Interprofessional transformation of clinical education: The first six years of the Veterans Affairs Centers of Excellence in Primary Care Education.

This paper describes the Centers of Excellence in Primary Care Education (CoEPCE), a seven-site collaborative project funded by the Office of Academic Affiliations (OAA) within the Veterans Health Administration of the United States Department of Veterans Affairs (VA). The CoEPCE was established to fulfill OAA's vision of large-scale transformation of the clinical learning environment within VA primary care settings. This was accomplished by funding new Centers within VA facilities to develop models of interprofessional education (IPE) to teach health professions trainees to deliver high quality interprofessional team-based primary care to Veterans. Using reports and data collected and maintained by the National Coordinating Center over the first six years of the project, we describe program inputs, the multicomponent intervention, activities undertaken to develop the intervention, and short-term outcomes. The findings have implications for lessons learned that can be considered by others seeking large-scale transformation of education within the clinical workplace and the development of interprofessional clinical learning environments. Within the VA, the CoEPCE has laid the foundation for IPE and collaborative practice, but much work remains to disseminate this work throughout the national VA system.

Leveraging the strength of comprehensive cancer control coalitions to support policy, systems, and environmental change.

Strategies that facilitate change to policy, systems, and environmental (PSE) changes can enable behaviors and practices that lead to cancer risk reduction, early detection, treatment access, and improved quality of life among survivors. Comprehensive cancer control is a coordinated collaborative approach to reduce cancer burden and operationalizes PSE change strategies for this purpose. Efforts to support these actions occur at the national, state, and local levels. Resources integral to bolstering strategies for sustainable cancer control include coordination and support from national organizations committed to addressing the burden of cancer, strong partnerships at the state and local levels, funding and resources, an evidence-based framework and program guidance, and technical assistance and training opportunities to build capacity. The purpose of this paper is to describe the impact of public policy, public health programming, and technical assistance and training on the use of PSE change interventions in cancer control. It also describes the foundations for and examples of successes achieved by comprehensive cancer control programs and coalitions using PSE strategies.

Interprofessional Academic Patient Aligned Care Team Panel Management Model.

The panel management model brings together trainees, faculty, and clinic staff to proactively provide team-based care to high-risk patients with unmet chronic care needs.

The Dyad Model for Interprofessional Academic Patient Aligned Care Teams.

Combining interprofessional education, clinical or workplace learning, and physician resident teachers in the ambulatory setting, the dyad model enhances teamwork skills and increases nurse practitioner students' clinical competence.

PACT ICU Model: Interprofessional Case Conferences for High-Risk/High-Need Patients.

Physician, nurse practitioner trainees, medical center faculty, and clinic staff develop proactive, team-based, interprofessional care plans to address unmet chronic care needs for high-risk patients.

Huddling for High-Performing Teams.

In short team huddles, trainees and PACT teamlets meet to coordinate care and identify ways to improve team processes under the guidance of faculty members who reinforce collaborative practice and continuous improvement.

Initiative to Minimize Pharmaceutical Risk in Older Veterans (IMPROVE) Polypharmacy Clinic.

An interprofessional polypharmacy clinic for intensive management of medication regimens helps high-risk patients manage their medications.

Lessons from the field: expanding health insurance coverage one county at a time.

From 2004 to 2007 the California HealthCare Foundation's Step by Step: Local Coverage Expansion initiative supported insurance coverage expansions for uninsured children and adults in thirty California counties. In this paper we descbribe the initiative and its achievements as well as challenges for grantees. Also, we discuss the implications of the initiative's outcomes for expanding coverage locally and more broadly. Implementing new insurance programs is possible in the most difficult settings. Although there are real challenges to sustaining these expansions and limits to what they can accomplish in the face of major unmet needs, they may lay useful groundwork for broader expansions later.