Reaching Out, From City to Small Town
Community engagement efforts target underserved areas both rural and urban
By: Richard Asa
When Robert Winn, MD, decided to come to the College of Medicine, his motivation was simple. Winn (pictured at right) has spent his career trying to remove barriers that isolate communities from their healthcare providers and separates colleagues who could be leveraging their expertise and knowledge by working together.
He saw the considerable reach of the University of Illinois Hospital & Health Sciences System and its Mile Square community clinics and says he recognized them as the best system in the U.S. to practice what he preaches: bringing health care and preventive education to patients into their own neighborhoods, which turns the traditional model of health care delivery on its head.
This newer model is practiced every day at the Mile Square Health Center, whose gleaming new headquarters at Roosevelt Road and Wood Street is a source of pride and dignity for the underserved community around it, says Kameron Matthews, MD, JD, Res ’10, chief medical officer of Mile Square.
On any given day, patients greet one another in the lobby and make small talk, and casually walk to and from the center’s pharmacy for their medication. An electronic signboard you can’t miss on the way to the pharmacy continuously flashes messages about asking questions and taking medications regularly—and introduces the staff one by one. The atmosphere is welcoming, low-key and bursting with the essence of equanimity.
There are now 13 satellite Mile Square clinics in underserved Chicago neighborhoods, including four school-based clinics (see map to the left) that give students and parents easy access to medical care at a place they come to every day. Mile Square was one of the first Federally Qualified Health Centers established in the late 1960s, and Winn sees the Mile Square network as the portal to a community engagement pipeline that flows both ways.
He spent 14 years at the University of Colorado before coming here and wore many hats. He was an associate professor of medicine, doing basic research on cancer; a clinician in the division of pulmonary critical care; and vice chair for career development, diversity and inclusion. Similarly, he has multiple, integral roles at the College of Medicine and UI Health that help him serve by example and reach many more medical professionals than he would in any one role.
As a professor of medicine, he does basic cancer research. As the director of the Cancer Center, he leads an innovative program that is focused on translational work. And as the vice president for community-based practice for UI Health, he has met dozens of community leaders on his own and through his “dynamic duo” of Karriem Watson, MS, MPH, manager of community engaged research for the University of Illinois Cancer Center; and Victor LaGroon, manager of engagement and strategic partnerships for the Cancer Center.
With both MS and MPH degrees, Watson has combined their respective frameworks to add a public health emphasis to the engagement of underrepresented communities in clinical research and has presented best practices in community engagement and training in clinical research at several national conferences.
LaGroon was named to the City of Chicago Advisory Council on Veterans by Mayor Rahm Emanuel, who recognized his long tenure of community service. LaGroon also was instrumental in the coordination of the State of the Cancer Union in 2014, which gathered researchers and cancer support organizations.
Winn credits both with having great influence on his goal of true community engagement in how the College of Medicine, UIC and UI Health operate.
That kind of legwork, Winn says, establishes trust in underserved communities that had been undermined over the years by clinical research that had a “get in and get out” approach with no practical outcome for the communities that provided volunteers.
Winn wants community health data collected to make a difference. In the 20th Ward, for example, community outreach has found that the rate of prostate cancer is three times the national average. He and the alderman, Willie Cochran, have met to talk about strategies they might take to explain the data and respond to it. Perhaps it’s environmental, Winn suggests, or perhaps it’s epidemiological in that area.
“As an institution that encompasses a variety of environments from the urban landscape of Chicago to the rural settings and everything in between, our varied College of Medicine locations bring a diverse faculty, with more than 250 members and a wide variability of research,” Winn told the Big Ten Cancer Research Consortium.
“Within our campuses, our attention is focused on the underserved and health disparities, with an intentional effort to integrate ourselves into the local community.”
He adds that the Mile Square network helps form partnerships with community-based hospitals, which increases access to patient care on a larger geographic scale.
