AAMC/CDC/Fullerton Sponsored Population Health Improvement ... · AAMC/CDC/Fullerton Sponsored Population Health Improvement Leadership Wednesday Ap, ... Psych clinic: Internal Med

AAMC/CDC/Fullerton Sponsored Population Health Improvement

Leadership

Wednesday, April 22, 201510:00 – 11:00 am

Agenda

Primary Care Leadership Track at Duke School of Medicine

Barbara Sheline, MD, MPHProfessor of Community and Family Medicine,

Duke School of Medicine

The Power of Health Communities: Power UP for Kids

Marna Canterbury, MS, RDDirector of Community Health and Wellness

at the Lakeview Health Foundation

Barbara Sheline, MD, MPHApril 2015AAMC/CDC/Fullerton Webinar

The Development of a Competency Map for Population Health Education

Primary Care Leadership Track at Duke School of Medicine

The Development of a Competency Map for Population Health EducationThe Development of a Competency Map for Population Health Education

All Rights Reserved, Duke Medicine 2007

Objectives of AAMC/CDC Fullerton Webinar

Appreciate the history of PCLT

Describe PCLT 4 year curriculum

Appreciate the population health training in PCLT

Presenter

Presentation Notes

Goals and objectives for the session (per the abstract submission). At the end of the session, attendees will be able to: a. Describe an example of a formal PCMH curriculum for medical students b. Outline the basic components required for carrying out a site-based research project


The Goal of the Primary Care Leadership Track (PCLT)

to create change agents for the US health care system in primary care to address the health of the public


History of PCLT

•Donation to increase primary care at Duke SOM

•Increasing calls for population health education

•Rich history of initiatives to improve health of the Durham community

Presenter

Presentation Notes

Produce leaders in primary care Provide nurturing environment to foster interest in primary care within a traditionally research-oriented school Increase student awareness of community and population health


Primary Care Leadership Track (PCLT)

• Four-year parallel track for medical students who apply simultaneously to Duke School of Medicine and to the PCLT

• 8 students admitted each year

• Scholarships awarded for students who pursue careers in primary care after graduation

• First student graduating this year – matched IM at John’s Hopkins - hopes to serve HIV patients


Year Science courses/doctoring course1 Leadership curriculum

Year Doctoring course/Clinical Skills Course

2 Longitudinal Integrated Clerkship (LIC) with primary care focus 7 mo. (Immersions 4 mo)

Year 3

Community-Engaged Population HealthResearch

Year Clinical Electives/Capstone4


LIC Year 2 – Typical Student WeekMon Tue Wed Thu Fri Sat Sun

AM Family Med Clinic

Psych clinic

Internal Med Clinic

CommunityTeam

Pediatric clinic

Noon

PM Tutorial Practice/Clinical Skills Course

Ob-Gyn/ Surgery clinic*

Roundson panel patients

evening Urgent Care/EmergencyRoom


History of PCLT

We chose a Longitudinal Integrated Clerkship (LIC) to:

• Combat the Hidden Curriculum of inpatient ward teams

• Allow flexibility to add longitudinal community service

• Promote relationships with preceptors and with patients over time.


Population Health Training Objectives, Competency Map

Students will develop skills in:• Team work • Public Health• Community Engagement• Critical Thinking

Kaprielian, et al. Teaching Population Health: A Competency Map Approach to Education. Academic Medicine 2013:88(5):626-637


Team Training Curriculum

• Excel in the science curriculum as a team• Work effectively as a team leader and member• Experience resiliency• Act with confidence and commitment• Create impactful feedback for self and others• Experience being in service to patients and

community


Team Training – Preorientation – 2 ½ days in late July

• Personal styles workshop (DiSC model)• Activities to build team – shared values, develop trust• Experience resiliency – receive support during

challenges, mindfulness training• Act with confidence and commitment in assignments• Create impactful feedback for self and others• Experience being in service to the community


Team Training – Year 1

Students use new skills to lead:

• weekly leadership meetings • monthly PCLT dinners• fall and spring semester project• Second-look weekend


Team Training

• Making plans to extend the team training into years 2-4


Public Health Skills

• Define population health

• Give examples of population health initiatives

• Describe the role and importance of clinicians in population health improvement

• Define the responsibilities of the public health sector and explain the importance of public health/primary care integration.


