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TRANSCRIPT
IPE in CBDE – INNOVATIVE CHANGE IN THE MODEL
Wilhelm Piskorowski, Mark Fitzgerald, Howard Hamerink University of Michigan School of Den?stry
Educa&onal ins&tu&ons are s&ll looking for best prac&ces in crea&ng learning environments that can effec&vely achieve an op&mal team interac&on. Tradi&onal siloes of learning approaches in the health care educa&onal community have not been effec&ve in crea&ng an apprecia&on for or skill set in team based pa&ent care. Recently IPE approaches based on adult learning principles involving students and preceptors from different health care fields working together to treat pa&ents in a health care seAng have shown promise as a model for achieving effec&ve team interac&ons and measurable, posi&ve pa&ent treatment outcomes. Recent reviews of IPE models have shown that this type of educa&on can have posi&ve outcomes in par&cipant’s reac&ons, aAtudes, knowledge/skills, behaviors and prac&ce, as well as improved pa&ent health outcomes. Adding to this challenge is the reality that achieving op&mal treatment outcomes are even more difficult in underserved communi&es. Unfortunately, most students in health care professions have liHle exposure to the underserved. The current state of the underserved popula&on work force is highly unpredictable and transitory, and hampered by difficulty in recrui&ng and retaining health care providers. Clinical immersion experiences in seAngs devoted to serving the underserved exposes the future and current workforce to an environment few have ever experienced. Such exposure has had significant impact on improving recruitment of new den&sts into the underserved popula&on work force in graduates from the University of Michigan School of Den&stry (UMSOD) in the last decade. In 2000 UMSOD graduates had minimal (2 weeks) of exposure in clinics serving the underserved. That year, only 1.7% of graduates chose to work in a community based clinic. By 2010, the number of weeks of exposure had risen to 8 and the number of graduates choosing community based clinic seAngs increased to 16.5%.
If there is any possibility of developing a team that can improve pa&ent outcomes the first step must be effec&ve interprofessional communica&on and interac&on. Accomplishing this first step in an environment that serves underserved popula&ons is an addi&onal bonus. This project will place fourth year dental and other allied health care students into a pa&ent-‐focused environment dedicated to trea&ng the total health needs of underserved popula&ons. An adult learning model will be used to facilitate skill development in interprofessional communica&on and coopera&on in pa&ent care. This ini&a&ve was started with a grant opportunity involving Michigan Department of Community Health (MDCH), the Michigan Primary Care Associa&on (MPCA), the Michigan Health Council (MHC) and their subsidiary support organiza&on ACE and Deans of Michigan Allied Health Schools. A fundamental component of this model is the use of reference and support resources from The Smiles For Life Curriculum modules (Figure 1), evidence-‐based posi&on papers and IPE program forma&on tools being developed by E2P (Figure 2). The Model requires the coordina&on of and collabora&on between mul&ple en&&es: Administrators, staff, preceptors and pa&ents at the suppor&ng sites, Program Directors of the par&cipa&ng health care profession schools and students from the par&cipa&ng schools.
