258023 Use of evidence in community health center settings: A Qualitative study in safety net community health centers

Sunday, October 28, 2012

Shalini Tendulkar, ScD, ScM , Institute for Community Health, Cambridge Health Alliance, Cambridge, MA
Nazmim Bhuiya, MPH , Institute for Community Health, Cambridge, MA
Jocelyn Chu, ScD, MPH , Institute for Commnuity Health, Cambridge Health Alliance, Cambridge, MA
Burak Alsan, MD , Uphams Corner Health Center, Dorchester, MA
Scott Early, MD , Lynn Community Health Center, Lynn, MA
Myechia Minter-Jordan, MD , Dimock Community Health Center, Roxbury, MA
Karen Hacker, MD MPH , Institute for Community Health, Cambridge Health Alliance, Cambridge, MA
Background: Community health centers (CHCs) are instrumental in providing evidenced based care for vulnerable populations. However there is a limited understanding of how they identify and adopt evidence and what factors impede or promote this adoption.

Study Aims: In 2011, the Harvard Clinical and Translational Science Center (Harvard Catalyst), Safety Net Initiative conducted a qualitative study in 3 safety net CHCs to answer this question.

Methods: In-person interviews with 10 medical directors and key staff in each of the health centers were conducted to ascertain 1) how evidence about new practices is gathered and evaluated, 2) the organizational process for identifying evidence, 3) and barriers and facilitators to the adoption of evidence. The interviews were transcribed and coded and analyzed by the research team using NVivo.

Results: Findings suggest that CHCs access evidence from a range of sources, including peer-reviewed literature, conferences/grand rounds, their own experiences and primary data collection. Several factors influence incorporation of evidence into practice, including relevance for patients, validity and reliability of the evidence, and the health center's capacity to implement the evidence. Barriers to the evidence adoption included provider factors such as provider resistance, lack of time and training, patient/community factors such as lack of relevance to patient populations, and organizational factors, such as competing organizational priorities, EMR capacity and financial barriers. Facilitators included the presence of key individuals championing the adoption of evidence as well as links to academic resources.

Discussion: These findings contribute to a limited literature on how CHCs collect and utilize research evidence. Addressing identified barriers while acknowledging inherent organizational processes is a critical component in improving the care of vulnerable patient populations.

Learning Areas:
Provision of health care to the public
Public health or related research

Learning Objectives:
1. Discuss how safetynet community health centers identify and adopt evidence. 2. Identify the factors that impede or promote the adoption of evidence in community health center settings.

Keywords: Primary Care, Community Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was integrally involved in conceptualizing this research, in conducting data collection, in analysis and in writing this abstract. I am also currently working through the Harvard Catalyst safetynet initiative to provide research mentorship to primary care providers at community health centers in Massaschusetts.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.