Evaluation and Research

The MGH Center for Community Health Improvement is committed to measuring outcomes for continuous quality improvement and program development. In order to assess if programs are making a difference, meeting the needs of communities, and efficiently and effectively carrying out goals and objectives, the CBP Research and Evaluation Team (RET) - affiliated with the MGH/Partners Institute for Health Policy - evaluates most programs.

The research and evaluation methods are guided by principles of community-based participatory research (CBPR). Key principles for CBPR include: building on a community’s strengths and resources, collaborative partnerships, mutual benefit of all partners, co-learning, empowerment, and dissemination of knowledge to all involved. In addition to evaluating programs, the projects described below were directed by members of the Research and Evaluation Team in collaboration with community and hospital leaders. 

Buprenorphine Treatment in Primary Care
Erica Sandman, MA
Michael Bierer, MD, MPH
Danelle Marable, MA
Martha Kane, PhD

A pilot study was conducted to describe care, assess resource use, and analyze outcomes of MGH primary care patients receiving buprenorphine (BUP) treatment for opiate dependence.  Seven primary care providers completed intake and follow-up forms for twenty-three buprenorphine patients tracked prospectively over two months. Data recorded included measures of severity of illness, social adjustment, illicit drug use, and intensity of service provision.  A medical record review, including a review of provider notes, supplemented the data and allowed for quality assessment. 

At two months, 61 percent remained in treatment and after six months, 43 percent of patients remained in treatment.  Of the 14 remaining in treatment after two months, 20 percent had urine tests positive for opiate use, as compared to 64 percent at intake.   In addition, after two months, these 14 patients also reduced needle use from 50 percent to 14 percent.  On average, providers assessed these patients as moderately improved as compared to baseline. The resources analysis revealed that clinical appointments are frequent and long. Of the 14 patients remaining in treatment, patients averaged three visits in the first two weeks and two visits per month in the second month of treatment. Clinical appointment duration in the first week averaged 39 minutes and reduced to approximately 21 minutes for appointments in the second month.  The quality assessment conducted on visit notes revealed that 91 percent documented the results of urine toxicology, 100 percent documented dose and appropriate number of pills prescribed, and 83 percent met all criteria for quality.  This pilot study demonstrates that BUP treatment is effective but requires considerable resources.  Taken together, these data have implications for systems design and resource allocation.  This research was presented at a poster session at the 2007 annual meeting of the Association for Medical Education and Research in Substance Abuse (AMERSA) in Washington, D.C. in November 2007. 

Women In Need
Leslie Aldrich, MPH
Edward Conley, Sergeant Detective

The Chelsea Police Department (CPD) received funding from the Massachusetts Executive Office for Public Safety to conduct a needs assessment of commercial sex workers (CSW) in Chelsea. The RET is collaborating with the CPD to conduct interviews and surveys with up to 40 women.   To date, 11 interviews have been conducted with preliminary results indicating food and housing are the most immediate needs. 

Although the majority of the sample had current housing, almost all of the women interviewed (90 percent) report being homeless at some point in their lives.  In addition, the majority (60percent) worry about where to get their next meal.  All of the women report having health insurance with the majority seeking out medical care when they feel it is necessary. Violence is also a real concern with 100 percent of the sample interviewed exposed to some sort of personal abuse at one time in their lives. The majority of CSW's report being abused by clients and over half report some type of childhood verbal, physical or sexual abuse from an adult or parent. Seventy percent report being physically and sexually abused by someone they dated.

Using drugs and alcohol before the age of 13 is common for this population with a high percentage of women reporting having used, and in many cases continuing to use, both cocaine and heroin. Unfortunately exchanging sex for money has only exacerbated these women’s addiction issues with 63 percent reporting that their drug use has increased since entering into prostitution. Although 80 percent of women rate their health as very good or good, 50 percent report currently feeling depressed enough that everything was an effort all or most of the time.  In addition, 88 percent of these women report feeling sad or hopeless every day for two weeks or more. When discussing potential services that may benefit their lives, all women (11) expressed an interest in receiving an education and developing useful job skills. In addition, all women thought services around food, clothing and childcare would be helpful followed by mental health services (91 percent), job training (91 percent), basic medical care (82 percent), and safe and accessible drug treatment (64 percent). Six out of eight women expressed the need for affordable housing.
 
Although initial data from this assessment reveals the need for direct services for these women, more data must be obtained. Once data collection is complete, the Chelsea Police Department and researchers at the MGH plan to collaborate with local community agencies and institutions in order to interpret the findings and assess resources for potential treatment and services and to develop a research-based harm reduction and safe intervention model for sex workers in Chelsea.