May Nawal Lutfiyya

A scoping review of interprofessional collaborative practice and education using the lens of the Triple Aim

Abstract The Triple Aim unequivocally connects interprofessional healthcare teams to the provision of better healthcare services that would eventually lead to improved health outcomes. This review of the interprofessional education (IPE) and collaborative practice empirical literature from 2008 to 2013 focused on the impact of this area of inquiry on the outcomes identified in the Triple Aim. The preferred reporting items for systematic reviews and meta-analyses methodology were employed including: a clearly formulated question, clear inclusion criteria to identify relevant studies based on the question, an appraisal of the studies or a subset of the studies, a summary of the evidence using an explicit methodology and an interpretation of the findings of the review. The initial search yielded 1176 published manuscripts that were reduced to 496 when the inclusion criteria were applied to refine the selection of published manuscripts. Despite a four-decade history of inquiry into IPE and/or collaborative practice, scholars have not yet demonstrated the impact of IPE and/or collaborative practice on simultaneously improving population health, reducing healthcare costs or improving the quality of delivered care and patients’ experiences of care received. We propose moving this area of inquiry beyond theoretical assumptions to systematic research that will strengthen the evidence base for the effectiveness of IPE and collaborative practice within the context of the evolving imperative of the Triple Aim.

Overweight and Obese Prevalence Rates in African American and Hispanic Children: An Analysis of Data from the 2003–2004 National Survey of Children's Health

Background: The prevalence of overweight and obesity was examined in African-American and Hispanic children compared with white children. Methods: Multivariate analyses were performed on cross-sectional data from the National Survey of Childrens Health collected in 2003 to 2004. Results: Analyses found that overweight children were more likely to be African American and Hispanic than white, be male, live in households with incomes below 150% of the Federal poverty level, watch television 3 or more hours daily, and not have received preventive care in the past 12 months. Overweight children were less likely to get minimum levels of moderate physical activity or have participated on a sports team. Conclusions: Poverty impacts childhood body mass index in at least 2 specific ways: unsafe neighborhoods and the cost and accessibility of healthy foods in low income communities. Addressing these issues require the concerted efforts of policy makers. The same is true for resolving the issues of children not receiving preventive care. Increasing the number of well child check-ups mandated by the government and required by school systems may be a beneficial policy. Furthermore, policymakers concerned with issues of childhood obesity may pursue the creation of school-based health clinics in schools where at least 50% of the student body live in households with incomes <150% of the Federal poverty level.

The impact of rural training experiences on medical students: a critical review.

Purpose To address the growing shortage of rural physicians, several medical schools have developed rural training experiences for their students. However, little is known about the educational impact of these experiences. Thus, the authors conducted a critical review of North American studies examining medical student outcomes associated with rural training experiences. Method A comprehensive search strategy was used to identify studies about undergraduate medical education in a rural setting, searching PubMed from 1966 to June 2009. The researchers evaluated titles and abstracts to identify publications that appeared to report measures associated with undergraduate medical school rural training experience. Only those studies with a measurable outcome such as career choice, practice location, clinical competency, and student satisfaction were analyzed. Results The review identified a total of 72 studies. Most were single-cohort studies or cohort studies with control groups, with career choice and practice location the most commonly reported measure. The majority reported that rural experiences influenced students toward primary care specialties and to consider rural practice. Studies using self-report found that students generally valued the experience and had a high degree of satisfaction. Conclusions This review shows that placement in rural settings is a positive learning experience that students and preceptors value. Although the evidence supports that these rotations influence practice site and career choice, it is not clear whether they reinforce preexisting interest or have the ability to motivate previously uninterested students to consider careers in primary care or rural medicine.

Disparities in adult African American women's knowledge of heart attack and stroke symptomatology: an analysis of 2003-2005 Behavioral Risk Factor Surveillance Survey data.

