Social Determinants of Health: Opportunity for Occupational Therapy.

There is a growing recognition that social determinants of health (or social drivers of health [SDOH]) affect physical well-being. In this Health Policy Perspectives column, we describe SDOH and the evolving landscape in health care. Policymakers are facilitating notable investments in social care and putting forth requirements for health care organizations to address SDOH. We share insights and perspectives on the roles occupational therapy practitioners can play in these efforts to address SDOH and the building ecosystems connecting health care and social care.

Analyzing Unnecessary Imaging for Low Back Pain in Nebraska from a Statewide Health Information Exchange.

Excessive amounts of resources in healthcare are wasted due to duplicated or unnecessary health screenings, especially in the diagnosis of low back pain (LBP). Research shows that two-thirds of people will present with LBP at some point throughout their lifetime, but 20-50% of high-tech imaging procedures fail to provide information that improves the patient's condition, representing unnecessary services. The purpose of this study was to evaluate the existence of unnecessary imaging for low back pain throughout healthcare systems in Nebraska based on what was documented in the electronic health record. This study was a retrospective electronic health record analysis of a limited data set focused on procedures related to imaging for LBP extracted from Nebraska Health Information Exchange (HIE) managed by CyncHealth. The sample included 937 patient records with a diagnosis of LBP who received imaging in the state of Nebraska and whose health record was recorded in the Nebraska HIE. To determine necessity, records were categorized in three areas including necessary imaging, likely wasteful imaging, or wasteful imaging based on the criteria from the "First, Do No Harm" study conducted by the Washington Health Alliance. Results revealed a total of 51% of low back pain imaging considered wasteful, 35% likely wasteful, and 14% necessary. Based on these results, further research is warranted to determine specific demographics related to necessary, likely wasteful, and wasteful imaging and the purpose for performing these expensive imaging procedures.

Creation of a primary care academic collaborative nexus: enabling and interfering factors.

With a renewed commitment to interprofessional education and collaborative practice, academic institutions and health care systems are collaborating to provide quality health care education and service delivery. This kind of partnership integrates interprofessional education with clinical practice redesign and strives to create "collaboration ready" graduates in clinical learning environments. In this reflective case analysis, we describe the intentional commitment and collaboration between an academic institution and a clinical health system in the U.S. to form what the U.S. National Center for Interprofessional Practice and Education calls a Nexus. The historical context and shared vision that led to the creation and evolution of the Nexus, as well as a description of the micro, meso, and macro level enabling, and interfering factors are provided.

Sustainable and replicable clinical and financial outcomes in an interprofessional education and collaborative practice nexus.

Our Interprofessional Education and Collaborative Practice (IPECP) Nexus previously reported significant reductions in Emergency Department (ED) visits, hospitalizations, hemoglobin A1c levels, and patient charges. This study examines sustainability of these results over two additional years and replication in two subsequent independent patient cohorts. Participants in the sustainability cohort (N = 276) met ≥1 of the following criteria: (a) ≥3 ED visits in first or second half of the year, (b) hemoglobin A1c level ≥ 9, or (c) Length of Stay, Acuity, Comorbidities, and ER (Emergency Room) Visits (LACE) score ≥ 10. Participants in two replicability cohorts (N = 255) and (N = 160) met the same criteria, but the LACE criterion was changed to ≥3 hospitalizations in baseline years. The Nexus, housed in a family medicine (FM) residency clinic, included professionals and students from multiple disciplines. IPECP skills and interventions included communication, team building, and conflict engagement skills training, daily huddles and pre-visit planning, immediate consultations, small teamlet IPECP interactions, and weekly IPECP case conferences for complex patients. Original health improvements and charge reductions were sustained for two additional years for ED visits, hospitalizations, A1c, and patient charges, and replicated in two additional patient cohorts. The IPECP Nexus interventions were associated with Quadruple Aim outcomes while training the next generation of health care professionals.

The Promise of Interoperability.

