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OCR for page 45
Chapter 3
The Core Competencies Needed
for Health Care Professionals
Addressing the challenges outlined in Chapter 2 will require profound changes in how health
systems are designed. At the heart of such systems are the skilled health care professionals without
whom such a redesign could not take place. Preparing health care professionals to take on this task
requires a common vision across the professions centered on a commitment to, first and foremost,
meeting patients' needs as envisioned in the Quality Chasm report (Institute of Medicine, 20014. The
committee recommends the following as an overarching vision for all programs and institutions
engaged in the education of health professionals:
Ad health professionals should be educated to deliver patient-centered care as
members of an interdisciplinary team, emphasizing evid~ence-based~practice, quality
improvement approaches, and informatics.
To this end, the committee proposes a set of simple, core competencies that all health clinicians
should possess, regardless of their discipline, to meet the needs of the 21 st-century health care
system:
· Provide patient-centered care identify, respect, and care about patients' differences, values,
preferences, and expressed needs; relieve pain and suffering; coordinate continuous care; listen to,
clearly inform, communicate with, and educate patients; share decision making and management;
and continuously advocate disease prevention, weliness, and promotion of healthy lifestyles,
including a focus on population health.
· Workin interdisciplinary teams cooperate, collaborate, communicate, and integrate care in
teams to ensure that care is continuous and reliable.
· Employ evidence-based practice integrate best research with clinical expertise and patient
45
OCR for page 46
HEALTH PROFESSIONS EDUCATION
.
.
values for optimum care, and participate in
learning and research activities to the extent
feasible.
Apply quality improvement identify errors
and hazards in care; understand and
implement basic safety design principles,
such as standardization and simplification;
continually understand and measure quality
of care in terms of structure, process, and
outcomes in relation to patient and
community needs; design and test
interventions to change processes and
systems of care, with the objective of
improving quality.
Utilize informatics communicate, manage
knowledge, mitigate error, and support
decision making using information
technology.
Figure 3-1 depicts the relationships among these
five core competencies.
As a guide in formulating its five
competencies, the committee examined core
skills outlined in the Quality Chasm report and
other core competencies formulated within and
across the health professions. Following a brief
Overlap of Com Co~mpetencies for
Health P~rfe~i~nal~
., , . ~ ~ ~ ~ ~
review of that committee process, this chapter
describes each competency in greater detail and
contrasts these competencies with the
corresponding current approaches in practice.
Also provided is a scenario illustrating the
effect on patient care when health care
professionals do not apply such competencies.
See Chapter 4 for more detailed discussion of
the current state of practice and the implications
of integrating these competencies into health
professions education.
Origin of the Five Competencies
As acknowledged in the Q2vaJ1ity Chasm
report and in Chapter 2 of this report, there are
many challenges facing health care in America.
As a result, clinicians are increasingly being
called upon to redesign better systems to
address the health needs of the American
population. The architects of the Quality
Chasm report identify 10 important rules to
guide the transition to a health system that better
meets patients' needs (see Box 3-1~.
The authors of the Q2vaJ1ity Chasm report
also foresaw that health professionals would
~ I::
Figure 3-1 Relationship among core competencies for health professionals.
46
_F
:_
._
._
OCR for page 47
THE CORE COMPETENCIES
have to perform differently to meet these rules.
Thus in the chapter "Preparing the Workforce,"
they identified the key skills required by all
health professionals to implement these new
rules in the changing health care environment.
The summit committee used this list of skills
and the vision set forth in the Quality Chasm
report as the foundation for its work, combining
the list of skills into common groupings. The
committee supplemented these groupings with a
review of other seminal reform efforts that have
articulated core competencies across or within
the health professions. Many such efforts have
emerged from the educational arena, both
professional educational organizations and
accreditation bodies, as well as from specialized
private commissions, in response to the need to
prepare the workforce adequately for the
changing practice environment (ABIM
Foundation, 2002; American Association of
Medical Colleges, 2001; Brady et al., 2001;
Center for the Advancement of Pharmaceutical
Education tCAPE] Advisory Panel on
Educational Outcomes, 1998; Halpern et al.,
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47
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HEALTH PROFESSIONS EDUCATION
2001; O'Neil and the Pew Health Professions
Commission, 1998~.
