Transcript Slide 1

Welcome!
¡Bienvenidos!
© 2010 College of Medicine
U.S. - Mexico Border
Center of Excellence Consortium:
Current and Future Directions
Ana Maria Lopez, MD, MPH, FACP
Associate Dean for Outreach and Multicultural Affairs
Professor of Medicine and Pathology
Medical Director, Arizona Telemedicine Program
University of Arizona College of Medicine
© 2010 College of Medicine
U.S. - Mexico Border
Center of Excellence Consortium
California
Arizona
New Mexico
Texas
© 2010 College of Medicine
Acknowledgement
© 2010 College of Medicine
US Mexico Border Center of
Excellence Consortium
 Who
are we?
 What is our overarching goal?
 What have we accomplished?
 What is our current focus?
© 2010 College of Medicine
United States-Mexico Border Center of
Excellence Consortium

Developed with the purpose of more clearly
defining the needs of health professionals,
especially physicians, dentists, pharmacists and
nurses in the border region.

Encouraged partnerships via communication,
collaboration and coordination with various
health professional schools, organizations,
HRSA funded programs, and international
collaboratives
© 2010 College of Medicine
Who are we?
• Consortium formed by the existing Centers of
Excellence (COEs) along the border states in 2002
• Efforts to date have focused on:
- Direct health service workforce
- Research workforce capacity
- Model programs
- Community service learning health curriculum
- Community engagement programs
© 2010 College of Medicine
COE Consortium Members
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University of Arizona
University of California, San Diego
University of California, San Francisco
University of California, Los Angeles
University of New Mexico, School of Medicine
University of Texas at Austin-(Pharmacy)
University of Texas at Houston HSC
University of Texas Medical Branch at Galveston
University of Texas at San Antonio (Medical and
Dental)
• Texas Tech University HSC at El Paso
© 2010 College of Medicine
National and Regional Partners
• Hispanic Association of
Colleges and Universities
• Hispanic Serving Health
Professions Schools and
Schools of Public Health
• US Mexico Border Health
Commission
• US Mexico Health Association
• Pan American Health
Organization
• Minority Faculty Fellowship
Program
• Centers of Excellence Program
• Area Health Education Ctrs
• Community Health Centers
• US Mexico Border Health
Association
• Border Health Office
• HRSA Regional Office
• TX Department of Health
• Health Careers Opportunity
Program
© 2010 College of Medicine
Consortium Goals
• To develop and implement a strategic
plan to reduce the health professional
workforce shortages along the U.S. Mexico border.
• To eliminate health disparities within
our border community by addressing
workforce capacity and their education
and training needs
© 2010 College of Medicine
Specific Goals
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Assess the needs and resources related to
health professions research workforce capacity
and diversity of HRSA funded programs;
Address research education and training along
the U.S.-México Border States;
Serve as a resource for other research
programs and institutions with an interest in
increasing the health research workforce in the
region.
© 2010 College of Medicine
Defining Needs
 Consortium
core members selected
two reports to help conceptualize
needs and goals along the USMéxico Border:
• Healthy Border 2010 (US-México Border
Health Commission, HRSA, 2003)
• Border Health Research Agenda Council
Meeting Report (PAHO, 2002).
© 2010 College of Medicine
Direct Health Service Workforce
2002-03
• Defined the health workforce pool
• Determined demographics and health status
of the border population
• Identified gaps in workforce
• Established collaboration efforts
© 2010 College of Medicine
Next Area of Focus and
Direction
 As
the next step in addressing
workforce shortage: research
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Develop an inventory and database of
completed and existing research along the
U.S.-México Border
© 2010 College of Medicine
Research Workforce Capacity
2004-05
• Defined the extent of shortages in health research
workforce
• Identified barriers to achieving research parity with
the rest of the region and the nation by developing the
following databases:
- Current research programs on the U.S.-Mexico border
- Latino research training programs in our own institutions
- Currently funded research projects that target health
disparities along the border
© 2010 College of Medicine
Research Database Project
 Main
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Objective:
identify border health disparities research
projects
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Cancer
Cardiovascular Disease
Infant Mortality
Immunizations
Diabetes
HIV/AIDS
© 2010 College of Medicine
Model Programs
2005-06
• Identified model programs related to health
promotion and service, health disparities research and
workforce training activities:
- Developed a resource guidebook of model programs
• Exposed health professions students and faculty to
border primary health, environmental, and public
health concerns through:
- Clinical rotations
- Internships
- Border health training
- Collaborations among agencies and programs along
border
© 2010 College of Medicine
Community Service Learning
2006-07
Developed a community service learning
health curriculum:
- Culturally and linguistically competent
- Gender sensitive and specific
- Incorporates community service learning
- Utilizes promotoras as lay teachers for
health profession students
© 2010 College of Medicine
Community Service Learning
2006-07
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Service learning in clinical education:
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Balance between service and learning
objectives
Emphasis on reciprocal learning
Integrating the role of community
partners
Emphasis on self-reflective practice
© 2010 College of Medicine
Community Engagement
2007-08
“Community-Based Programs to Create
Community-Responsive Health Professional
Workforce”
 keeping connected to our communities
 teaching students to become future leaders
 Sub-themes
 community engagement
 community service
 health literacy
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© 2010 College of Medicine
How Does Research Translate
into Best Practices?