A living and breathing symbol of what Winn wants the College of Medicine and the UI Health to accomplish is Jeanette Moore, who has been connected to Mile Square most of her life as a volunteer, employee and patient.
While still in high school, she was hired for a special project that took her into the underserved West Side to take blood pressure readings, helping to identify people with hypertension who would benefit from medical care and preventive education before the condition led to cardiovascular disease and heart attacks.
“I was so impressed with the center’s commitment to the community that I wanted to be a part of it. I got my wish, and for 20 years, I worked with the Women and Infant Children program (there), counseling the young moms and helping them get the support and education they needed,” Moore says.
She has been on the MSHC board for more than 20 years, relying on her experience as both a patient and volunteer to share knowledge on “how to best serve the neighborhoods.”
Winn says further that the delivery of health care must change to accommodate the influx of newly insured patients under the Affordable Care Act to better meet the needs of patients who traditionally have been underserved. As part of the leadership team at Mile Square Health Center, Winn helped develop an innovative model for the delivery of health care for the new Mile Square facility, which opened in 2014.
The center offers unprecedented specialty services on site, including oncology and cardiology. Winn is determined that the list will grow. And, it is the only federally qualified health center in the U.S. to offer urgent care—a departure from the traditional community clinic. Overall, more College of Medicine and UI Health specialists now see patients at the community based centers, which Winn says not only brings needed care to underserved areas, but forms partnerships between primary care physicians and specialists that didn’t exist before.
“We have a unique relationship between the university—with all its academic abilities, all of its resources in the context of specialties and research—and primary care,” Winn says. “That makes us different than any other academic institution or FQHC because we’re really in a partnership between Mile Square and the university.”
Winn says UI Health’s approach simply makes sense in an era when health care providers are focused on eliminating health disparities. “The reason it might be hard for people to get their arms around it is because it’s not typical, that a science guy would want his work to have a real impact on communities, to get beyond bench to bedside. The care is out into the community now, so why aren’t we building a health model that meets the needs of the people?
“If we can talk about a bench to bedside model for 50 years, I don’t understand why the next logical conclusion wouldn’t be to get beyond the bedside.” He terms that concept “bench to community.”
“It’s really not all that clever what I’m trying to do,” Winn adds. “It’s really just taking the best of the spirit of the 1960s, the desire to understand human disease from a molecular perspective to a population-based perspective, then using academia and research and figure out how to get the best and most affordable care to the folks in our community.”
UIC has been able to do that, he adds, because it’s “among less than a handful” of universities that owns its FQHC.
The community engagement effort is being abetted by programs in the College of Medicine that are sensitizing students to working within this new model and inspiring them to be creative in the ways they can reach the underserved.
College of Medicine students and faculty are working with communities across Chicago and in communities and small towns throughout Illinois to assess local health care needs, spread preventive messages and tell children they could have futures in a field they might very well not have considered.
This inclusive approach to serving specific communities has led the COM to break down the “silos” within health-care related education that keep disciplines apart and on paths that may not intersect. Community engagement medical education programs at the college include both the Urban Medicine Program in Chicago and the Rural Medicine Program based in Rockford.
UMED is a four-year curriculum that integrates core principles of public health with direct interventions in local, under-served communities. The program’s foundation is experiential learning theory, and it engages students with community organizations to develop and evaluate health promotion and disease prevention projects.
To receive credit for the separate educational track, students must log at least 200 hours of community service over their four years in medical school, says director Jorge Girotti, PhD ’90, associate dean for special curricular programs.
From 2005 to 2012, 180 students participated in UMED. Evaluations showed significant gains in their knowledge of program evaluation, qualitative assessment, community epidemiology and community disparities within the urban environment. In 2012-13, 91 students worked with 19 community organizations on 22 projects, Girotti says.
