Boot Camp Translation
Boot Camp Translation
BCT has translated evidence-based medical care, guidelines, and recommendations into reliable clinical opportunities for communities in rural Colorado to increase colon cancer testing, improve asthma diagnosis and management, improve high blood pressure care, and improve implementation of the PCMH. Through the use of this process, communities can successfully determine the content of messaging and how to best disseminate that message to maintain the scientific integrity of the evidence and assure it is locally relevant and culturally appropriate. We include several health care providers in each boot camp to assure alignment with local medical standards. By including local primary care in the process, community members are assured of a common language in both the public health and primary care setting. We have found boot camp to be an effective method for building stronger partnerships between primary care and public health as both organizations work together on a common topic. Projects have been incorporated into local primary care practices through continuing education, building practice-level capacity, and encouraging patients to access local services for their medical care. For example, in Asthma Toolkits and Community AIR, local practices received a new spirometer, on-site training in asthma management, and toolkits to give to patients. The primary care practices derive tangible benefits as well as education and practice support through participation in HPRN projects.
A rural community becoming engaged and activated around a pertinent health issue results in a large number of individuals, organizations, health care providers, and community leaders becoming collaborators. By linking primary care, public health, community-based organizations, and schools, BCT is an effective means of developing a community of solution to address local health concerns. Our colon cancer prevention program began with a CAC of 10 and grew to 15 members. By the end of our program more than 230 individuals had participated. Thirty-one community members partnered with 29 clinicians to provide 50 talks to more than 900 community members. Pocket-sized cards with local photographs were placed in 162 locations: more than 1450 were taken and another 900 were distributed at talks. Sixty-four unique ads and 45 unique personal stories were printed in 15 local newspapers. This colon cancer community of solution developed and deployed a locally relevant answer to an important health concern. Likewise, Community AIR engaged more than 700 rural community members and providers in building a community of solution to address the high rate of asthma and associated morbidity. BCT provides a tangible and replicable process for building a community of solution: participants identify quickly with the tasks and outcomes necessary to improve local health.
BCT is not a rhetorical process that simply takes guidelines and recommendations and changes a few medical terms. It alters the conceptual framework that patients and community members hold for certain medical conditions. We do not know what we are going to end up with when we start the process. By combining both local and medical expertise, BCT creates local experts who, once educated about a specific health topic, have the capacity and local knowledge to frame the condition in the community milieu. For instance, in our first BCT related to colon cancer, rural male farmers were clearly not compelled by the concept of early detection and diagnosis of colon cancer. However, when the CAC gained a more sophisticated and nuanced understanding of colon polyps leading to colon cancer and realized that removal of polyps early can actually prevent colon cancer, they gravitated to this message for dissemination into the community. "Testing to Prevent Colon Cancer" was much more compelling to the rural and frontier communities and provided the context for a more accessible conversation between patients and providers. The Asthma Toolkit was a tangible gift from the clinic to the patient that used the common toolkit metaphor. This changed the concept of asthma as an activity-limiting disease to a condition that needed upkeep and maintenance, similar to machines and equipment common in rural Colorado.
Common to every boot camp is the message to patients and community members to access their local health care providers. The CAC is clear that while they have learned much about each medical condition, they want community members to go talk to their doctor to get the best care for their individual condition. The CAC provides talking points and relevant language so that community members can have a more thorough and meaningful conversation with their providers. Participation of providers assures that messages align with local medical standards.
BCT requires flexibility and modification. Time frames are approximate. Sometimes an issue may take several phone calls to complete, whereas for other issues groups may develop language quickly. Much of this depends on the complexity of the health condition, the evidence-based recommendation, and the cultural context of the specific community. In 4 experiences with BCT, our CACs have worked through a host of topics and ideas. Each time the final product was both intuitive and a surprise, and each time the community owned the language and proudly presented it to their community. The engagement of the local community in the process assures local and cultural relevance and increases the chance of uptake and implementation.
Not everyone likes the name boot camp for this activity; the term implies a short, intense learning activity, not military or hierarchical hazing. We have found the process to be difficult, requiring commitment to completing tasks and activities. We all come through the process stronger and with a much better message. The name itself is not important, and those who wish to should call it something else. The process of local community engagement and discovery is the crucial element. It is important to understand that the community members act as the brainstorm interpreters and idea generators, but they do not act as facilitators or note takers or serve in a longitudinal support role. The partnership of the researcher is essential. The community alone may not have the resources or expertise to proceed effectively and produce a scientifically valid message. An academic partner may be necessary to lead and facilitate the conversation and keep the process moving forward.
BCT addresses the core concepts of patient-centered care by addressing one of the barriers to advancing the quality of care in the United States. Specifically, the process provides an approach that maintains the scientific integrity of the robust evidence base in health care while honoring the local and cultural aspects of community and health. BCT addresses community health priorities, brings together key stakeholders, and develops and refines evidence-based care in a manner that respects local and individual patient preference. BCT may be an effective method for building communities of solution that address the priorities set out by the Patient-Centered Outcomes Research Institute.
