John O'Brien knows the healthcare industry from the inside out: He has served as the president and CEO of UMass Memorial Health Care in Worcester, Mass., the Cambridge Health Alliance in suburban Boston, and also as the commissioner of health for the city of Cambridge.
O'Brien has traded in his metaphorical hospital gown for that of an academic, and in so doing, is in the vanguard of one of the nation's pioneering efforts at coordinating comprehensive public health data-gathering and dissemination. O'Brien, now the Jane and William Mosakowski Distinguished Professor of Higher Education at Clark University in Worcester, is overseeing the creation of an academic health department, the fruition of a new partnership between the university and the City of Worcester's public health department.
The partnership, OBrien says, is a natural outgrowth of healthcare delivery stakeholders' reaction to the goals of healthcare reform. Realizing it is more cost-effective to encourage healthier lifestyles and provide better healthcare in people's homes and neighborhoods than in hospitals, the city's academic community, healthcare providers, and public health staff are now beginning to create communications channels and data collection efforts that work hand-in-hand with the city's Community Health Improvement Plan (CHIP), the comprehensive blueprint that aims to make Worcester the "healthiest city in New England" by 2020.
"I think it's a very exciting time," O'Brien says. "It's long overdue for this country. I think we really lagged behind a lot of our neighbors, particularly in Scandinavia, where people are focusing upstream. Unless we start dealing with these issues of healthy eating, physical activity, and dealing more effectively with mental health issues, you're never going to be able to drive the price of healthcare down. It's something as a country we should be a little mortified about."
O'Brien recently co-authored a piece in Health Affairs outlining his views on how health systems need to begin aligning with community partners sooner rather than later:
"Hospitals and communities working side by side can be catalytic," O'Brien and Community Catalyst Executive Director Rob Restuccia wrote. "Jointly, they bring energy to the work that they could not achieve individually. They will be rewarded as the nation shifts from healthcare to a health framework and from fee-for-service to risk-bearing payment arrangements. As more stringent community benefit, financial reporting and other related regulations continue to roll out, hospitals focused on addressing the social and economic determinants of health will not see them as burdens or threats. They will see them as key components of their strategy."
And, O'Brien's community is now taking advantage of the new mindset. Like many communities, Worcester had a problem connecting the dots between the provider community and many of the people they serve, and a resource-stretched public health department, but it also has a panoply of intellectual capital--it is home to the University of Massachusetts Medical School as well as Clark University, Worcester State University, Worcester Polytechnic Institute, and the College of the Holy Cross.
Marianne Sarkis, a professor and applied medical anthropologist at Clark, says that prior to the formal creation of the academic health department, researchers often created unwitting redundancies and silos.
"What we have right now is this really disorganized model of research in the community," Sarkis says. "We each at the various universities are in our own little bubbles - we publish in our own journals and nobody sees them. The idea is to bring it all together, creating a warehouse of sorts where we can archive the findings. So we would have quantitative and qualitative data of various sorts. For example, we have the program in Geographic Information Science for Development and Environment right here at Clark, and they've been doing work on food deserts and policy and food justice the past five years, but no one from the DPH has accessed it--and that is one of the domains identified in the CHIP. So now we will bring them all together."
Healthy Baby Collaborative
A fundamental element of successful population health management will be how information is disseminated between healthcare providers and the people they serve. Sarkis is emphatic when she says the academic and provider community in Worcester has learned the information must flow both ways. One of the pioneering projects demonstrating that is the Worcester Healthy Baby Collaborative.
Over the past decade, the city's infant mortality rate has ranged between seven and nine infant deaths for every 1,000 live births, between 1.4 and 1.8 times the Massachusetts state average of five deaths per 1,000.
Worcester public health officials have been monitoring the infant mortality trends in the city since the late 1990s, when Dale Magee, M.D., began annual chart reviews of infant deaths at UMass Memorial Hospital and St. Vincent's Hospital. Over the years, he saw an upward infant mortality trend develop among immigrant West African mothers.
In response, the city's public health and academic sector has created a concerted education campaign targeting the West African community. Sarkis says the providers soon learned a stock "one size fits all" approach to encouraging good pre-natal nutrition, for example, was not applicable to Ghanaian women. Nhyira Ba, the collaborative's educational platform for Ghanaian women, created a YouTube video, "Please Pass The Palavar Sauce," explaining the intricacies of their nutritional needs for providers.
"It allowed them to explain what they eat and some of the things they don't eat," Sarkis says. "Milk, for example. They're all lactose intolerant. You can't tell them to eat milk and cereal. We're now doing brown bag lunches at the hospital at UMass, showing the providers the videos. The response has been incredible. Now they know how to ask questions and what kind of questions to ask. The quantitative data is really cool for data geeks, but you also are missing a lot of the qualitative stuff, that unless you are working closely with the community, you're not going to get."
Sarkis also had some of her students interview local healthcare providers about information they felt they were not getting from the Ghanaians and asked the Ghanaians how best to close those gaps. "They said, 'Oh, the reason why we say this is because of this. So ask us in a different way and you'll get the right response.' This dialogue never happened before," Sarkis says.
Nhyira Ba has also created a Facebook page and is promoting the use of the national Text4Baby cell phone text service, customized locally in the Twi language for Ghanaian women.
Sarkis is collaborating with researchers at UMass on patient-centered health grants to identify information transmission about healthy pregnancy in social networks among immigrant communities.
Sarkis believes she and her students occupy a critical spot in ensuring best practices percolate into the community health paradigm. While making raw data available to providers is important, she says: "There are also people like me who serve as a liaison between the community and the providers. I get the data from the community, translate it to a way the providers can understand, and vice versa. We are not just extracting the data from the community. We are processing it and sending it back in some way that would benefit them."
O'Brien asserts that the Clark faculty and students truly represent the next generation of community health workers for whom data interpretation and dissemination will lead to healthier communities.
"There'll be a whole new set of careers for young people," he says. "I'm very excited. I keep telling my kids that it's going to be a far more equitable system."
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