A Step in the Right Direction for Interprofessional Education

Valerie P. Pracilio, MPH
Project Manager for Quality Improvement

On May 18^th, close to 250 professionals gathered together on the Jefferson campus in Philadelphia to explore ways to redefine education and practice to focus on interprofessional collaboration.

The conference, sponsored by the Jefferson InterProfessional Education Center (JCIPE), attracted key leaders in interprofessional education, including Dr. Carol Aschenbrener from AAMC and Dr. Susan Meyer from the University of Pittsburgh. There is clearly an impetus for change to bring professionals from different disciplines together to practice collaboratively for the benefit of their patients.

Both Dr. Aschenbrener and Dr. Meyer were integral in the development of interprofessional core competencies, which were released a year ago. The competencies serve as the framework for collaborative practice and set the stage for the meeting.  The program highlighted experiences of professionals working to educate and assess competency at their institutions.

A few take-home insights from the conference include:

• Leadership is needed at the faculty level to integrate interprofessional practice  into the curriculum. Faculty leading those efforts should also represent multiple disciplines.
• Improvement methodologies such as complexity science and TeamSTEPPS  – a teamwork system designed for health care professionals –  were given as examples of useful tools for collaboration.
• Students are interested in opportunities to engage with their colleagues through practical experiences, including interactions with patients and opportunities to discuss clinical experiences and challenges.

Dr. Aschenbrener said, “The closer we move toward integration the less team-based care will be an option – it will become a requirement."

Interprofessional collaboration presents an enormous opportunity to learn from one another. Let’s make it happen!

Guest Commentary: The Many Meanings of Population Health

Tamar Klaiman, PhD, MPH
Assistant Professor
Jefferson School of Population Health

Last month, I attended the 2012 Keeneland Conference for Public Health Systems and Services Research (PHSSR). This growing body of research examines the organization, financing and delivery of public health services within a community and determines the links between the quality and performance of the public health system and population health outcomes. The conference brought together researchers and practitioners with an eye toward translating research into practice and policy through information exchange, feedback, and collaboration.

Keynote presenters at this year’s Keeneland Conference focused much of their presentations and discussion on defining population health in the context of public health systems, primary care, and the Affordable Care Act. Presenters and attendees seemed to agree that the term “population health” means very different things to different stakeholders. Public health practitioners focus their efforts toward community health, and consider the public to be the population of interest. Health care providers tend to think of population health as the health of their patient population. Insurers and employers think of population health in terms of their enrollees or employees.

The PHSSR research agenda defines the public health workforce, public health systems structure and performance, public health financing and economics, and public health information technology as its top research priorities. These closely align with many of the priorities set forward in other areas of health-related research. Although there are disparate perspectives about the definition of population health, there is no question that a paradigm shift from treatment to prevention is occurring across the United States. As a PHSSR researcher, I look forward to seeing the impact of current research on future practice and policy and ultimately on people’s health.

American College of Physicians Annual Meeting 2012

I have just returned from an "over the top" Annual Meeting of the ACPE in San Francisco CA---over the top because it was the largest gathering of physician executives of the past seven years with more than 800 docs from around the nation, and the world. I taught the Quality Section of the Physician in Management (PIM) Series. PIM is an intensive, all day, five consecutive day immersion into the world of the physician executive. My session was closed out as we topped 160 attendees for an 8am to 430pm all day overview of the world of healthcare quality and safety. We covered the history of the quality and safety movement, evidence based medicine, practice guidelines, the culture of clinical practice and health reform. The program was very interactive and it is a real privilege for me to engage with so many emerging leaders simultaneously. It was an extra special day because our new book debuted too---HEALTH CARE QUALITY:The Clinician's Primer. I signed scores of books at the ACPE event and I hope you will go to www.acpe.org/publications and order your copy today.Finally, Dr Jim Pelegano, the Director of our Masters Program in Quality and Safety gave his lunch time talk about our program and I am confident that dozens of new applications will be arriving soon due to his enthusiastic presentation. This Annual Meeting of ACPE and the debut of our latest book made for an exciting event. I wish I could "bottle" some of this energy and give every downtrodden doctor a quick sip to perk them up and to join us on the journey to measure and improve the quality of care in our country. Once again, JSPH is at the forefront of this critical issue. DAVID NASH

Guest Commentary: April is National Child Abuse Prevention Month

Ruth S. Gubernick, MPH

In 2009, approximately 3.3 million child abuse reports and allegations were made involving an estimated 6 million children. More than five children die every day as a result of child abuse and approximately 80% of those children that die from abuse are under the age of 4 (Source: http://www.childhelp.org/pages/statistics/).