One such major effort was undertaken by
the Pew Health Professions Commission, which
in 1992 articulated 17 competencies for future
clinicians (O'Neil, 1992) and later expanded the
list to 21 (Lenburg et al., 1999; O'Neil and the
Pew Health Professions Commission, 19984.
Debates centered on how to evaluate
competency, focusing on the reliability, validity,
and predictive ability of related measures.
Nursing groups and some physicians cautioned
against including only competencies that can be
measured, such as those based on technical
skills, as opposed to those that rely more on
cognitive and critical thinking and difficult-to-
assess interpersonal skills (Benner, 1982;
Epstein and Hundert, 20024.
The five competencies are meant to be core
and span the professions but are not intended as
Table 3-1. Rules and the Core Competencies
an exhaustive list. The committee recognizes
that there are many other competencies that
health professionals should posses, such as a
commitment to lifelong learning. However, the
committee believes the five competencies set
forth in this report are most relevant across the
clinical disciplines and best advance the 10
rules envisioned in the Quality Chasm report.
(See Table 3-1 for how the competencies
address the 10 rules.)
The committee recognizes that each of the
disciplines has its own contribution and unique
skills to bring to patient care this is what
makes the professions unique and valuable. The
five core competencies are not discipline-
specific and each profession will have its own
way of operationalizing such competencies in
practice. However, based on patient
perspectives and needs, there are certain
competencies that all health professionals
Rules for the 215t-CenturyT Provide Patient- T Employ 1 Apply Quality 1 Work in Bern Utilize
Health System Centered Care Evidence-Based Improvement disciplinary Informatics
Practice Teams
1. Care is based on X X X X X
continuous healing
relationships. -
2. Care is customized XX X X
according to patient
needs and values.
3. The patient is the X X X
source of control.
. Knowledge is shared, X X X X X
and information flows
freely.
. Decision makingis T T ~ x ~ x ~ x ~
ev~dence-based.
5. Safety is a system X X X
property.
7. Transparency is X X X
necessary.
3NeedsareanticipatedT x T x 1 x 1 x 1 x 1
9. Waste is continuously X X
decreased.
10. Cooperation among X X X X
clinicians Is a priority.
48
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THE CORE COMPETENCIES
should possess, regardless of their title or
discipline.
The committee also recognizes that the
definition of a professional's competency will
change over time. Indeed, professionals will
likely progress from novice, the stage of their
initial academic preparation, to expert, the stage
toward the end of their career when they have
learned to do their work intuitively (Batalden et
al., 2002~. However, the committee is also
cognizant that the fundamental competencies
that define health professionals over their career
are unlikely to change greatly, even though the
knowledge that they must acquire, and its
application, will change dramatically.
Several cautions are in order, however.
First, the competencies are interrelated (see
Figure 3-1), and therefore, the maximum benefit
can be derived when they are applied together.
Second, health professionals should apply these
competencies to most clinical interactions, but
they do not cover every possible clinical
decision. For example, not all care is delivered
by teams. Third, the following discussion of the
state of application of the competencies today is
not intended to be pejorative, but to capture
common practices and contrast these with the
committee's vision for the future.
The Five Competencies in Practice
Over the course of a lifetime, patients have
numerous encounters with health care
professionals. Often such encounters are
effective, patients leave feeling satisfied with
the care received, and their health improves.
Unfortunately, this is not always the case,
because health care professionals are often not
supported by a system that aids them in
providing optimum care. The scenario in Box
3-2, developed by the committee, is meant to
illustrate some of the serious problems facing
patients during an encounter with clinicians, and
to show why the five core competencies
outlined above are critical to improving health
care. This scenario is not meant to be
representative of all encounters, but is an
example of a situation in which many elements
have been problematic.
49
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HEALTH PROFESSIONS EDUCATION
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................................................................... ................................................ .. .......
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dev:elo
::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
::::::::::::::~::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::.::::::::: - ::::::::::::::::::::::::::: :::::::::::::::::::::::::::::::::::::: ::.::::::::::.::: :::::::::::::::::::::::::::::::::::::::::::: :::::::
.. . . .
~ -err us n--s- e eel e- t~ ~ I -- I -a-e-a w-n-eln-er~ singer s-n-o-u-l-a~ eta- e e-ml-s-l-n-~ wn-el-n-e-r~ sinker co-u-l-a~ ~
............. ............................................. .~ ................................ ............
