Access Community Health Network: 'Moving the Needle' on Community Health Outcomes
As the Executive Director of Research, Evaluation, and Innovation at Access Community Health Network (ACCESS), Danielle Lazar consistently tries to move the needle on community health outcomes. At ACCESS, a network composed of 35 federally qualified health centers (FQHCs), Lazar heads an embedded research and evaluation division that is a critical part of providing high-quality primary care to patients. Her approach to research and evaluation is pragmatic. How can research be applied in a setting like ACCESS?
When she first started as head of research, she launched a number of community stakeholder listening sessions, where she gained perspective from patients and primary care providers about research done in their communities and health centers. Patients and providers expressed great interest in research; they just wanted to know how this research would benefit their communities and their patients directly. From these discussions and her experience in the larger safety net, Lazar became passionate about bringing the voice of patients and community health experts into research.
"It's the combination of knowledge in the field, patient voice, and academic rigor that's going to get us to solutions," says Lazar.
One of the biggest challenges in community health research is trust, claims Lazar. People are wary of researchers who may have good intentions, but fail to create sustainable solutions that benefit the community they came into in the long term. Lazar cites shared decision making, an evidence-based practice where patients and providers work together to choose treatment options that are usable and workable for the patient in their environment, as an innovation of health practice that works toward building up trust by centering the patient, at all times. Applied to research and evaluation, Lazar believes that leveraging this idea of partnering and leveling the playing field between practitioners, patients and researchers can make real headway in changing the narrative around health equity in underserved communities.
Health disparities in the neighborhoods where ACCESS' FQHCs are based are difficult to address in large part because of factors outside of providers' and patients' control. These challenges, Lazar states, are problems that can't be solved alone. Often times, solutions coming directly from the community and those on the front lines are the ones that can be most effective.
Moving the needle on these disparities requires a partnership between those who know what works best in a community health setting like ACCESS, patients, community residents and community-based organizations, and researchers, all of whom have historically worked in silos. During the height of the COVID-19 pandemic, many of these traditional silos started to break down, as organizations across the spectrum of disciplines worked together to address the glaring disparities in access to testing, information, and other resources. Lazar believes the breakdown of these silos was important for the impactful work between organizations like ACCESS and other institutions, and will be key to further progress.
At ACCESS, Lazar has actively strived to open up communication and partnership across institutions for the benefit of patients and communities. She leads the ACCESS Center for Discovery and Learning, an NIH-funded translational research center, which partners with researchers who understand what it means to work in community health and are in it for the long haul. Just a few examples of ACCESS' excellent collaborations include: working with (NU) Dr. Mark Huffman on QUARTET USA, ACCESS' first clinical pharmaceutical trial testing the effect of a ultra low-dose, quadruple hypertension pill versus a standard single dose pill; creating a cognitive literacy cohort whose ten-year progress has given special insight into cognitive decline with Dr. Michael Wolf (NU) and subsequently working with Dr. Richard Gershon (NU) on implementing Toolbox Detect, which is an intervention for medical providers to detect early stages of dementia; working with Dr. Abel Kho (NU) on practice facilitation around hypertension; and developing culturally relevant diabetes education with Drs. Marshall Chin and Monica Peek (UChicago), which is now being used as the basis for further improvement and sustainability models for diabetes education and care.
These collaborations with ACCESS and its Center for Discovery and Learning intently focus patient voice and preference, as well as community well-being. The impact of this union between research, evaluation, innovation, and community is derived from being able to learn from each other through the model of shared decision making says Lazar. She encourages researchers to challenge their assumptions about FQHC patients, the vibrant communities they live in, and listen to what they and primary care providers have to say.
"When we step back and allow communities and patients to have these discussions, there's so much more we can achieve," says Lazar.
Written by Ari Crockett