Health Care in Urban Communities

J. Randolph Hillard

For our 2010 issue, The Engaged Scholar Magazine asked three prominent scholars for their "Perspectives" on academic engagement with urban communities. This interview is Dr. J. Randolph Hillard's response.

A recent Annals of Internal Medicine study¹ ranked Michigan State University's medical colleges among the top U.S. medical schools for social mission, defined by the researchers as producing doctors who are minorities, practice primary care, or work in underserved areas. According to J. Randolph Hillard, Associate Provost for Human Health Affairs, this commitment extends across all of the University's human health programs. TESM talked with Dr. Hillard about the challenges involved in delivering health care services to urban communities.

How do MSU's medical schools engage with urban communities?

The College of Human Medicine (CHM) has six regional campuses. The associate dean at each campus has the job of overseeing engagement. All of them give technical assistance on community boards. The College of Osteopathic Medicine has students in over 40 community hospitals across the state, including a new program in downtown Detroit at the Detroit Medical Center. Overall, more than 1,000 students and 1,000 resident physicians are providing clinical services.

The CHM's Institute for Health Care Studies has a strong history of successful collaborative partnerships. Denise Holmes, the director, has high-level input into state and community policy. The Clinical and Translational Sciences Institute (CTSI) facilitates team research in collaboration with community health care providers; CTSI promotes research with multiple sites across the state. Leadership in Medicine for the Underserved/Vulnerable is a clinical option for students that focuses on international issues at the Saginaw campus. The Flint campus focuses on public health.

What is your personal involvement?

I chair the Capital Area Health Alliance (CAHA). Along with other community agencies, we started a regional health information organization (RHIO). A RHIO is about sharing information. When I was in Cincinnati we had one, and I miss it. RHIOs lead to better coordination of care. For example, fewer patient tests are needed because the ones the patient has already had are available to other providers. Dr. Holmes brought in state money to get one here and President Simon was very supportive as well. Hospitals are oriented to being competitive rather than cooperative. There's no competitive gain for them, so they didn't originally see the benefit.

What are the urban issues in health care services?

The RHIOs are most important for urban areas. Even in Lansing where there are only two hospitals, it's a challenge to ensure coordination of treatment. The Obama administration is pushing it, particularly in urban areas where there are many service portals. In rural areas you've probably only got one option anyway so coordination is not an issue.

Also, health care is a possible industry for urban area growth. We're trying to become a magnet here, now that there's more cooperation between Sparrow and Lansing General. This is a focus of CAHA and also Lansing Economic Area Partnership (LEAP).

1. Mullan, F., Chen, C., Patterson, S., Kolsky, G., & Spagnola, M. (2010). The social mission of medical education: Ranking the schools. Annals of Internal Medicine, 152, 804-811.. Retrieved from annals.org/content/152/12/804.full?aimhp
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