Cynthia Pineda– Associate Medical Director, Continuing Professional Education, MedStar Health, Washington, District of Columbia
Health Care Problem
Healthy People 2020, launched to identify our nation's health improvement priorities, highlights the importance of addressing the social determinants of health which are conditions in the environment in which people are born, live, learn, work and play which affects functioning, quality of life, outcomes, risk and health of populations. The social determinants of health are interrelated and reach beyond the boundaries of traditional healthcare. Continuing Medical Education (CME) providers need to identify factors outside of their control as well as barriers to practice and address them to improve patient outcomes. A quality improvement project was undertaken by our CME department to link these factors and barriers to the social determinants of health to close the gap through interprofessional continuing education strategies, collaborative practice and action. Activity planning documents and post-evaluations of interprofesional continuing education (IPCE) activities, over a one year period, were assessed. Expected outcomes include: (1) revision of activity planning form to reflect social determinants of health; (2) standardization of post-activity evaluations to reflect outcomes focused on improving population health; (3) revision of data base to allow for more precise reporting and tracking of data; (4) increased collaboration and partnerships with stakeholders to address health improvement priorities in the healthcare system.
Qualitative thematic content analysis was performed on the following data: (1) factors outside of the health system's control identified by activity planners; (2) barriers to practice identified by learners after attending a CME activity; (3) strategies to address factors and barriers identified by activity planners and continuing education committees. Data was reviewed by the CME Department. The factors outside of our control and barriers to practice were categorized and linked to the social determinants of health. Focus groups were conducted during CME committee meetings to discuss and brainstorm on how to effectively overcome these factors and barriers. Activity planners were given feedback on post-activity evaluations to explore how they can enhance future activities.
Patient-Level Outcome(s) Measured
Qualitative thematic content analysis revealed that factors affecting quality and safety which are outside of our control and barriers to practice include: (1) access to health care services; (2) insurance coverage, (3) patient and caregiver language and literacy; (4) patient level of education; (5) reimbursement issues; (6) patient/family cultural beliefs; (7) provider issues (lack of time, resources, support). A number of these factors can be linked to social determinants of health. Since the implementation of this project, we have been able to identify and explore system strategies to address these factors and barriers and collaborate with more stakeholders. The activity planning form and post-activity evaluations have been revised and standardized across the system. Our electronic database has been set up to capture needed data for better tracking and reporting. Future studies are ongoing to determine impact on patient and population health outcomes.
Associate Medical Director, Continuing Professional Education
Washington, District of Columbia
Cynthia Pineda, MD is currently the Associate Medical Director of CME at MedStar Health and Chair of the CME Committee at MedStar Montgomery Medical Center. Dr. Pineda is a board certified Physical Medicine and Rehabilitation specialist and an Associate Professor of Clinical Rehabilitation Medicine at Georgetown University School of Medicine. She is a member of the Alliance for Continuing Education in the Health Professions, Society for Academic Continuing Medical Education and Society for Simulation in Healthcare. Dr. Pineda is a Diplomate of the American Board of Physical Medicine and Rehabilitation and a Fellow of the American Academy of Physical Medicine and Rehabilitation.