The goal of Partnerships for Quality Education (PQE) was to align training of physicians and nurse practitioners with the demands of 21^st century clinical practice.

PQE program goals were to seek improvement in a core set of skills in physicians and nurse practitioners, including interprofessional collaboration, chronic illness management, systems-based care and practice-based quality improvement. See the program's Web site for more information.

Key Results of PQE's Four Programs
Over time PQE has consisted of four distinct programs:

• The Partnerships Program (1999–2001) prepared primary care medical residents and nurse practitioner students for practice in managed care settings. The program provided support to academic institutions to partner with managed care organizations to develop new curricula, methods and training opportunities for teaching about managing care. See two sidebars on Partnerships programs:
  • Georgia Southern University
  • Jamaica Hospital Medical Center
  Program office staff reported the following results for the Partnerships Program in 1999–2002 to RWJF.
  • 886 learners participated in the Partnerships Program's 58 projects—582 residents and 304 nurse practitioner students.
  • 474 learners received new classroom teaching in managed care and 412 completed either administrative or community rotations in managed care.
  Yedidia and the program staff grouped 26 patient care tasks into 22 managed care competencies seen as central to effective practice by medical residency directors and managed care medical directors. Yedidia and Greene reported the following key findings to RWJF in 2003:
  • Using pre- and post-tests, evaluators found changes in the numbers of managed care competencies addressed in training. Under the Partnerships Program, the training programs increased on average from 11 to 15 the number of managed care competencies they addressed which had been identified as central to effective practice.
  • In a knowledge assessment of four broad managed care competency areas taken by 600 learners in 17 projects, overall scores improved by 8 percent between pre- and post-tests, while scores of a comparison group of learners decreased by 1 percent. The four areas evaluators examined were:
    • Managed care and health care delivery
    • Evidence-based medicine and epidemiology
    • Cost effectiveness, practice profiling and quality improvement
    • Population health, prevention and disease management
• Collaborative Interprofessional Team Education (CITE) (2000–03), supported the development of clinical and educational interventions to teach individuals from medicine, nursing, social work and pharmacy to work collaboratively in teams. See sidebars on two CITE projects:
  • Case Western Reserve
  • University of Louisville
  According to national program staff:
  • CITE was unable to deliver an effective model of teamwork.
  • The models created were not strong enough or generalizable enough to work well in other institutions.
  • There was no national impact, which was a key goal of CITE.
    
    Elizabeth March, deputy director of PQE, put it this way:

  What was happening was that people were trying to do what was really a small initiative that went against the grain of the institution. There was no structure for medicine and nursing to collaborate. Administrative systems, such as scheduling of appointments, were not supportive of teamwork. Few, if any, faculty practiced in teams, which meant that the trainees had no models to emulate. Their academic years were different. Everything was working against it.

  The evaluation yielded findings on changes in learners' perceptions about teamwork attributable to CITE projects (see Evaluation Findings). Yedidia and Greene reported the following key findings to RWJF in 2005.
  • Attitudes toward other disciplines improved among CITE participants more than among nonparticipants. For example, CITE learners became more comfortable with the amount of authority wielded by colleagues from other disciplines and more confident that their clinical recommendations were given fair consideration by such providers.
  • CITE training improved participants' confidence in working with others significantly more than non-CITE participants.
• Take Care to Learn: Teaching Clinical Care Management (2002–03), which supported the development of chronic illness management initiatives in asthma and diabetes to serve as platforms for innovative education in managing care. See Take Care to Learn for more information. For sidebars on two Take Care to Learn projects, see:
  • Albert Einstein Healthcare Network
  • University of California, Davis
  Evaluators Yedidia and Green conducted a study of participating learners and a comparison group not enrolled in the program. It showed that TCTL learners reported significantly more improvement than the comparison group in their ability to:
  • Mobilize relevant resources for implementing the chronic care model. For example:
    • Consult guidelines during a patient visit.
    • Access detailed information on diabetes-related community programs.
    • Get timely input from a pharmacist on a complex medication regimen.
  • Support patient self-management of their conditions. For example:
    • Explain diabetes or asthma in a way that patients can understand.
    • Give patients choices about how to manage their diabetes/asthma care.
    • Involve patients in making a plan for their care.
  • Address difficult patient care issues in chronic disease management. For example:
    • Address cultural issues in promoting lifestyle changes.
    • Accept patients' preferences for care that differ from those of the medical learners.
    • Promote lifestyle changes in a patient who denies having a chronic illness.
  At one project treating asthma sufferers, patient utilization data could be linked to learner providers. There the evaluators Yedidia and Greene found that:
  • Participating patients reduced Emergency Department use by 43 percent. Evaluators ruled out the possible influence of other key factors in explaining this difference.
  The evaluators also surveyed patients of all Take Care to Learn learners:
  • Patients (or parents of child patients) who view health care providers as highly supportive of their self-management efforts reported greater confidence in caring for their (or their child's) conditions.
  • Diabetes patients with highly positive assessments of their provider's support, reported engaging in self-management tasks approximately one day more often per week than those with negative views.
  • These relationships between patients' confidence in caring for their (or their child's) condition and their view of their physician were significant for patients with either asthma or diabetes and from varied socioeconomic backgrounds.
• Achieving Competency Today (ACT) (2003–06). ACT supported multi-disciplinary education in systems-based practice and clinical practice improvement. For more information see ACT. For sidebars on two projects, see:
  • University of Pennsylvania Health System
  • University of Virginia Health System

In addition, with funding from Pew, PQE developed the FORCE (Future-Oriented Redesign of Clinical Education) program, under which nine grantees developed detailed curricula in eight managed care competencies. FORCE is not covered in this report.

Evaluation
Michael Yedidia, Ph.D., at New York University and Jessica Greene, Ph.D., at the University of Oregon have evaluated the four programs. The first phase of ACT was evaluated by Antoinette S. Peters, Ph.D., assistant professor, Harvard Medical School, Department of Ambulatory Care and Prevention. Evaluation findings for each program appear in the program's section of this report.

Program Management
PQE is managed by a program office at Harvard Medical School and Harvard Pilgrim Health Care and makes grants directly to organizations to implement projects within the programs.

Funding
PQE was started by the Pew Charitable Trusts in 1996. Its funding moved to the Robert Wood Johnson Foundation (RWJF) in April 1999 with an authorization of up to $9 million from its Board of Trustees.