1. Challenges and Opportunities for Strengthening Academic/Practice Partnerships to impact Population Health in Chronic Disease and Emergency Response
Roberta Proffitt Lavin, PhD, FNP-BC, FAAN
Joanne Langan, PhD, RN, CNE
Tener Goodwin Veenema, RN, PhD, MPH, FNAP, FAAN
Rachel L. Charney, MD
Keeta Holmes, PhD
Rick Zimmerman, PhD
This work is partially fund by an AACN and CDC cooperative agreement with University of Missouri – St. Louis, Saint Louis University, and Johns Hopkins University

2. Learning objectives
Learner Objective 1. The learner will be able to identify curricular materials to implement disaster preparedness within a population health framework that fits within existing curriculum.
Learner Objective 2. The learner will be able to implement collaboration and partnership-centered approaches to disaster preparedness and response to lead to a better prepared primary care workforce.

3. Let’s Talk about A Prepared Workforce
The goal was to address the impact of population health in chronic disease and emergency management through the creation of a toolkit to be used for primary care provider training.
And Gaps

4. Academic practice partnerships to impact population health in chronic disease and emergency management
Disaster and public health emergencies adversely impact population health
It isn’t just what is caused by disaster, but what is exacerbated by disaster that matters
Identifying and mitigating infectious disease outbreaks and those adversely impacted by disasters requires primary care provides have:
Knowledge
Skills
Abilities
Our primary care workforce is best served by collaborative academic/practice partnerships
Background and Significance: The United States needs a healthcare and public health workforce that possesses the knowledge, skills, and abilities to respond to any disaster or public health emergency in a timely and appropriate manner. The level of readiness and willingness to participate is critical to the success of any large-scale disaster response. The role of healthcare professionals across a broad range of specialties and during all phases of a disaster should be understood as disaster competence will be critical to population outcomes. The absence of a clearly articulated vision and framework for disaster education is not without consequences. An unprepared workforce has the potential to limit the effectiveness of local, state and federal response plans, limit organization surge capacity and to negatively impact health outcomes in populations impacted by disasters.

5. Create and sustain education & training environments for population health
Colleges of Nursing
Medical Schools
Schools of Public Health
Health Departments
Hospitals
Veteran Emergency Management Evaluation Center
This list of partners were key to what we wanted to accomplish

6. Key components & Objectives
Survey-based needs assessment of public health schools and primary care training programs for disaster preparedness and response
Achieve consensus - Convene nine key stakeholders to review current population health competencies and identify current resources and curricular needs, identify remaining gaps, and develop a collaborative dissemination plan
Create, curate and disseminate a publically available toolkit
Written population health curricular training materials for partnership-based disaster preparedness and response with core content and educational methods
Related online curricular content that can be supported by a practical playbook like website
New success stories related to Flint water crisis, Zika, and Long-term health impacts of disaster/terrorism
Develop and implement a workshop focused on collaboration and partnership-centered approaches to preparedness and response

7. Structured Analytic Approach
In-Depth Discussion
Document Review
Stakeholder Meetings
Surveys of Schools of Nursing/Med/PH
Expert Interviews
Access State/Local/University Training
Identify Essential Core Competencies
Synthesize the Data:
Explore
Ascertain
Verify
Evidence
Success Stories
Model Curriculum
Methods and Data: A multi-pronged approached was used to identify essential educational needs and core competencies, as well as to assess the status of integration of state and local-level population focused training. Data were synthesized from in-depth discussions with key informants, review of relevant documents, guided discussions at key partner stakeholder meetings, review and abstraction from available core competencies and other government planning documents, the survey of medical, public health, and nursing programs and interviews with experts.
Toolkit
Workshop
Test and Refine

8. Surveys sent Responses The survey Public Health 54
Nurse Practitioner
Osteopathic 31
Medical (allopathic) 55
Administrators
Public Health 9 (16%)
NP (17.6%)
DO 4 (13%)
MD 4 (7.5%)
Students
PH in 7 schools
NP in 12 schools
DO in 15 schools
MD 38 in 1 school

9. knowledge, skills, and understanding considered to be weakest in Curriculum
Students
Administrators
Least covered in curriculum: 60% of MPH & DO students, and 70% of NP students identified the following were not covered at all:
Location and capabilities of shelters
Implementation of the Incident Command System
Connecting survivors with available resources
Processing and lines of communication and coordination among the various partners
25% of DO indicated most topics were not covered
75% or 100% of MD administrators indicated that almost every topic was not covered at all.
Topics least covered in curriculum: 35% or more of administrators of MPH and NP programs saying the following were not covered at all
Location and capabilities of shelters
Implementation of the Incident Command System
Connecting survivors to available resources
Processes and lines of communication
Implications of loss of community resources

10. Student Responses
The level of confidence a student had in their ability to respond was assessed using a Likert scale
1 = Not confident at all
7 = Extremely confident
The general consensus is that 7-point scales are better for highly educated populations (e.g. students and administrators) while 5-point scales are best for the general public. The literature reviews in the articles lend support for the use of Likert scales in sociological research. Hopefully that will forestall critics at the presentation! Weijters, B., Cabooter, E., & Schillewaert, N. (2010). The effect of rating scale format on response styles: The number of response categories and response category labels. International Journal of Research in Marketing, 27(3),   Revilla, M. a., Saris, W. E., & Krosnick, J. a. (2013). Choosing the Number of Categories in Agree-Disagree Scales. Sociological Methods & Research, 43(1),  

11. Administrator Data
The level of confidence faculty had in students’ ability was assessed using a Likert scale
1 = Not confident at all
7 = Extremely confident

12. Relationship to core competencies
Core competencies and sub competencies for Disaster medicine and Public health
Weakest areas identified by students and administrators
1.0 Demonstrate personal and family preparedness for disasters and public health emergencies
10.0 Demonstrate knowledge of legal principles to protect the health and safety of all ages, populations, and communities affected by a disaster or public health emergency
4.0 Communicate effectively with others in a disaster or public health emergency
3.0 Demonstrate situational awareness of actual/potential health hazards before, during, and after a disaster or public health emergency
Less than 50% of students had an emergency plan
Less than 50% of students said basic legal and regulatory issues were covered
Use principles of risk and crisis communication (2.74 – 4)
Refer matters outside of one’s scope through the chain of command ( )
Report unresolved threats to physical and mental health through the chain of command (3-4.37)
Core Competencies for Disaster Medicine and Public Health Lauren Walsh, MPH; Italo Subbarao, DO, MBA; Kristine Gebbie, DrPH, RN; Kenneth W. Schor, DO, MPH; Jim Lyznicki, MS, MPH; Kandra Strauss-Riggs, MPH; Arthur Cooper, MD, MS; Edbert B. Hsu, MD, MPH; Richard V. King, PhD; John A. Mitas II, MD; John Hick, MD; Rebecca Zukowski, MSN, RN; Brian A. Altman, PhD; Ruth Anne Steinbrecher, MPH; James J. James, MD, DrPH

13. Cross walk of competencies and survey data

14. Soft skills

16. The project
Toolkit
Try out the interactive toolkit. The toolkit can be remixed through thinglink so that it meets your needs. Please make your remix free and available to all.
Creative Commons License. This work is licensed under a Creative Commons Attribution 4.0 International License.