April is National Child Abuse Prevention Month. The Blue Ribbon Campaign and Prevent Child Abuse America (PCAA)’s Pinwheels for Prevention® campaign have shifted to positive messages of supporting families and strengthening communities to prevent child abuse and neglect. But while blue ribbons and pinwheels may raise awareness, there is little evidence to suggest that health promotion alone can change behavior! As a QI Advisor, I facilitated pediatric primary care teams in implementing Practicing Safety, a child abuse and neglect prevention intervention (http://www2.aap.org/qualityimprovement/quiin/PracticingSafety.html ). We identified key strategies to help pediatricians intervene with families at risk of abuse and neglect. This work was supported by a grant from the Doris Duke Foundation to the American Academy of Pediatrics and our research identified strategies that practice teams could successfully implement. The practices we worked with as a result of Practicing Safety would:

• Discuss crying with all new parents, not just those with expressed concerns. Help parents be aware of their baby’s temperament. Teach new parents how to swaddle their infant.
• Screen all new moms for post-partum depression using a standardized screening tool, such as the Edinburgh, and conduct follow-up for moms found to be at risk.
• Encourage parents to read to their baby. Practice enrollment in the Read Out And Read (ROAR) program provides free books in multiple languages and appropriate age levels that can be given to families.
• Talk about child development at each well-child visit, starting at 6 months, to help parents understand each stage of their child’s development. This can help parents keep their perspective as their child goes through developmental changes. Discuss establishing routines, modeling behaviors and that discipline equals teaching, not punishment.
• Provide stickers and potty charts for parents who are toilet-training their toddlers, making it a more positive and rewarding experience. Personal Note: My adult daughter was toilet trained that way and she still uses a chart and star stickers to achieve a personal goal!

When working with primary care practices I often start a learning session on the topic of abuse and neglect by describing a story about villagers who spend much time and resources rescuing babies that have fallen into the river as they flowed down to their village. Then one day a villager traveled upstream and figured out how to prevent the babies from falling into the river. I encourage us all to go “upstream” and test and implement strategies that focus on prevention! By ensuring that parents have the knowledge, skills, and resources they need to care for their children, we can help promote children’s social and emotional well-being and prevent child maltreatment within families and communities.

Ruth Gubernick is a JSPH doctoral student.

TechSolve in Cincinnati, OHIO

This past week I had the distinct pleasure, and honor, of speaking at the TechSolve series of health policy events, at their headquarters just outside of Cincinnati, Ohio. TechSolve is a 25-year-old, not for profit, consulting company that specializes in process improvement in healthcare. According to their own materials, "TechSolve collaborates with healthcare organizations to implement business improvement solutions. These solutions reduce process variation and eliminate wasteful activities - leading to increased capacity throughout and improved patient care and satisfaction"... All music to my ears!! I spoke for four hours about the history of the quality and safety movement in our country and its direct connection to health reform under the ACA. TechSolve brought together many of its key customers and we had an awesome interactive session. They also purchased scores of copies of DEMAND BETTER and I stayed to autograph every copy. TechSolve is a gem...and I am hoping that our school will be further engaged with their ongoing work. I am also convinced that some junior staff at TechSolve will want to join us in our growing on line Masters Degree in Healthcare Quality and Safety. It's a great potential partnership for sure. Stay tuned for more news about the good work of our colleagues at TechSolve and visit them at www.techsolve.org. DAVID NASH

Guest Commentary: Connecting to a sense of purpose in Washington

Pavan Ganapathiraju

When I first joined the one-year accelerated Master of Public Health program at Jefferson, I walked in with a variety of interests. Most students you ask about me will say emergency preparedness. However, I have always been interested in health policy.