Perhaps most importantly, direct contact with diverse communities has improved students’ effectiveness and the skills needed to make a positive impact on underserved, urban communities. They gain greater awareness of underserved populations, the precise health problems faced in different communities, and what residents in those communities believe are the main needs and priorities. They learn how to communicate and provide care in a culturally sensitive and appropriate manner, and they get to know leaders in the community who can help them achieve their goals.
Girotti says few medical schools provide community-based education that spans all four years, and fewer still do so in urban areas. “We hope UMED will serve as a model for medical schools that want to establish community-based programs that prepare medical students to serve underserved populations,” Girotti says. “We want our students to understand the needs of the community, which, in turn, can impact the quality of medical care.”
Among the many projects, COM students Stephen Addington and Ayodele Oke have helped direct an after-school program called the Young Doctors Club in North Lawndale on the city’s West Side. Addington describes it as a longitudinal educational pipeline program for elementary through high school students interested in the health sciences.
The long-term goal is to help eliminate health disparities and poor health outcomes in the predominantly African-American community, where nearly 70 percent of residents live far below the poverty line, and only 35 percent of young adults between the ages of 18 and 24 have graduated high school.
Through weekly sessions, field trips and community service events, the club seeds the community with aspiring health care leaders who will potentially practice where they grew up and bring with them the intrinsic experience of what a neighborhood needs.
“UMED and Young Doctors has impacted my life in ways I couldn’t have predicted,” Addington says. “Even beyond the superb leadership training in advocacy, effective community partnering and associated outcomes in health education and prevention in North Lawndale, my involvement has further defined my purpose and passion for being a physician, and specifically as a physician/advocate for medically underserved communities.”
The Rural Medical Education Program, directed by Craig Davenport, MD ’07, has a similar goal in terms of immersion, but its primary mission is to fill geographic gaps in medical care and advocacy across the rural portions of Illinois. The medical students partner with pharmacy students enrolled in a similar track, RPHARM.
RMED is part of the National Center for Rural Health Professions, located on the Rockford campus. Established in 2003, that center supports collaborative projects across the health professions, emphasizing recruitment and retention of physicians and health care delivery initiatives to meet the needs of rural Illinois residents.
“Our philosophy has always been ‘grow your own,’ ” Davenport says. “Our recruitment is almost exclusively focused on students who are from rural Illinois.” The goal: see those students return to the area in which they grew up. From 1997 through 2007, 60 percent of physicians who graduated from RMED were practicing within 90 miles of their hometowns.
A bout 19 percent of the U.S. population lives in rural areas, but only about 11 percent of physicians choose to practice there—and the farmland and small towns of Illinois are no exception.
“From a public health perspective, the students are given the opportunity to learn how to figure out what’s going on in a community, what the health measures are and how to expand that,” Davenport says. “From a pure numbers perspective, they’re seeing a decent volume of patients one-on-one with the community primary care physician.”
The program’s capstone in the fourth year is a 16-week community immersion rotation in which students live in a rural community, participate in primary care learning and healthcare delivery, and conduct a community-oriented primary care project.
“In many ways, medical schools have looked very inward in thinking about what they need internally, and my belief is we do need to do that but in the context of what is the greater societal need,” says COM Regional Dean Alex Stagnaro-Green, MD, MPHE. “So, we’ve begun to change our focus … to reach out more into the community, to see where the areas are that we can be actively involved in.”
Part of that approach has manifested in the Rockford public school district, where students are receiving health and wellness messages through the Rockford campus, while COM-Rockford faculty give monthly public seminars on topics that have included pregnancy, depression and Ebola during the height of public panic.
Third-year medical student Emily Metzger from Rochelle, Ill., is currently planning her fourth-year project in Dixon, another small town. She and her capstone partner from the College of Pharmacy at the University of Illinois-Chicago are already meeting with community leaders to hone their focus.
“By doing this, the idea that our school—the Rockford campus and the University of Illinois in general—cares about the state as a whole really is perceived by those we encounter,” she says. “Many people don’t know the University of Illinois has a medical school so close to them and can affect change in their lives personally.”