Deliberative Collaborative Practice Nursing and Dentistry 2014 ADEA Signature Series March 15, 2015 Theresa G. Mayfield, D.M.D. Associate Dean for Clinical Affairs University of Louisville School of Dentistry
The mix of health care professionals we will need in the future is different than the mix we have at present. Health care in the United States needs to become more affordable and accessible without compromising quality. Christensen CM, Gossman JH, Hwang, J. The Innovator s Prescription: A Disruptive Solution for Healthcare. New York: McGraw-Hill Companies, 2009.
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Form a collaborative partnership to advance interprofessional education Improve access to high quality primary health care including oral health care.
The transformation (in health professions education) envisioned would enable opportunities for health professions students to engage in interactive learning with those outside their profession as a routine part of their education. The goal of this interprofessional learning is to prepare all health professions students for deliberatively working together with the common goal of building a safer and better patient-centered and community/population oriented U.S. health care system. Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative
The concept of a Health Care Team is one of the basic principles proposed by the ADEA Commission on Change and Innovation (CCI) that is shaping the dental education environment. Access to oral health care and the connection of oral health to general health form a nexus that links oral health care providers to colleagues in other health professions. Haden NK, Andrieu SC, Chadwick DG, Chmar JE, Cole JR, George MC, et al. The Dental Education Environment. J Dent Educ 2006; 70(12); 1265-70.
Interprofessional team-based care: Care delivered by intentionally created, usually relatively small work groups in health care, who are recognized by others as well as by themselves as having a collective identity and shared responsibility for a patient or group of patients
Nursing Faculty Whitney Nash, PhD, APRN Director of Practice and International Affairs Principal Investigator Dedra Hayden, MSN, APRN Assistant Professor Course Coordinator of IPE Seminar and Adv. Health Assessment Faculty Lee Ridner, PhD, APRN Associate Professor Associate Dean of Graduate Programs Myra Goldman, MSN, APRN Assistant Professor Health Assessment Faculty Lynne Hall, PhD Associate Dean of Research Evaluation Lead Dental Faculty Wendy Hupp, DMD Assistant Professor, Oral Medicine Theresa Mayfield, DMD Associate Dean for Clinical Affairs John Firriolo, DDS, PhD Professor of Oral Diagnosis and Oral Medicine Health Assessment Lab Faculty Grant Staff Chandra Weathers, MP Program Manager, HRSA Grant Carrie Bohnert, MPA Standardized Patient Program Director Jeff Black, IT Specialist Enhancing Inter-professional Collaborative Practice Between Nursing and Dental Students via a Technology Enhanced IPE Model Focused on the Oral-Systemic Health Connection D09HP25034-01-00 (HRSA)
Implement and evaluate a technology-enhanced Interprofessional Education model through team based learning in the Interprofessional Education Collaborative (IPEC) core interprofessional competencies. Improve interprofessional communication and collaboration in the identification and management of oral-systemic diseases. Change practice patterns in patient assessment, consultation, and management to improve outcomes for the underserved.
Underserved populations suffer disparities in both their disease burden and access to needed services. Limited access to oral health care contributes to poor oral health. Adults aged 65+ with all natural teeth extracted - 24.8%. Nationwide Median - 16.2%. (Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System. 2012) Unaddressed oral health care needs are at a critical level in Jefferson County, Kentucky (REACH Evaluation contracted by the Louisville Metro Department of Public Health & Wellness Center for Health Equity. 2011).
Gap in integrating oral health care into overall primary health care, especially for the underserved in the community Need for IPE to prepare for deliberative interprofessional collaborative practice Gap in interprofessional education for ANP/FNP and dental students regarding the oral-systemic health connection
Values and Ethics Roles and Responsibilities Interprofessional Communications Teams and Teamwork Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative
Increase knowledge of the roles and responsibilities of each discipline. Increase knowledge of students about their role as a member of an interprofessional team. Increase favorable attitudes of NP and Dental students toward IPE in comparison to baseline attitudes. Evaluate the effectiveness of students as members of an interprofessional team. Increase students perception of self-efficacy related to functioning as a part of an interprofessional team.