Because of the variability between proposed sites for implementa&on of the Model and the educa&onal programs to par&cipate in the Model, it was decided that the Model needed to be: • Profession independent • Pa&ent focused. • Focused on improved pa&ent care with preceptor(s), facilitator(s) and student(s) interac&ng to improve pa&ent care via: • Morning “huddles” to review cases for day and iden&fy needed
interven&ons • End of day “huddles” to review outcomes of cases reviewed in the
morning • Regularly scheduled de-‐briefings summarizing outcomes and “lessons
learned” with facilitator(s)
Assessment of outcomes will accomplished using various instruments: • Interprofessional Collaborator Assessment Rubric • Communica&on • Collabora&on • Roles and Responsibili&es • Collabora&ve Pa&ent/Client-‐Family Centered Approach • Team Func&oning • Conflict Management/Resolu&on
• Pre and Post Student and Pa&ent Percep&on Indicator (PPI )assessments • Treatment outcomes • Quality of life surveys • QI measurements (pt. compliance, reduc&on of revisits/retreats, reduced
incidence of adverse outcomes) • Focus groups: Students, Facilitators, Pa&ents • Value add for host sites
Romanow, 2002 stated "If health care providers are expected to work together and share exper&se in a team environment, it makes sense that their educa&on and training should prepare them for this type of working arrangement”. The World Health Organiza&on's defini&on and vision of the team concept incorporates an Interprofessional Educa&on/Prac&ce (IPE/IPP) model that has 2 or more professionals that learn about, from and with each other to enable effec&ve collabora&on and improve health outcomes. Dr. Donald Berwick, the former Administrator for Medicare and Medicaid said that 20-‐30% of health spending is "waste" with no benefit to pa&ents, because of overtreatment, failure to coordinate care, administra&ve complexity and fraud. The Michigan Department of Community Health (MDCH) contracted with the Michigan Health Council (MHC) in January 2012. The MHC’s Alliance for Clinical Experience (ACE) mapping program through its web based scheduling program for health professionals was charged to develop a flexible IPE model that will add quality to a student's clinical rota&on. The new ini&a&ve is now called the "Bridging Educa&on to Prac&ce: (E2P)" program. The University of Michigan School of Den&stry’s Community-‐Based Dental Educa&on (CBDE) program is presently working with the MDCH and MHC in developing an IPE/IPP pilot at several CBDE Clinics Sites that can accommodate such an ini&a&ve. The highly successful and self-‐sustaining Dental model has shown that properly developed programs can maximize a student’s educa&onal experience while concurrently enhance the clinics produc&vity and increase access to care. Properly structured IPE through team-‐based interac&ons under the guidance of a facilitator with defined measurable outcomes could result in improved pa&ent care and reduced healthcare costs. It is evident that health care clinics and organiza&ons with an academic thread are more produc&ve and have more predictable outcomes. The development of this IPE/IPP rota&on should also have the same successful outcome of recruitment and reten&on that the CBDE program has shown with their host sites. Cri&cal factors that have been realized in development of over 30 CBDE clinic sites and represen&ng 5 diverse models for the U of M School of Den&stry also include factors that involve development of an IPE/IPP program. Previous successful interac&ons have paved the way for pilo&ng an IPE experience for student teams of healthcare providers. Iden&fying IPE objec&ves and recognizing community champions are paramount to the development of a successful IPE/IPP experiences. Goals of the program include:
• Developing effec&ve communica&on and planning with sites and allied health professionals
• Recognizing champions in developing IPE/IPP educa&on rota&ons • Enhancing the clinical site's produc&vity or at a minimum be cost
neutral • Providing a template for the development of an IPE experience at host
sites • Providing a framework for professional collabora&on guided by a
facilitator to promote integrated pa&ent care that discourages healthcare silos.
• Providing assessment tools to measure efficacy of the IPE/IPP experience
• Providing pa&ent assessment tools rela&ng to health and quality of life outcomes
INTRODUCTION
METHODS The Expected Outcomes for the various par&es involved are:
• Pa&ents • Improved quality of care • Improved quality of life • Reduced cost of care
• Suppor&ng sites • Reduced cost of care • Reduced risks of care • Improved quality of care • Improved reten&on and recruitment of health care
providers and staff • Student den&sts:
• Iden&fied role in team based pa&ent care. • Contribu&on to effec&ve team func&on. • Collabora&on with other health care providers in
pa&ent care designed to improve health outcomes.
EXPECTED OUTCOMES
Once established, this model can be expanded to include other health care seAngs beyond those focused on the underserved.
FUTURE DIRECTIONS
ACKNOWLEDGEMENTS
We would like to thank all of our CBDE affiliated partners (Figure 3) who embraced the value of using an academic thread to improve service to the underserved and embraced the future ini&a&ve of Interprofessional Care (IPC).
CHALLENGES
• Proving Value of the IPE Model to facilitate buy-‐in by other sites • Preparing learners and sites for IPE experiences
• Students from all professions equally comfortable in the clinic-‐based model • Coordina&on of curriculums across professions • Synchroniza&on of student skill development • Iden&fica&on of “resources” each profession brings to the
process • Iden&fying and training facilitators/preceptors for IPE
• Roles and responsibili&es • Calibra&on
ABSTRACT
Figure 1: Smiles For Life Curriculum modules
Figure 2: Collabora&ons and resources