2008-09
Outlined approach to new questions
 How can research effectively and practically be
translated into clinical practice?
 How can practice inform research?
 Are both questions equally important?
© 2010 College of Medicine
Identified Emerging Collaborators
Considered collaborative activities
with:
 National Institute of Health
 Agency for Health Research and Quality
(AHRQ),
 The National Library of Medicine (NLM)
 Continuing Education (CE/CME) Providers
© 2010 College of Medicine
National Institute of Health
 Excellence
in Partnerships for Community
Outreach, Research on Health Disparities
and Training (Project EXPORT) at
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University of Arizona
University of California at San Diego
University of Texas at El Paso
 Clinical
and Translational Science Awards
(CTSA)
© 2010 College of Medicine
EXPORT
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Model research programs addressing health
disparities along the US-Mexico Border selected for
inclusion in the Consortium Research Database
Project.
Funded by National Institutes of Health, National
Center on Minority Health and Health Disparities
(NCMHD)
NCMHD supports basic, clinical, and behavioral
research, promotes research infrastructure and
training, advocates for outreach to underserved
© 2010 College of Medicine
EXPORT Goals
 Rigorous
population and epidemiologic
research to:
 build research capacity for health disparities research in
minority-serving and other designated institutions;
 promote the participation of health disparity groups in
biomedical and behavioral research and prevention and
intervention activities; and,
 promote planning for the conduct of minority health
and/or other health disparities research.
© 2010 College of Medicine
Clinical and Translational Science
Awards (CTSA)
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Purpose: narrow time between bench and bedside
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“enable institutions to engage in innovative and
transformative efforts appropriate to their own environment
that will develop and advance clinical and translational
science as a distinct discipline within a definable academic
home.”
Current funded CTSAs within the Border States:
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The University of California at San Diego
The University of California at San Francisco
The University of Texas Health Science Center at San Antonio
© 2010 College of Medicine
Agency for Health Quality Research
Implement health services research into
practice
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AHRQ has devoted funds to support primary care
Practice-Based Research Networks (PBRNs).
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PBRNs draw on the experience and insight of
practicing clinicians to identify and frame research
questions whose answers can improve the practice
of primary care.
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Since 2000, AHRQ has funded over 52 PBRNs
through targeted grant programs.
© 2010 College of Medicine
PBRNs in Border States
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California (6):
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New Mexico:
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The USCF/Stanford Collaborative Research Network , San Francisco;
Community Health Center Network, Alameda; Pediatric Diagnostic
Center PBRN, Ventura; UCSF Collaborative Research Network, San
Francisco; San Diego Unified Research in Family Medicine Network,
San Diego; UCLA Primary Care Research Network, Los Angeles
RIOSnet, University School of Medicine, Albuquerque
Texas (5):
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Central Texas Primary Care Research Network, Temple; The
Southern Primary-Care Urban Research Network, Houston;
Residency Research Network of Texas , San Antonio; North Texas
Primary Care Practice Based Research Network, Fort Worth; South
Texas Ambulatory Research Network, San Antonio
© 2010 College of Medicine
National Network of Libraries of
Medicine (NN/LM)
 Mission:
 to advance the progress of medicine and
improve the public health by providing all U.S.
