Tyler Reimschisel, M.D., director of the Division of Developmental Medicine and the Center for Child Development, has been selected for the 2016 Class of Macy Faculty Scholars. The following highlights the first year of the development of the pilot project:
Pilot of a Working-Learning Health System
The Macy Foundation Faculty Scholars Program is supporting an innovative working-learning health system (WLHS) pilot that relies on interprofessional teams to provide personalized, cost-effective, comprehensive health services to a panel of patients.
Most of the health care provided through academic centers in the U.S. is highly specialized tertiary, or even quaternary, care. Unfortunately, there is too often limited collaboration with community agencies or other local resources that could have significant impact on the health and well-being of patients and their families. Since many medical schools are administered through these academic centers, health professions education too frequently lacks meaningful training and experiential learning in community-based practice. Furthermore, the rotations and other educational interventions are often brief and cursory; therefore, students and residents lack genuine experience in interprofessional practice.
Recently, academic health centers (AHCs) across the country have begun to transform their care models in response to the national call for integrated systems that focus as much on disease prevention and population health as they do on highly specialized inpatient services. This shifting paradigm creates a mandate: AHCs must fundamentally change their education models so that future professionals are equipped to provide personalized care to individuals in partnership with communities.
In a WLHS an interprofessional team of health care students providing supervised, comprehensive health care, including care navigation, to patients with complex health care needs will 1) improve patient quality of care and health outcomes and 2) glean a robust education in health systems science.
A multigenerational, interprofessional team of health care professionals will include faculty in medicine, advanced practice nursing, and social work as well as medical, advanced practice nursing, pharmacy, physician assistant, and social work students. Students will be immersed in the WLHS for an extended period of time - daily for one to three months.
Teams will provide panel-based care to patients at The Clinic at Mercury Courts, a community-based clinic associated with Vanderbilt University Medical Center. Each morning the team in each WLHS will review its patient panel to discuss individuals who are scheduled for upcoming appointments and any patients who have come to the team’s attention via alerts, messages, study results, or admissions. During the huddle, tasks will be assigned in a way that matches the care needs of patients with competencies and learning needs of team members. Gaps in learner knowledge will be identified and addressed. In addition to providing services in a traditional clinic setting, learners will participate in their panel’s care activities throughout the integrated system, including rehabilitation and therapy sessions, outpatient procedures, admissions, and surgeries. Patient interactions will also extend beyond these traditional care settings to allow learners to engage with patients in other settings that influence health and well-being. For example, learners will conduct home visits, participate in individualized education plan meetings at schools, and work as care navigators to connect patients with community partners and resources.
The WLHS will include three domains of content:
- The first is core knowledge that transcends all of the WLHS, regardless of the characteristics of the patients in each panel. This includes understanding health systems science, population and public health, health policy, socio-cultural determinants of health, communication and leadership skills, and organization management.
- The second domain of the curriculum will include predefined content that is relevant to the patient panel, such as specialized medical knowledge that is essential for effective patient care, specific community resources for patients, and services for uninsured adult patients.
- The third domain of the curriculum is content that will be identified on an on-going basis by the health care team as care is being provided to the patient panel, and these curricular elements will be compiled and provided on a just-in-time basis during predesignated periods of time in the formal curriculum.
A critical component for the success of this project is the comprehensive process for evaluation of the WLHS pilot and assessment of the learners. We will use the Institute of Medicine’s (IOM) Health Care Quality conceptual framework to guide this process. This framework includes six aims for quality health care delivery: patient-centered, safe, timely, efficient, effective, and equitable. Students will participate in continuous quality improvement based on this framework by compiling and analyzing data from patient engagement and chronic care surveys; care plans; ambulatory care, emergency room and inpatient utilization rates; missed work days; and medication adherence. Learners will be assessed through reviews of clinical care documentation, summative and formative knowledge examinations, essays to measure depth of learning across the IOM quality aims framework and it application to the quality improvement process, stimulated chart reviews, milestone-based rubrics, and a health professions satisfaction survey.
We envision that the WLHS is the future construct of academic health professions education. This innovation project will enable us to inform how health professions education responds to imminent changes facing the U.S. health care system. As the emphasis turns to population health and health maintenance, learners need to spend less time in inpatient settings, and the WLHS could become a new “rotation” model in health professions education. As quality improvement and maintenance of certification requirements better align with authentic clinical practice, the multigenerational synergy within our WLHS will help interprofessional students, residents, and faculty meet their individual program and professional requirements while working together to maximize the health and well-being of their patient panels and corresponding populations in their communities.
For more information about Dr. Reimschisel' selection as a Macy Foundation Faculty Scholar, please visit http://vanderbi.lt/2016macyscholar.