Advisory Committee on Interdisciplinary, Community-Based Linkages

“Toward Quality Healthcare Reform:  Preparing the Interprofessional Healthcare Workforce for Primary Care”

August 13 and 14, 2009

MEETING MINUTES

ATTENDANCE

ACICBL Members
Stephen Wilson, PhD, Chairperson
Alan Adams, DC
Robert J. Alpino, MIA
Brandy Bush, OTD, OTR, CLVT
Linda J. Kanzleiter, MPsSc, DEd
Jane Hamel-Lambert, PhD, MBA
Beth D. Jarrett, DPM
Barbara N. Logan, PhD, MA, MSN
David H. Perrin, PhD, ATC
Elyse A. Perweiler, RN, MA, MPP
Ronald R. Rozensky, PhD, ABPP
Stephen R. Shelton, MBA, PA-C
Laurie Wylie, MA, RN, SNP

HRSA Staff
Marcia Brand, PhD, Deputy Administrator, HRSA
Diana Espinosa, Associate Administrator, BHPr
Joan Weiss, PhD – Designated Federal Official, ACICBL and Director, Division of Diversity and Interdisciplinary Education (DDIE)
Lou Coccodrilli, MPH, Branch Chief, Area Health Education Centers Program (AHEC)
Norma Hatot, CAPT/USPHS, Senior Project Officer, AHEC Program
Maria Pena, MPH, HRSA Scholar

Invited Guests
Jennifer Butlin, Ed.D.
Carolyn Giordano
Kathy McGuinn
Molly Rose, Ph.D.
Ronald Weinstein, M.D.

FORMAT OF MINUTES

These minutes consist of five sections:

1. Opening Remarks
2. Bureau Update/Period of Inquiry
3. Expert Presentations
4. Review/Status of Eighth Report
5. Committee Business

SECTION I – OPENING REMARKS

Dr. Stephen Wilson, Chairperson of the Advisory Committee, opened the meeting and welcomed all attendees.  After establishing a quorum, Dr. Wilson discussed the goals for the meeting and outlined the schedule of expert presentations.  He introduced Dr. Marcia Brand, Deputy Administrator – HRSA, who acknowledged the contributions of departing committee members with certificates and letters of appreciation signed by the Secretary.  Retiring members included Dr. Stephen Wilson, Chairperson; Dr. Alan Adams; and Dr. Brandy Bush. 

Dr. Brand especially acknowledged the leadership of Dr. Wilson as he extended his tenure on the Committee at the request of HRSA’s Bureau of Health Professions (BHPr) and served as the Committee Chairperson during the first All Advisory Committee meeting sponsored by the Bureau of Health Professions (BHPr).  In bringing greetings from Dr. Mary Wakefield, HRSA Administrator, Dr. Brand noted that HRSA has been in a state of transformation in its approaches to work and collaboration across agencies and departments largely due to Dr. Wakefield’s vision.  She noted the special opportunity for HRSA to exercise leadership on the issue of  Healthcare Reform.  Dr. Brand also commented on the availability of the American Recovery and Reinvestment Act (ARRA) funding.  Nursing faculty practice funding awards were among the first ARRA grants released by HRSA.  She elaborated that there would also be a new grant competition for approximately $50 million in equipment funding.

SECTION II – UPDATE/ BUREAU OF HEALTH PROFESSIONS with PERIOD OF INQUIRY

Dr. Joan Weiss, Designated Federal Official, welcomed the Committee and reviewed the meeting agenda with Dr. Wilson, Chairperson.  She discussed the need for Committee recommendations to be specific and measurable.  Dr. Weiss introduced Ms. Diana Espinosa, Acting Associate Administrator of the Bureau of Health Professions, who discussed recent Bureau updates including significant investments in diversity programs for disadvantaged students to pursue health professions.  She noted the Bureau’s public health traineeships, preventive medicine residencies, and dental public health opportunities.  Ms. Espinosa highlighted budget increases to several Bureau programs based on the President’s budget.  Those programs highlighted were the diversity programs, Area Health Education Center programs, geriatrics, and workforce analysis.

CAPT Norma Hatot, Senior Project Officer – Area Health Education Centers, was introduced and gave a brief update on Committee membership and the status of Committee nominees.  Eleven proposed nominees were submitted to the Office of the Secretary several months ago, prior to the appointment of the current Secretary.  We expect to have a full complement of 21 Committee members at the next meeting in January 2010.

SECTION III – EXPERT PRESENTATIONS

(To obtain a copy of the PowerPoint presentations, please contact the Division of Diversity and Interdisciplinary Education at (301) 443-6950.) 