Public Health Methods

• Population Health Improvement and Teamwork Course

– for the Family Medicine residents and faculty

– Meets twice a month, PCLT students attend in Year 2


Community Engagement

Explain what community engagement is, what it "looks like on the ground," and its importance to population health improvement.

• Community Orientation – 7 days in Yr 2• Community Service – 7 months once a week Yr 2• Community Engaged Population Health Research –

Yr 3


Community Orientation

7 days in the Durham community during the clinical year (Yr 2):

• Windshield survey• Community Scavenger hunt• Introduction to the Durham Health Dept• Meet with Duke and Durham population health

leaders• Visit agencies that address population health needs




Community Service

One half day a week for the 7- month LIC. Examples of student placements:

Senior pharmAssistHomeless clinicEl Centro HispanidadCAARE, Inc – free clinic and support servicesSchool health programsCrisis CenterCoordinated care for specialty access


Critical Thinking

Define, compare, and contrast research, quality improvement, and evaluation

Think through key considerations to design a plan for the collection, analysis, and interpretation of data

• PCMH minicourse, YR 2• QI chart audit for a PCMH, Yr 2• PHIT course, Yr 2• Community-engaged population health research Yr 3


Community-engaged Population Health Research

• Third year study track director, from the Division of Community Health

• MPH option

• Leadership opportunities with service projects and small group teaching


PCLT Evaluation – Future Plans

• Compare with traditional track students:– Clinical shelf exam scores– Research thesis grades– Residency matching– Numbers entering primary care– Type of careers chosen


What we are missing

• Clinical work in sites that serve the underserved (e.g. longitudinal placement in FQHC)

• Principles of leading in a complex environment• Experiencing the interface between public health and

primary care (limited examples)• Advocacy and policy work to promote population

health• Critical analysis of the literature (unless they do

MPH)

Questions?

Thank you

The Power of Healthy Communities: PowerUp for Kids

April 6, 2015Marna Canterbury, MS, RDDirector of Community [email protected]

Health Affairs, 32, no.8 (2013):1446-1452 HealthPartners Adopts Community Business Model To Deepen Focus On Nonclinical Factors in Health Outcomes. Isham, Zimmerman, Kindig, Hornseth

Multiple Determinants of Health

• Model to guide our work• Complexity of health and

obesity require cross-sector collaboration

• Consistent with Community Health Needs Assessment (CHNA) Priorities

• Supports the need to work in and with the community

PowerUp: Key Community Initiative

• Lead organizations: Lakeview Hospital and HealthPartners

• Part of Community Health Needs Assessment Implementation Plan

• A community-wide initiative, to make better eating and physical activity easy, fun, and popular, so that our youth can reach their full potential

• Long-term, 10 year plan, launched broadly in 2013

Where is PowerUp?• Mixed suburban, small town and rural area outside St.

Paul and Minneapolis, MN• 2 states, 2 counties, 12 “towns”, 5 school districts.

St. Croix River Valley Region

Community Initiatives

Community Initiatives Framework

Community-based

Multi-levelEnvironmentEngagement ProgramsClinical

COMMUNITY

Engagement: Community StakeholdersTotal Sectors =13Stakeholders/Advisors=100+Involved through:

• Committees• Workgroups• Advising• Partnerships• Outreach• Volunteering• Advocate for change in

their own community

Engagement: PowerUp Structure

Part of the Community Innovation Process modelBush Foundation and Wilder Foundation, 2013

Partnership and Innovation

• Tied to community vision for change

• Positive and consistent (5-2-1-0)

• A “super-hero”… Chomp!