.
--""c""o-""n"'""'e""""''""""ffi''"'"""""""""""' s"""'s'i"''T'T'i'''es""""''"""""''e''"""" ffi"i"l''""""""
......................................................................................................................................................................................................................................................
50
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THE CORE COMPETENCIES
Mrs. Johnson's care failed on several
accounts.
efficacy of self-care along with other relevant
health beliefs. Strategies to this end provide the
patient the opportunity to demonstrate success
First, the health professionals she saw d~d
· ~ · ~ ~~ en ~ In the self-management of diabetes, such as
not provide pat~ent-centerea care. ~ ney oTTerea
mastery of the glucometer In dally usage.
little education to help her understand her
condition, such as the physical difference
between Type I and Type II diabetes, the
treatment process, and related complications.
Mrs. Johnson and her health care providers
lacked a partnering relationship in deciding how
she should manage her diabetes. Her plan of
care was not sufficiently individualized to
account for her hectic lifestyle and issues
related to being a wife, mother, and student. In
addition, her providers did not address the
impact the disease would have on the daily lives
of her family and the family's need to
understand the condition.
Second, the various health professionals did
not work as an interdiscip1/tinary team in the
development of an individualized treatment plan
for Mrs. Johnson. Her care was characterized
by a lack of collaboration and communication
among the doctor, laboratory personnel, the
dietician, and the pharmacist. Because of the
necessary interdisciplinary nature of diabetes
management, a team approach is required to
provide quality patient care and prevent
associated long-term complications. The team
must consist of the patient and all involved
health care providers, for example a nurse to
coordinate care, a diabetes educator for general
education regarding the disease, a dietician for
nutritional education, a pharmacist for
medication review and education, a physician
for primary care, a podiatrist for foot care, and
perhaps a psychologist to address anxiety or
other mental health issues.
Third, the health professionals did not
emp11toy evidlence-basehlpractice in Mrs.
Johnson's care. The goal of diabetes education
has been to promote self-management, but
research has shown that knowledge alone is an
insufficient predictor of an individual's ability
to incorporate new self-care behaviors.
Educational programs that promote effective
self-care among people with Type II diabetes
should be designed to foster a belief in the
Fourth, the clinic did not apply quantity
improvement methods. A diabetes registry had
been implemented, but it was not being used to
improve the quality of care provided to patients.
The diabetes team attempted to monitor the
number of patients entered into the registry, the
services they received, and outcomes related to
changes in their health status. Since the registry
was not continuously updated, the key measures
for individuals, subpopulations, and the total
population were incorrectly reported. As a
result, trends could not be monitored. If the
diabetes registry had been continuously
updated, the provider's office manager would
have printed out the encounter form upon a
patient's visit and clipped it to the front of the
chart. This form would have provided various
graphs displaying a 6-month history of care
while alerting health care providers to needed
tests and services. In the paper-based system
that characterizes the scenario in Box 3-2,
patient input depends on each health care
provider's remembering to update encounter
forms and office staffs having time for data
entry.
Finally, health professionals did not utilize
informatics in the clinic visited by Mrs.
Johnson. Administrators in the clinic had
implemented the diabetes registry, but they had
not designated a specific individual to be
responsible for monitoring data entry and
disseminating output reports. As a result, it was
impossible to know whether health care
providers had failed to update the encounter
forms at the time of patient visits or had
delegated the paperwork to their staff, who may
not have completed it correctly, if at all. When
inquiries were made about updating of the
encounter forms, all the health care providers
stated they were positive the necessary
paperwork had been completed after each visit.
Yet when they received monthly reports, they
believed the statistics did not correctly reflect
51
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HEALTH PROFESSIONS EDUCATION
their patient load or the number of services
provided; they thought the numbers should be
higher in both areas. Without an effective
monitoring system in place, however, it was
difficult to validate those beliefs. In sum, the
paper-based system limited the health care
providers' ability to search, retrieve, and
manage client data from the diabetes registry.
