Interprofessional population health advocacy: Developing and implementing a panel management curriculum in five Veterans Administration primary care practices

Health care systems expect primary care clinicians to manage panels of patients and improve population health, yet few have been trained to do so. An interprofessional panel management (PM) curriculum is one possible strategy to address this training gap and supply future primary care practices with clinicians and teams prepared to work together to improve the health of individual patients and populations. This paper describes a Veterans Administration (VA) sponsored multi-site interprofessional PM curriculum development effort. Five VA Centers of Excellence in Primary Care Education collaborated to identify a common set of interprofessionally relevant desired learning outcomes (DLOs) for the PM and to develop assessment instruments for monitoring trainees’ PM learning. Authors cataloged teaching and learning activities across sites. Results from pilot testing were systematically discussed leading to iterative revisions of curricular elements. Authors completed a retrospective self-assessment of curriculum implementation for the academic year 2015–16 using a 5-point scale: contemplation (score = 0), pilot (1), action (2), maintenance (3), and embedded (4). Implementation scores were analyzed using descriptive statistics. DLOs were organized into five categories (individual patients, populations, guidelines/measures, teamwork, and improvement) along with a developmental continuum and mapped to program competencies. Instruction and implementation varied across sites based on resources and priorities. Between 2015 and 2016, 159 trainees (internal medicine residents, nurse practitioner students and residents, pharmacy residents, and psychology post-doctoral fellows) participated in the PM curriculum. Curriculum implementation scores for guidelines/measures and improvement DLOs were similar for all trainees; scores for individual patients, populations, and teamwork DLOs were more advanced for nurse practitioner and physician trainees. In conclusion, collaboratively identified DLOs for PM guided development of assessment instruments and instructional approaches for panel management activities in interprofessional teams. This PM curriculum and associated tools provide resources for educators in other settings.

医疗体系期望初级保健临床医师能够管理患者小组并改善人群健康状况，但鲜有医师接受过相关专项培训。跨专业患者小组管理（Panel Management, PM）课程正是填补这一培训缺口的可行方案之一，可为未来的初级保健实践输送能够协同合作的临床医师与团队，以优化个体患者及人群的健康水平。本论文介绍了由美国退伍军人事务部（Veterans Administration, VA）资助的多中心跨专业PM课程开发项目。五家VA初级保健教育卓越中心携手合作，共同确立了一套适用于PM的跨专业通用预期学习成果（Desired Learning Outcomes, DLOs），并开发了用于监测受训人员PM学习情况的评估工具。研究团队对各试点的教学与学习活动进行了整理归档。系统研讨了试点测试的结果，据此对课程内容进行了多轮迭代修订。研究团队针对2015-2016学年的课程实施情况开展了回顾性自我评估，采用5分制评分标准：构思阶段（分值0）、试点阶段（分值1）、实施阶段（分值2）、维持阶段（分值3）以及嵌入常规阶段（分值4）。采用描述性统计方法对实施评分进行了分析。预期学习成果被划分为五大类别：个体患者、人群健康、指南/指标、团队协作与质量改进，并构建了发展连续体，与项目能力要求进行了对应映射。各中心的教学与课程实施情况因资源与优先级的差异而有所不同。2015至2016年间，共有159名受训人员参与了PM课程，其中包括内科住院医师、执业护士学员及住院医师、药学住院医师以及心理学博士后研究员。所有受训人员在指南/指标与质量改进类预期学习成果的课程实施评分较为相近；而执业护士与临床医师受训人员在个体患者、人群健康及团队协作类预期学习成果上的评分更为优异。综上，通过协同合作确立的PM预期学习成果，为跨专业团队的患者小组管理活动提供了评估工具与教学方法的开发指引。本PM课程及配套工具可为其他医疗场景的教育工作者提供参考资源。