Kentucky Consortium for Accountable Health Communities

UK receives $4.5M award to study social issues that impact health

Researchers at the UK Center for Health Services Research (CHSR) will use a $4.5 million award to address the health-related social needs of vulnerable patients across the Commonwealth.

The award comes from the Centers for Medicare and Medicaid Services (CMS) and establishes the Kentucky Consortium for Accountable Health Communities (KC-AHC).

Over the next five years, principal investigator and director of the CHSR Dr. Mark V. Williams, along with co-principal investigator Dr. Jing Li, is partnering with the Kentucky Primary Care Association, Appalachian Regional Health, Norton Healthcare and Kentucky HomePlace.

This collaboration will work across 27 counties in Appalachia and the Louisville Metro area to collect information from Medicare and Medicaid patients about unmet social needs that impact their health.

The partnership between Kentucky Primary Care Association and CHSR came from “a shared understanding of what is involved in maintaining the health of the patients we serve, which are beyond medical, dental and mental health services,” said Joseph Smith, chief executive officer of the association.

Identifying gaps in care

The KC-AHC will implement patient screening for health-related social needs in various healthcare delivery sites, provide community service referrals and offer patient navigation for identified needs.

The goal of this research is to reduce the use of healthcare services for issues that can be addressed by existing social programs.

Changing the approach to care in this way would more easily enable patients in Appalachia and Jefferson County to access the information and assistance they need in their own communities. This is a vitally important goal of UK and UK HealthCare.

“At UK HealthCare, we believe Kentuckians should be able to receive the best in care without ever leaving the state,” said Dr. Michael Karpf, UK executive vice president for health affairs. “With this award from the Centers for Medicare and Medicaid Services, our researchers will have the opportunity to identify where gaps exist in the care that residents of Appalachia may be experiencing.”

Addressing social needs that impact health

There are many factors that can contribute to poor health, but many are best addressed using existing community-based services.

These social factors include housing instability, food insecurity, interpersonal violence and lack of transportation, which are focus areas for the KC-AHC and CMS.

Unfortunately, patients experience many barriers in accessing existing programs to address these hardships, including lack of awareness and resources to locate appropriate services, low health literacy, and even geographic and distance barriers in the Appalachian region of Kentucky.

“This award – and the research being done with it – will allow physicians to better address the health and social needs of the patients they serve,” said Mark D. Birdwhistell, vice president for administration and external affairs for UK HealthCare. “Addressing those needs on the front lines of care will be critical for reducing the burden of health disparities, especially confronted by patients in Eastern Kentucky and Appalachia.”

One important aspect of the project is ensuring these communities can continue to identify social needs and link patients to appropriate services after the funding has ended. Williams and Li will engage communities to identify leaders who can help connect local social resources to patients identified as high utilizers of healthcare, or those who seek treatment in the emergency room three or more times per year.

“This isn’t money being spent solely on a research project,” Williams said. “We want to integrate these efforts into the healthcare of the community and ensure sustainability.”

Communitywide cooperation

CHSR has been approved as a Track 3 participant, the highest level of participation in the Accountable Health Communities model developed by CMS. This track emphasizes community participation, including assistance from community members in identifying social services available in the region and training navigators who can assist patients in accessing services.

This award will not only help meet the research goals of CHSR, but the goals of the Kentucky Department for Public Health.

“A major goal of the Department for Public Health is better cooperation among medical and health professionals and their organizations,” said Dr. Hiram Polk, commissioner of the department. “This seems like a step in the correct direction.”

Next steps:

During the third annual Appalachian Research Day, UK researchers revealed the insights of their studies aimed at addressing health problems of rural Ky.

Appalachian Research Day addresses rural health issues

Inviting researchers to “come sit on the porch” and share their findings with community members, the UK Center for Excellence in Rural Health (CERH) hosted its third annual Appalachian Research Day in Hazard, Ky., on May 24.

Rural Appalachian communities experience some of the most severe health disparities in the nation, and community-based research is an effective method to identify problems and develop collaborative, effective solutions.

This type of engaged research begins at the local level, built on the foundation of relationships with individuals, neighborhoods and groups who have common questions and concerns. And for many researchers at UK and partner institutions, the CERH is an indispensable resource for conducting community-based research. It provides local connections, infrastructure, dedicated research personnel and a team of community health workers, called Kentucky Homeplace, who engage participants and gather data.

“Appalachian Research Day is an important and exciting day for us each year at the UK Center of Excellence in Rural Health. It is an opportunity for us to provide research updates to our community about relevant issues that affect all of us,” said Fran Feltner, director of the CERH. “Appalachian Research Day is also an opportunity for dialogue with community members to discuss what we can come up with together to better our lives in Appalachia.”

This year’s event, which was held at Hazard Community and Technical College to accommodate the growing number of participants, included Hazard Mayor Jimmy Lindon and Perry County Judge-Executive Scott Alexander, who both made remarks during lunch. Also present were Andrea Begley, field office representative for U.S. Congressman Hal Rogers, and Jenna Meyer of the U.S. Centers for Disease Control and Prevention, who is on special assignment in Eastern Kentucky for the Shaping Our Appalachian Region (SOAR) initiative.

Research insights in cancer, addiction, nutrition

Featured presentations reported findings from five health research studies conducted with Appalachian communities:

  • Dr. Susanne Arnold, associate director of clinical translation at the UK Markey Cancer Center, presented her research examining the interrelated causes of lung cancer and how to combat them. She reported that lung cancer risk has environmental, physical and molecular causes, some of which can be prevented.
  • Nancy Schoenberg, PhD, associate dean for research of the UK College of Public Health and Marion Pearsall Professor of Behavioral Science in the UK College of Medicine, studies the health of grandfamilies in Appalachia. Her recent study with rural adults over age 65 found that half of them struggled to make ends meet and experienced many physical health problems.
  • Dr. Judith Feinberg, professor in the Department of Behavioral Medicine & Psychiatry at West Virginia University School of Medicine, studies behavioral medicine and psychiatry. She presented her research on addiction as a chronic, relapsing brain disease, reporting that syringe services programs (SSPs) operate under the principles of harm reduction and have been shown to offer significant protection for people injecting drugs, including lower risk of HIV infection.
  • Jarod T. Giger, PhD, of the UK colleges of social work, medicine and public health, studies child well-being in Eastern Kentucky. In a recent study, he found that children in three Eastern Kentucky counties reported relatively high amounts of electronic health literacy but low amounts of overall life satisfaction and affective and psychological well-being.
  • Omopé Carter Daboiku is an Appalachian foodways scholar who leads workshops that operate on an emotional level to help participants understand that adapting family recipes to healthier versions doesn’t disrespect one’s ancestors. Her work incorporates nostalgic attachment to food memories, with the understanding that the relationships these memories invoke can make it difficult to prepare healthier food.

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