and

implement it into their practice?

Plan for White Paper Background Literature Review Methods Results Recommendations


Literature Review

1996-2008 publications electronic search within the University of

Texas Health Science Center at San Antonio Briscoe Library

identified 1,917 articles in Medline limited to English language and human subjects


Literature Review Identified

Limited access Within the U.S.-Mexico border region, access

is a challenge because of the distance to academic institutions and libraries that house this up to date medical information including access to CME. Access to web-based education may also be limited depending on the community.


Prospective Collaborative Qualitative Study

Conduct focus groups and in-depth interviews with clinical practitioners within Community and Rural Health Centers between December of 2008 and February of

2009.


Defining health information needs:

How can we better define the health information needs within our geographic area?

What were the problems in accessing health information and continuing education?

How can access be improved? What type of additional health information,

continuing education or other resources could be helpful?


Access to Health Information

What access do you or staff have to the Internet, telephone conferencing, video conferencing, or funds for CE in your practice setting?

Do you access health information from Mexico to make decisions about your patients who might also be accessing health care in Mexico? For example, the Pan American Health Organization?


What methods do practitioners use to access health information?

What can we learn about how practitioners identify, collect, and analyze the information for various sources?

What gaps were identified in the information accessed? How can we fill the gaps identified? What kind of evidence-based health and research

information do you access? Who do you turn to for medication update information? What access do you have to Internet or computer services

in your clinic setting to find health information or updates?


How do you prefer to receive new updates?

Continuing education Internet Workshops Videos Telemedicine (patient care) Teleconferencing (distance learning) Videostreaming Border conference


Comfort with/access to technology What access do you and your staff have to

Internet or computer services in your clinic setting to find health information or updates? Are these readily available in the patient exam rooms? in your office?

What access do you or staff have to funds for CE in your practice setting?

What is your comfort level with technology? What type of barriers impact your ability to access

this information, and to what degree?


Relevance and Analysis

Once you have reviewed new information, what is the deciding factor to the relevance of this information in your practice, practice setting, or patient population?

Do you feel that the evidence-based research information is relevant to your border practice?

How do you analyze and distill this information in order to implement it into your practice?


Implementing into Practice When do you think it is appropriate to implement

new evidence-based information into your practice?

Have you made changes in your clinical practice, based on this new evidence-based clinical or research information?

What are the barriers to implementing this evidence-based clinical and research information into your practice? Budget? Staff? Space? Other?


Implementation into practice

How have you implemented and monitored changes in your clinical practice with other initiatives? (e.g., HRSA Action plans, JCAHO Accreditation standards, HRSA Diabetes Collaborative)

How do you receive information about changes that impact your practice and/or practice policies? (e.g., provider meetings, newsletter, e-mail, staff training)


Training and Education

What would be the ideal way for you to receive new updates on evidence-based practice?

What would be the ideal way for you to learn about new practice standards?

In general, when is it convenient for you to participate in continuing education?• Days of the week• Time of day


Suggestion Questions What could be done to improve the relevance of research for the U.S.-

Mexico border region? What are some useful methods or models that could be utilized to move

research protocols and procedures into the clinical setting? Have you attended a border health-related conference or meeting? What types of forums are needed where health policy issues can be

discussed in light of the latest research? What options do you recommend that HRSA could implement to improve

the application of research in the clinical setting in the border region? Do you have any final thoughts regarding how clinicians can access

evidence-based information? Are there questions that we should be asking other practitioners about

accessing evidence-based and research information to utilize in their practice?


Methods

Thematic Analysis A thematic analysis was done of each group

report to summarize common themes in the individual state reports.

For the overall results, the results by state were prioritized via the top five themes, ranking the most important to least important themes.

This method was utilized to formulate the conclusions


Results: Ten Themes

Evidence-based practice is perceived as an ideal. Border clinicians recognize the importance of

critically appraising research for its relevance to their patients.

Cultural differences, poverty, and patients’ low health literacy are significant challenges for clinical care in the border region.

Access to pharmaceuticals in Mexico has an impact on border clinicians’ standards of practice.

Time is a more significant constraint than access to information resources.


Results: Ten Themes Clinicians are challenged by the frequency of changes in

research-based information. Having an academic affiliation enhances access to new

clinical information. Information about complementary and alternative

medicine (CAM) is relevant to clinical practice in the border region.

Information from Mexico and other international sources is used on a limited basis.

There is a need for more CME events specifically addressing border health issues.

Conclusions



The U.S.-Mexico border region unique demographic and geographic area

cultural, socioeconomic, and epidemiologic characteristics different from the rest of the US

“developed” and “developing” worlds unite along a 2,000-mile international border.

government policy and physical barriers influence the fluidity of human movement across this politically delineated border

health issues do not respect such bounds conflict between the necessity for care and the inherent

challenges in fulfilling that need


US-Mexico Border Disparities disparities in:

economic well-being access to health care services availability of public health care infrastructure work force

research studies are needed on health problems affecting the U.S.-Mexico border region

should be conducted in border communities should be conducted by people living on the border, border

academicians and clinicians.


