Mission and Commitment to Primary Care:
"The University of Kansas School of Medicine commits to enhance the quality of life and serve our community through the discovery of knowledge, the education of health professionals and by improving the health of the public."
As the only medical school in the state of Kansas, a key part of this mission is training developing physicians to meet the health needs of the state. Only five of Kansas' 105 counties are classified as "urban"; 38 counties are "rural" with between six and 19.9 persons per square mile, and 31 counties are classified as "frontier", with fewer than six persons per square mile. In addition, many population pockets of the urban counties, especially Wyandotte County (Kansas City), where the medical school is located, are severely underserved. Meeting the needs of these groups requires training of physicians and the conduct of applied research to understand the mechanism of poor health and the development of programs to address healthy disparities. The Research Division with the Department of Family medicine is dedicated to spear heading such an applied health disparities research agenda.
Our mission is to highlight and promote the value of high-quality primary care research within our academic health center, within our communities, and across the nation.
Rationale for Primary Care Research:
The majority of funded research studies influencing medicine and health care come from highly specialized researchers in research settings such as tertiary/quaternary care hospital campuses. Clinical research continues to undervalue the benefit of service-learning and participatory methods as a means to advancing our understanding of health disparities in primary care and community settings. There is a pressing need to expand the body of clinical and applied research occurring in primary care settings and use community participatory research methodologies. Primary Care-Based Research Networks and collaborative service-learning projects can provide important infrastructure and stability as long-term project funding and sustainability concerns move through inevitable cycles. The Research Division capitalizes on recent advances in health care informatics to bring useful clinical services, novel research questions, and appropriate expertise and energy to collaborative partnerships between researchers, trainees, and community members interested in reducing health disparities. Using faculty development, a strategic mission to assure rigorous evaluation/research, and a theory driven approach to community-based participatory research with community member ownership, our projects will bring the local and regional community one step closer to the understanding and elimination of health disparities, a target national concern of Healthy People 2010.
National Need: A large body of work supports the contention that research in primary care settings is needed to improve health care and the health of the public. As the population ages, information from primary care will become crucial. Since the majority of chronic disease care in the United States is delivered by primary care providers, these providers can significantly influence overall health.48, 49 For minority and underserved populations, this is especially true. Health care workforce analyses have shown that the removal of family physicians from urban and rural geographic areas would lead to a remarkable increase in the total number of physician shortage areas across the U.S.50, 51 Further research within the practices and communities these physicians serve will provide the knowledge to improve health and eliminate disparities for a great number of marginalized patients. This proposal seeks to directly address this need by conducting research with community partners and through rural and urban Primary Care practices serving minority and underserved patients. We will do this using a unique combination of service-learning and information technology approaches.
Local Need: The State of Kansas has experienced significant demographic and economic change over the last several decades.52, 53 After half a century of stability based on agriculture and rural habitation, there has been a dramatic migration of younger individuals to the urban areas of Wichita, Topeka, and Kansas City. In part, as a response to this, there has been an influx of immigrants and 1st generation Kansans to frontier and densely settled rural counties to work for rural industry such as in the meat packing plants of southwestern Kansas. The urban cores of Kansas City, Kansas and Wichita have experienced decay and flight of resources to wealthier suburbs.54 These changes have produced health and access to health care consequences seen by primary care providers and University of Kansas medical students and residents as they work throughout the State.55 There are a growing number of both urban and rural areas with medically underserved and socially impoverished populations. The gap between those with resources and those unable to afford access to health care has widened. The groups most affected by these marginalizing conditions are ethnically, racial and socioeconomically diverse, in spite of the overall homogeneity of the majority population of Kansas when compared to other states. They come from diverse ethnic backgrounds (e.g. Southeast Asians and HispanicsLatinos in southwest Kansas, or African American and Hispanics/Latinos in Wichita and Kansas City), as well as diverse occupational (agricultural or industrial) and residential environs (farm or high rise housing development).52 Counties such as Wyandotte County, the urban core of Kansas City, Kansas, fall amongst the lowest counties in the state by traditional health indicators. Extensive work, including a recent HRSA HCAP grant to the county, has been unable to make significant headway in reversing these disparities. Direct service provision, such as that provided by the JayDoc Clinic continues to be in high demand for those unable to afford routine medical care.
The University of Kansas Medical Center is the medical and health care training facility for the greater Kansas City metropolitan area and for the state of Kansas. It serves as the premier clinical and biomedical research organization within the region with over 65.2 million dollars in current extramural research funding for FY 2005 ($44.6M NIH awards dollars FY05). The School of Medicine has approximately 450 faculty members at its Kansas City campus and 113 on the Wichita campus, and offers masters and doctoral degree programs, as well as statewide continuing education. There are approximately 750 students enrolled in the M.D. program and 150 students in other graduate studies.
Through its clinical, community service, and educational activity the Department of Family Medicine has developed close working relationships with other departments in the School of Medicine, the School of Nursing and Allied Health, the Center on Aging, the office of external Affairs, and the Kansas Masonic Cancer Research Institute. A core faculty of 15 physicians, a clinical psychologist, a medical social worker, two doctoral-level educators, and three nurse practitioners have been successful in all aspects of the educational, service, and research missions of the department. The pre-doctoral program has incorporated family medicine principles and educators in all years of the medical school curriculum, and recent KUSOM calculations found that Family Medicine faculty spends significantly more teaching hours per FTE than any other clinical department within the Medical Center. The residency program is one of the oldest in the United States, with approximately 40 percent of graduates electing to practice the full spectrum of family medicine skills, many in rural communities. A number of other graduates have gone on to work in underserved urban areas and the department continually seeks to meet the workforce needs of the state of Kansas. The department is recognized for its responsiveness to the needs of the community through affiliations with the local county health department, the Wyandotte County Community Health Council, the County Safety-Net Clinic Coalition (WCSNCC), the department supported student-run JayDoc free Clinic, nearby federally qualified community health centers (Swope Wyandotte, Swope Quindaro and Swope Health Central), and a host of community organizations partnering with our community-based residency training initiative.
Existing Research Activities in Clinical/Community Research:The Department of Family Medicine has a growing and well funded portfolio of community-based research. Departmental faculty have a record of health disparities publications. The departmentally administered KPEPR network now includes both rural and urban practices (see Summer Rural Program).
The urban clinics in the network are primarily safety-net clinics and we have strong collaborative relationships with the Wyandotte County Safety-net Clinic Coalition that oversees joint projects for these 9 clinics. Faculty member, Kim Kimminau, Ph.D., directs a series of projects with local and regional public health organizations. This range of active projects and development opportunities will provide extensive opportunity for growth of clinical and community researchers