Discussion
BCT has translated evidence-based medical care, guidelines, and recommendations into reliable clinical opportunities for communities in rural Colorado to increase colon cancer testing, improve asthma diagnosis and management, improve high blood pressure care, and improve implementation of the PCMH. Through the use of this process, communities can successfully determine the content of messaging and how to best disseminate that message to maintain the scientific integrity of the evidence and assure it is locally relevant and culturally appropriate. We include several health care providers in each boot camp to assure alignment with local medical standards. By including local primary care in the process, community members are assured of a common language in both the public health and primary care setting. We have found boot camp to be an effective method for building stronger partnerships between primary care and public health as both organizations work together on a common topic. Projects have been incorporated into local primary care practices through continuing education, building practice-level capacity, and encouraging patients to access local services for their medical care. For example, in Asthma Toolkits and Community AIR, local practices received a new spirometer, on-site training in asthma management, and toolkits to give to patients. The primary care practices derive tangible benefits as well as education and practice support through participation in HPRN projects.
A rural community becoming engaged and activated around a pertinent health issue results in a large number of individuals, organizations, health care providers, and community leaders becoming collaborators. By linking primary care, public health, community-based organizations, and schools, BCT is an effective means of developing a community of solution to address local health concerns. Our colon cancer prevention program began with a CAC of 10 and grew to 15 members. By the end of our program more than 230 individuals had participated. Thirty-one community members partnered with 29 clinicians to provide 50 talks to more than 900 community members. Pocket-sized cards with local photographs were placed in 162 locations: more than 1450 were taken and another 900 were distributed at talks. Sixty-four unique ads and 45 unique personal stories were printed in 15 local newspapers. This colon cancer community of solution developed and deployed a locally relevant answer to an important health concern. Likewise, Community AIR engaged more than 700 rural community members and providers in building a community of solution to address the high rate of asthma and associated morbidity. BCT provides a tangible and replicable process for building a community of solution: participants identify quickly with the tasks and outcomes necessary to improve local health.
BCT is not a rhetorical process that simply takes guidelines and recommendations and changes a few medical terms. It alters the conceptual framework that patients and community members hold for certain medical conditions. We do not know what we are going to end up with when we start the process. By combining both local and medical expertise, BCT creates local experts who, once educated about a specific health topic, have the capacity and local knowledge to frame the condition in the community milieu. For instance, in our first BCT related to colon cancer, rural male farmers were clearly not compelled by the concept of early detection and diagnosis of colon cancer. However, when the CAC gained a more sophisticated and nuanced understanding of colon polyps leading to colon cancer and realized that removal of polyps early can actually prevent colon cancer, they gravitated to this message for dissemination into the community. "Testing to Prevent Colon Cancer" was much more compelling to the rural and frontier communities and provided the context for a more accessible conversation between patients and providers. The Asthma Toolkit was a tangible gift from the clinic to the patient that used the common toolkit metaphor. This changed the concept of asthma as an activity-limiting disease to a condition that needed upkeep and maintenance, similar to machines and equipment common in rural Colorado.
Common to every boot camp is the message to patients and community members to access their local health care providers. The CAC is clear that while they have learned much about each medical condition, they want community members to go talk to their doctor to get the best care for their individual condition. The CAC provides talking points and relevant language so that community members can have a more thorough and meaningful conversation with their providers. Participation of providers assures that messages align with local medical standards.
BCT requires flexibility and modification. Time frames are approximate. Sometimes an issue may take several phone calls to complete, whereas for other issues groups may develop language quickly. Much of this depends on the complexity of the health condition, the evidence-based recommendation, and the cultural context of the specific community. In 4 experiences with BCT, our CACs have worked through a host of topics and ideas. Each time the final product was both intuitive and a surprise, and each time the community owned the language and proudly presented it to their community. The engagement of the local community in the process assures local and cultural relevance and increases the chance of uptake and implementation.
Not everyone likes the name boot camp for this activity; the term implies a short, intense learning activity, not military or hierarchical hazing. We have found the process to be difficult, requiring commitment to completing tasks and activities. We all come through the process stronger and with a much better message. The name itself is not important, and those who wish to should call it something else. The process of local community engagement and discovery is the crucial element. It is important to understand that the community members act as the brainstorm interpreters and idea generators, but they do not act as facilitators or note takers or serve in a longitudinal support role. The partnership of the researcher is essential. The community alone may not have the resources or expertise to proceed effectively and produce a scientifically valid message. An academic partner may be necessary to lead and facilitate the conversation and keep the process moving forward.
BCT addresses the core concepts of patient-centered care by addressing one of the barriers to advancing the quality of care in the United States. Specifically, the process provides an approach that maintains the scientific integrity of the robust evidence base in health care while honoring the local and cultural aspects of community and health. BCT addresses community health priorities, brings together key stakeholders, and develops and refines evidence-based care in a manner that respects local and individual patient preference. BCT may be an effective method for building communities of solution that address the priorities set out by the Patient-Centered Outcomes Research Institute.
