Outcomes of an interprofessional SBIRT training program: Knowledge attainment and perceived competence for practice.

Background: One way to address substance misuse is to train health professional students in Screening, Brief Intervention, and Referral to Treatment (SBIRT), an early intervention strategy. This study evaluated a semester-long, 50-hour elective SBIRT training that blended online coursework with interprofessional experiences. Medicine, nursing, pharmacy, and social work students completed an interprofessional standardized patient experience and completed a minimum of two interprofessional SBIRT experiences at community agencies. Methods: We analyzed longitudinal data from 197 students using structural equation modeling to examine gains in knowledge and perceived competence, as well as to test if background variables predicted 30-day application of SBIRT knowledge and skills, 30-day satisfaction' 12-month frequencies of care for performing SBIRT; and number of SBIRT clients/patients served directly. Results: Overall, student SBIRT knowledge and perceived competence both increased by more than a standard deviation during the course. Students who experienced larger gains in perceived competence rated the course significantly higher in terms of relevance and usefulness and, in turn, served significantly more SBIRT clients/patients during the following year. We did not find evidence that intra-individual growth in knowledge impacted the degree to which students ultimately applied SBIRT components. Finally, students who had more previous training and experience related to substance abuse ultimately reported greater application of SBIRT knowledge and skills. Interprofessional differences included: At baseline, medicine students had significantly lower substance abuse education knowledge as compared to the other disciplines. Pharmacy and social work students were more likely to have had previous experience with motivational interviewing. Baseline perceived competence in applying SBIRT was higher in social work and nursing. Upon completion, pharmacy and medicine students had lower satisfaction with the course. Conclusions: These findings suggest that SBIRT courses can increase knowledge and perceived competence; moreover, student background characteristics, work settings, and experiences may have important effects on learning SBIRT.

Provision of Recommended Chronic Pain Assessment and Management in Primary Care: Does Patient-Centered Medical Home (PCMH) Recognition Make a Difference?

BACKGROUND: Chronic pain (CP) care in the patient-centered medical home (PCMH) model has not been well studied. We assessed whether PCMH recognition is associated with increased provision of key practice recommendations for CP assessment and management. METHODS: Chart reviews were completed for 12 primary care practices affiliated with one health system in the Cincinnati Area Research and Improvement Group (CARInG). Recommendations were abstracted and compared based on PCMH status: 3 practices had received prior PCMH level 3 recognition, 5 were in an ongoing process of applying, and 4 had no recognition and were not applying. RESULTS: A total of 485 charts were reviewed from 65 PCPs. Eight of 10 key recommendations were documented more often in the prior and ongoing PCMH cohorts, including assessing pain severity, function, psychosocial distress, and substance abuse, and using structured instruments for these assessments. There were fewer differences between the cohorts in the management of chronic opioids, with only the ongoing PCMH cohort having higher documentation for 5 of the 7 recommendations, including performing urine drug screens and using a structured instrument to assess for misuse. CONCLUSIONS: These findings support the usefulness of the PCMH model in managing patients with CP, but patient outcomes need to be addressed in future studies.

Connecting resident education to patient outcomes: the evolution of a quality improvement curriculum in an internal medicine residency.

As part of the Accreditation Council for Graduate Medical Education's Next Accreditation System, residency programs must connect resident-physician education to improved patient care outcomes. Residency training programs, however, face multiple obstacles in doing so. Results from residency quality improvement (QI) curricula tend to show improvement in simple process-based measures but not in more complex outcomes of care such as diabetes or blood pressure control. In this article, the authors describe the evolution of their QI educational program for internal medicine residents at the University of Cincinnati Medical Center within the structure of a novel training model called the Ambulatory Long Block. They discuss a resident-run project that led to reduced rates of patients with uncontrolled diabetes as an example of improvement in outcome measures. Despite favorable results from that particular resident group, the successful intervention did not spread practice-wide. Using this example, they detail the phases of evolution and lessons learned from their curriculum from 2006 to 2014 within a framework of previously published general principles for successful QI education, including those of exemplary care and learning sites. Successful programs require leadership, faculty expertise and mentorship, data management, learner buy-in, and patient engagement. Their experience will hopefully be of help to others as they attempt to simultaneously improve care and education. Further research and innovation are needed in this area, including optimizing strategies for strengthening resident-driven projects through partnership with nursing, allied health, and longitudinally engaged faculty members.

Sociocultural influences on the determinants of breast-feeding by Latina mothers in the Cincinnati area.