BACKGROUNDnHeart disease and stroke are the first and third leading causes of death of American women, respectively. African American women experience a disproportionate burden of these diseases compared with Caucasian women and are also more likely to delay seeking treatment for acute symptoms. As knowledge is a first step in seeking care, this study examined the knowledge of heart attack and stroke symptoms among African American women.nnnMETHODSnThis was a cross-sectional study analyzing 2003-2005 Behavioral Risk Factor Surveillance Survey (BRFSS) data. A composite heart attack and stroke knowledge score was computed for each respondent from the 13 heart attack and stroke symptom knowledge questions. Multivariate logistic regression was performed using low scores on the heart attack and stroke knowledge questions as the dependent variable.nnnRESULTSnTwenty percent of the respondents were low scorers, and 23.8% were high scorers. Logistic regression analysis showed that adult African American women who earned low scores on the composite heart attack and stroke knowledge questions (range 0-8 points) were more likely to be aged 18-34 (OR = 1.36, CI 1.35, 1.37), be uninsured (OR = 1.32, CI 1.31, 1.33), have an annual household income <

Knowledge of heart attack and stroke symptomology: a cross-sectional comparison of rural and non-rural US adults.

35,000 (OR = 1.46, CI 1.45, 1.47), and have a primary healthcare provider (OR = 1.22, CI 1.20, 1.23).nnnCONCLUSIONSnThe findings indicated that knowledge of heart attack and stroke symptoms varied significantly among African American women, depending on socioeconomic variables. Targeting interventions to African American women, particularly those in lower socioeconomic groups, may increase knowledge of heart attack and stroke symptoms, subsequently improving preventive action taken in response to these conditions.

Reflections from the intersection of health professions education and clinical practice: The state of the science of interprofessional education and collaborative practice

BackgroundUnderstanding the signs and symptoms of heart attacks and strokes are important not only in saving lives, but also in preserving quality of life. Findings from recent research have yielded that the prevalence of cardiovascular disease risk factors are higher in rural populations, suggesting that adults living in rural locales may be at higher risk for heart attack and/or stroke. Knowledge of heart attack and stroke symptomology as well as calling 911 for a suspected heart attack or stroke are essential first steps in seeking care. This study sought to examine the knowledge of heart attack and stroke symptoms among rural adults in comparison to non-rural adults living in the U.S.MethodsUsing multivariate techniques, a cross-sectional analysis of an amalgamated multi-year Behavioral Risk Factor Surveillance Survey (BRFSS) database was performed. The dependent variable for this analysis was low heart attack and stroke knowledge score. The covariates for the analysis were: age, sex, race/ethnicity, annual household income, attained education, health insurance status, having a health care provider (HCP), timing of last routine medical check-up, medical care deferment because of cost, self-defined health status and geographic locale.ResultsThe weighted n for this study overall was 103,262,115 U.S. adultsu2009>u2009=18 years of age. Approximately 22.0% of these respondents were U.S. adults living in rural locales. Logistic regression analysis revealed that those U.S. adults who had low composite heart attack and stroke knowledge scores were more likely to be rural (ORu2009=u20091.218 95%CI 1.216-1.219) rather than non-rural residents. Furthermore, those with low scores were more likely to be: male (ORu2009=u20091.353 95%CI 1.352-1.354), >65 years of age (ORu2009=u20091.369 95%CI 1.368-1.371), African American (ORu2009=u20091.892 95%CI 1.889-1.894), not educated beyond high school (ORu2009=u20091.400 955CI 1.399-1.402), uninsured (ORu2009=u20091.308 95%CI 1.3-6-1.310), without a HCP (ORu2009=u20091.216 95%CI 1.215-1.218), and living in a household with an annual income ofu2009<u2009

Setting a research agenda for interprofessional education and collaborative practice in the context of United States health system reform

50,000 (ORu2009=u20091.429 95%CI 1.428-1.431).ConclusionsAnalysis identified clear disparities between the knowledge levels U.S. adults have regarding heart attack and stroke symptoms. These disparities should guide educational endeavors focusing on improving knowledge of heart attack and stroke symptoms.

