Professionals Accelerating Clinical and Educational Redesign (PACER)
Request for Applications – August 3, 2015
1. BACKGROUND AND RATIONALE
Though still evolving in response to health care reform, the Patient Centered Medical Home (PCMH) holds promise as a transformative model for the delivery of primary care leading to better quality of care, better health and contained cost, i.e. the “Triple Aim.”[1],[2] New collaborative skills are needed to enhance the preparation of the next generation of primary care physicians and health professionals to practice in medical homes, especially skills in assembling, working effectively in, and leading teams.[3],[4],[5] Physicians, nurses, physician assistants, behavioral health providers, pharmacists, care managers, and other health care professionals working in a PCMH must coordinate their efforts for effective patient care. Yet most of these professionals have never trained together in this model. Faculty in all health care professions will need practical skills to break down traditional siloes and create a culture of interprofessional learning and team-based care in their everyday practice.4
Many PCMH competencies, such as team-based care and quality improvement, require ongoing practice and reinforcement.[6] A lack of faculty skills in quality improvement among medical and nursing faculty has been identified as a barrier to building collaborative interprofessional quality improvement programs.[7] The three primary care disciplines and other health professions in academic health centers are typically in very different places in their PCMH and interprofessional education (IPE) work. Learning together has been shown to be a successful strategy for undertaking change. Given the emergent nature of the PCMH and the newness of clinical interprofessional education experiences, organizing efforts across disciplines and professions, i.e. a “learning community approach,” will accelerate change and leverage resources needed to transform primary care training and practices.6,[8],[9],[10]
The clinical learning environment where training occurs does affect future performance and spending patterns.[11],[12],[13] Proficient clinical systems are necessary to produce competent physicians. Centering transformation efforts in primary care practices where residents are trained creates an explicit link between clinical and educational redesign efforts and exposes residents and other trainees to new care models and core competencies for interprofessional collaborative practice.[14] This exposure of trainees is generative in that it will positively affect future trainees when current trainees become faculty and preceptors.
PACER (Professionals Accelerating Clinical and Educational Redesign), a three-year initiative, has been designed to meet the challenge of producing a better trained primary care workforce. This professional development program will equip an interprofessional team of primary care faculty with the skills to transform a traditional primary care training environment into a medical home with interprofessional collaborative practice and education at its center. This program, which builds upon on a previous initiative, is intended to reach tipping points in both sustainability and expansion that will enable ongoing transformation of practices to PCMHs simultaneously with educational transformation to create effective interprofessional collaborative practices.
2. PACER OVERVIEW
a. Description
The overarching goal of PACER is to catalyze meaningful change in preparing the primary care workforce through faculty development that involves the requisite competencies to transform primary care training models and practices. The American Boards of Family Medicine, Internal Medicine, and Pediatrics, along with the ACGME and the Josiah Macy Jr. Foundation are working together to effect this change by combining expertise and resources to create this national program, which will be administered and evaluated by a team of experienced educational researchers based at Oregon Health Science University (OHSU). PACER is a new program that draws from foundational work of prior training redesign initiatives as well as the primary care boards’ in-depth expertise in implementing innovations in clinical training.
b. Program Components
PACER has two overlapping Phases, a Training Phase and an Expansion Phase. The Training Phase involves providing professional development for faculty from 9 institutions; these nine groups will be known as PACER Leadership Teams. More specifically, two in-person trainings, a collaborative site visit with each institutional team, and coaching from faculty experts will be provided to the PACER Leadership Teams as part of this program. Interprofessional teamwork will be a primary focus of the curriculum in each of the following areas: 1) patient-centered care, 2) quality improvement, 3) leadership for change, 4) stewardship of resources, and 5) competency assessment. Emphasis during the training will be on building relationships, trust and accountability in the interprofessional faculty teams.
In advance of the first training session (held in the Spring of 2016), teams will devise plans for transforming their clinical practices and educational programs to prepare their trainees to work together in high performing patient centered medical homes. These plans will undergo further refinement during the in person sessions with guidance from expert coaches (a group of faculty from medicine, nursing, pharmacy or behavioral health, with real life experiences with primary care practice transformation and interprofessional education). Participating faculty will acquire skills through a combination of instructional and experiential activities and are expected to apply these skills back in their respective residency continuity practices and training programs. Based on a needs assessment conducted prior to the first training, teams will be paired with a coach to assist them with innovations, evaluation and help them apply skills learned during the trainings.
The initial training will cover foundational concepts to help all teams with their practice and IPE transformation work. It will give teams the opportunity to meet as a group to begin the discussion of shared values and their joint planning for collaborative work at their respective institutions.
Following the initial meeting, a team comprised of faculty coaches and the OHSU Evaluation Team will visit each institution to assess progress and level of collaboration, provide the teams with additional needs-based content and coaching, re-energize and focus the participants in their work, and help inform a larger audience of stakeholders about the work they are doing.
A second 1½ day face-to-face training will occur in the Spring of 2017 and will focus on skill reinforcement, overcoming challenges, sustainability and dissemination. Teams will present their results and progress to date to implement new IPE models and PCMH transformation activities.
In the Expansion Phase, each of the 9 institutional PACER Leader Teams will identify Partner Programs (residencies in family medicine, internal medicine or pediatrics in their local region), with whom they will collaborate to establish larger learning communities of educational practices developing interprofessional team-based care models together. We will begin discussion of outreach to the Partner Programs during the first training session and share strategies to begin collaborative work. Faculty from Partner Programs will be invited to attend the site visits, where additional plans for collaboration will occur.
