Placement: Harvard Medical School Center for Primary Care
Mentor: Russell S. Phillips, M.D., Director of the Center for Primary Care, William Applebaum Professor of Medicine and Professor of Global Health and Social Medicine, Harvard Medical School
Co-mentor: Erin E. Sullivan, Ph.D., Research and Curriculum Director, Harvard Medical School Center for Primary Care
Project: Addressing Social Determinants of Health in the Context of the Patient-Centered Medical Home
Mylaine Breton, M.B.A., Ph.D. is a 2019–20 Canadian Harkness/CFHI Fellow in Health Care Policy and Practice. Breton is an associate professor in the Department of Social Science and Medicine at the University of Sherbrooke’s Longueil campus and holds a Canadian Research Chair in clinical governance on primary health care. Breton’s research program for improving health care organization is comprised of applied research projects undertaken in partnership with clinicians and managers. Its focus is innovations to improve accessibility and continuity of primary health care, such as a centralized waiting list for patients without a primary health care provider and advanced access models. Breton is first author on 18 peer-reviewed publications in leading journals, including Implementation Science, BMC Health Services Research, BMC Family Practice, and the International Journal of Integrated Care, and principal investigator on grants totalling $1,200,000 from the Canadian Institutes of Health Research (CIHR) and Fonds de recherche du Québec — Santé (FRQS). Breton completed basic training as an occupational therapist and holds an M.B.A. from Université Laval. Breton earned her doctorate in health service management from University of Montréal in 2009 and completed a postdoctoral appointment at Université de Sherbrooke/McGill University.
Project Overview: Patients, particularly those from communities with high rates of poverty, experience significant nonmedical challenges that negatively affect their health. Despite advances in medicine, socioeconomic disparities in health increase, and heath care leaders now recognize that health system goals cannot be achieved without careful consideration of the social determinants of health. Several medical associations, including the British and Canadian Medical Associations, have called on the health sector to play a greater role in addressing social determinants and evaluating new interventions. Primary care providers follow patients longitudinally, giving them the opportunity to understand the broader contextual factors that shape the health of the people they care for. As a result, they are uniquely positioned to act based on the social determinants of health. The Patient-Centered Medical Home (PCMH) model is an innovation in health care delivery designed to improve patient experience and population health and reduce the cost of care, and it has been recognized as an ideal model for improving quality of care and health outcomes. It also offers the opportunity to screen patients according to social needs while making connections to community-based services.
This research, through case studies, aims to understand how primary health care organizations in the U.S. are addressing social determinants of health. Four Community Health Centers in Massachusetts that have been accredited as PCMHs and are participating in the Advancing Teams in Community Health program (led by Harvard Medical School’s Center for Primary Care in 2019–2020) will be selected, and document analysis, direct observation, and semi-structured interviews will be conducted. This study, which is embedded in an improvement project, will analyze decision-making and innovative actions put in place by community health centers to improve the health of their patient population.