Spring 2013 Introduction to Interprofessional Education Course (One hour credit course) 120 D1 dental and 33 graduate FNP and ANP students in teams IPEC interprofessional core competencies Scope of practice for each profession Oral-Systemic Connection Social Determinants of Health Smiles for Life: A National Oral Health Curriculum delivered via the web. Blackboard-supported peer to peer problem-based learning exercises and team based study
Summer 2013 Advanced Physical Assessment Course (12 hours) 45 NP students and 120 D2 dental students Four selected lectures delivered to NP and dental students in a combined lecture and lab setting HEENT/oral assessment Common oral findings Dermatological assessment Basic office laboratory testing Standardized Patients to evaluate competencies in oral communication and physical assessment
Summer 2014 and 2015 Provide a fully integrated IPE and Advanced Health Assessment Course to D2 dental and NP students
Interprofessional Education Pre- and post-test data collected Knowledge of Interprofessional Core Competencies Knowledge of and attitudes about interprofessional collaboration Perceptions of self-efficacy in functioning as a member of an interprofessional team Attitudes toward working with a team Peer evaluation of team members effectiveness Baseline dental knowledge obtained from online course and interaction with dental students
Change in practice patterns in patient assessment, consultation, and management to improve outcomes for the underserved Practice patterns of ANP/FNP students Oral, written and electronic record presentation of clinical data Nursing School Student Tracking System to evaluate practice patterns of ANP/FNP students on rotation Number of student practicum experiences in IPC in Federally Funded Health Centers
Interprofessional Education Core Competencies Improved communication and collaboration in managing oral-systemic diseases Assessment skills and documentation of head and neck findings Building a safer and better patientcentered and community, population oriented health care system Collaborative Practice Change practice patterns in patient assessment, consultation, and management for Nursing and Dentistry Improved Outcomes Access to care Team management of oral-systemic diseases
School of Dentistry collaborative practice in care of persons living with HIV/AIDS Ryan White Care Act HRSA HIV/AIDS Programs Huang, A., Mayfield, TG. A Medical-Dental Partnership for Integrating Oral Health into Comprehensive Patient Care. Presentation. Ryan White All Grantee Meeting 2008. Mayfield, TG. How Improving Access to Care Fostered an Interprofessional Approach to Oral Health Care. Panel Presentation: Expanded Educational Opportunities through the provision of Oral Health Care to Patients living with HIV. ADEA Annual Meeting 2010. 2
Christensen and Raynor describe a model for creating a disruptive growth engine embedding the ability to disrupt in a process. The Disruptive Growth Engine Step1: Start before you need to Step 2: Appoint a senior executive to shepherd ideas into the appropriate shaping and resource allocation processes Step 3: Create a team and a process for shaping ideas Step 4: Train the troops to identify disruptive ideas Christensen, CM, Raynor ME. The Innovator s Solution: Creating and Sustaining Successful Growth. Boston: Harvard Business School Press, 2003.
Start Before You Need To Early discussions around a care model for school aged children unsuccessful No community based model with resources, processes, and values Senior executive support - Deans of Schools of Dentistry and Nursing support collaboration Appointment of Senior Executives in Charge to Shepherd Ideas into Appropriate Shaping and Resource Allocation Processes School of Nursing Director of Practice and International Affairs and School of Dentistry Associate Dean for Clinical Affairs discuss educational and care models. Christensen, CM, Raynor ME. The Innovator s Solution: Creating and Sustaining Successful Growth. Boston: Harvard Business School Press, 2003.
Resource Allocation SOD supports salary for Nurse Practitioner, faculty appointment Office space at SOD SON supports work plan for development Creation of Team and a Process for Shaping Ideas NP and Oral Medicine faculty Director of Innovation and Community Engagement Social Worker with experience in HIV/AIDS care model. Christensen, CM, Raynor ME. The Innovator s Solution: Creating and Sustaining Successful Growth. Boston: Harvard Business School Press, 2003.
