Health Professionals Training in the Era of the Patient Protection and Affordable Care Act (P.L. 111-148): Educating to Meet Workforce Demands

The 2010 Patient Protection and Affordable Care Act (P.L. 111-148) (PPACA) heralds new challenges for the education of health professionals and the development of a healthcare workforce primed to meet the influx of previously marginalized populations into healthcare systems. Changes in insurance coverage and mechanisms coupled with the focus on preventive care will require a healthcare workforce skilled in navigation, care coordination, ambulatory care models, and care for underserved populations. This dissertation is comprised of three studies that examine the current state of education for two professions impacted by the PPACA: social workers and physicians. The first study, a systematic review of accredited MSW programs (n=200), was undertaken to investigate the level of health- related preparation provided by social work training program. Bivariate statistics and logistic regression models revealed that of the 200 programs, only 13 (6.5%) offer targeted health concentrations (HC). Controlling for university-level characteristics, university size (β=1.69, p \u3c .001) and presence of an MPH program (β=2.0, p\u3c.0001) were associated with having a HC. The second study focused on education of medical students to meet PPACA stipulations of community-based training and graduates who go on to provide primary care. Using a grounded theory framework, 468 written assignments from a community-based experience were examined. Five domains emerged. Themes reflected a continuum of students\u27 abilities to understand the experiences and perspectives of community members and communicate their understanding. The third manuscript examined resident experiences (N=22) in underserved communities through the lens of curricular requirements of community-based training. The assessment tool was found to have good reliability with Cronbach\u27s alpha coefficients for the scales in the assessment tool ranging from 0.88 to 0.95. Significant differences in pre- and post- educational intervention mean scores were found

An Innovative Interprofessional Simulation: Preparing Students to Tackle the Challenge of Care Transitions

INTRODUCTION Transitions of Care (TOC) are associated with communication breakdowns that contribute to medical errors, medication mistakes, and hospital re-admissions. The purpose of this one-day workshop was to teach interprofessional (IP) skills to healthcare students, focusing on verbal and written communication during a TOC of a standardized patient (SP). METHODS Forty-seven students, representing six healthcare disciplines, worked in IP teams to plan a family meeting for a hospitalized SP who had recently experienced a stroke. Students were to communicate pertinent medical, social, and physical issues to the SP, as well as make discharge recommendations. Discharge summaries were entered into an electronic medical record and transmitted to IP teams simulating either a rehabilitation setting or ambulatory care. IP teams utilized these summaries in their family meeting with the SP. After each scenario, students debriefed, focusing on IP competencies. RESULTS Significant improvements were found in nine of fourteen areas measured by the Attitudes Towards Healthcare Teams Scale. Significant improvements were found for confidence in writing an accurate and concise note as well as gleaning information from a discharge summary. CONCLUSIONS This study demonstrated the effectiveness of a short workshop on improving IP verbal and written communication and confidence in TOC scenarios in acute care, rehabilitation, and ambulatory care

A Monte Carlo simulation approach for estimating the health and economic impact of interventions provided at a student-run clinic

<div><p>Background</p><p>Student Run Clinics (SRCs) are a common aspect of medical education, present at more than half of US medical schools, and noted for providing care to communities that might otherwise lack access, including the uninsured and underinsured. To date, few studies have rigorously quantified the health and economic benefits of SRCs, and the present study remedies that.</p><p>Methods and findings</p><p>We used Monte Carlo simulations to estimate the health impact of common preventive health interventions applied to individuals in quality-adjusted life-years (QALYs). We then used those measurements to estimate the health and economic impact of United Community Clinic (UCC), a student-run clinic in Philadelphia, PA. We found that with an annual operating budget of $50,000, UCC saves 6.5 QALYs, corresponding to over$850,000 saved.</p><p>Conclusions</p><p>Using Monte Carlo simulation methods, the health and economic impact of SRCs can be reasonably estimated to demonstrate the utility of SRCs and justify their growing importance in the healthcare delivery landscape of the US.</p></div

Interventions with estimated coefficients of variation.

<p>Interventions with estimated coefficients of variation.</p

Annual health and economic impact of the preventive health interventions at UCC.

<p>Annual health and economic impact of the preventive health interventions at UCC.</p

Annual health and economic impact of potential preventive health interventions at UCC.

<p>Annual health and economic impact of potential preventive health interventions at UCC.</p

Kernel density estimation plots for QALYs/10³-interventions for 10⁶ Monte Carlo simulations.

<p>Kernel density estimation plots for QALYs/10³-interventions for 10⁶ Monte Carlo simulations.</p

QALYs/10³-interventions as calculated by Monte Carlo simulations.

<p>QALYs/10³-interventions as calculated by Monte Carlo simulations.</p

How Nurse-Led Practices Perceive Implementation of the Patient-Centered Medical Home

Purpose The Affordable Care Act (ACA) promotes the Patient-Centered Medical Home (PCMH) model as a way to improve healthcare quality, the patient experience, and has identified nurse-led primary care as a mechanism meeting the increasing demand for quality primary care. The purpose of this study was to investigate the implementation of a PCMH model in nurse-led primary care practices and to identify facilitators and barriers to the implementation of this model. Methods Data were collected through in-depth interviews with providers and staff in nurse-led practices. Results These data suggest two categories of processes that facilitate the integration of PCMH in the nurse-led practice setting: patient-oriented facilitators and organizational facilitators. In addition, a number of barriers were identified to implementing the PCMH model. Overall, these practices creatively engaged in the transformation process by structuring themselves as a complex adaptive system and building upon the core principles of nurse-led care. Conclusion Since the core principles of nurse-led care map onto many of the same principles of the PCMH model, this study discusses the possibility that nurse-led practices may experience fewer barriers when transitioning into PCMHs