health professionals equal access to biomedical
information and by improving the public's access
to information to enable them to make informed
decisions about their health
© 2010 College of Medicine
National Network of Libraries of
Medicine (NN/LM)
 In
2006, NN/LM awarded 5Y Regional
Medical Library (RML) contracts
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Houston Academy of Medicine – Texas Medical Center Library
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University of California Los Angeles
 RMLs
focus their efforts on reaching
underserved health professionals in rural
and inner city areas
© 2010 College of Medicine
MedLine Go Local
 National
initiative complementing
MedlinePlus
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develop and maintain databases of health
service providers in specific geographic
areas
27 “MedlinePlus Go Local” projects in 24
states:
• University of Arizona
• UT Health Science Center, San Antonio
• University of New Mexico.
© 2010 College of Medicine
MedLine Go Local Opportunities
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Development and evaluation of a Spanish
interface for MedlinePlus Go Local
Evaluation of Go Local directories from the
perspective of community members living
in the Border region, including promotoras
Sharing best practices for maintaining Go
Local Border region projects
© 2010 College of Medicine
Continuing Education Programs
 The
Accreditation Council of
Continuing Medical Education
(ACCME) 2006:
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Updated accreditation criteria to link CME to
quality improvement and more effectively
address current and emerging public health
concerns
© 2010 College of Medicine
CE/CME Evolving Criteria
 Practice-based
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learning and improvement
the content of CME matches the scope of the
learner’s practice
learning activities are linked to practice-based needs
changes in competence, performance, or patient
outcomes are measured
opportunity for interprofessional CE/CME
CE/CME: building a bridge between translational research
and clinical practice.
© 2010 College of Medicine
How clinicians in border practices
access evidence-based information and
implement it into their practice?
Plan for White Paper
 Background
 Literature Review
 Methods
 Results
 Recommendations
© 2010 College of Medicine
Literature Review
 1996-2008
publications
 electronic search within the University of
Texas Health Science Center at San
Antonio Briscoe Library
 identified 1,917 articles in Medline limited
to English language and human subjects
© 2010 College of Medicine
Literature Review Identified
 Limited
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access
Within the U.S.-Mexico border region, access
is a challenge because of the distance to
academic institutions and libraries that house
this up to date medical information including
access to CME. Access to web-based
education may also be limited depending on
the community.
© 2010 College of Medicine
Prospective Collaborative
Qualitative Study
 Conduct
focus groups and in-depth
interviews
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with clinical practitioners
within Community and Rural Health Centers
between December of 2008 and February of
2009.
© 2010 College of Medicine
Defining health information needs:
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How can we better define the health
information needs within our geographic
area?
What were the problems in accessing health
information and continuing education?
How can access be improved?
What type of additional health information,
continuing education or other resources could
be helpful?
© 2010 College of Medicine
Access to Health Information
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What access do you or staff have to the Internet,
telephone conferencing, video conferencing, or
funds for CE in your practice setting?
Do you access health information from Mexico to
make decisions about your patients who might also
be accessing health care in Mexico? For example,
the Pan American Health Organization?
© 2010 College of Medicine
What methods do practitioners
use to access health information?
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What can we learn about how practitioners identify,
collect, and analyze the information for various sources?
What gaps were identified in the information accessed?
How can we fill the gaps identified?
What kind of evidence-based health and research
information do you access?
Who do you turn to for medication update information?
What access do you have to Internet or computer services
in your clinic setting to find health information or updates?
© 2010 College of Medicine
How do you prefer to receive new
updates?
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Continuing education
 Internet
 Workshops
 Videos
 Telemedicine (patient care)
 Teleconferencing (distance learning)
 Videostreaming
 Border conference
© 2010 College of Medicine
Comfort with/access to technology
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What access do you and your staff have to
Internet or computer services in your clinic setting
to find health information or updates? Are these
readily available in the patient exam rooms? in
your office?
What access do you or staff have to funds for CE
in your practice setting?
What is your comfort level with technology?
What type of barriers impact your ability to access
this information, and to what degree?
© 2010 College of Medicine
Relevance and Analysis
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Once you have reviewed new information, what
is the deciding factor to the relevance of this
information in your practice, practice setting, or
patient population?
Do you feel that the evidence-based research
information is relevant to your border practice?
How do you analyze and distill this information in
order to implement it into your practice?
© 2010 College of Medicine
Implementing into Practice
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When do you think it is appropriate to implement
new evidence-based information into your
practice?