INTERPROFESSIONAL COMMUNICATION AND COLLABORATION FOR IMPROVING PATIENT OUTCOMES
Kathy McGuinn, MSN, RN, CPHQ
Director, Special Projects, American Association of Colleges of Nursing

In summary, Ms. McGuinn presented the development of a set of standards (The Essentials Series) that documents and outlines the necessary curriculum content and expected competencies of graduates of baccalaureate, master’s, and doctorate of nursing practice programs.  Ms. McGuinn described the development of the Essentials Series that include the IOM competency recommendations for the education of all healthcare professionals:  patient-centered care, evidence-based practice, quality improvement, informatics, teamwork and collaboration.  She discussed the consensus-building process that was utilized to develop the Essentials Series.  The format of the Essential Series was outlined and included a discussion of the content of the standards for the Baccalaureate and Master’s document.  Programs that have implemented the interprofessional curriculum content and competencies were highlighted in the presentation and included the University of Minnesota, St. Louis University, the University of Kentucky, and the University of Tennessee.

CCNE ACCREDITATION: AN UPDATE
Jennifer Butlin, EdD
Director, Commission on Collegiate Nursing Education

Dr. Butlin presented and further clarified information on accreditation of baccalaureate and higher degrees, specifically in regard to the Commission on Collegiate Nursing Education.  Dr. Butlin defined the recognized scope of operation and the recognition status of accrediting institutions of nursing.  CCNE accredits the baccalaureate degree in nursing, the master’s degree in nursing and just recently accredits the doctorate of nursing practice which is the clinically focused practice doctorate for nursing.  Dr. Butlin differentiated between accrediting bodies and associations like AACN as presented by Ms. McGuinn.  Dr. Butlin informed the Committee of the goals of the CCNE which iincludeholdomg nursing programs accountable as to methods used to prepare their students for the nursing profession including meeting all  certificate requirements.  Other CCNE goals include assessing and evaluating nursing programs to meet the established standards for nursing programs.  Discussion included the relationships between accrediting institutions and the promotion of interprofessional education.

THOMAS JEFFERSON UNIVERSITY INTERPROFESSIONAL EDUCATION CENTER
Molly A. Rose, PhD, RN
Professor of Nursing and Co-Director of the Jefferson InterProfessional Education Center

Carolyn Giordano, MA
Senior Research Analyst, Center for Collaborative Research

In summary, this presentation provided an overview of the Jefferson InterProfessional Education Center including its programs, evaluation, strengths and next steps.  Dr. Rose offered a definition of InterProfessional Education (IPE).  The Center, initiated in 2007, is dedicated to implementing and evaluating the use of patient-centered interprofessional education in the classroom, in clinical simulation, and in clinical education.  Dr. Rose outlined faculty development programs conducted by the Center to promote interprofessional education - IPE conference for faculty, mini-grant program for development of interprofessional projects, faculty networking events, and partnering with the local Geriatric Education Center.  Dr. Rose also outlined the factors to consider in IPE and for learning with, from and about other professions – attitudes, knowledge, skills, and supportive behavior.  In addition, she outlined the factors to consider in developing IPE programs and the requirements of IPE programs that are learner-focused, faculty-focused, and organizational-focused.  The presentation highlighted  the many IPE programs currently in progress at the Center, curricula examples, and data and information from the evaluation process.

EMERGING TECHNOLOGIES FOR INTERPROFESSIONAL HEALTH EDUCATION
Ronald S. Weinstein, MD
Director, Arizona Telemedicine Program – University of Arizona

Dr. Weinstein provided an overview of how emerging technologies, including  telemedicine, can be transformative in the field of medicine based on his work with the Arizona Rural Telemedicine Network.  He described where technology might fit in telemedicine due to several factors – the evolving nature of the workforce and its objectives including opportunities for emerging technology and the changing patient population and their sophistication with technology.  Through the creation and use of broadband access across rural areas and among multiple communities, underserved sites and health care organizations in remote areas have enhanced communication efforts.    Dr. Weinstein described the many fields of healthcare utilized in telemedicine including psychiatry.  He discussed the structure of the Arizona Telemedicine Program, which includes facilities that house an amphitheater and training center to facilitate e-learning and distance learning across the network.  Also mentioned was the future of technology and telemedicine and how they could transform learning and the delivery of care through team-focused educational pathways, encouraging more interprofessional team research, more patient-centered healthcare training, and the ultimate emergence of simulation and virtual reality programs.

INTEGRATING INTERPROFESSIONAL EDUCATION
Amy V. Blue, PhD
Assistant Provost for Education and Professor of Family Medicine
Medical University of South Carolina

David Garr, MD
Executive Director, South Carolina AHEC
Associate Dean for Community Medicine and Professor of Family Medicine
Medical University of South Carolina

In summary, Dr. Blue presented the Interprofessional Education program at the Medical University of South Carolina (MUSC).  She discussed MUSC’s approach to IPE implementation, current IPE work with its emphasis on community linkages, and development issues associated with IPE.  The IPE program allows students to acquire teamwork competencies along with the knowledge, values, and beliefs of health professions that differ from their chosen professions.  They can apply their teamwork competencies in a collaborative interprofessional learning context and demonstrate their teamwork competencies in a collaborative interprofessional health care and translational research context.

