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.

COVID-19 Vaccine Acceptability Among Clients and Staff of Homeless Shelters in Detroit, Michigan, February 2021.

Understanding COVID-19 vaccine acceptability among clients and staff of homeless shelters can inform public health efforts focused on communicating with and educating this population about COVID-19 vaccines and thus improve vaccine uptake. The objective of this study was to assess COVID-19 vaccine acceptability and uptake among people in homeless shelters in Detroit, Michigan. A cross-sectional study was conducted from February 9 to 23, 2021. Seventeen homeless shelters were surveyed: seven male-only, three male/female, and seven women and family shelters. All clients and staff aged ≥18 years and able to complete a verbal survey in English or with a translator were eligible to participate; of the 168 individuals approached, 26 declined, leaving a total sample of 106 clients and 36 staff participating in the study. The median client and staff ages were 44 and 54 years, respectively. Most participants (>80%) identified as non-Hispanic Black or African American. Sixty-one (57.5%) clients and 27 (75.5%) staff had already received or planned to receive a COVID-19 vaccination. Twelve (11.3%) clients and four (11.1%) staff were unsure, and 33 (31.1%) clients and five (13.9%) staff did not plan to get vaccinated. Reasons for hesitancy were concerns over side effects (29 clients [64.4%] and seven staff [77.8%]) and unknown long-term health impacts (26 clients [57.8%] and six staff [66.7%]). More than half of the clients had already received or planned to receive the vaccine. Continuing efforts such as vaccine education for hesitant clients and staff and having accessible vaccine events for this population may improve acceptability and uptake.

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.

Capacity Building for and Implementation of Policy, Systems, and Environmental Change: Results from a Survey of the National Comprehensive Cancer Control Program.

Policy, systems, and environmental (PSE) approaches are commonly used to improve population health. Cancer-related examples include providing data and education to stakeholders about policies that support healthy living, or health systems changes such as universal reminders about recommended cancer screening. The National Comprehensive Cancer Control Program (NCCCP) funds health departments to form cancer coalitions that develop and implement cancer plans. NCCCP initiated a demonstration program in 13 of 65 funded grantees to determine whether skilled, dedicated staffing and using a strategic process to examine data, form a workgroup, and develop an agenda would enhance their capacity to implement PSE approaches, recruit new partners, and provide data and education to stakeholders. The objective of this study was to compare demonstration program grantees to other NCCCP grantees on their ability to develop and implement PSE strategies, and the short-term results that were achieved. Program directors (PDs) from each NCCCP-funded jurisdiction completed web surveys at 2 time points during implementation to assess changes in their capacity for PSE approaches, identify implementation activities, and document short-term outcomes. Responses from demonstration program PDs and other PDs at both time points were compared in a descriptive analysis. Demonstration program grantees experienced greater increases in skills and capacity to address PSE approaches, engaged in necessary implementation activities more often, and achieved greater improvements in stakeholder and decision maker awareness and support for PSE strategies, compared to nonparticipating NCCCP grantees. These findings support continued implementation of PSE approaches for sustainable cancer prevention and control.

Evaluating the Feasibility of Using a Mobile App to Track Oncology Patient Navigation Activities and Outcomes.

Background: The Centers for Disease Control and Prevention supports the implementation of evidence-based interventions to prevent and control cancer, including patient navigation (PN); however, PN lacks standardized tools to measure effectiveness and aggregate data across programs. Using a mobile application (app) could provide a systematic infrastructure for cataloging PN activities and measuring patient outcomes. Objective: Our goal was to evaluate the feasibility of using a mobile app to assist with PN services within cancer control programs. Methods: Seven navigators in 6 geographically diverse PN programs evaluated the mobile app over a period of 5 to 9 months by using the app to track their daily activities. We evaluated the app's capability for collecting and reporting core data elements, such as time spent on outreach, patient care, and administrative tasks, as well as standardized metrics for program evaluation and monitoring. We obtained qualitative data during calls with the navigators through weekly journals and in-depth interviews. Results: The app was effective in tracking caseload, profiling patients' health challenges and barriers to screening and treatment, and capturing PN activities performed during patient encounters. App limitations included an unreliable reporting function, a requirement for internet connectivity, patient privacy concerns, and evolving technology. Discussion: Lessons learned from this evaluation will be useful in developing an app with more robust capabilities while retaining user-friendly features. Conclusion: Mobile technology may reduce individual and health system barriers to accessing cancer care and treatment and support posttreatment cancer survivors while also assisting navigators in conducting their work efficiently and effectively.

