The vision of a state-of-the-art health professions clinic where students from various disciplines can practice as teams is well on the way to realization at Marshall B. Ketchum University. The big moment arrived in May, when the doors of Ketchum Health opened at 5460 E. La Palma Avenue in Anaheim.
Patients are already receiving services at the University Eye Center at Ketchum Health. The roomy new facility, almost twice the size of the previous eye center, features modern exam rooms, a spacious showroom for eyewear and a comfortable patient lounge.
A wide range of optometric services are available in addition to primary eye care: subspecialty areas like cornea and contact lenses, pediatric vision therapy, ocular disease and vision rehabilitation. “I think these are really important resources for the community, because not every optometrist has the expertise, technology or the support to be able to deliver this kind of service, ” says the Dean of the Southern California College of Optometry, Stanley Woo, OD, MS, MBA.
Within the next 12 to 18 months, a medical clinic and dispensing pharmacy will be added to Ketchum Health, where students from the School of Physician Assistant Studies and the College of Pharmacy will begin their clinical training. The center will also feature team consultation rooms where all three disciplines can meet together to discuss patient care.
Edward Fisher, PhD, RPh, is dean of the College of Pharmacy, which welcomed its first class this fall. He is looking forward to the completion of the pharmacy at Ketchum Health: “When our students rotate through Ketchum Health, they will experience a cutting edge, state-of-the-art community practice.”
For the first time in Ketchum University’s history, the new facility will bring to life the vision of interprofessional collaborative practice and education. In the case of patients with diabetes, for example, pharmacists on the team may discuss drug interactions and reconciliation, while the PAs talk about managing the disease. At the same time, the optometrists would be concerned about blurry vision, diagnostic testing and treatment for the ocular implications of diabetes.
“We envision a joint clinic where faculty members across disciplines come in and enhance the learning experience by having case discussions among teams of students who are going to learn to help each other through their various professions,” says Dr. Woo.
The team approach promotes collaborative care to reduce costs while improving the quality of care. Coordinated medical management of a patient’s case can reduce unnecessary duplication of services, help prevent errors and result in a holistic approach that better serves the patient.
Making interprofessional collaborative practice a reality, of course, begins with training students in an interprofessional environment. On that front, Ketchum University has the advantage.
“We have the benefit of IPE throughout the whole university,” says Dr. Fisher. “While others are struggling with it, we’re not going to struggle. It’s going to be prominent in how we teach our students.”
A Synergistic Vision
Much of the credit for Ketchum’s model of team-based care and education goes to University President Kevin Alexander, OD, PhD. When he joined the university in 2009, Dr. Alexander laid out the vision for what would become Ketchum Health: “a campus-based, interprofessional clinic or surgical center [that] would enhance student interactions with other health care professionals.”
A past president of the American Optometric Association, Dr. Alexander has led the profession through groundbreaking initiatives nationally. “It’s part of his character to be at the edge of where the profession is going,” notes Senior Vice President and Chief of Staff Julie A. Schornack, OD, MEd. “With him at the helm, we became a university.”
As the notion of interprofessional education and interprofessional care came to the forefront of health care delivery, Dr. Alexander and other college leaders looked at ways to branch out into other professions that would provide synergy to the 100-plus-year-old optometry program. After extensive research into the needs and opportunities in health care, PA studies and a college of pharmacy were added, all under the umbrella of Marshall B. Ketchum University.
“In 2009, our institution engaged in a ‘futuring’ process to evaluate our readiness to train optometrists for the future and to sustain the viability of our institution in the years ahead. We concluded that we are in the health care education business, not just optometric education,” says Dr. Alexander. “The realization of Ketchum Health is an exciting part of our development as a university.”
Growing Pains
The next hurdle was how to create space for lectures and classroom instruction, laboratory training and clinical practice for all three disciplines — while maintaining the focus on interprofessional education. Adding a building like Ketchum Health could easily have provided more square footage for the new programs, while keeping optometry in place at the Fullerton campus, Dr. Schornack says. “But if we’re really in pursuit of interprofessional education, if all the disciplines aren’t together, both physically and philosophically, how do you ever make that happen?”
After much deliberation, the decision was made to house all lecture and laboratory functions on the Fullerton campus, with Ketchum Health becoming the clinical facility for all three professions. “We’ve purposely built in team rooms and conference rooms where the disciplines can get together and discuss shared patients and shared issues for the best patient results,” Dr. Schornack says.
The concept of building rooms where teams of medical professionals can collaborate is very much an emerging notion in health care. In a classical medical setting, a physician might confer with a social worker, a physical therapist, an occupational therapist, a nutritionist and a pharmacist about a single patient. “This is a very similar notion,” Dr. Schornack says.“How does a PA intersect with the optometry part and the pharmacy part for the best outcome for the patient?”
The challenge is to ensure that the collaborative care model succeeds, not only for patients but for the health care organization. The dream for Ketchum Health, as Dr. Woo describes it, is to create an incubator where the faculty and students can innovate with different methods and approaches to providing team-based care. Not only will students leave prepared to be effective members of a primary care team, but experience will reveal the most promising business practices. “We want to see if we can show those cost savings and quality improvements that everybody is hoping for in this model of care,” says Dr. Woo.
Active Learning
Instead of a traditional lecture format in the classroom, students from all three disciplines actively learn together, explains Director of the School of Physician Assistant Studies Judy Ortiz, PhD, PA-C. Coursework for all students includes medical ethics and an overview of public and population health. To build empathy and understanding of families experiencing poverty, for example, the students participate in exercises that ask them to grapple with the challenges their patients face, such as how to access transportation or the resources they need to feed their family and care for their health.
Electives also include a popular primer in medical Spanish. “Students practice phrases they might say to their patients,” Dr. Ortiz says. “They’re learning about the culture as well.”
The university’s “active learning” philosophy continues during the second phase of Ketchum’s interprofessional education environment, when patient case management is emphasized. As students discuss a patient’s care, they are exposed to the way each profession approaches the case. An optometrist seeing a patient with untreated diabetes, for instance, may note retinopathy but wish to refer the patient to a PA to check their insulin levels. A pharmacist will thereafter review the patient’s medicines with him or her to ensure he or she understands their use. The team then coordinates the next best steps for that patient’s health and well-being.
“While they’re working as an interprofessional team they’re learning about each other and their professions,” Dr. Ortiz says.
That’s good stuff, says Dr. Schornack. “It’s such a rich educational experience. You just get nuance from those other professions that you wouldn’t get alone. There are levels of understanding and levels of sophistication in patient care you just couldn’t do by yourself.”
Because of their interaction with Ketchum’s optometrists, the pharmacists and PAs graduate with increased awareness and understanding of optometry that will allow them to guide patients to the appropriate provider. “That’s the reciprocal benefit,” says Dr. Woo. “Now you’re going to have other primary care providers who have a clear understanding of what contemporary optometry services can do to help their patients.”
The Future is Bright
With the impressive eye care center and exam rooms in place and occupied, the opportunities during the pharmacy and medical clinic build-out over the next 12 to 18 months are exciting.
“Really, the story continues to evolve,” says Dr. Schornack. “The chapters aren’t all written. There are still things on the horizon for us.”
“I hope that we put clinicians in all three professions out into the world that truly understand the scope of practice of all of the other professions,” says Dr. Schornack, “and that they want these collaborative relationships with other professions as they go out and practice on their own so that it’s just the way they expect to do business. That would be a fantastic outcome.”