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