Train the Troops to Identify Disruptive Ideas NP and Oral Medicine faulty work together in the management of medically complex dental patients NP faculty along with Oral Medicine faculty in the Admissions Clinic Faculty team teaching in Physical Diagnosis course Oral health curriculum in nurse practitioner curriculum NYU College of Dentistry and College of Nursing Model Visit to NYU (2 visits) Christensen, CM, Raynor ME. The Innovator s Solution: Creating and Sustaining Successful Growth. Boston: Harvard Business School Press, 2003.
Train the Troops to Identify Disruptive Ideas Interprofessional education to promote collaborative practice in communication, physical assessment, and management of oral-systemic diseases Health Resources and Services Administration (HRSA) Grant University of Louisville School of Nursing - Enhancing Inter-professional Collaborative Practice Between Nursing and Dental Students via a Technology Enhanced IPE Model Focused on the Oral-Systemic Health Connection Christensen, CM, Raynor ME. The Innovator s Solution: Creating and Sustaining Successful Growth. Boston: Harvard Business School Press, 2003.
Train the Troops to Identify Disruptive Ideas Primary Care School of Dentistry as Working Model for the Community Technological enabler Common Electronic Health Record Business Model Innovation Lab testing and radiologic facilities one stop shop Primary care and oral health professionals perform health assessments in co-located clinic Management of chronic diseases Value Network Promotion of wellness and patient-centered care Christensen, CM, Raynor ME. The Innovator s Solution: Creating and Sustaining Successful Growth. Boston: Harvard Business School Press, 2003. Christensen CM, Gossman JH, Hwang, J. The Innovator s Prescription: A Disruptive Solution for Healthcare. New York: McGraw-Hill Companies, 2009.
176 ULSD Patients Surveyed Average Age =59 +/- 16 years 18% No Primary Care Provider 80% No Dentist 60% Passport (Medicaid) 39% Medicare University of Louisville School of Nursing and School of Dentistry Primary Care Clinic Needs Assessment. Dedra M. Hayden, APRN-BC, Primary Investigator, Christopher Swift, BSN Student, Co-Investigator University of Louisville. Poster Session for the Summer Undergraduate Research Programs. August 1, 2012. 2
University of Louisville School of Nursing and School of Dentistry Primary Care Clinic Needs Assessment Where do you go when you get sick? 68% Family MD 32% Hospital ER 22% Urgent Care Center 7% Other What Nurse Practitioner services are of interest? 50% Health Maintenance 44% Infections and Injuries 40% Referral to Specialists 35% Ed and Support Programs 32% DM, HTN, HLD, and Asthma 28% Mental Health 23% Well Exams 16% STI s 66% would seek services if available 3
Primary Care Clinic at local racetrack NP Students and General Practice Residents perform assessments and care to racetrack employees Pediatric and Pediatric Dental Clinic Pediatric and Pediatric Dental Residency Programs located on the grounds of Kosair Charities, one the largest pediatric charitable organizations in the U.S. Co-located other specialty charitable organizations for children 1.7 million dollar investment
Pediatric Medical and Oral Health Care at Home of the Innocents Medical, Dental, Pharmacy, Social, Rehabilitative, Special Needs
Elements of Disruptive Innovation 1. Sophisticated technology that simplifies 2. Low-cost innovative business models 3. Economically coherent value network Regulations and Standards that facilitate change Christensen CM, Gossman JH, Hwang, J. The Innovator s Prescription: A Disruptive Solution for Healthcare. New York: McGraw-Hill Companies, 2009.
Enhancing Inter-professional Collaborative Practice Between Nursing and Dental Students via a Technology Enhanced IPE Model Focused on the Oral-Systemic Health Connection D09HP25034-01-00