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February 1, 2011

Research to Action

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Melissa Riba

Melissa Riba

Research Team Lead
Center for Healthcare Research & Transformation

In my role at CHRT, I work daily with the best research minds in the country and I work with communities and “grass roots” groups. I often describe what I do as bridging two worlds and helping to translate and balance between them. The work engages solid research design but in ways that are practical and able to be translated into community settings.

The two most gratifying aspects of this are when I get to see research put into action (as when results are used to improve a program, a policy or the way services are delivered) and when through the research process, we are able to pair human faces and stories to the conclusions we draw. Research is a scientific and logical process but it is also very much a human, creative enterprise. It can provide data and generate important conclusions, but it can also put a human face to the issues we are trying to address.

An excellent example involves some recent work in Genesee County. The Genesee Health Plan (GHP) is a community-based health care program for low-income individuals. In order to delve into the growing health and social service needs of families in the county, GHP received a planning grant from the Community Foundation of Greater Flint to engage the community in the research and planning process.

The research design was qualitative and included focus groups with community members, interviews with front-line health and social service intake workers and a series of community partner engagement sessions with representatives from all the major health care and social service organizations in the county. This triangulation of methods provided us with three very important but different perspectives on what gaps exist for families in Genesee County and how best to address them.

From the most conventional research perspective, this kind of work can be messy and has its known limitations. The research had to be done quickly—over the course of a few months—and within a very small budget. There were limited opportunities for creating comparison groups. One could argue that the participants were a self-selected group, and therefore may not be fully representative of the population and issues about which we are trying to learn, but nonetheless, the data—the stories—generated from this work say a lot about the needs of the community:

  • Person after person describing confusion about their health coverage. One woman admitted she just presented her insurance card to her provider and thought to herself ‘Well, I hope what I need is covered.”
  • A mother who had employer-based insurance—a high deductible plan that carried a $4,000 deductible – estimated that she spent about $300 a month out of pocket on prescriptions for her daughter, who had chronic health conditions. By the time she had finally reached her annual deductible, the year was almost over and she would have to start all over.
  • A husband/father of three who was laid off in the most recent round of auto industry troubles in Flint described losing his job and health benefits after two decades of working. Although he recently received coverage through the Genesee Health Plan and was extremely grateful that such a resource existed, he still found himself frustrated and confused about his new status.
  • A woman who described, with great pain in her voice, making a choice between spending $5 on a co-pay for a prescription or putting gas in her car which she needed to get to work.
  • Another mother, who said she knew what she should do to make her child’s life healthier but felt severely constrained by her neighborhood, where gun shots and shootings were regular occurrences, making it too dangerous for her son to go outside and play.
  • A young woman who had strep throat and was told she couldn’t get an appointment with her primary care doctor for two weeks. After missing a week of work, she ended up going to the emergency room.

The next steps of the process in Flint will involve taking the data – and these compelling stories – and working with the community to develop a viable plan for addressing the gaps they reveal. This process will carry the human element forward, and translate this research into the kind of action that can truly improve lives.

 


Melissa Riba is a health policy consultant at CHRT, responsible for the research and evaluation design components of CHRT projects and identifying researchers and research partners in both major project categories: care delivery/financing systems and population health/access to care.

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