The presentation outlined the relationship of AHECs and other organizations in the integration of interprofessional education programs.  Dr. Garr described what AHECs are doing to support IPE programs along with current IPE activities.

SECTION IV – REVIEW/STATUS OF EIGHTH REPORT

Mr. Coccodrilli, Branch Chief of the Area Health Education Centers Program, presented an in-depth discussion of the draft of the ACICBL’s Eighth Annual Report and recommendations for the Secretary and the Congress.  He indicated that his goal was to review and finalize the recommendations for the final draft of the report.  Discussion included the purpose of some of the recommendations, content, and final wording for the final draft.  The relevance to rural health care workforce issues and the priority of issues needed to be clearly established.  Upon final review of the recommendations, the final draft of the report will be made available for examination by the Committee prior to being submitted for clearance within HRSA.  The goal is to have the report printed and available to the public by December 2009.

Discussion of Recommendations:

1. Establishing a National Advisory Committee on Healthcare Workforce Policy;
2. Expanding the capacity to conduct more healthcare workforce analyses including discipline-specific as well as interdisciplinary training analyses;
3. Exploring new and alternative health workforce training strategies; and
4. Efforts to improve access to care and quality of care in rural and underserved areas.

SECTION V – COMMITTEE BUSINESS

Awards Presentation

Dr. Joan Weiss presented special trophy awards to Dr. Steven Wilson – departing member of the Committee and Chairperson of the Committee for the past three years

She also presented special awards to the BHPr staff who supported the activities of the committee along with their other important duties.  Those recognized were Mr. Lou Coccodrilli, AHEC Branch Chief and Former Designated Federal Official of ACICBL and CAPT Norma Hatot, Senior Project Officer/AHEC Branch.

UPDATE/REVIEW OF NINTH ANNUAL REPORT OUTLINE/RECOMMENDATIONS

Mr. Eric Moore, Consultant, presented the following information on the Ninth Report:

1. Activities: 

Mr. Moore reviewed his perspective specific to the April meeting and analyzed the transcripts and comments in a detailed fashion.  In addition, a literature search was conducted.  He developed preliminary recommendation areas.  Focus was placed on the background and language for the justification of the recommendations.  A framework was developed given the feedback provided at the April meeting.  Incorporating discussions from this meeting, an additional literature search will be needed prior to the development of the final draft of the Ninth report.

2. Objectives and Style of the Report: 

Discussion of options – 1)develop a fairly focused case for the recommendations; 2) identify topics or themes that are important, discuss them, and develop a set of recommendations from the discussion; 3) provide a broader rationale for interdisciplinary or interprofessional practice, discuss, and develop recommendations within that context.

3. Outline: 

1. Background – discusses the importance of interprofessional education and its contribution to health care reform
2. Challenges -  challenges on the local, state, and national level
   
   Issues (examples):

• National – accreditation, reimbursement
• State - scope of practice issues
• Local - curriculum, scheduling, logistics

3. Strategies -  framework for addressing challenges
4. Potential Recommendations based on discussion
   1. Establish a National Center of Excellence
   2. Fund demonstration models and professional development for faculty
   3. Improve alignment in accreditation requirements
   4. Engage accreditation agencies in facilitating interprofessional approaches in the health care professions
   5. Recommend that HRSA convene a summit of the major accrediting agencies of the health care professions to compare accreditation guideline and standards and to discuss opportunities for facilitating interprofessional approaches to education
   6. Expand capacity to conduct longitudinal evaluations
   7. Fund a self-study by institutions on interprofessionalism or an institutional assessment tool or development of other evaluation tools

COMMITTEE NOMINATIONS

Nominations for new Committee members are pending at this time and final decisions as to approval will be made in the next few months.  It is anticipated that 11 new members will be added to the Committee by January 2010.  There will be a brief orientation during the January 2010 conference call with a more intensive orientation during the April 2010 meeting.   

The 2010 Committee meeting dates were confirmed:

Meeting #1 – via conference call on January 14, 2010

Meeting #2 – in person on April 22 and 23, 2010

Meeting 3# - in person on August 19 and 20, 2010.

COMMITTEE LEADERSHIP

As Dr. Wilson leaves the Committee, Dr. Ronald Rozensky has agreed to serve as Chair of the Advisory Committee.  Nominations will be emailed to CAPT Hatot for the position of Vice-Chairperson.  The results will be shared with the Committee by September 1, 2009.