Devdutta Sangvai

Teaching Population Health: A Competency Map Approach to Education

A 2012 Institute of Medicine report is the latest in the growing number of calls to incorporate a population health approach in health professionals’ training. Over the last decade, Duke University, particularly its Department of Community and Family Medicine, has been heavily involved with community partners in Durham, North Carolina, to improve the local community’s health. On the basis of these initiatives, a group of interprofessional faculty began tackling the need to fill the curriculum gap to train future health professionals in public health practice, community engagement, critical thinking, and team skills to improve population health effectively in Durham and elsewhere. The Department of Community and Family Medicine has spent years in care delivery redesign and curriculum experimentation, design, and evaluation to distinguish the skills trainees and faculty need for population health improvement and to integrate them into educational programs. These clinical and educational experiences have led to a set of competencies that form an organizational framework for curricular planning and training. This framework delineates which learning objectives are appropriate and necessary for each learning level, from novice through expert, across multiple disciplines and domains. The resulting competency map has guided Duke’s efforts to develop, implement, and assess training in population health for learners and faculty. In this article, the authors describe the competency map development process as well as examples of its application and evaluation at Duke and limitations to its use with the hope that other institutions will apply it in different settings.

Clinical presentation and response to treatment of novel influenza A H1N1 in a university-based summer camp population

BACKGROUND Little is known about the clinical presentation and course of novel H1N1 influenza in summer camps. OBJECTIVES To describe the clinical course and evaluate the effect of influenza treatment in a summer camp population. STUDY DESIGN Two large influenza outbreaks occurred in university-based residential camps between May 21 and August 2, 2009. Through active daily surveillance, medical evaluation at symptom onset, and data collection during isolation, we describe the clinical course of a large outbreak of novel H1N1 influenza. RESULTS Influenza-like illness (ILI) was documented in 119 individuals. Influenza A was confirmed in 66 (79%) of 84 samples tested. Three early samples were identified as novel H1N1. ILI cases had an average age of 15.7 years and 52% were male. Sixty-three were treated with oseltamivir or zanamivir, which was initiated within 24h of diagnosis. Cough, myalgia and sore throat occurred in 69, 64 and 63% of cases, respectively. The highest temperature over the course of illness (T(max)) occurred within 48h after symptom onset in 87.5% of individuals. Average T(max) was 38.4 degrees C (range 36.1-40.2 degrees C). Among confirmed influenza cases, 69% defervesced by 72h and 95% defervesced by 96h. Defervescence at 72h was not different in the treated and untreated groups (p=0.12). CONCLUSIONS Novel H1N1 generally has a mild, self-limited course in healthy adolescent campers. Defervescence occurred within 72h and was unaffected by treatment.

An Infection Control Program for a 2009 Influenza A H1N1 Outbreak in a University-Based Summer Camp.

Abstract Objectives: Describe two 2009-H1N1 influenza outbreaks in university-based summer camps and the implementation of an infection control program. Participants: 7,906 campers across 73 residential camps from May 21–August 2, 2009. Methods: Influenza-like-illness (ILI) was defined as fever with cough and/or sore throat. Influenza A was identified using PCR or rapid-antigen testing. We implemented an infection control program consisting of education, hand hygiene, disinfection, symptom screening, and ILI case management. Results: An initial ILI cluster involved 60 cases across 3 camps from June 17–July 2. Academic Camp-1 had the most cases (n = 45, 14.9% attack rate); influenza A was identified in 84% of those tested. Despite implementation of an infection control program, a second ILI cluster began on July 12 in Academic Camp-2 (n = 47, 15.0% attack rate). Conclusions: ILI can spread rapidly in a university-based residential camp. Infection control is an important aspect of the medical response but is challenging to implement.

Eating Disorders in the Primary Care Setting

Eating disorders are a complex set of illnesses most commonly affecting white adolescent girls and young women. The most common eating disorders seen in the primary care setting are anorexia nervosa, bulimia nervosa, and binge eating disorder. Treatment in the primary care environment ideally involves a physician, therapist, and nutritionist, although complex cases may require psychiatric and other specialist care. Early diagnosis and treatment are associated with improved outcomes, whereas the consequences of untreated eating disorders, particularly anorexia nervosa, can be devastating, including death.

Pivoting to Value-Based Care in North Carolina

Health care in the United States, and by extension in North Carolina, is in a perpetual state of flux. From the Nixon-era predictions of runaway costs to the insurance-anchored efforts of Hillarycare to wide-sweeping reforms of Obamacare, established providers are regularly counseling the next generation on how different medicine will look when they are in practice. The accuracy of some of these predictions aside, one thing is sure: the pace and magnitude of change is palpably different this time. Pushed by both private and public payers to move from fee-for-service to value-based care while striving to meet the Triple Aim of improving patient experience, improving population health, and reducing costs, all arenas of medicine—hospital-based, ambulatory, and public health—are feeling the pressure. At the same time, patients are acting more like consumers, demanding transparency in pricing and increased quality. In this issue of the NCMJ, experts from a broad range of backgrounds and health care organizations discuss the trials and rewards facing providers and health systems as they promise better outcomes and assume greater financial risk in care delivery. The ways that we are striving to meet new payment models—and the successes we are achieving—are as varied as the practices across North Carolina. In the following pages, you will read about the many efforts to implement these new models, both stories of success and a few cautionary tales.