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12 Community Health Center, Inc. W anda Montalvo, PhD, associate director of the Weitzman Institute at Community Health Center (CHC), is the lead principal investigator for an unprecedented study by the Na- tional Institutes of Health: the All of Us SM - Precision Medicine Initiative. CHC was selected specifically for its research experience, expertise and innovative pro- grams at its Weitzman Institute, said Montalvo. e scope of this national study is unprecedented, as is the participation of Federally Qualified Health Centers (FQHCs). Historically, NIH partners with academic centers for clinical research. It's a unique mix. CHC's patients are also fortunate, benefitting from a forward-thinking FQHC like CHC, which is willing to open new doors and lead new discoveries in healthcare delivery, treatment, outcomes and well- ness. Collaborating with colleagues at NIH and others, Montalvo describes All of Us as a unique opportunity. Over the span of a decade, the program will be gath- ering participant data to address things like health concerns, lifestyles, genomics and more. e goal is to develop more personalized care by focusing on the unique differences among participants to inform the future of medicine and healthcare. For example, stud- ies on pharmocogenics and diabetes may not fully re- flect African-American or Hispanic women as com- pared to Caucasian males, she says. "It's a very ambitious goal," said Montalvo of the observational, participant-focused study. "All this in- formation has to be taken into account. It's an enor- mous amount of data, work and commitment by both researchers and participants across the country." Pilot testing gets underway later this year. e ini- tial pilot at CHC will enroll 100 participants at its Meriden and Middletown locations. Aer that, there are plans to scale up the enrollment process and move across all of CHC sites to reach approximately 600 participants. e information collected by CHC will inform the NIH strategy. "We are regionally dispersed, enroll a very diverse population and have a good geographic spread. We are really interested in making sure we have the abil- ity to enroll under-served populations, which are generally underrepresented in biomedical research," said Montalvo. Information about these groups and diverse factors at play will help spur more personal- ized medicine. "is is the strength of the program — the en- gagement of expertise around genomics and social sciences, and the gamut of brain trust to look at this information is broad and deep," as is the capacity for effective collaboration, she said. n NIH Chooses CHC for Precision Medicine Initiative T he U.S faces a dire shortage of primary-care providers, when the need has never been greater. An aging population, incidence of chronic illness and new and emerging health threats create demand for superb primary-care providers. Nurse practitioners (NPs) are already a significant part of the primary- care workforce, and that will only continue to grow. Margaret Flinter, PhD, APRN and a family nurse practitioner since 1980, has long supported the advancement of NPs as independent primary care providers — but also identified a major challenge, and then launched a national innovation to address it. "What we observed … was that there was a significant gap between the readiness of the new NP for clinical practice, and the demands of the NP role," she said. "And nowhere was this truer than in the setting of com- munity health centers, where clinical complexity is the norm, and adverse social determinants of health add another layer of challenge." Flinter determined that the missing piece was post-graduate residency training, like physicians and dentists have had for decades. In 2007, Flinter and CHC colleagues launched the country's first post- graduate residency training program for new family nurse practitioners, with a particular focus on NPs who aspired to be primary-care providers in a community health center setting: e CHC Nurse Practitioner Resi- dency Training Program. Now in its 10th year, the program has an annual cohort of 10 NPs recruited from top U.S. universities. e 12-month program was designed as a model that could be repli- cated nationally, said Flinter. e cornerstone of the post-graduate resi- dency year is the opportunity to build a panel of diverse patients during "precepted sessions." e program also includes specialty training in areas like HIV care and behavioral health. "Other community health centers kept asking us if we could just create and run a program for them," says Kerry Bamrick, senior program man- ager. She and Flinter designed a model to remotely host post-graduate residency and fellowship programs in which CHC provides support for recruitment, evaluation, curriculum design, and preceptor training, while the host site selects and employs the NP residents and their faculty. CHC now hosts programs in six states, with 38 such programs nationwide. Flinter points to a growing body of published evidence on the model's success in advancing the competence, confidence, and mastery of new NPs for the full scope of a primary-care practice. She continues to advo- cate nationally for the inclusion of postgraduate NP residency and fellow- ship training. CHC's NP residency program earned full accreditation from the Na- tional Nurse Practitioner Residency and Fellowship Training Consortium (www.nppostgradtraining.com). e training is making a difference, said Bamrick. "It's incredibly satisfying to see the growth of the programs, but even more so to see the transition from our new NPs … and then to see them in practice, providing exceptional care, and in turn becoming preceptors to other NP students and residents." n Nurse Practitioner Residency Training Program