In the following subsections, the rationale
and a detailed definition for each of the five
core competencies identified by the committee
are presented. It should be noted that there is
not in all cases a strong evidence base
supporting the view that adopting a competency
would result in better patient and population
outcomes. Where such evidence is available, it
is cited; where it is not, this lack is indicated,
and the rationale for the committee's espousal
of the competency is provided.
Provide Patient-Centered Care
Shifting health care needs for the American
population have added a growing need for care
for chronic conditions to the once predominant
need for acute, episodic care. Today, 4 in 10
Americans report having a chronic condition,
and by 2020, this proportion will increase to
half of the nation's population (Wu and Green,
2000~. Unlike those who receive acute,
episodic care, patients with many coexisting
conditions see a variety of health providers, in a
multitude of settings, over an extended period of
time. Disease-focused and clinician-centered
care, which emphasizes treating a disease
without attention to the needs of the patient and
centers on the health professional as the sole
source of control, is out of step with changing
patient needs and demands. Patients are
increasingly interested in customized treatment
recommendations that are responsive to their
preferences and beliefs and reflect an
understanding of their environment, including
home life, job, family relationships, cultural
background, and other factors.
The health care financing syste~which
largely does not reimburse professionals for
time spent coordinating and integrating care or
providing care through alternative vehicles,
such as over the Internet or via telephone-
further constrains clinicians' efforts to care for
patients (Institute of Medicine, 20014.
Significant work done by researchers and
experts in this competency area reveals specific
skills needed by today's health professionals to
be more responsive to patient needs (Gerteis et
al., 1993; Halpern et al.,2001; Institute of
Medicine, 2001; Lewin et al., 2001; Mead and
Bower, 2000; O'Neil, 1992; Pew Health
Professions Commission, 1995; Stewart, 20014:
· Share power and responsibility with patients
and caregivers.
Engage in an ongoing dialogue with
patients that brings about
understanding, acceptance, cooperation,
and identification of common goals and
related care plans.
Guide and support those providing care
to patients (e.g., family members,
friends) by involving them as
appropriate in decision making,
supporting them as caregivers, making
them welcome and comfortable in the
care delivery setting, and recognizing
their needs and contributions.
Understand and respect patients' self-
management activities.
Provide physical comfort and emotional
support.
Ease pain and suffering.
Provide timely, tailored, and expert
management of symptoms.
Relieve fear and anxiety.
· Communicate with patients in a shared and
fully open manner.
Allow patients to have unfettered access
to the information contained in their
medical records.
Communicate accurately in a language
that patients understand. Offer
trustworthy information using patients'
preferred communication channels (e.g.,
52
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THE CORE COMPETENCIES
face-to-face, e-mail, other Web-based
communication technologies).
Explore a patient's main reason for a
visit, associated concerns, and need for
information.
· Take into account patients' individuality,
emotional needs, values, and life issues.
Provide care for patients in the context
of the culture, health status, and health
needs of the population of which each is
a member.
Provide care that reflects the whole
person.
· Implement strategies for reaching those who
do not present for care on their own,
including care strategies that support the
broader community.
Accept responsibility for enrolled
members of a health plan, and consider
the needs of underserved members of a
community who do not initiate visits or
present for care.
· Enhance prevention and health promotion.
Apply population-based strategies to
identify and reduce risk factors and to
improve patients' use of and access to
appropriate services and providers.
Define and describe populations by
health status.
Deliver health care services intended to
prevent health problems or maintain
health.
Understand and apply principles of
disease prevention and behavioral
change appropriate for specific
populations with which patients may
identify. Understand the links among
healthy lifestyles, prevention, and the
cost of health care.
Multiple studies demonstrate that meeting
the aim of patient-centeredness can improve
health status and other outcomes desired by
patients (Benbassat et al., 1998; Henbest and
Stewart, 1990; Kaplan et al., 1989; Lewin et al.
2001; Roter et al., 1995; Stewart et al., 1999~.
Evidence demonstrates that patients who are
involved in their care decisions and
management have better outcomes, lower costs,
and higher functional status than those who are
not so involved (Gifford et al., 1998; Superio-
Cabuslay et al., 1996; Von Korff et al., 1998;
Wagner et al., 20014. In a randomized
controlled trial of a self-management program
for chronic disease patients, participants who
received the intervention showed improvement
as compared with the control group in health
behaviors such as frequency of exercise and
improved communication with health providers,
as well as improved health status and reduced
hospitalization (Lorig et al., 20014. Providing
patient-centered care also has been shown to
lead to greater clinician satisfaction, a reduction
in malpractice claims, and patient loyalty to the
clinician (Meryn, 19984. Box 3-3 describes an
example of care from the patient's perspective.
