IMPROVING AND TEACHING POPULATION HEALTH

Taking a look at teaching methods and materials

July 1 2014 webinar AAMC / CDC / Duke collaboration

Mina Silberberg, Ph.D.

Associate Professor Vice-Chief for Research and Evaluation Division of Community Health J. Lloyd Michener, MD Professor and Chair Department of Community and Family Medicine Director, Duke Center for Community Research Gwen Murphy, RD, MS, PhD Assistant Consulting Professor Division of Community Health Department of Community and Family Medicine

Population Health: the health outcomes of a

group of individuals, including the distribution of such outcomes within the group.

Source: Kindig D, Stoddart G. What is Population Health? Am J of Public Health. 2003; 93(3): 380-383.

The Goal: “from Health Care to Health”

How do we teach clinicians to collaborate in population health improvement?

• • not training clinicians to be public health professionals, but to collaborate with public health and other sectors from their unique vantage point and strengths sometimes clinicians will take the lead, but not always

Focus today: Sample training materials and methods

• • • • Population Health Competency Map Practical Playbook iCollaborative Population Health Collection Duke Family Medicine PHIT curriculum

The Population Health Competency Map Kaprielian VS et al. A Competency Map Approach to Education for Population Health. Academic Medicine 2013 8(5): 628-637. PMID: 23524919.

The Population Health Competency Map Training Levels: 1. Foundational

— Basic

awareness

of the principles and appreciation for their impact and importance in community health.

2. Applied

— An intermediate level of learning, enabling

skilled participation

in community-engaged population health activities.

3. Proficient

— Advanced learners who achieve competence for

independent practice

or leadership of the design and implementation of community-engaged health improvement activities.

Competencies

• Public Health • Community Engagement • Critical Thinking • Team Skills

Population Health Curriculum, sample competency: Training levels Learner types Competency Basic Intermediate Advanced

• All students & residents • • Primary care residents CFM faculty • Discuss potential population-based interventions to improve health • Identify appropriate preventive strategies for a population, based upon literature, data assessment and stakeholder input  • • Population health fellows & faculty CH faculty Develop and implement population-based prevention strategies in collaboration with community partners

The Practical Playbook for the Integration of Public Health and Primary Care

www.practicalplaybook.org

What is integration?

The Institute of Medicine defines integration as ‘the linkage of programs and activities to promote overall efficiency and effectiveness and to achieve gains in population health.’  Principles of Integration:  Shared goal of population health  Aligned leadership  Community engagement  Sustainability  Collaborative use of data

What is the Practical Playbook?

Practical guidance to support the application of integration principles to practice

Practical Playbook Overview

3. Share

The AAMC MedEdPORTAL iCollaborative

https://www.mededportal.org/icollaborative/ https://www.mededportal.org/icollaborative/about/initiatives/populationhealth/

Population Health Improvement Teamwork (PHIT)

An evolving curriculum of Duke Family Medicine For residents (4/year) And faculty

Domain Population Health Non-Specific, i.e., covers multiple domains PHIT Year 1 (PGY1)

Introduction to Pop. Health. Lead: Michener

PHIT Year 2 (PGY2)

Population Health Core Course (2 nd , 4 th , and 5 th Tuesdays). Lead: Silberberg.

PHIT Year 3 (PGY3)

Advanced Population Health (12 sessions (1/month)). Lead: Murphy Pop. Health Workshop. Lead: Martinez-Bianchi Facilitation of one core course discussion session. Lead: Silberberg A Real-Life QI Experience. Lead: Hull All three years: Population Health Workshop with Residency Applicants. Lead: Martinez-Bianchi.

Population Health Management Rotation (includes community health rotation with informatics component). Lead: Shahsahebi Attend Partnership for a Healthy Durham meetings. Lead: Martinez-Bianchi Balint Group. Lead: Kingsolver.

Population Health Projects. Leads: Silberberg and Shahsahebi Presentation: The Durham Community Health Needs Assessment (Erika Samoff). Lead: Silberberg

Domain Population Health Domain I: Public Health PHIT Year 1 (PGY1)

Public Health Essential Function web based modules with one follow up discussion. Lead: Murphy

PHIT Year 2 (PGY2) PHIT Year 3 (PGY3) Population Health Domain II: Community Engagement

Site visits (e.g., CAARE, Lincoln, Public Health Dept.). Lead: Tran Community health assessment and presentation. Lead: Tran.

Rotation in community clinic. Lead: Martinez Bianchi Leading a community health education session. Lead: Tran Attending a PAC meeting. Lead: Ragsdale Rotation in community clinic. Lead: Martinez-Bianchi All three years: Community Health Engagement Day. Lead: Martinez-Bianchi Sometime over the three years: Involvement with community health education training. Lead: Martinez-Bianchi

Domain Population Health Domain III: Critical Thinking PHIT Year 1 (PGY1)

(See RCD below)

PHIT Year 2 (PGY2)

I-3 Quality Thread Webinar. Lead: Ramer All three years: Journal club. Lead: Ostbye

PHIT Year 3 (PGY3)

I-3 Quality Thread Webinar. Lead: Ramer

Population Health Domain IV: Leadership/Team Skills (Lead: Ragsdale)

Resident as Clinical Director I -- quality improvement and informatics, assessment of leadership skills/training plan, time management, professionalism. Lead: Ragsdale Resident as Clinic Director II - team development /group facilitation, organizational behavior and culture, collaboration in large systems, health policy. Lead: Ragsdale.

Resident as Clinic Director III -- assessment of remaining leadership training needs and corresponding plan, business of medicine. Lead: Ragsdale All three years: Workshops on leadership, communications, and conflict management. Lead: Kingsolver

Resident Population Health Project Requirements During the course of the three years, the resident must: 1. Play a lead role in at least one effort that involves two or more rapid CQI 2. Design an evaluation plan, collect data, analyze data, or write up evaluation results. 3. Collaborate with non-clinical entities on a community health initiative. Additional requirements 1. Document and disseminate 2. Use appropriate tools 3. Formal mentor 4. Approved workplan

Population Health Curriculum evaluation methods

• • • • • Discussion participation Project completion Final assessment – just alpha-tested Post-graduation activity Real test – health improvement in home communities

Recent/ongoing developments • • • • • • PHIT, not PHIL Inclusion of population health management rotation Changes to project to enhance community engagement, alignment with ongoing work of clinic Testing and revising of final assessment Development of alumnae survey questions’ Increased integration among PHIT components and between PHIT, larger curriculum, and clinical practice

Milestones webinar schedule repeated June 3 rd Tuesday 2:30pm EST June 19 th Thursday 3:30pm EST repeated repeated repeated repeated July 1 st Tuesday 10am EST July 15 th Tuesday 9am EST August 5 th August 12 th Tuesday 9am EST Tuesday 9am EST September 9 th September 16 th Tuesday 10am EST Tuesday 3pm EST October 8 th October 14 th Wednesday 3pm EST Tuesday 9am EST

Next Steps • • Anybody willing to volunteer today to make an institutional presentation?

Sharing of alumnae survey questions and other evaluation tools…