Sustainable community engagement in a constantly changing health system

Abstract

Engaging patients and communities is invaluable for achieving a patient-centered learning health system. Based on lessons learned in genomic and public health public engagement efforts of our community-based organizations in Flint, Michigan, we offer a continuum model for distinguishing various levels of community engagement and recommendations for approaching community, patient, and public engagement for health care systems that are expanding uses of health information. KEYWORDSCommunity engagement, learning health system, patient-centered health care, public engagement, Health Care in America, defines a learning health system (LHS) as a system "designed to generate and apply the best evidence for the collaborative health care choices of each patient and provider; to drive the process of discovery as a natural outgrowth of patient care; and to ensure innovation, quality, safety, and value in health care." 1 Learning health system core values were developed to present a gold standard approach toward the mission of a national patient-centered LHS. 2 One core value is cooperative and participatory leadership, which ensures the participation/engagement of diverse communities and populations. 3 As LHS frameworks increasingly shape health information use in a variety of ways ranging from research to largescale quality improvement and to chronic disease management, there are abundant opportunities and challenges for engagement. A critical factor in a productive LHS is the engagement of patients, family members, and community. 3 The National Academy of Medicine posits engaged and empowered patients as a key characteristic of the LHS. 4 Understanding the optimal strategies for knowing when, how, and to what extent to engage the public will be critical to building meaningful relationships between health care systems and the communities they aim to serve. Notably, an important consideration is the cultural context within which these processes occur (Figure 1) as supported by the Institute of Medicine, National Academy of Medicine's table of characteristics of a LHS. It is also important to have a clear definition of "community" and shared definitions across communities that enable dialogue about the goals and activities of efforts, such as LHSs, toThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Community Science as a Pathway for Resilience in Response to a Public Health Crisis in Flint, Michigan

“…Recognizing that an incomplete or partial narrative can be just as harmful or damaging as no narrative at all, the current work seeks to allow Flint narratives to be told by Flint residents in order to elevate their perspectives, lived experiences, and reactions as they continue to move from crisis to recovery. Our efforts fall along the spectrum of community engagement, as community serves as the driver and equitable partner in unveiling the missing narrative and disseminating it to the world (Key and Lewis 2018). For this paper, we define community to be the residents of the geographic space of the city of Flint, Michigan.…”

The Church Challenge: A community-based multilevel cluster randomized controlled trial to improve blood pressure and wellness in African American churches in Flint, Michigan

“…Community Engaged Research (CEnR) has increased over the last couple of decades. Community engagement has been implemented various research designs, across various disciplines, and systems including learning health systems [ 17 ]. The National Institutes for Health, Clinical Translational Science Awards Programs has championed CEnR and believe it will yield innovative solutions for improving efficiency, quality and impact for translation to improve the health of individuals and communities [ 17 ].…”

“…Community engagement has been implemented various research designs, across various disciplines, and systems including learning health systems [ 17 ]. The National Institutes for Health, Clinical Translational Science Awards Programs has championed CEnR and believe it will yield innovative solutions for improving efficiency, quality and impact for translation to improve the health of individuals and communities [ 17 ]. Community Based Participatory Research (CBPR) is an approach to research that ensures community involvement in all phases of the research process and falls on the continuum of CEnR [ 17 ].…”

“…The National Institutes for Health, Clinical Translational Science Awards Programs has championed CEnR and believe it will yield innovative solutions for improving efficiency, quality and impact for translation to improve the health of individuals and communities [ 17 ]. Community Based Participatory Research (CBPR) is an approach to research that ensures community involvement in all phases of the research process and falls on the continuum of CEnR [ 17 ]. Guided by nine core principles, CBPR looks to ensure equity in decision making, power dynamics, and ownership of data [ 18 , 19 ].…”

Health Policy-Making Requirements to Attain Universal Health Coverage in the Middle-Income Countries: A Brief Report

“…Despite some controversies, in general, decentralization of policy-making is a good strategy to overcome challenges such as inefficiency and inequity in MICs health systems (2). In addition, community participation in policy-making process could enhance social capital in health sector and improve the effectiveness of health policy-making (15). Finally, health attachment to all public policies should become mandatory by the governance to make all policies in line with restoring and promoting health (16).…”