Providing patient-centered care is
particularly important in light of the ethnic and
cultural diversity that increasingly characterizes
much of the United States. Although minority
populations represent less than 30 percent of the
national population, they constitute about 50
percent of the population in some states, such as
California (Institute for the Future, 20004. A
culturally diverse population poses challenges
that go beyond simple language competency
and include the need to understand the effects of
lifestyle and cultural differences on health status
and health-related behaviors; the need to adapt
treatment plans and modes of delivery to
different lifestyles and familial patterns; the
implications of a diverse genetic endowment
among the population; and the prominence of
nontraditional providers, as well as family
caregivers (Institute of Medicine, 20024. Box 3-
4 presents an example of a system of care that is
designed to respond to cultural diversity.
Researchers caution, however, that though
scattered studies demonstrate positive outcomes
with the provision of patient centered care, more
attention needs to be paid to the methodological
quality of such studies. Currently there is no
53
OCR for page 54
HEALTH PROFESSIONS EDUCATION
gold-standard measure for patient-centeredness.
The absence of valid, reliable, and appropriate
tools to assess the effects of interventions to
promote patient-centered care has been a large
obstacle in performing such assessments
uniformly (Mead and Bower, 2000~. Another
obstacle has been associated with the definition
of terms related to this competency. Though a
widely used phrase, patient-centered care has
little shared meaning within and across the
health professions. In their systematic review,
Lewin and colleagues (2001) note that more
work needs to be done on defining common
language and terms related to patient-centered
care that can be operationalized in effectiveness
studies.
Work in Interdisciplinary Teams
An interdisciplinary team is composed of
members from different professions and
occupations with varied and specialized
knowledge, skills, and methods. The team
members integrate their observations, bodies of
expertise, and spheres of decision making to
coordinate, collaborate, and communicate with
one another in order to optimize care for a
patient or group of patients. It should be noted
that, although patients and their caregivers are
increasingly performing tasks once performed
strictly by health professionals (Hart, 1995;
Lorig et al., 1999; Von Korff et al., 1997) and
so could be considered part of the larger health
care team when they so desire, this report
focuses on the educational needs of trained
health professionals. Thus this competency
refers to the various disciplines working
together to address the needs of patients.
Interdisciplinary teams are critical in dealing
with the increasing complexity of care,
coordinating and responding to multiple patient
needs, keeping pace with the demands of new
technology, responding to the demands of
payers, and delivering care across settings
(Bluml et al., 1999; Hall and Weaver, 2001;
Institute of Medicine, 2001~. Teams tend to
reduce the utilization of redundant or duplicate
services, and they also tend to develop more
creative solutions to complex problems because
of their members' diverse academic
backgrounds and experience. Patients needing
chronic care, critical acute care, geriatric care,
54
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THE CORE COMPETENCIES
and care at the end of life require smooth team
functioning because of the complexity of their
needs. Different means and settings for
delivering care, such as managed care,
community-based care, rehabilitation centers,
and critical pathway systems, are gaining
momentum and require interdisciplinary teams
to provide the necessary coordination
(Amsterdam et al., 1980; McDonough and
Doucette, 2001; Weingart, 19964. Most but not
all care should be delivered by teams, either
formally or informally organized.
Interdisciplinary teams have been shown to
enhance quality and lower costs in some studies
(Baldwin, 1996; Burl et al., 1998; Curley et al.,
1 998; McDonough and Doucette, 2001;
Shortell, 1994; Wagner et al., 20014. The
identification or addition of team members to
achieve greater concordance with complex
treatment protocols on the part of both providers
end patients has improved outcomes for several
chronic conditions (Wagner, 20004. Studies
have also demonstrated a relationship between
better interaction among team members in
intensive care units and decreased risk-adjusted
length of stay (Shortell, 19944. Still other
studies have demonstrated some impact of
effective team care on patient safety and
reduction of medical errors (Silver and
Antonow, 2000; Weeks et al., 2001~. However,
more research is needed to fully explore the
effect of teams on patient outcomes and cost, as
well as the effectiveness of teams in ambulatory
settings (Cooper and Fishman, 2003~. Summit
participants suggested making systematic
evaluation a part of all interdisciplinary team
55
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HEALTH PROFESSIONS EDUCATION
..............................................................................................................................