While breast-feeding initiation and duration among US Latina women appear to decrease with acculturation, health care providers in the Greater Cincinnati area have noted lower rates of breast-feeding among even first-generation Latina immigrants. This study's purpose was to identify determinants of breast-feeding for Latina mothers in Cincinnati through qualitative interviews and Spanish Breastfeeding Self-Efficacy Scale ratings. Our findings suggest that, along with similar levels of breast-feeding self-confidence, foreign-born Latina women in the Greater Cincinnati area share similar breast-feeding determinants with the general population. However, characteristics of these determinants and their impact vary because of unique pressures experienced by this community.

The ambulatory long-block: an accreditation council for graduate medical education (ACGME) educational innovations project (EIP).

INTRODUCTION: Historical bias toward service-oriented inpatient graduate medical education experiences has hindered both resident education and care of patients in the ambulatory setting. AIM: Describe and evaluate a residency redesign intended to improve the ambulatory experience for residents and patients. SETTING: Categorical Internal Medicine resident ambulatory practice at the University of Cincinnati Academic Health Center. PROGRAM DESCRIPTION: We created a year-long continuous ambulatory group-practice experience separated from traditional inpatient responsibilities called the long block as an Accreditation Council for Graduate Medical Education Educational Innovations Project. The practice adopted the Chronic Care Model and residents received extensive instruction in quality improvement and interprofessional teams. PROGRAM EVALUATION: The long block was associated with significant increases in resident and patient satisfaction as well as improvement in multiple quality process and outcome measures. Continuity and no-show rates also improved. DISCUSSION: An ambulatory long block can be associated with improvements in resident and patient satisfaction, quality measures, and no-show rates. Future research should be done to determine effects of the long block on education and patient care in the long term, and elucidate which aspects of the long block most contribute to improvement.

The resident scholar program: a research training opportunity for internal medicine house staff.

BACKGROUND: Housestaff research training is a challenging task that is complicated by the lack of a structured process and dedicated time. The Resident Scholar Program (RSP) at the University of Cincinnati, Department of Internal Medicine was created to overcome these challenges. METHODS: Interested internal medicine house staff are required to submit an application to the residency research director including a project description signed by a faculty mentor. If the project is approved, a 4-month elective rotation is scheduled for the following year. Residents spend the first month on a consult service in the subspecialty area of their research and the remaining 3 months performing their research project. The RSP was launched in July 2003. RESULTS: The percentage of residents participating in research more than tripled. The subspecialty areas represented by RSP research were more diverse than those represented in prior years. Most participants participated in clinical research projects (84%), with 63% of projects being prospective in design. The RSP residents were twice as likely to obtain subspecialty fellowship positions compared to non-RSP residents (89% vs 46%, respectively). CONCLUSION: The RSP enables house staff to participate in research opportunities in their areas of interest. Development of a more systematic assessment method to study the impact of the program is underway, but the high participation rate reflects resident interest in such a program, particularly for residents with aspirations in pursuing fellowship training.

Implementing duty-hour restrictions without diminishing patient care or education: can it be done?

PURPOSE: To implement and evaluate a new ward team call system that would meet the Accreditation Council on Graduate Medical Education's (ACGME) duty-hour requirements without compromising patient care or detracting from resident education. METHOD: The new system was implemented in the internal medicine residency program at the University Hospital at the University of Cincinnati Medical Center. In 2003-04, residents and faculty were surveyed about their experiences with the new and old ward systems relative to duty-hour requirements, patient care, and resident education. Responses were given on a five-point scale (5 = strongly agree, 1 = strongly disagree). Data were compiled and compared using a two-sample t-test. RESULTS: Faculty believed the new system improved compliance with the duty-hour requirements (mean = 4.3, 95% confidence interval [CI]: 4.1-4.6), although were neutral regarding patient care (mean = 3.5, 95% CI: 3.2-3.8) and education (mean = 3.3, 95% CI: 2.9-3.6). Residents were more neutral regarding ACGME requirements (mean = 3.5, 95% CI: 3.3-3.7) and patient care (mean = 3.2, 95% CI 3.0-3.3). Residents reported a slightly negative impact on education (mean = 2.8, 95% CI: 2.5-3.0). In response to an exclusive question, residents reported that the new system did not reduce fatigue (mean = 2.7, 95% CI: 2.6-3.0). CONCLUSIONS: Respondents perceived that this ward call system met ACGME requirements and maintained quality patient care but may have sacrificed some traditional resident education tenets.