E.P. Fraher is associate professor, Department of Family Medicine, and director, Carolina Health Workforce Research Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
B. Lombardi is assistant professor, Department of Family Medicine, and deputy director, Carolina Health Workforce Research Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Acad Med. 2022 Sep 1;97(9):1272-1276. doi: 10.1097/ACM.0000000000004794. Epub 2022 Jun 21.
Health disparities between rural and urban areas are widening at a time when urban health care systems are increasingly buying rural hospitals to gain market share. New payment models, shifting from fee-for-service to value-based care, are gaining traction, creating incentives for health care systems to manage the social risk factors that increase health care utilization and costs. Health system consolidation and value-based care are increasingly linking the success of urban health care systems to rural communities. Yet, despite the natural ecosystem rural communities provide for interprofessional learning and collaborative practice, many academic health centers (AHCs) have not invested in building team-based models of practice in rural areas. With responsibility for training the future health workforce and major investments in research infrastructure and educational capacity, AHCs are uniquely positioned to develop interprofessional practice and training opportunities in rural areas and evaluate the cost savings and quality outcomes associated with team-based care models. To accomplish this work, AHCs will need to develop academic-community partnerships that include networks of providers and practices, non-AHC educational organizations, and community-based agencies. In this commentary, the authors highlight 3 examples of academic-community partnerships that developed and implemented interprofessional practice and education models and were designed around specific patient populations with measurable outcomes: North Carolina's Asheville Project, the Boise Interprofessional Academic Patient Aligned Care model, and the Interprofessional Care Access Network framework. These innovative models demonstrate the importance of academic-community partnerships to build teams that address social needs, improve health outcomes, and lower costs. They also highlight the need for more rigorous reporting on the components of the academic-community partnerships involved, the different types of health workers deployed, and the design of the interprofessional training and practice models implemented.
城乡健康差距正在扩大，而此时城市医疗保健系统正越来越多地收购农村医院以获取市场份额。新的支付模式正在从按服务收费向基于价值的护理转变，这为医疗保健系统提供了激励，以管理增加医疗保健利用和成本的社会风险因素。医疗系统的整合和基于价值的护理越来越将城市医疗保健系统的成功与农村社区联系起来。然而，尽管农村社区为跨专业学习和协作实践提供了自然生态系统，但许多学术医疗中心 (AHC) 并没有投资在农村地区建立基于团队的实践模式。AHC 负责培训未来的医疗保健劳动力，在研究基础设施和教育能力方面投入大量资金，因此它们在农村地区发展跨专业实践和培训机会以及评估基于团队的护理模式相关的成本节约和质量结果方面具有独特的地位。为了完成这项工作，AHC 需要发展包括提供者和实践网络、非 AHC 教育组织以及基于社区的机构在内的学术-社区伙伴关系。在这篇评论中，作者强调了 3 个学术-社区伙伴关系的例子，这些伙伴关系制定并实施了跨专业实践和教育模式，并且是围绕具有可衡量结果的特定患者群体设计的：北卡罗来纳州的阿什维尔项目、博伊西跨专业学术患者对齐护理模式以及跨专业护理准入网络框架。这些创新模式表明了学术-社区伙伴关系对于建立解决社会需求、改善健康结果和降低成本的团队的重要性。它们还强调了需要更严格地报告所涉及的学术-社区伙伴关系的组成部分、部署的不同类型的卫生工作者以及实施的跨专业培训和实践模式的设计。