.............................................................................................................................
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............................................................................................................................
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. .
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::::::::::::::: :::::::::::::::::::::::: ::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
~ ~
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................................. ....................... ......................... ...................................... .... ..... .................................. it.
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
~ e ~ a ~
Inieg area n-ea-l-t-n~ terms l-t-n~t~ n-- -Ilal Juu l al- aml--e~ Al-- 9 terms arena-- IIIt
..... ..
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.............................................. ..............................................................................
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, . . . . .
.-.-.n.n-vS.lclans ana nU seS work lo monitor lne alaceles Tlow snee s~ uo-m--n-u-te-rlzea~ m-e-a-l-cal~
::::::::::::: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
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mc ~ l l -n~ l ~l t' """"' -n-- l l lil ~ t' """'' " """'U"1' 'D'' t' ' "'
...................................................................................... . - -
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j , . . .
~ """"""""'Q'' 't' ' ' -e """t' ''"""D' tn enl 9 Ce lDen an e na e n n ~ tantlal
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::
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.,.,.,,,~,,,,,.9.,,,a,,,,,,,.,,J,,,.,u,,,,,,, ana sunslanilal Incmase$ 1n lne pemenlage
~ ~ .
..... n-e-m-oq--l-o-~-ln tesls wltnln a ~ar t~ooennelmer et al ~ ~-uu- -;~ l--n~t-l-t-u-te~ ~-r~ H--e,,a,l-~-n-ca-re~ l-m--p-rove~
::: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
~ l~ The---~---Di" ' ' i' ' ""' ' ' ' ' ' i' ""i' ""'."' ''
:::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
:: :::::::::::::~:::: :~:::::::::~::::::::::::::::~:::::::: :: - :::::::::::::::::::::.:::::::::: ~:::::::::::::~::::::~:::::::::::
~--o~uabon~ s---p --t--~ -~ -~m --U --~-D d--W- O--J- ~ -~- O~1 ---~UUz)~ th --l td~ --t --n Hh ~ 1
.... .. ..... ....
64
OCR for page 65
THE CORE COMPETENCIES
A Vision of the Prepared Health Care
Professional
The core competencies described in this
chapter can lead to fundamentally better care.
Having begun in this chapter with a scenario
that depicts a patient encountering significant
deficits and gaps in care (Box 3-2), we conclude
with a scenario developed by the committee that
depicts care as it could be if health care
providers exhibited the five competencies (Box
3-10~.
Mrs. Johnson's health care needs were met
in several ways.
First, health professionals provide~patient-
centerec! care as they shared information on the
decision-making process and the management
of diabetes with the patient. It was evident that
Mrs. Johnson valued her education and family.
In the interdisciplinary team meeting, she
voiced her frustration regarding the amount of
time it was taking her to learn how to self-
manage her diabetes while attempting to meet
her responsibilities as wife, mother, and
graduate student. She was fearful that she
would have to quite graduate school. The
interdisciplinary team members reviewed Mrs.
Johnson's short-term self-management goals
with her and emphasized her successes. In
addition, they discussed options that would
allow her to meet her varied responsibilities.
By the end of the interdisciplinary team
meeting, Mrs. Johnson felt confident that she
was making progress in the self-management of
her condition. In addition, she and her husband
decided that instead of quitting graduate school,
she should decrease her course load to one class
per semester until she felt comfortable with
juggling the self-management of her diabetes
and her other responsibilities.
Second, the health professionals worked in
an interbliscip11tinary team in approaching Mrs.
Johnson's care. She was referred to a number
of health care providers who offered education
65
OCR for page 66
HEALTH PROFESSIONS EDUCATION
......................................................................................................................................................................