• Shared across sectors

PowerUp Communications

PowerUp CommunicationsPowerUp Community Outreach

Powerup4kids.org

ClassesPowerUp Kids Cook Classes

PowerUp Partnerships-Schools• School boards, leaders and

Health Councils• PEP Grant (DOE)• Food Service and After

School Programs• Teachers/Coaches• PTOs/Booster Clubs• PowerUp School Challenge

Reaching 10,000 kids in 4 school districts

PowerUp School Challenge

Environment Change

• Policy and Systems-School and Government

• Training “food coaches”• Hospital, Clinic and School

foods and beverages• Open gyms and pools • School events and carnivals• School Change Toolkits• Transforming the Food Shelf

Better Shelf for Better Health Partnership

• Partner project with Valley Outreach food shelf

• Mutual goals to create better food environment for clients

• Focus on Fruits, Vegetables, whole grains and less processed foods

• Apply food marketing and behavioral economic principles

Food Lists and Inventory

PowerUp the Food Shelf

Better Shelf For Better Health Results

$12,954

$7,742

$6,184

$10,574

$3,000

$5,000

$7,000

$9,000

$11,000

$13,000

$15,000

$17,000

$19,000

$21,000

2012/2013 2013/2014

Total Spent on Healthy/Less Healthy Food Items

Less Healthy

Healthy

Fiscal Year: Oct. 2012-Sept. 2013 & Oct. 2013- Sept. 2014

$18,267.01$20,880.95

PowerUp Evaluation Framework

919-403-9005

Num

ber o

f occ

urre

nces

PowerUp Outreach Measures

School Environment Change Measures

3

133

9

11

20

2

9

1

10

0

10

20

30

40

50

60

70

Pre BearPower 2013-2014

Average Score, 9 Elementary SchoolsScreen Time

Physical Activity

Healthy Beverages

Healthy Rewards

Healthy Food

Presenter

Presentation Notes

Types of change Guidelines for food and beverages at events and in school Active classroom strategies Use of active, non-food rewards Activity-based fundraisers and events Reduction of recreational screen time Working with schools, we have added new recommendations for the coming year, so all schools will be building on their progress.

PowerUp Family Community Survey

• Online survey with random sample mailing list, January 2014 in communities• Establishes the “baseline” for family and child attitudes, awareness, behaviors and perceived barriers to change• Repeat January 2016

Family Community Survey, Jan 2014

Presenter

Presentation Notes

High Awareness in communities reached Awareness grows with time 95%+ in all communities indicate PowerUp and BearPower are important or very important. Fills gaps in available data Compare results over time

PowerUp Family Community SurveyParent Awareness of PowerUp

23%

88%

55%

39%

3%

33%

14% 13%

0%10%20%30%40%50%60%70%80%90%

100%

PowerUpwithoutprompt

PowerUp fromlist

Chomp fromlist

SchoolChallengefrom list

Communiites after 1 yr.

New communities


95% indicated PowerUp is Important.

PowerUp Family Community SurveyParent report of Key Child Behaviors


44% 45%

71%77%

45%50%

65%

77%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

5 F/V a day 60 mins PA Less than 2 hrsScreen Time

0 SSB

Still/Mah/Somerset

Hudson/New Rich

5-2-1-0 Child Behaviors at Goal by Community

PowerUp Lessons Learned• A lead organization and long term

commitment convene and guide the collective work.

• Local shared leadership for authenticity, relevance and momentum.

• Audience-specific communications essential.• Authentic partnerships and relationships

take time and dedicated people. • Evaluation needs to be practical, meaningful

and a priority.• Community change is not a linear process.

Presenter

Presentation Notes

Strengthened by “local” stakeholders Each partner brings unique contributions to the work

We PowerUp in the St. Croix Valley!

Upcoming Webinars:

May 4th, 2015 12:00-1:00pm EST

Repeat of May 4th session◦ May 14th, 2015 3:00-4:00pm EST

Recordings of past webinars are available at: http://cfm.mc.duke.edu/modules/cfm_resrc/index.php?id=1

http://cfm.mc.duke.edu/modules/cfm_resrc/index.php?id=1

Documents

AAMC/CDC/Fullerton Sponsored Population Health Improvement ... · AAMC/CDC/Fullerton Sponsored Population Health Improvement Leadership Wednesday Ap, ... Psych clinic: Internal Med