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.

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.

Are you ready for audits.

Audits can cost your practice thousands--if not millions--of dollars. Protect yourself with internal audits to ensure compliance.

Clinic consortia media advocacy capacity: partnering with the media and increasing policymaker awareness.

Media advocacy is a popular means of crafting and disseminating messages broadly and has been used by advocates to increase policymaker and public awareness of key health policy issues, such as the large number of uninsured. Some media advocacy activities are more effective than others, however, requiring increased sensitivity to the media environment and adequate resources and expertise. This article describes the results of media advocacy activities undertaken by 19 clinic consortia funded under The California Endowment's Clinic Consortia Policy and Advocacy Program from 2002 to 2006. The consortia used different media advocacy strategies and venues, including newspaper, television, radio, video, brochures, newsletters, and websites. The findings indicate that consortia may have influenced the media agenda and increased the likelihood of securing coverage of key issues, such as the role of clinics in supporting the health care safety net. There is evidence that suggests that clinic consortia media advocacy activities, such as front-page coverage in local and major daily newspapers, increased public and policymaker awareness of key clinic policy issues. Although grantees rated media advocacy overall as less effective than other advocacy activities and few reported that it had directly achieved a policy change or increased funding to clinics, nearly all thought it was effective in increasing policymaker awareness. We conclude that media advocacy is a useful tool for partnering with the media and increasing stakeholder awareness more broadly, but it should not be solely relied upon to achieve a policy change.

Choropleth map design for cancer incidence, part 1.

Choropleth maps are commonly used in cancer reports and community discussions about cancer rates. Cancer registries increasingly use geographic information system techniques. The Centers for Disease Control and Prevention's Division of Cancer Prevention and Control convened a Map Work Group to help guide application of geographic information systems mapping techniques and to promote choropleth mapping of data from central cancer registries supported by the National Program of Cancer Registries, especially for planning and evaluation of comprehensive cancer control programs. In this 2-part series in this issue of Preventing Chronic Disease, we answer frequently asked questions about choropleth map design to display cancer incidence data. We recommend that future initiatives consider more advanced mapping, spatial analysis, and spatial statistics techniques, and include usability testing with representatives of state and local programs and other cancer prevention partners.

Choropleth map design for cancer incidence, part 2.

Choropleth maps are commonly used in cancer reports and community discussions about cancer rates. Cancer registries increasingly use geographic information system techniques. The Centers for Disease Control and Prevention's Division of Cancer Prevention and Control convened a Map Work Group to help guide application of geographic information system mapping techniques and to promote choropleth mapping of data from central cancer registries supported by the National Program of Cancer Registries, especially for comprehensive cancer control planning and evaluation purposes. In this 2-part series, we answer frequently asked questions about choropleth map design to display cancer incidence data. We recommend that future initiatives consider more advanced mapping, spatial analysis, and spatial statistics techniques and include usability testing with representatives of state and local programs and other cancer prevention partners.

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.

Increasing access to care for the uninsured: considering the options in California counties.

We interviewed California county health agency staff and administered a 58-county survey in 2002 and 2004 to inventory programs designed to improve access to care for the uninsured, and to assess county ability to meet the needs of California's uninsured during slow economic periods. Most counties have established means to connect people to existing public insurance programs and services have been expanded. Growth in new health care insurance programs for children and modest growth for adults are apparent. Counties pursue funding opportunities by a variety of strategies (e.g., leveraging of existing funding to secure new funds such as federal Healthy Community Access Program (HCAP) grants). While counties vary in their resources, political will, and barriers to care, they share a strong commitment to access to care. The implications of local efforts for state and federal policymaking are significant. In the absence of federal or state reform, county initiatives, particularly children's coverage expansions, may coalesce into state-level reform. Second, the state may move closer to access to health care for all as it recognizes the complementarity of county programs.

Virtual scheduling. A 21st-century approach to staffing.

Nursing professionals have been aware of the management challenges associated with hospital scheduling and staffing for years. However, today's changing work force, advances in technology, increased financial pressures, and regulatory oversight have put the scheduling process on health care's strategic agenda. Virtual staffing is the optimization of front-to-back hospital processes, integrating traditionally disparate systems to provide prospective and informed decisions about resource planning.