CER 2016 Nguyen ctsi collaborative research
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Transcript of CER 2016 Nguyen ctsi collaborative research
Collaborative Patient-Centered Research to Reduce Health
Disparities: The Health Within Reach Project
Tung Nguyen, MD, Division of General Internal Medicine, UCSFMandana Khalili, MD, Division of Gastroenterology and Hepatology,
UCSF/SFGHArcadi Kolchak, San Francisco Hep B Free
February 2, 2016Patient-Centered Research Outcomes Institute (PCORI) AD-12-11-4615
Asian American Research Center on Health (ARCH)
Asian Americans
• Asian Americans fastest growing racial group
• 66% born outside the U.S, and 50% of foreign-born came after 1990
• 37% are limited English proficient: Chinese: 48%, Vietnamese: 55%
• 1 out of 3 San Franciscans is Asian
Scientific and Community Needs
• Hep B infection among Asian Americans ~10-15%• 1/3 never had hep B screening test
• Few studies on Asian Americans and hepatitis C
• Liver cancer incidence much higher among Asian Americans compared to non-Hispanic Whites
• Very few clinical interventions to improve quality of care among Asian Americans
Health Within Reach Aims
• Develop interactive patient education video (Video Doctor) and Provider Alert to increase screening of hepatitis B and C in Asian American patients
• Evaluate the efficacy of the Video Doctor + Provider Alert intervention + Provider Panel Notification vs. Provider Panel Notification in 2 healthcare systems through provider randomized controlled trial
Health Within Reach Team
• Sites: UCSF General Medicine, SFGH General Medicine and Family Practice
• Team: General Medicine (Nguyen, Walsh, Goldman), Hepatology (Khalili), Psychology (Tsoh), Community (SF Hep B Free Exec Director)
• Stakeholders: Asian American Network for Cancer Awareness, Research, and Training (AANCART); Patient Advisory Councils, Vietnamese Community Advisory Board
• Research Associates : Chinese-Vietnamese (Wong), Chinese (Lau, Chow), Vietnamese (Lam, Bui)
How/Why Was the Team Formed?
• SF Hep B Free Perspective
• SFGH Hepatology Perspective
• UCSF General Medicine Perspective
Why Was the Team Formed?
• Passion for Asian American health and health disparities
• Commitment to community-based and patient-centered work
• Common focus on hepatitis B and liver cancer
• Complementary expertise• Hep B Free: community mobilization, stakeholder engagement• SFGH/Hepatology: clinical research, underserved, specialty• UCSF/General Medicine: community-based participatory
research, multi-lingual interventions, prevention
How Was the Team Formed?
• SFGH/Hepatology and Hep B Free• SFGH/Hepatology and UCSF/General Medicine
• San Francisco AANCART• NCI Program Grant on Hepatitis B screening
• Hep B Free and UCSF/General Medicine• UCSF: Vietnamese portion of Hep B Free Campaign• Hep B Free requested consultation through CTSI
Community Engagement & Health Policy (CE&HP) Program
• All 3: CE&HP Working Group---SF Hep B Quality Improvement Collaborative
• Grant opportunities
Benefits to the Project
• Funding: Innovation, Collaboration, Capabilities, Stakeholder Engagement
• Intervention Development: Scientific, Logistics, Culture/Language, Patient-Centered
• Implementation: Instrument Development, Informed/Consent/Recruitment, Clinic/System Logistics
• Dissemination
Benefits: Application Algorithm
Benefits: Mobile App and Provider Alert
Benefits: Empowerment
Benefits: Control Group
Benefits: Usability
Challenges of Collaboration
• Different perspectives and approaches
• Aligning expectations
• Communication
• Personnel and other changes
Addressing Challenges
• Budget
• Logistics: regular team meeting with rotating sites, coordinators meetings, PI phone calls
• Respectful communication• time for discussion so everyone’s viewpoints are heard• problem solving not finger pointing• consensus decision making
• Stakeholder engagement: regular meetings on site with food, being open-minded, sense of humor
Recommendations
• Establish relationships early before thinking about writing a grant together
• Be flexible and modify your approach as needed
• Establish open communication
• Understand that resolving challenges caused by intersection of different perspectives lead to innovation and generalizability
Discussion
• How to find stakeholders or collaborators?
• How to be flexible?
• How to deal with conflict?
[email protected]@ucsf.edu