Have you made changes in your clinical
practice, based on this new evidence-based
clinical or research information?
What are the barriers to implementing this
evidence-based clinical and research
information into your practice? Budget? Staff?
Space? Other?
© 2010 College of Medicine
Implementation into practice
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How have you implemented and monitored
changes in your clinical practice with other
initiatives? (e.g., HRSA Action plans, JCAHO
Accreditation standards, HRSA Diabetes
Collaborative)
How do you receive information about changes
that impact your practice and/or practice
policies? (e.g., provider meetings, newsletter,
e-mail, staff training)
© 2010 College of Medicine
Training and Education
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What would be the ideal way for you to receive
new updates on evidence-based practice?
What would be the ideal way for you to learn
about new practice standards?
In general, when is it convenient for you to
participate in continuing education?
• Days of the week
• Time of day
© 2010 College of Medicine
Suggestion Questions
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What could be done to improve the relevance of research for the U.S.Mexico border region?
What are some useful methods or models that could be utilized to move
research protocols and procedures into the clinical setting?
Have you attended a border health-related conference or meeting?
What types of forums are needed where health policy issues can be
discussed in light of the latest research?
What options do you recommend that HRSA could implement to improve
the application of research in the clinical setting in the border region?
Do you have any final thoughts regarding how clinicians can access
evidence-based information?
Are there questions that we should be asking other practitioners about
accessing evidence-based and research information to utilize in their
practice?
© 2010 College of Medicine
Methods
 Thematic
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Analysis
A thematic analysis was done of each group
report to summarize common themes in the
individual state reports.
For the overall results, the results by state were
prioritized via the top five themes, ranking the
most important to least important themes.
This method was utilized to formulate the
conclusions
© 2010 College of Medicine
Results: Ten Themes
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Evidence-based practice is perceived as an ideal.
Border clinicians recognize the importance of
critically appraising research for its relevance to their
patients.
Cultural differences, poverty, and patients’ low health
literacy are significant challenges for clinical care in
the border region.
Access to pharmaceuticals in Mexico has an impact
on border clinicians’ standards of practice.
Time is a more significant constraint than access to
information resources.
© 2010 College of Medicine
Results: Ten Themes
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Clinicians are challenged by the frequency of changes in
research-based information.
Having an academic affiliation enhances access to new
clinical information.
Information about complementary and alternative
medicine (CAM) is relevant to clinical practice in the
border region.
Information from Mexico and other international sources
is used on a limited basis.
There is a need for more CME events specifically
addressing border health issues.
© 2010 College of Medicine
Conclusions
© 2010 College of Medicine
The U.S.-Mexico border region
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unique demographic and geographic area
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cultural, socioeconomic, and epidemiologic characteristics
different from the rest of the US
“developed” and “developing” worlds unite along a 2,000mile international border.
government policy and physical barriers influence the
fluidity of human movement across this politically
delineated border
health issues do not respect such bounds
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conflict between the necessity for care and the inherent
challenges in fulfilling that need
© 2010 College of Medicine
US-Mexico Border Disparities
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disparities in:
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economic well-being
access to health care services
availability of public health care infrastructure work force
research studies are needed on health problems
affecting the U.S.-Mexico border region
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should be conducted in border communities
should be conducted by people living on the border, border
academicians and clinicians.