After enrolling in PBH 509: Public Health Policy and Advocacy, our class was notified of the Annual Health Education Advocacy Summit sponsored by the Coalition of National Health Education Organizations and Partner Organizations that was held in Washington, DC. The agenda for the summit included training on advocacy, discussing priority public health issues, and meeting with Congressional representatives to lobby/advocate for such issues. After hearing about it, I knew I had to take advantage of this experience; it would be a great opportunity to develop new skill sets in advocating and networking.

When I returned from the conference, I was beyond happy. Not only did I get to see the Capitol of our great country for the first time, but I had the pleasure of talking to the offices of senators and representatives from my home state of Illinois. I was skeptical at first, as were most people. As my fellow classmate Alexander Yang , who also went to the summit, said, “We have this assumption that Congressmen are these invisible people you see once in a while on television, but they actually are human.”

Alex’s cynicism is actually very true. When you walk into a legislative office and tell them you are a constituent from their district that gives you the power above them. They are actually very willing to listen to you about issues. This experience proved to me that the system works; our congressmen do listen to our concerns.

Overall, I had a surreal experience being on Capitol Hill and advocating for something I believe in. This experience was very rewarding and I felt like I had a sense of purpose. In my future career, I hope to do some more lobbying/advocating.

Any public health student at Jefferson needs to take advantage of this opportunity when it arises again.

Pavan Ganapathiraju is a student in the Master of Public Health Program at the Jefferson School of Population Health.

Guest Commentary: A Different Perspective on Patient-Centeredness

Stephen Wilkins, MPH

Running concurrently with the recent Population Health & Care Coordination Colloquium in Philadelphia was the Fourth National Medical Home Summit, at which I was privileged to speak. Patrick Monaghan of the Jefferson School of Population Health noted in his recent post that “patient-centered care appears to finally be at the heart of the way healthcare is delivered in this country. And if it’s not, it’s certainly on the way.”

Now you would think that at a conference on the Medical Home, the care delivery model for value-based care and all things patient-centered, the topic of patient-centered care would be a topic of discussion….but you would be wrong. In fact, I was one of the few speakers that substantively addressed the challenges associated with the concept of “patient-centeredness.”

To be sure, patient-centeredness has arrived at the health care policy level. Health care markets too have discovered the benefits of being patient-centered. Like patient empowerment and patient engagement, the term patient-centered is ubiquitous in both the health care and popular media. The one place you apparently do not find things patient-centered discussed is at conferences dealing with Patient-Centered Medical Homes.

Of course there were presentations about EMRs, embedded care coordinators, population health management, and patient advisory committees. Yes, these are all prerequisites for PCMH certification– but there is nothing inherently patient-centered about any of these things. What was missing at the Summit, and from the current discourse about Medical Homes, is any meaningful discussion of what the providers of care (or the sponsors of PCMH pilots) are doing to engender a patient-centered orientation into the way they communicate with and care for patients.

Perhaps the biggest disconnect between the reality and the promise of patient-centeredness is found in the way physicians communicate with patients. As defined in Crossing the Quality Chasm, patient-centered care begins with the provider understanding the patient’s perspective, e.g., their fears, concerns, expectations, and previous health experiences.

However, many primary care physicians, including those practicing in Medical Homes, still communicate with patients using the same physician-directed style they were taught in medical school. Like the medical interview itself, a physician-directed style of patient communication does not allow much time for the patient’s story or for that matter identifying all the reasons why the patient wants to consult with their doctor. As a result, the patient is the subject of the medical exam…not an active participant.

Patient-centered communication has been the subject of research going back 30 years, including detailed descriptions of effective patient-centered communication techniques. The use of patient-centered communication is directly correlated with improved outcomes, quality, and patient satisfaction. When employed consistently over time, it probably even saves time. Yet the use of patient-centered communication in the Medical Home is not a priority for providers or accreditation agencies.

To bridge this disconnect and eventually realize the promise of patient-centered care, professionals in both the Medical Home and Population Health arenas need to focus more on the true meaning of patient-centeredness and how to integrate the philosophy of patient-centered care and the commensurate communications skills into everything we do.

Stephen Wilkins is the CEO/Founder of Smart Health Messaging, a communication firm committed to improving the quality of physician-patient communication. He is also the author Mind the Gap, a blog dedicated to the same subject. Mr. Wilkins was a contributor to Disease Management and Wellness in the Post-Reform Era, (Chapter 3 - Disease Management & the Medical Home) published in 2011.