In the latest move to advance their partnership of five years and counting, Arizona State University and Dignity Health have announced the launch of a new project to design, implement and evaluate a new model for interprofessional primary care education that will build in changes and lessons learned from COVID-19, including the dramatic increase in remote visits, telemedicine, new teamwork models and distance education.
“Primary care is the hub of our health care system,” said Gerri Lamb, an Edson College of Nursing and Health Innovation professor who serves as co-principal investigator along with Dr. Keith Frey, chief medical officer at Dignity Health Arizona and a professor of practice at ASU’s W. P. Carey School of Business.
Primary care providers and teams are responsible for prevention of illness, helping patients manage chronic illnesses and coordination across various health care settings.
“Even before COVID, we were seeing signs that primary care needed some reenvisioning,” Lamb said. “Not only in terms of quality of care, but also in how we educate students.”
Some of the signposts of the need for change she and Frey listed include primary care workforce shortages, diminishing numbers of new residents (according to Lamb and Frey, 2019 saw the lowest number of residents applying for primary care positions in decades) and a decline in the number of younger and middle-age people scheduling visits with their primary care providers.
“What happens then is everybody all the sudden shows up in the emergency room or urgent care, overwhelming those resources,” Frey said. “So this is a system issue, from a regional and national level.”
Another issue with the current system he and Lamb hope to address is the lack of emphasis on interprofessional education.
“We already know that when you're done with your training, your work environment is going to be a team sport, and yet historically, we don't train people together very well,” Frey said. “So the idea behind this is to create an environment where we can get the trainees — physicians, advanced-practice nurses, physician assistants, behavioral health professionals, registered nurses and all members of the health care team — to learn health care in a more integrative model.”
Funded by a $525,000 grant from the ASU – Dignity Health Collaborative Strategic Initiatives Program, phase one of the Transforming the Primary Care Workforce project began Sept. 1 and will last 18 months, during which project investigators will conduct focus groups and stakeholder interviews, hold advisory meetings, and make facility site visits to design, test and analyze the new model for integrated primary care practice and education.
“The way the project is framed is we are doing this with and from and about the stakeholders,” Lamb said. “Patients, families, students and providers. … We will be inviting them and celebrating them at the table as our advisers in this. They know what they need, so we're going to listen to them, and we’re going to create something that works for them.”
She and Frey had been discussing the possibility of such a project for some time when the opportunity arose for Dignity to create a new family medicine residency in the East Valley, a region of the Phoenix metropolitan area that is swiftly growing, making physician shortages even more acute. The decision to partner on the venture was a natural one.
“Rather than set up a program on our own, we thought why not partner with colleagues who I've known for many years at ASU, like Gerri Lamb, who are national thought leaders in this space,” Frey said. “Why not stack hands, come together and build on this partnership that we already have enjoyed for several years and see if we can reconceptualize a new model that will get us where we always wanted to go.”
Susan Pepin, ASU’s managing director of health and clinical partnerships, praised Dignity Health in turn for its commitment to the communities it serves.
“As a health system, they really care about the social determinants of people’s health and meeting people in underserved populations,” she said. “They’re not a hospital on a hill. They really reach out into the community and want to make a difference.”
Indeed, the purpose of this new model of interprofessional training is not only to prepare outstanding practitioners to deliver top quality care, but to attract top students who will stay in Arizona.
“Keith has a vision for this,” Lamb said. “And his vision was very aligned with my vision for what was possible, and with Edson's vision, in terms of a community partnership and doing meaningful work while also addressing workforce issues.”
They expect residents of the new program to begin in the summer of 2023, once the soon-to-be-developed clinical learning environment program has been tested and evaluated.
The project includes co-investigators from ASU’s College of Health Solutions: Kristen Will, a clinical associate professor and current chair of the steering committee for the National Collaborative for Improving the Clinical Learning Environment (NCICLE); and Bradley Doebbeling, professor of the science of health care delivery and biomedical informatics. It also involves collaboration between ASU’s Center for Advancing Interprofessional Practice, Education and Research (CAIPER) and ASU’s Center for Innovation in Healthy and Resilient Aging (CIHRA).
Of the many social determinants of health that the COVID-19 pandemic has laid bare, those that affect Arizona’s aging population will be the main focus of phase one of Transforming the Primary Care Workforce. Later phases will examine others, such as poverty, racial inequities and food insecurity.
According to David Coon, CIHRA director and associate dean of research at Edson College, the pandemic has highlighted issues already of concern for older adults, such as social isolation and loneliness, and also raised awareness of the importance of telemedicine. Furthermore, he believes there should be more emphasis on the role of caregivers in the wellness and health outcomes of older adults.
“As our society continues to age, we really need to be thinking about how we can up the game of the primary care workforce and prepare them to work with older adults and their family members and caregivers, because they’re not always seen as a part of that interprofessional care team, but they are critical members,” Coon said.
If patient experience and outcomes are one half of the Transforming the Primary Care Workforce project, provider well-being is the other.
“The amount of burnout in nurses and physicians and students is shocking,” Lamb said. “And COVID is making it worse. So there's huge need not only to reenvision primary care from a practice and learning perspective, but also because we really need to pay attention to the well-being of providers. All of that is part of this project.”
Top photo courtesy of Pixabay