Rochester Center to Improve Communication in Health Care
Building Relationships and Eliminating Disparities
Ronald M Epstein, MD, Director
Professor of Family Medicine, Psychiatry and Oncology
Kevin Fiscella, MD, MPH, co-director
Associate Professor of Family Medicine
Mission
The mission of the Center is to improve health and healthcare by implementing novel interventions, educating healthcare providers and consumers, and conducting research on healthcare communication, with a special emphasis on underserved and vulnerable populations.
The scope of the Center includes communication among health care professionals, between health professionals and patients and their families and caregivers, and between health care professionals and diverse communities to optimize health and health care.
By creating a vehicle for collaboration among various departments and Centers at the University, the Center contributes to research that shows that effective communication can (a) improve health outcomes of acute and chronic conditions, (b) reduce the impact of racial, ethnic, disease-specific and socioeconomic factors in care, and (c) improve the effectiveness of prevention and health promotion.
The Center is a national and international model for cutting-edge translational research in communication and health, and a vehicle for dissemination of strategies to improve healthcare communication.
Rationale for the Center
The Institute of Medicine report, “Crossing the Quality Chasm”, documented the large gap between expected and achieved quality in health care. Many of these gaps result from ineffective communication. The Institute of Medicine report: “Unequal Treatment: Confronting Racial and Ethnic Disparities in care” documents disturbing gaps in quality between whites and minorities that are not explainable by differences in insurance or socioeconomic status. The report underscores the crucial role that inadequate communication and lack of cultural competence play. Many patients report that they are not satisfied with the quality of their interactions with healthcare professionals. Significant gaps in communication between patients and healthcare professionals are evident in the general population. These gaps are more pronounced among (a) marginalized groups such as those with disabilities, low literacy, limited English proficiency or low socioeconomic status, (b) stigmatized groups such as those with HIV infection, obesity, or mental illnesses, and (c) minority populations such as African-Americans and refugees.
Poor communication has a strongly negative impact on outcomes of (a) chronic diseases including diabetes and hypertension, (b) acute illnesses, including pain control, morbidity following surgery, and length of hospital stay, (c) mental illnesses such as depression and schizophrenia, and d) end of life care.
It is possible to improve communication in healthcare settings, and such improvements have led to better health outcomes. Better communication has led to improvements in prevention, motivation for behavior change, and adherence to treatment. Furthermore, these changes may contribute to greater equity in health and healthcare for racial, ethnic, socioeconomic, educational and minority populations when compared to the general population.
We integrate four parallel trends in research and interventions on communication and health.
- The public health approach has traditionally focused on the use of printed and electronic media to transmit health-related messages to populations. Our standardized patient study of ad-driven requests for prescription medication has documented the strong impact of the media on physician prescribing habits.
- The behavioral approach has focused on improving specific physician behaviors believed to improve patient adherence, participation in decision-making and feeling of having been understood. One current NCI-funded study evaluates exercise promotion in disadvantaged populations. We also have evaluated the effect of a mindful communicaion program for physicians on burnout and quality of care.
- The patient empowerment approach has focused on training patients to assume a more active role in their care. Our PNRP (Patient Navigation Research Program), our IMIP study and our SIP2 study use computer-assisted patient coaching interventions to improve health outcomes.
- Finally, the health systems approach as exemplified by the chronic disease management model offers promise for changing how providers, nurses and allied health professionals communicate with each other and with patients. Our patient navigator studies examine the effect of providing better access to - and communication with - health care providers on outcomes of care for patients with newly-diagnosed cancer.
The Center addresses health-related communication on several levels, including (a) the individual psychological makeup of physician and patient and potential for bias, (b) the 1:1 patient-clinician relationship, (c) the patient’s family and relevant social networks, (d) clinical communication among members the health care team, (e) communication with specific, targeted groups of patients, including the use of electronic media, (f) communication between health care researchers and those in clinical settings, and (g) communication between the larger health care system and individual patients and populations.
The Rochester Center to Improve Communication in Health Care
The Department of Family Medicine is a national leader in research on healthcare communication and health disparities, with over $12 million in funding over the past 10 years. In 2009 the Department ranked #10 in the USA in funding from The National Institute of Health. The Department’s reputation of being one of the top Family Medicine Departments in the USA rests on our work on communication, health, and disparities.
During the past several years, there has been a significant expansion of funding for research on communication, disparities and health. Elias Zerhouni, former Director of the NIH, on the issue of health disparities, said that "to call it a priority is wrong. It should be a core mission… It is something that permeates the entire concerns of NIH."
Specific Activities in Service of the Mission
Research areas include:
- basic research on the science of communication in health care settings to develop further theories of communication practice and guide interventions.
- applied research on interventions to improve communication and relationships between patients, their families and caregives; physicians; and other personnel in the health professions.
- translational research on the application of new communication interventions and technologies to healthcare practice, particularly cardiovascular disease, cancer and mental health.
- research on disparities in care for marginalized, underserved and minority populations.
- research on individual and health systems changes to improve access, awareness, and communication.
- Educating clinicians and patients to improve communication.
- Community outreach to empower patients from marginalized and underserved populations.
- Training the next generation of health communication researchers.
- Funding pilot projects.
Target Populations
Vulnerable populations that have been the focus of research by members of the proposed Center include:
- members of racial and ethnic minority groups, including refugees
- people at risk for and infected with HIV
- people who are under- or un-insured
- people facing a life-limiting illness
- people who are deaf or hard-of-hearing
- people who are lesbian, gay, bisexual or transgender
- people who have experienced domestic violence and abuse
- people with undetected and/or chronic mental illness
In addition, studies have addressed physician competence, professionalism, burnout and well-being.
Faculty Expertise
The core faculty of the Center have expertise in areas such as (but not limited to):
- behavioral counseling about exercise and smoking
- care of those with depression, mental disorders, and psychosocial distress, including patients with multiple unexplained symptoms
- healthcare for people with disabilities as well as those who are deaf and communicate in American Sign Language (ASL)
- improving patient safety and reducing medical errors by improving communication within the health care team
- informed decision-making, adherence to treatments, and behavior change
- involvement of family members and social networks in care, including complex ethical and genetic issues
- physicians’ responses to patients’ stated requests and expectations
- prevention and treatment of cancer, HIV and other life-threatening illnesses
- racial, ethnic and socioeconomic disparities in care
- remote healthcare interpreting using telehealth technology
- use of patient navigators to improve access to care and communication
- assessment of professional competence
- peer assessment and review