For the past several posts, we have discussed the importance of stories in moving healthcare policy. Each of these stories are precious and deserve to be told and heard. Policy makers often take great comfort in knowing what is really happening on the ground; these stories offer up hope and simultaneously highlight some of the problems in healthcare.
There is also a substantial need for our community to conduct and possess research to also help make a comprehensive healthcare policy case. While not as important at times as stories, research can add to our dialogue and help keep us informed around certain items that are and are not working.
One way to remain connected to the stories and start to conduct research in our communities is through what is called community based participatory research (CBPR). One definition of CBPR is as follows:
“(CBPR is a) collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community, has the aim of combining knowledge with action and achieving social change to improve health outcomes and eliminate health disparities.”
What is innovative about CBPR is that it allows for the community to help establish what the research priorities are, and then work with other partners in the community (often academic medical centers or the like) to complete the research. A strong partnership often consists of advisory groups that help come up with the questions prior to the research team designing the study. It is one thing for a researcher to take his or her idea to the community and another thing to work collaboratively with the community to create the research question from the beginning. There are robust resources on CBPR that I would encourage anyone interested to look into.
While CBPR is one very successful way to partner with the community on research, there remains some pretty important questions around how we can use research to support our cause at changing healthcare. These questions are likely to be different depending on who you are and where you live. By taking the CBPR approach as outlined above, we can start to think through some of these questions with our community.
In a previous post I highlighted the need to address four changes in healthcare. These foci are around clinical, operational and financial elements in healthcare. Research must also adopt this approach. When we think through any research collaboration in the community we must think about how the question we are studying can take into account these categories. Often, communities are very aware of how a clinical care process can be changed or modified (and then studied); however, they may be less informed in how to measure some of the financial costs associated with the clinical intervention. Patient communities who are invested in changing healthcare could benefit from partnering with academic institutions just as academic institutions could benefit from partnering with patient communities.
We also need to be able to take research and to explain it in ways that the larger community can understand. There are many good examples of how to do this, but some of the best, in my opinion, are done by the Robert Graham Center in Washington, D.C. The Graham Center publishes what they call “one pagers.” These one pagers are a snapshot into a problem supporting possible solutions with data. For example, the Graham Center publishes one pagers on topics like “EHR implementation without meaningful use can lead to worse health outcomes” and “Comprehensive medical school rural programs produce rural family physicians.” What is powerful with these one pagers is that they are driven by data and make a profound policy case in very few words.
One of my favorite one pagers, “Who will have health insurance in the year 2025?” graph can be seen here. While we have written about these data before on OH, I want to use this as just one example of how data can make a powerful case as to why we need to change. From the one pager:
“If current trends continue, U.S. health insurance costs will consume the average household’s annual income by 2025. As health care becomes unaffordable for most people in the United States, it will be necessary to implement innovative models to move the system in a more equitable and sustainable direction.”
How powerful a policy talking point is that? How powerful is this image? Based on this evidence we can begin to make a case that there is a massive change that needs to unfold in our country in order to allow for healthcare to have the slightest chance of being affordable for the vast majority of the public. This is the power of the one pager.
As we all work towards change in healthcare it is important that we consider who we partner with and how we communicate what we find. Policy makers and the like are in need of such evidence to help them make informed decisions. A potent combination seems to be CBPR and taking findings from these efforts and transforming them into something like a one pager. Let us be informed in the case we make for transforming healthcare based on all the evidence.
Stories and data can help lead the way.