A population-based study of edentulism in the US: does depression and rural residency matter after controlling for potential confounders?

This informed reflection, from the intersection of health professions education and clinical practice, takes stock of the state of the field of interprofessional education (IPE) and collaborative practice (CP) (together IPECP) by answering the following three questions: (1) As a field of study, where is IPECP? (2) As a research enterprise, what are the current analytical gaps? (3) Scientifically, what needs to be done going forward? While IPE and CP, as well as IPECP, have been areas of scholarly inquiry for nearly 50 years, they have collectively and individually had a limited sphere of influence. Analytical gaps identified include little research dealing with big picture health-related outcomes; mixed results on the effectiveness of health care teams; increasing recognition that additional IPECP competencies might be needed; a gap between the identification and application of educational best practices; and the need for sound, reliable, and validated tools for measuring IPECP. The authors outline the work of the National Center for Interprofessional Practice and Education at the University of Minnesota, which is focused on filling the identified analytical gaps by way of strategic actions organized around three domains—(1) developing an IPECP research agenda, (2) nurturing IPECP intervention research grounded in comparative effectiveness research study designs and the assumptions of critical realism, and (3) the creation of a sound informatics platform. The authors argue that filling these gaps is important because if the effectiveness of IPE on CP and of CP on health outcomes is ever to be ascertained, generalizable findings are paramount.

Rurality as a Root or Fundamental Social Determinant of Health

ABSTRACT Interprofessional education (IPE) and collaborative practice (CP) have been prolific areas of inquiry exploring research questions mostly concerned with local program and project assessment. The actual sphere of influence of this research has been limited. Often discussed separately, this article places IPE and CP in the same conceptual space. The interface of these form a nexus where new knowledge creation may be facilitated. Rigorous research on IPE in relation to CP that is relevant to and framed by health system reform in the U.S. is the ultimate research goal of the National Center for Interprofessional Practice and Education at the University of Minnesota. This paper describes the direction and scope for a focused and purposive IPECP research agenda linked to improvement in health outcomes, contextualized by health care reform in the U.S. that has provided a revitalizing energy for this area of inquiry. A research agenda articulates a focus, meaningful and robust questions, and a theory of change within which intervention outcomes are examined. Further, a research agenda identifies the practices the area of inquiry is interested in informing, and the types of study designs and analytic approaches amenable to carrying out the proposed work.

A review of the current epidemiology and treatment options for prostate cancer

BackgroundOral health is an integral component of general health and well-being. While edentulism has been examined in relation to socioeconomic status, rural residency, chronic disease and mental health, no study that we know of has examined edentulism and these factors together. The objective of this study was to determine whether depression and rural residency were significantly associated with partial and full edentulism in US adults after controlling for potential confounders.Methods2006 Behavioral Risk Factor Surveillance Survey (BRFSS) data were analyzed to identify factors associated with increased odds of partial or full edentulism. This year of BRFSS data was chosen for analysis because in this year the standardized and validated Personal Health Questionnaire-8 (PHQ-8) was used to measure current depression. This measure was part of the optional questions BRFSS asks, and in 2006 33 states and/or territories included them in their annual surveillance data collection. Bivariate and logistic regression analyses were performed on weighted BRFSS data.ResultsLogistic regression analysis using either full or partial edentulism as the dependent variable yielded that rural residency or living in a rural locale, low and/or middle socioeconomic status (SES), depression as measured by the PHQ-8, and African American race/ethnicity were all independent risk factors when controlling for these and a number of additional covariates.ConclusionsThis study adds to the epidemiological literature by assessing partial and full edentulism in the US utilizing data from the CDC’s Behavioral Risk Factor Surveillance System (BRFSS). Examining data collected through a large national surveillance system such as BRFSS allows for an analysis that incorporates an array of covariates not available from clinically-based data alone. This study demonstrated that current depression and rural residency are important factors related to partial and full edentulism after controlling for potential confounders.