when the population is “the patient”: developing population health milestones
TRANSCRIPT
February 28, 2015
@PracPlaybook
SES129 When the population is “the patient”: Developing Population Health Milestones to teachessential skills for tomorrow’s clinicians
Lloyd Michener, MD [email protected]
Denise Koo, MD MPH [email protected]
Kathy Andolsek, MD MPH [email protected]
Accreditation Council for Graduate Medical Education Conference | San Diego,
CA
Who are you?
• Geography: NE (5) SE (4) SW (1) Mid-Atlantic (1)
Midwest (3) outside US (1) n/a (1)
• Specialty: IM (2) Peds (2) FM (6)
Psych (1) Plastic Surgery (1)
• Profession: MD (10) DO (1) MPH (2) PhD (1) Masters
Education (3) MA (1) Bachelors (1)
• Role: DIO (1) PD (3) Core faculty (6) RAC (1)
Div chief (1)
Who are you?
• How long in GME
– 1-2 year 1
– 3-5 years 3
– 6-10 years 1
– 11-15 years 2
– > 16 years 9
• Population Health Curriculum?
– Institution Yes (5) No (8) don’t know (2) n/a (1)
– Program Yes (3) No (11) don’t know (2)
Please seat yourself at a table based on the milestone placard you are most interested in.
Placard 1: Applies principles of public health to improve
the health of populations (BLUE)
Placard 2: Applies principles of community engagement
to improving the health of populations (RED)
Placard 3: Utilizes critical thinking to improve the health
of populations (GREEN)
Placard 4: Utilizes team and leadership skills to
improve the health of populations (PURPLE)
Goals and Objectives
• Prioritize milestones in population health
• Identify gaps in available curricular materials
• Recognize solutions to common challenges
Definition of population health
“The health outcomes of a group ofindividuals, including, the distributionof such outcomes within a group”
David Kindig and Greg
Stoddart
Medical education:
Flexner’s principles • The training, quality, and quantity of physicians
should meet the health needs of the public
• Collaborations between the academic medicine and public health communities… benefits both
Why does population health
matter?
http://macyfoundation.org/docs/macy_pubs/JMF_GME_Conference2_Monograph%282%29.pdf
Conclusions and Recommendations
Conclusion 1 GME must meet the needs of – and be accountable to – the public.
Why does population health
matter?
http://www.iom.edu/~/media/Files/Report%20Files/2014/GME/GME-RB.pdf
Graduate performance
• Historically: board pass rates
• Today: ?
% fulfilling US healthcare needs?
GME links with Population
Health
GME links with population
health:CLER
• Patient Safety
• Health Care Quality
Disparities
• Care Transitions
• Supervision
• Fatigue Mitigation/Duty Hours
• Professionalism
GME links with population
health:CLER
HQ Pathway 5: Resident/fellow, faculty education on
reducing health care disparities.
Focus
• Extent to which individuals receive education on clinical
site’s priorities/ goals for addressing health care disparities in
its patient population.
• Extent to which individuals receive training in cultural
competency relevant to patient population served.
• Proportion aware of clinical site’s progress in
meeting its goals/priorities.
How does this connect with
GME?CLER Pathways
https://www.aamc.org/download/419276/data/dec2014communityhealth.pdf
How does this connect with
GME?Milestones
Our vision is to:
• Collaborate
• Align with what we’re already doing
• Identify/Develop Relevant Population Health
Milestones
• Match to available curricular, assessment, and
evaluation tools
Q-Sort “Game”
We asked “your help” prioritizing some potential population milestones
Where did we find them?
• Extracted from existing specialty milestones
• Identified from literature review
• Editorial license . . .
What is Q-Sort?
Competency Domains PH 1-4
• Applies principles of public health
• Applies principles of community engagement
• Utilizes critical thinking to address
population health
• Demonstrates team and leadership
skills for population health
Competency Domains–What’s
missing?
• Applies principles of public health
• Applies principles of community engagement
• Utilizes critical thinking to address
population health
• Demonstrates team and leadership
skills for population health
Please seat yourself at a table based on the milestone placard you are most interested in.
Placard 1: Applies principles of public health to improve
the health of populations (BLUE)
Placard 2: Applies principles of community engagement
to improving the health of populations (RED)
Placard 3: Utilizes critical thinking to improve the health
of populations (GREEN)
Placard 4: Utilizes team and leadership skills to
improve the health of populations (PURPLE)
Small Group Task
• You are seated within small
groups at your table by
“milestone”
• Introduce yourself
• Analyze/Edit your milestone
(use worksheet)
Small Group Task
Analyze/Edit your milestone (use worksheet)
• Is it relevant at some level for all/most resident specialties?
• Can you make it more so?
• Are levels appropriately progressive?
• Are levels sufficiently robust? Too hard? Too easy?
Is 5 “a stretch”; is 3-4 where “most residents might be at
program completion”?
• How might this be best “assessed”?
Debrief
“We cannot solve our problems with the same thinking we used when we created them”
— Albert Einstein
Resources Used
• AAMC MedEd Portal - 3
• iCollaborative - 1
• American Teachers of
Preventive Med - 1
• CDC - 7
• Practical Playbook - 0
• Local and Duke - 1
Association of Schools & Programs of Public
Health
http://www.aspph.org/educate/models/population-health-across-all-professions/
American Academy of Family Practices
http://www.aafp.org/dam/AAFP/documents/about_us/initiatives/choosing-wisely-fifteen-questions.pdf
Example of Evaluation Resource
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4266696/pdf/nihms615280.pdf