IMPROVING AND TEACHING POPULATION HEALTH

Taking a look at teaching methods and materials

July 1 2014 webinarAAMC / CDC / Duke collaboration

J. Lloyd Michener, MDProfessor and ChairDepartment of Community and Family MedicineDirector, Duke Center for Community Research

Mina Silberberg, Ph.D.Associate ProfessorVice-Chief for Research and EvaluationDivision of Community Health

Gwen Murphy, RD, MS, PhDAssistant Consulting ProfessorDivision of Community HealthDepartment 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

Training levels Basic Intermediate Advanced

Learner types • All students & residents

• Primary care residents

• CFM faculty

• Population health fellows & faculty

• CH faculty

Competency • Discuss potential population-based interventions to improve health

• Identify appropriate preventive strategies for a population, based upon literature, data assessment and stakeholder input

Develop and implement population-based prevention strategies in collaboration with community partners

Population Health Curriculum, sample competency: Apply strategies that improve the health of populations

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 MedEdPORTALiCollaborative

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 PHIT Year 1 (PGY1) PHIT Year 2 (PGY2) PHIT Year 3 (PGY3) Population Health- Non-Specific, i.e., covers multiple domains

Introduction to Pop. Health. Lead: Michener Pop. Health Workshop. Lead: Martinez-Bianchi A Real-Life QI Experience. Lead: Hull

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

Advanced Population Health (12 sessions (1/month)). Lead: Murphy Facilitation of one core course discussion session. Lead: Silberberg

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 PHIT Year 1 (PGY1)

PHIT Year 2 (PGY2) PHIT Year 3 (PGY3)

Population Health Domain I:Public Health

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

Population Health Domain II: Community Engagement

Site visits (e.g., CAARE, Lincoln, Public Health Dept.). Lead: Tran

Community health assessment and presentation. Lead: Tran. Leading a community health education session. Lead: Tran

Attending a PAC meeting. Lead: Ragsdale

Rotation in community clinic. Lead: Martinez-Bianchi

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 PHIT Year 1 (PGY1)

PHIT Year 2 (PGY2) PHIT Year 3 (PGY3)

Population Health Domain III: Critical Thinking

(See RCD below) I-3 Quality Thread Webinar. Lead: Ramer

I-3 Quality Thread Webinar. Lead: Ramer

All three years: Journal club. Lead: Ostbye

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

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 requirements4. Document and disseminate5. Use appropriate tools3. Formal mentor4. Approved workplan

Resident Population Health Project Requirements

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

June 3rd Tuesday 2:30pm ESTrepeated June 19th Thursday 3:30pm EST

July 1st Tuesday 10am EST repeated July 15th Tuesday 9am EST

August 5th Tuesday 9am EST repeated August 12th Tuesday 9am EST

September 9th Tuesday 10am EST repeated September 16th Tuesday 3pm EST

October 8th Wednesday 3pm EST repeated October 14th Tuesday 9am EST

Next Steps

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

• Sharing of alumnae survey questions and other evaluation tools…