Field of Work: Aligning the training of physicians and nurse practitioners with the demands of 21st-century clinical practice.
Problem Synopsis: In the 1990s, managed care became one of the dominant forces in health care. Physicians and nurse practitioners (NP's) were expected to know how to manage patients' health, often within a fixed budget. Although care was increasingly taking place in outpatient settings, physicians continued to receive most of their training in hospitals rather than in ambulatory care centers. They also received little training in preventive care, or in interprofessional collaboration.
According to Allan Arbeter, M.D. of Philadelphia's Albert Einstein Healthcare Network, "Our patients and families don't always understand all we have to offer in terms of education, and how much they can affect their own health. The single biggest turning point for patients is when they really understand our relationship with them and their relationship with their chronic condition."
Synopsis of the Work: Partnerships for Quality Education (PQE) (April 1999 through January 2009), was initially funded by the Pew Charitable Trusts (during which time it focused on physicians only) and then by RWJF (which expanded it to include NP's). The program sought to improve a core set of skills in physicians and nurse practitioners, including interprofessional collaboration, chronic illness management, systems-based care and practice-based quality.
The Albert Einstein Healthcare Network participated in the Take Care to Learn (TCTL) component of PQE. A project team of eight faculty and senior staff introduced changes enhancing asthma care at the Pediatric and Adolescent Ambulatory Center of the Albert Einstein Medical Center.
Lessons Learned: The project directors in 2003 offered this advice to others implementing a chronic illness management project:
- Engage all interested parties early in the project.
- Work hard to secure faculty buy-in.
- Visit with institutions that have practical experience you can use.
- Clearly identify roles for all project participants.
- Give residents who show the most interest in project activities the most responsibility.
- Use a multiple disease approach in teaching chronic care.
- Take on one chronic care model component at a time.
- Do not give up on creating change or become overwhelmed.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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