I. Executive Summary

The members of the Advisory Committee on Interdisciplinary, Community-Based Linkages (the Committee) represent programs funded under Federal Title VII, Part D, Section 751 through 755 Interdisciplinary, Community-Based Training Grant Programs.  They are aware of the services these programs provide in their communities and the key roles they play in the training of our Nation’s health care workforce.  Committee members are also aware of the significant impact the recent defunding and dismantling of some of these programs has had on the communities they serve.  Other Title VII Interdisciplinary, Community-Based Training Grant Programs have experienced funding cuts but are still striving to meet the needs of students and patients.

In response to these negative developments for Title VII Interdisciplinary, Community-Based Training Grant Programs, the Committee shifted its focus in 2006.  In the past, the Committee has addressed such issues as workforce diversity, cultural competence, and expanding the involvement of allied health in Title VII Interdisciplinary, Community-Based Training Grant Programs.  These past efforts were intended to expand and enhance the focus of the Title VII Interdisciplinary, Community-Based Training Grant Programs and ultimately to improve the quality of health care in the Nation.

In 2006, as a result of the recent funding developments, the Committee focused on “best practices” in providing interdisciplinary education and training for improved access to and quality of care for medically underserved populations.  The Committee addressed two inter-related questions: 1) what are the best practices/models of interdisciplinary training and/or community-based training; and 2) has such training improved access to care or the quality of care provided to underserved populations?   The intent of the Committee was to identify activities of Title VII Interdisciplinary, Community-Based Training Grant Programs that directly improve access to and the quality of health care, with the goal of documenting and disseminating these practices (through Recommendations to the Secretary and to Congress) so that they can be implemented by other programs.

On a daily basis, Committee members witness the benefits resulting from their own programs.  The testimony provided during 2006 offered examples from across the country and across Title VII Interdisciplinary, Community-Based Training Grant Programs of the vital programs and services provided.

Note: The FY 2006 budget for “Allied Health and Other Disciplines” included funds only for the Chiropractic Demonstration Program and the Graduate Psychology Education Program; the Allied Health Projects Program and the Podiatric Program were not funded.

Programs funded under Section 755, Allied Health and Other Disciplines, were considered in the 2005, Fifth Annual Report and appropriate recommendations were developed (see Appendix 4, Previous Recommendations, page 39).  The Allied Health Projects Program, the Chiropractic Demonstration Program, the Graduate Psychology Education Program, the Geropsychology, and the Podiatric Program are not included in this report or in its recommendations.

Health Education and Training Centers

The Health Education and Training Centers (HETCs) serve the most resource-poor populations and address their health concerns at the local level by providing: training to community members, especially community health workers (CHWs); health education programs; learning opportunities to health professions students; linkages between the community and available health services; and opportunities for families and children to explore health professions.  In FY 2004-2005, HETCs trained more than 1,000 CHWs. A Texas program for CHWs won an innovative practice award from the Centers for Medicare and Medicaid Services (CMS) for enrolling uninsured children into the CHIP Program—57,000 children in 6 months with a 90 percent retention rate.  Texas has adopted legislation to certify CHWs, and the Texas HETC model has been adopted by three other States.  HETCs supported or facilitated clinical experiences for over 8,600 health professions students.  Forty-two (42) best practices from 13 programs have been compiled in a document that was created for an annual HETC meeting.

Area Health Education Centers

Area Health Education Centers (AHECs) connect students to health careers; recruit and place health professionals; and improve health services within communities.  Through AHECs, approximately 300,000 students, ranging from kindergarten through college, have been introduced to health careers. A “best practices” example is the Arkansas AHEC and its M*A*S*H Program, which has enabled over 3,200 students (15% minorities) to interact with health care experts.  Two AHECs from Washington State serve as “best practices” examples of recruiting health professionals into community settings.  These two programs work closely with safety net providers in all 39 counties of the State and have clinical training and service delivery sites in the following safety net programs: 40 community/minority health centers; 40 National Health Service Corps (NHSC) sites; 39 local health departments; 30 tribal health clinics; and 110 rural clinic sites.  Approximately 65 percent of the students who participate in the AHEC clinical rotations return to work with underserved populations.  In 2003-2004, the Washington AHECs expanded the delivery of direct patient care through over 6,000 hours of service/learning by health professions students in over 250 safety net clinical sites.   

Geriatric Education Centers

The goal of the Geriatric Education Centers (GECs) is to facilitate training of health professions faculty, students, and practitioners in addressing problems of the elderly, using a train-the-trainer model. Fifty (50) GECs were funded through December 2006, mostly in areas that are more than 50 percent rural.  An example of their efforts is the Des Moines GEC’s Delirium Reduction Program, which effected a 40 to 50 percent reduction in delirium, as well as a reduction in the length of hospital stay and a decrease in overall facility costs.  The program has been recognized as a best practice and is being implemented in nursing homes.  The Arkansas GEC developed linkages with 50 rural community health centers (CHC) to provide geriatric education to: rural health professionals; faculty in the health professions; and primary health care providers who serve as student training sites or mentors.   

Quentin N. Burdick Program for Rural Interdisciplinary Training

Exemplifying best training practices, the Interdisciplinary Rural Health Training Program of East Carolina University, funded under the Quentin N. Burdick Program, trained students in multiple disciplines. The curriculum included an interdisciplinary patient case conference, resulting in a care plan; community projects (such as assessment of asthma incidence in schools); community site visits; and team visits.  The Program’s Burdick funding was scheduled to continue until January 2007.  North Dakota’s Quentin N. Burdick Program-supported Project CRISTAL sought to improve health care services to populations residing on an Indian Reservation.

Also in 2006, the Committee considered new research relating to inflammatory gum disease.   Common conditions among elderly nursing home residents (cerebrovascular, cognitive, and musculoskeletal disorders) are associated with inflammatory gum disease, with risk of systemic inflammation, exacerbation of chronic diseases, and respiratory infections such as pneumonia.  The dental insurance industry responded to the new research findings by incorporating dental information into medical disease management educational materials, encouraging dental visits, enhancing benefits (more extensive coverage), and waiving the frequency on preventive services for at-risk members.  A model is needed that overlaps disease boundaries, is focused on prevention and treatment of inter-related inflammatory conditions, and includes progressive diagnosis and treatment of periodontal disease.  A proposed model for addressing this growing need is a nursing/dental hygienist collaboration to assess and diagnose the patient and develop a long-term plan of care, which is comprehensive, cost-effective, and focused on prevention.

The Committee discussed at length the testimony, bringing the expertise and experience of Committee members to bear on the various topics.  From these discussions arose the Recommendations to the Secretary and to the Congress.

It is important to note that the work of the Committee has also been affected by the funding reductions.  Instead of two to three face-to-face meetings a year, as the Committee has held in the past, in 2006 the Committee held one face-to-face meeting and two conference calls to conduct its work.  During the meeting and conference calls, the Committee received testimony from individuals representing a variety of HRSA-supported agencies and programs.