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f If f it irl Off ~ l l f Ir.~ it YE A J ~~
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:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
~-r- rac -y. l--n- ormec ~ virs 0 1nson ; 1a he was orc erlng a Dase line e ec rocker
- -
.. .. . . -.~ Hi.. .~ . .. ~.-~!--=~V]-- Y ~ V-~- .~.~.~.~ . -Vat LV-~= ~ ~-E--E-V-E-~..-~-L=..-!--V!~ ~-~ ~---t~-~
::::: :::::i:::::::::::::::::::::::::::::::::::::::::::::::: :::::::::::: ::::::: ::::::::::::::::::::::A::::: ::::~::::::::::::::::::::: ::::::t::::::::::::::::::: ::::::::::::::::::::: ::::::::::::::::::::::::::::i::::::::::::::::::: :::::::::: ::
,.,., H, -e-m-og--l-A-~-~-n~ ~~ I--- ~-e~ l-n-sl-ru-~ea~ n-e-r~ An now l,-o~ a-l-al lineal Intel ~-4- -nA-u-r---
--I-I llwl l t laLl~l l OUOL=l l l Lo unwell~l l=~l aL~l v l O~ultO
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
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:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
~ ~e-r~ l-n-e~ v-l-s-lt~ ~-r~ ~-- aa-V enlerea nls nn~lclan noles into lne mealcal recom
::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :::::::
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.:::::::::::::::::::::::::::::::::::::::::::::: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
:::::::::::::::: :::::: ::::::::::::::::::::::: ::: ::::: :::::::::::::::: ::::::::::::::::::::: ::::::,::::::::::::::::::::::::
Qgist~ wnicn allo QU team memDQ s~ ac~s-s~ to~ c~ rre-n-t~ ~-ata~ s-o~ t-n-~- -ere~ a-~-l-
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............................................................................................................................
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.-.-lo~ a-~-cu-m-e-nl~ n-e-~ m-ea-l-s~ a-~-a~ DI-oOa~ s-u-~-a-~ l-eve-l-s~ a-n-a~ e-n-cou-- an-e-a~ n-er~ lo~ ~-rl--nn~ ll~ ~-n~ re u--rn~
.. .... .... .... ..... ........... ... .. ........ ... ... .... ... ... ....... ... ... .. ... ........ ........... ........ ............ ... ........ ....
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
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and support according to the recommended
standards ofcare. The team members,
including Mrs. Johnson and her husband, met to
communicate and coordinate the treatment plan.
Third, the health care professionals
emp1/toyed evidenced-basedpractice. Health
professionals frequently expect newly
diagnosed diabetics to change multiple
behaviors to decrease their risk of
complications. Patients often fail at self-
management because they are overwhelmed by
the number of changes. In accordance with the
current literature, the diabetes educator and
dietician each had Mrs. Johnson choose one
basic self-management goal. They provided her
with the information and tools necessary to be
successful, and then on her follow-up visits,
they reviewed her progress.
Fourth, the team app11tieh1 qua11tity
improvement in the provision of care through
use of the diabetes registry. Key outcome
measures were tracked for individual patients, a
subpopulation, or the general registry
population. At Mrs. Johnson's next
66
OCR for page 67
THE CORE COMPETENCIES
appointment, health care providers will print out
a record that displays data and graphs of visits
and care provided for the past 6 months. Doing
so allows providers and patients to note trends.
addition, care reminders can be printed out
and given to health care providers to remind
them of needed services, or a letter can be sent
to the patient as a reminder for care.
Finally, health care providers utilized
informatics as a way to communicate and
manage Mrs. Johnson's diabetes care. All the
health care providers used PDAs to input data
into the diabetes registry so they had continual
access to updated information. Mrs. Johnson
was able to obtain results of her EKG and
laboratory tests from an automatic recorded
information system. If she had questions related
to diabetes and self-management, she had e-
mail access to her health care team. In addition,
she was encouraged to seek out current diabetes
information on the Web while obtaining support
Tom others with diabetes through a chat room.
Conclusion
In conclusion, the committee stresses that
narrowing of the quality chasm can be realized,
at least in part, by reforming health professions
education:
· For health professionals, there is a
set of core competencies that can
advance adherence to the rules of a
redesigned health care system as
envisioned in the Quality Chasm
report: provide patient-centered
care, work in interdisciplinary
teams, employ evidence-based
practice, apply quality improvement,
and utilize informatics.
· The extent to which current health
professionals are implementing these
competency areas does not meet the
health care needs of the American
public.
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Representative terms from entire chapter:
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