Institute for Clinical and Translational Science

These interactions increase the impact of community-based research and provide an infrastructure for disseminating and implementing evidence-based disease prevention and management practices. Since CHCs provide primary care to disadvantaged patients (e.g., 40-50% of CHC patients in Iowa's urban areas are minorities), they are mandated to conduct community needs assessments and have experience in both building disease registries and participating in quality improvement collaboratives. We nurture these relationships as a means for improving the health of disadvantaged populations and engaging these individuals in clinical research.

Accomplishments

A number of activities and research projects have been initiated:

• Through a series of consensus development meetings and conference calls, the Working Group identified high-priority research topics that included diabetes, pediatric asthma, behavioral health, and missed appointments. The Working Group then decided to focus initial projects on diabetes.
• With support from the NINR P30 Gerontological Nursing Interventions Research Center, training workshops in community-based participatory research and implementation science methods for Coordinators are being provided.
• With support from the Center for Research in the Implementation of Innovative Strategies in Practice, a project to analyze CHC diabetes clinical registry data was initiated. This project will identify clinical and demographic factors associated with poor glycemic control and specific management strategies associated with improved glycemic control.
• A Coordinator-led project to improve the effectiveness of diabetes self-management programs was initiated. Guided by Wagner's Chronic Care Model, the goals of this project are to collect information on patient's attitudes and perspectives towards self-management using standardized instruments and to utilize this information in targeting self-management interventions to patients most likely to benefit.
• The Key Function in collaborative with the University of Iowa Hardin Health Science Libraries and the CHCs submitted and were recently awarded a Consumer Health Subcontract by The National Network of Libraries of Medicine, Greater Midwest Region (NN/LM GMR) to promote outreach projects and provide high quality electronic information resources for minorities and under served populations. The outcome is to provide an easy-to-navigate consumer-focused health information web site targeted to the specific communities and to facilitate easy-access to online health information at point-of-care. Some of the information provided will include diabetes and asthma management strategies.
• The Key Function has begun a collaboration with the CHC in Des Moines to establish a Wellness Institute focusing on disease prevention that will be a model for the 3 other CHCs.

Goal 2: Integrate CHCs with other Key Functions and selected UI Centers

A second goal is to develop integrative relationships among the 4 CHCs and the UI CTSA Key Function areas and with selected UI Research Centers/Programs to increase community-based research and minority participation. Currently, the Community Engagement Key Function is working with the Diversity, Pediatrics, and Regulatory Key Functions to: 1) enhance the UI infrastructure for conducting community-based research; 2) decrease barriers to conducting such research; 3) promote the use of community-based participatory research methods; and 4) promote recruitment of under-represented minorities into health centers.

The following are current partnerships and collaborations with other UI Research Centers/Programs:

• The Key Function is partnering with UI research teams that focus on dissemination and of evidence-based practices in community settings and on promoting diversity (i.e. Iowa Research Network, School Nurse Network, Center for Research in the Implementation of Innovative Strategies in Practice, Gerontological Nursing Interventions Research Center, and UI Area Health Education Center).
• The Key Function is collaborating with several community-based research projects (i.e. Children's Health Study, Aberdeen Area Tribal Chairman's Health Board Oral Health Initiative). The Key Function will use its relationship with the Des Moines CHC to promote the recruitment of minority and lower income subjects into the Children's Health Study. Key Function leaders are also providing expertise in community-based participatory research methods in the Tribal Health Board Oral Health Initiative. Twenty-four UI investigators have been networked with participating CHCs.
• The Key Function is actively working with the UI IRB leadership to address one of the largest barriers to community-based research---liability related to UI IRB sponsorship of research in community practices. Efforts have focused on refining a model developed at Yale by which community practices are certified as UI research affiliates. Once such status is designated, the community practice can be included in studies that are then reviewed for IRB approval.

National/Regional CTSA Consortium

The UI Community Engagement Key Function Directors have participated by phone with the national and regional Community Engagement Committees. The regional Community Engagement Group held a 2-day workshop meeting in Chicago (September 2008). The UI-CHC partnership is becoming a model for broader CTSA - Health Resources and Services Administration (HRSA) collaborations. UI was one of two institutions presenting on CTSA-CHC collaborations at an October 16, 2008 web meeting of the CTSA Community and Academic Practice Partnership Workgroup.