The PACER Leader Teams from the selected institutions will receive more intensive training and coaching specifically so they can assist faculty in the Partner Programs transform primary care training and practice. The Expansion Phase will continue with the establishment of three regional centers that will function post-PACER to provide professional development for faculty in other primary care residencies and health professions schools. Additionally, the centers will support a learning community for the training programs affiliated with the center. Building on the work and leadership already established through our prior primary care faculty development initiative, the PCFDI, Advocate Lutheran General Hospital outside Chicago will serve as one of the regional centers. The Advocate team will work closely with the PACER Steering Committee to define core functions and resources for the regional centers and develop a sustainable business model for operating the centers.
c. Expected Support
Participants and training programs selected for PACER do not receive a grant. All travel, expenses and training materials will be provided for each faculty member to attend the two 1½ day face-to-face training meetings. Following the initial meeting, a team of expert faculty will visit each institutional team selected for this program to provide ongoing coaching and assist faculty in the application of new skills gained in the program.
d. Expected Work
While PACER will cover direct costs of the program, participating training programs must commit to permitting full participation of 10 faculty on the team to attend the two face-to-face training sessions (Spring 2016 and Spring 2017) and participate in the collaborative site visit (end summer-Fall 2016). Participating faculty are expected to work on practice and educational changes, consult with program faculty, fully participate in all PACER evaluation activities (completing core study instruments and participating in focus groups and interviews) and agree to share information on progress, including successes and missteps.
Because we expect to publish findings from this project with site participants as collaborators, and because you may want to publish information on site-specific activities, the team leader or designee for each selected institution will be expected to submit this project to their local IRB for review. This project should receive an IRB exemption. The central evaluation team at OHSU will provide documents and assistance to selected institutions to facilitate IRB approval.
As part of this effort, we are seeking interprofessional teams of faculty from the three primary care disciplines in medicine as well as nursing, pharmacy, behavioral health or other health professions who embrace innovation and change, who have started the redesign process in their residency continuity practices and training programs and are ready to work together. What makes this program different from other faculty development initiatives is the development of learning communities of primary care professionals within institutions and the emphasis on application of learning in a competent local clinical environment.
This is a unique opportunity for faculty from multiple health professions to participate in a national program that is well positioned to serve as THE faculty development model to catalyze transformation in primary care and interprofessional education and foster collaboration among primary care health professionals.
3. APPLICATION PROCESS & REQUIREMENTS
a. Team Application
The application must come from an interprofessional team of faculty who desire support for re-designing their residency practices and training programs toward a patient centered medical home with interprofessional collaborative practice and education at its center. Each team must have 10 faculty members from professions involved in primary care residency, nursing, physician assistant, pharmacy or behavioral health training and they must apply as a group. The make-up of the team should be as follows:
2 faculty from family medicine
2 faculty from internal medicine
2 faculty from pediatrics
4 faculty from a combination of nursing, physician assistant, pharmacy or behavioral health
All three residencies in family medicine, internal medicine and pediatrics must be represented on your team. The majority of faculty members on your team from the different professions should hold some type of educational/training leadership role (e.g. associate residency director, director of advanced practice nursing, pharmacy residency director). It is highly suggested that the physician team members have an ambulatory clinical leadership role in their respective residency practices. The different combinations of health professional trainees connected to the practices of the selected teams is desirable to test this faculty development model in the various combinations of training programs present in today’s academic health centers. All professions represented on the team should be substantially involved in writing the application and devising plans for transforming their clinical practices and educational programs.
We will select PACER Leader Teams from up to 9 institutions. It is our hope that this program announcement encourages dialogue among the primary care residencies and other health professional training programs in a region that will foster applications from several institutions each fielding an interprofessional team.
b. Eligibility to Apply
All ACGME-accredited residency programs in family medicine, internal medicine, pediatrics; all ARC-PA accredited physician assistant programs; and all ASHP-accredited pharmacy residencies are eligible to recruit a team of faculty. We are seeking residencies and training programs that have just started or are continuing their journey toward to a patient centered medical home and have programmatic leadership support for change. It is expected and desirable that the continuity practices in the 3 residencies per team are in quite different places along their respective journeys. Some may be just applying for PCMH certification and others are continuing to push beyond the checklist approach to become truly patient-centered. There is no requirement of a certain level of PCMH recognition (e.g. NCQA or state-based) to apply to PACER and PCMH recognition status will not be used in the selection process.
A collegial relationship and programs located within reasonable commuting distance of one another is desired for the programs to work together in the most productive way. The residencies and training programs represented on each team do not need to have the same institutional sponsor. Including community-based residency, nursing, physician assistant, pharmacy or behavioral health training programs is encouraged.
c. Requirements
Applications for PACER must meet all of the requirements listed below. This is a two step application: Step 1 is a Letter of Intent indicating you are planning to submit a full application and Step 2 is the full application.
STEP 1: Letter of Intent
Letters of Intent will serve as an indication of interest in PACER and will provide important planning guidance for the PACER Steering Committee. Letters of Intent will NOT be used in the selection process.
Letters of Intent are due no later than Sep 4, 2015 and must be sent via e-mail to the to the central project office at Oregon Health & Science University at . Include “Letter of Intent for PACER” in your email subject line.
Include the following information combined into one document and attach to your email submission:
a) Statement that you intend to submit a full application and will participate in all evaluation activities for PACER, including obtaining IRB approval. Include an attestation that you have notified the respective Designated Institution Officials (DIO) and administrative leads (e.g. department chair) for each of the three primary care residencies and other training programs represented on your team of your intent to apply to PACER.
b) Name and sponsoring institution for each health profession training program represented on your team