© 2010 College of Medicine
Health impact of transmigration
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The growth rates of border counties and
municipalities exceed state and national
averages
 Transmigration: people move northward
seeking opportunities to improve standard of
living
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Millions cross the border legally and illegally each
month
Binational public health challenge
© 2010 College of Medicine
Binational and multicultural health
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Develop collaborative and responsive research
and partnerships
 Nurture local physicians as principal and subinvestigators
 Foster binational research and sharing of
research findings
© 2010 College of Medicine
Recommendations
© 2010 College of Medicine
Recommendations
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Establish HRSA entity: information repository on
health research affecting border communities
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trustworthy source of information
university consortium: serve as hub for extramural funding
staff live on the border, understand the problems affecting
the border and are familiar with the health care system and
resources available at the border
Attracting clinicians to the U.S.-Mexico border region,
especially to the rural communities, will require
incentives
© 2010 College of Medicine
Proposed Future Work
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U.S-Mexico Border Centers of Excellence
Consortium proposes:
1. Prepare a “Best Practices Manual on Collaboration” (5 Best
Practices Along the Border for Public and Private
Collaborations and Partnerships)
2. Qualitatively and quantitatively assess outcomes and
impact of the U.S. Mexico Border Centers of Excellence
Consortium Contract
3. Plan the US Mexico Center of Excellence Consortium
Forum in El Paso Texas for July 2010: “How Does
Research Translate Into Best Practices”
© 2010 College of Medicine
Best Practices Manual
 Plan
state meetings prior to Forum in
July and identify state best practices
 Collaborate with:
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NIH/CTSA
NN/LM
PBRN
CE/CME providers
© 2010 College of Medicine
Assessment
 Qualitatively
and quantitatively outline
activities, outcomes and impact of the
U.S. Mexico Border Centers of
Excellence Consortium Contract
© 2010 College of Medicine
US Mexico Center of Excellence
Consortium Forum: July 2010
 Showcase
best border practices
 Present outcomes of U.S.-Mexico Border
COE Consortium Contract and strategic
thinking
 Document recommendations in Forum
Proceedings
© 2010 College of Medicine
Consortium Partners
 Texas
Tech Health Sciences Center at El
Paso
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Jose Manuel De La Rosa, M.D., Founding Dean, Texas
Tech University Health Sciences Center - El Paso, Paul L.
Foster School of Medicine
© 2010 College of Medicine
Consortium Partners
 University
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of Arizona College of Medicine
Ana Maria López, MD, MPH, FACP, Professor of
Medicine and Pathology at the University of Arizona;
faculty, College of Public Health and BIO-5. Dr. López is
Principal Investigator of the Arizona Hispanic Center of
Excellence.
Oscar Beita, MD, MPH, Clinical Assistant Professor in
Family and Community Medicine at the University of
Arizona College of Medicine
© 2010 College of Medicine
Consortium Partners
 University
of California San Francisco at
Fresno
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Katherine Flores, MD, Assistant Clinical Professor in Family
Medicine at the UCSF School of Medicine will serve as the
COE Consortium Core Member representing California. Dr.
Flores is the Director of the California Border Health
Education and Training Centers Program (HETC) as well as
the Director of the UCSF Fresno Latino Center for Medical
Education and Research (LaCMER).
© 2010 College of Medicine
Consortium Partners
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University of New Mexico School of Medicine
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Lisa Cacari Stone, Ph.D., Principal Investigator for the Border
Consortium sub-contract at the University of New Mexico Health
Sciences Center. She is an Assistant Professor with the Department
of Family and Community Medicine and Senior Research Fellow
with the Robert Wood Johnson Center for Health Policy at UNM.
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Alexis Padilla, PhD., Community Relations Manager at the
University of New Mexico School of Medicine in conjunction with the
US-Mexico Border COE Consortium and the Health Science Center
Executive Vice-President’s Office of Community Affairs.

Robert Otto Valdez, Ph.D. ,RWJF Professor Family & Community
Medicine and Economics serves as the Executive Director, Robert
Wood Johnson Foundation Center for Health Policy at the University
of New Mexico, a national program office for increasing diversity in
health and health care leadership.
© 2010 College of Medicine
Consortium Partners
 University
of Texas Health Science Center
at San Antonio
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Vidal Garza Balderas, DDS, MPH, Clinical Assistant
Professor, Department of Community Dentistry at the
UTHSCSA. Dr. Balderas serves as the primary
investigator for this contract.
Juanita Lozano Pineda, DDS, MPH, Clinical Assistant
Professor, Department of Community Dentistry at the
UTHSCSA.
© 2010 College of Medicine
Consortium Partners
 University
of Texas Medical Branch at
Galveston
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Lauree Thomas, M.D., Associate Dean for Student Affairs and
Admissions in the School of Medicine at the University of
Texas Medical Branch at Galveston, TX
Norma Perez, M.D., Dr.P.H., Adjunct Assistant Professor in the
Department of Internal Medicine, Division of Geriatrics at
UTMB.
LeTanya D. Walker, B.S., is the Director of Recruitment and
Student Support Services for the University of Texas Medical
Branch (UTMB) School of Medicine.
© 2010 College of Medicine
Questions?
© 2010 College of Medicine
Thank-you!
© 2010 College of Medicine