Population Health Competencies and Milestones for Family Medicine Viviana Martinez-Bianchi, MD, FAAFP Brian Halstater, MD Perry Pugno, MD, MPH Mina Silberberg, PhD Justine Strand de Oliveira, DrPH, PA-C, DFAAPA STFM May 2014

Objectives: ▪ Explain why population health competencies and milestones are important in training medical providers ▪ Describe the competencies needed to train family physicians in population health ▪ Utilize the competency map in the development of curriculum and milestones for participants’ programs ▪ Describe an array of training methods and resources in population health 2

Green LA, Fryer GE Jr, Yawn BP, Lanier D, and Dovey SM. Ecology of Medical Care Revisited. NEJM 344: June 28, Most illness and care occurs in the community

commissiononhealth.org Life spans vary by where you live

And so do costs… CalPERS Excess Medical Spending attributable to selected preventable conditions by county (2008) THE URBAN INSTITUTE

POPULATION HEALTH -In one sentence: Know the burden of preventable illness in your community, and partner with community practices and agencies to prevent these illnesses 6

▪ Population Health: the health outcomes of a group of individuals, including the distribution of such outcomes within the group. Source: Kindig D, Stoddart G. What is Population Health? Am J of Public Health. 2003; 93(3): ▪ The Goal: “from Health Care to Health” 7

Population Health: A Competency Map Approach ▪ Set of competencies that form an organizational framework for curricular planning and training Academic Medicine, Vol. 88, No. 5 / May

9

4 domains of competency for teaching population health 1.Public Health (PH) 2.Community engagement (CE) 3.Critical thinking (CT) 4.Team skills (TS) 10

Teaching Population Health: A Competency Map Public Health Community Engagement Critical thinking Team Skills

Duke CFM collaboration with AAMC/CDC ▪ Identify population health competencies within milestones, across specialties ▪ Develop a core set of population health competencies that could be used by all specialties ▪ Identify and make available curricula and materials for teaching population health (iCollaborative, MedEd Portal—ongoing) 12

Population health competencies in Family Medicine ▪ Population health competencies are woven through Family Medicine’s milestones, to a greater degree than any other specialty 13

Population health: Family Medicine ▪ Copies of the Family Medicine Milestones Project document provided for each table ▪ Highlighted areas identified as population health competencies ▪ Others may add/delete, depending on how broad or narrow the approach 15

EXAMPLE MK-2: applies critical thinking skills in patient care (CT) ▪ Level 2: begins to integrate social and behavioral sciences... ▪ Level 4: Uses experience with patient panels to address population health ▪ Level 5: Integrates in-depth knowledge of patient, family and community... to address health problems for individuals and communities 16

EXAMPLE PC-2: Cares for patients with chronic conditions ▪ Level 2: Understands the role of registries in managing patient and population health ▪ Level 4: Facilitates... use of community resources and services ▪ Level 5: Continually uses experience with patients and evidence based medicine in population management of chronic condition patients 17

Activity: develop core population health milestones ▪ Based on the 4 domains ▪ One domain per table ▪ Choose your table based on topic (1 to 4) ▪ Template provided ▪ Copies of the article provided ▪ Create core, or generic milestones that could be adapted/integrated by all specialties 18

Teaching Population Health: A Competency Map 1 Public Health 2 Community Engagement 3 Critical thinking 4 Team Skills

Tables report back to the group ▪ 1: Public health ▪ 2: Community engagement ▪ 3: Critical thinking ▪ 4: Team skills 20

Future Directions ▪ Family Medicine as the leader/exemplar of population health ▪ Population health competencies should be addressed in all specialties ▪ Concepts need to be introduced/taught in UME ▪ Concepts need to be embraced by all health professions ▪ Public health education programs—introduce integration with medicine 21

For copies of today’s work, questions or input: ▪ ▪ ▪ Thank you! 22