Despite technological advancements in health care documentation and the proliferation of electronic health records, health information and health data remain disparate. Patients and health care teams benefit from access to comprehensive patient records to make informed health care decisions. Significant governmental policy and investments have been made to promote interoperability of systems that connect health information with the ultimate intent of developing a longitudinal patient record. In this article, we discuss how health data, interoperability, and related systems are influenced by federal policy. The intent is to expand occupational therapy practitioners' understanding of the promise of interoperability and the role the occupational therapy profession can play in advancing the infrastructure needed to optimize health care delivery.

Measuring the impact of an online IPE course on team perceptions.

Interprofessional education (IPE) needs to begin with foundational learning experiences for health professions learners at an institution. There is a recognized need for IPE to be embedded into health profession curriculums; however, several barriers prevent the implementation. The purpose of this project was to determine if an introductory online IPE course can overcome some of the existing barriers to implementing IPE while influencing team perceptions among health professional students. The modified Team Skills Scale was used to assess perceptions of students from six health professions programs pre-posttest to the introductory course. The researchers grounded the development of the course in the Institute of Medicine's Interprofessional Learning Continuum. Results show that an introductory online course in IPE can affect team perceptions of students and can be offered on a large scale with minimal impact on faculty workload. The pedagogical approach implies institutions with large numbers of health professions programs, large numbers of students and distance learners may benefit from a similar approach to introducing interprofessional collaboration.

The development of an instrument to evaluate interprofessional student team competency.

Healthcare institutions, accreditation agencies for higher learning, and organizations such as the National Academy of Medicine in the United States, support interprofessional education (IPE) opportunities. However, incorporating IPE opportunities into academic settings remains difficult. One challenge is assessing IPE learning and practice outcomes, especially at the level of student performance to ensure graduates are "collaboration-ready". The Creighton-Interprofessional Collaborative Evaluation (C-ICE) instrument was developed to address the need for a measurement tool for interprofessional student team performance. Four interprofessional competency domains provide the framework for the C-ICE instrument. Twenty-six items were identified as essential to include in the C-ICE instrument. This instrument was found to be both a reliable and a valid instrument to measure interprofessional interactions of student teams. Inter-rater reliability as measured by Krippendorff's nominal alpha (nKALPHA) ranged from .558 to .887; with four of the five independent assessments achieving nKALPHA greater than or equal to 0.796. The findings indicated that the instrument is understandable (Gwet's alpha coefficient (gAC) 0.63), comprehensive (gAC = 0.62), useful and applicable (gAC = 0.54) in a variety of educational settings. The C-ICE instrument provides educators a comprehensive evaluation tool for assessing student team behaviors, skills, and performance.

The Knowledge of Rehabilitation Professionals Concerning Fetal Alcohol Spectrum Disorders.

The purpose of this study was to explore rehabilitation professionals' knowledge regarding signs and symptoms, prevention, and intervention of fetal alcohol spectrum disorders (FASD). Participants were 111 rehabilitation practitioners (e.g., occupational therapy, physical therapy, and speech-language pathology practitioners) recruited through email using a quantitative online survey design with purposive, snowball sampling. Results showed the majority of participants' demonstrated accurate knowledge of the signs and symptoms of FASD. Since professionals who received formal education on FASD reported significantly higher feelings of preparedness to identify children with FASD and manage/coordinate intervention plans, this study suggests rehabilitation professionals may be better prepared to treat individuals with FASD if they participate in formal training.

A Call for a Health Data-Informed Workforce Among Clinicians.

Unlabelled: A momentous amount of health data has been and is being collected. Across all levels of health care, data are driving decision-making and impacting patient care. A new field of knowledge and role for those in health care is emerging-the need for a health data-informed workforce. In this viewpoint, we describe the approaches needed to build a health data-informed workforce, a new and critical skill for the health care ecosystem.

Reflections from an interprofessional education experience: evidence for the core competencies for interprofessional collaborative practice.

The Core Competencies for Collaborative Practice identify the skills needed by every health care provider to be successful in implementing interprofessional practice. Health professions students need to build skills for interprofessional practice as emerging professionals. Reflection is a core skill needed for successful interprofessional practices. This study identifies themes from an interprofessional education research project and discusses their congruency with the Competencies.

Social determinants of health: critical consciousness as the core to collective impact.