Health impact of transmigration

The growth rates of border counties and municipalities exceed state and national averages

Transmigration: people move northward seeking opportunities to improve standard of living

Millions cross the border legally and illegally each month

Binational public health challenge


Binational and multicultural health

Develop collaborative and responsive research and partnerships

Nurture local physicians as principal and sub-investigators

Foster binational research and sharing of research findings


Recommendations


Recommendations Establish HRSA entity: information repository on

health research affecting border communities trustworthy source of information university consortium: serve as hub for extramural funding staff live on the border, understand the problems affecting

the border and are familiar with the health care system and resources available at the border

Attracting clinicians to the U.S.-Mexico border region, especially to the rural communities, will require incentives


Proposed Future Work U.S-Mexico Border Centers of Excellence

Consortium proposes: 1. Prepare a “Best Practices Manual on Collaboration” (5 Best

Practices Along the Border for Public and Private Collaborations and Partnerships)

2. Qualitatively and quantitatively assess outcomes and impact of the U.S. Mexico Border Centers of Excellence Consortium Contract

3. Plan the US Mexico Center of Excellence Consortium Forum in El Paso Texas for July 2010: “How Does Research Translate Into Best Practices”


Best Practices Manual

Plan state meetings prior to Forum in July and identify state best practices

Collaborate with: NIH/CTSA NN/LM PBRN CE/CME providers


Assessment

Qualitatively and quantitatively outline activities, outcomes and impact of the U.S. Mexico Border Centers of Excellence Consortium Contract


US Mexico Center of Excellence Consortium Forum: July 2010

Showcase best border practices Present outcomes of U.S.-Mexico Border

COE Consortium Contract and strategic thinking

Document recommendations in Forum Proceedings


Consortium Partners

Texas Tech Health Sciences Center at El Paso

Jose Manuel De La Rosa, M.D., Founding Dean, Texas Tech University Health Sciences Center - El Paso, Paul L. Foster School of Medicine


Consortium Partners

University of Arizona College of Medicine Ana Maria López, MD, MPH, FACP, Professor of Medicine

and Pathology at the University of Arizona; faculty, College of Public Health and BIO-5. Dr. López is Principal Investigator of the Arizona Hispanic Center of Excellence.

Oscar Beita, MD, MPH, Clinical Assistant Professor in Family and Community Medicine at the University of Arizona College of Medicine


Consortium Partners

University of California San Francisco at Fresno

Katherine Flores, MD, Assistant Clinical Professor in Family Medicine at the UCSF School of Medicine will serve as the COE Consortium Core Member representing California. Dr. Flores is the Director of the California Border Health Education and Training Centers Program (HETC) as well as the Director of the UCSF Fresno Latino Center for Medical Education and Research (LaCMER).


Consortium Partners University of New Mexico School of Medicine Lisa Cacari Stone, Ph.D., Principal Investigator for the Border

Consortium sub-contract at the University of New Mexico Health Sciences Center. She is an Assistant Professor with the Department of Family and Community Medicine and Senior Research Fellow with the Robert Wood Johnson Center for Health Policy at UNM.

Alexis Padilla, PhD., Community Relations Manager at the University of New Mexico School of Medicine in conjunction with the US-Mexico Border COE Consortium and the Health Science Center Executive Vice-President’s Office of Community Affairs.

Robert Otto Valdez, Ph.D. ,RWJF Professor Family & Community Medicine and Economics serves as the Executive Director, Robert Wood Johnson Foundation Center for Health Policy at the University of New Mexico, a national program office for increasing diversity in health and health care leadership.


Consortium Partners

University of Texas Health Science Center at San Antonio

Vidal Garza Balderas, DDS, MPH, Clinical Assistant Professor, Department of Community Dentistry at the UTHSCSA. Dr. Balderas serves as the primary investigator for this contract.

Juanita Lozano Pineda, DDS, MPH, Clinical Assistant Professor, Department of Community Dentistry at the UTHSCSA.


Consortium Partners University of Texas Medical Branch at

Galveston

Lauree Thomas, M.D., Associate Dean for Student Affairs and Admissions in the School of Medicine at the University of Texas Medical Branch at Galveston, TX

Norma Perez, M.D., Dr.P.H., Adjunct Assistant Professor in the Department of Internal Medicine, Division of Geriatrics at UTMB.

LeTanya D. Walker, B.S., is the Director of Recruitment and Student Support Services for the University of Texas Medical Branch (UTMB) School of Medicine.


Questions?


Thank-you!

Documents

© 2010 College of Medicine Welcome! ¡Bienvenidos!