Social determinants of health have become widely recognized as important to overall health. Many areas of social determinants of health are growing from policy to reimbursement to the connecting of health and social care. The efforts around social determinants of health require reflection and awareness of structural issues. The work of Paulo Freire in critical consciousness provides guidance for how to engage in social determinants of health efforts. This manuscript offers a summary of the social determinants of health under the guidance of critical consciousness to build skills and interactions to promote social care to build toward health equity.

Partnering with the Health Professions to Promote Prevention of an Alcohol-Exposed Pregnancy: Lessons Learned from an Academic⁻Organizational Collaborative.

Background: Evidence-based strategies exist to train healthcare professionals to ask their patients and clients about alcohol use, and are successful. Implementation of these strategies utilizing a system-level approach has not been conducted nationwide. This case study reports on the success of academic partnerships with national health professional organizations to increase adoption of evidence-based strategies to prevent alcohol-exposed pregnancies. Methods: Authors reviewed and summarized multi-level strategies created as part of the developmental phase of this project in order to report successes and challenges. We applied the three principles of reflection, sense-making, and reciprocal learning, as identified in the practice change literature, to synthesize our experience. Results: There were five primary lessons learned as a result of this work: Development of technology-based training websites requires significant time to design, implement, and test; project 'mission-drift' is inevitable, but not necessarily unwelcome; time and effort is required to create and sustain functioning workgroups when there are different organizational cultures; and changing real-world practice is hard to do, yet changing the conversation on screening and brief intervention is possible. Conclusions: Use of multi-level strategies within an academic-professional organization model was successful in promoting awareness and education of healthcare professionals in the prevention of alcohol-exposed pregnancies.

Epic failure: Lessons learned from interprofessional faculty development.

Interprofessional education (IPE) is now recognized as an important initiative to prepare the next generation of health providers. Although IPE has been embraced by many institutions, faculty development still remains an issue. In this manuscript, the authors share their story of one attempt to educate a variety of health science faculty on IPE in what was perceived as an approachable venue. The story of its epic failure and lessons learned will be shared to help others avoid similar pitfalls.

Interprofessional Practice and Education in Clinical Learning Environments: Frontlines Perspective.

This Invited Commentary is written by coauthors working to implement and study new models of interprofessional practice and education in clinical learning environments. There are many definitions and models of collaborative care, but the essential element is a spirit of collaboration and shared learning among health professionals, patients, and family members. This work is challenging, yet the benefits are striking. Patients and family members feel seen, heard, and understood. Health care professionals are able to contribute and feel appreciated in satisfying ways. Learners feel included. Care interactions are richer and less hierarchical, and human dimensions are more central. A crucial insight is that collaborative care requires psychological safety, so that people feel safe to speak up, ask questions, and make suggestions. The most important transformation is actively engaging patients and families as true partners in care creation. A leveling occurs between patients, family members, and health professionals, resulting from closer connections, deeper understandings, and greater mutual appreciation. Leadership happens at all levels in collaborative care, requiring team-level capabilities that can be learned and modeled, including patience, curiosity, and sharing power. These abilities grow as teams work and learn together, and can be intentionally advanced by reconfiguring organizational structures and care routines to support collective team reflection. Collaborative care requires awareness and deliberate practice both individually and as a team together. Respectful work is required, and setbacks should be considered normal at first. Once people have experienced the benefits of collaborative care, most "never want to go back."

Fostering cultural competency, clinical reasoning, and leadership through international outreach.

ABSTRACT The Centennial Vision of the American Occupational Therapy Association (AOTA) has called for occupational therapy to be globally connected. Students can gain cultural competency, clinical reasoning, and leadership from attending didactic coursework and participating in discussions and clinical simulations. Immersing oneself in international settings, however, tends to have a greater impact on learning. The authors describe the outcomes of two international outreach programs: China Honors Immersion Program (CHIP) and Institute for Latin American Concern (ILAC). The outcomes of these programs indicate that students believe that such international experiences greatly affect their development, both professionally and personally. Implications of the program outcomes to current professional education are discussed. Future research directions are also proposed.