Interprofessional Education in Practice: Teaching and Evaluating Collaborative Practice Among Interprofessional Learners at a Family Medicine Residency

Interprofessional Education in Practice: Teaching and Evaluating Collaborative

Practice Among Interprofessional Learners at a Family Medicine Residency Program

Jason Ricco, MD, MPH, Assistant ProfessorJerica Berge, PhD, MPH, Associate Professor

University of Minnesota North Memorial Family Medicine Residency Program

Collaborative Family Healthcare Association 17th Annual ConferenceOctober 15-17, 2015 Portland, Oregon U.S.A.

Session # A4aOctober 17, 2015

Faculty Disclosure

The presenters of this session• have NOT had any relevant financial

relationships during the past 12 months.

Learning Objectives

At the conclusion of this session, the participant will be able to:

• Describe how interprofessional education (IPE) is integral to helping the healthcare workforce achieve the Triple Aim through collaborative care

• Discuss various interprofessional education approaches within a family medicine residency program

• Identify the role for more robust evaluation of interprofessional education activities by focusing more on assessment of IPE competencies to measure preparedness for collaborative practice

Bibliography / References

1. Brandt B, Lutfiyya MN, King JA, Chioreso C. A scoping review of interprofessional collaborative practice and education using the lens of the Triple Aim. J Interprof Care. 2014; 28(5):393-99.

2. Chong WW, Aslani P, Chen TF. Shared decision-making and interprofessional collaboration in mental healthcare: a qualitative study exploring perceptions of barriers and facilitators. J Interprof Care. 2013;27(5):373–379.

3. Farrell B, Pottie K, Woodend K, et al. Shifts in expectations: Evaluating physicians’ perceptions as pharmacists become integrated into family practice. J Interprof Care. 2010;24(1):80-89.

4. Hughes L, Tuggy M, Pugno P, Peterson L, Brungardt S, Hoekzema G, Jones S, Weida J, Bazemore A. Transforming training to build the family medicine workforce our country needs. Fam Med. 2015;47(8):620-7.

5. Interprofessional Education Collaborative Expert Panel. Core competencies for interprofessional collaborative practice: report of an expert panel. Washington, DC: Interprofessional Education Collaborative, 2011. http://www.aacn.nche.edu/education-resources/ipecreport.pdf. Accessed June 20, 2011.

6. World Health Organization. Framework for action on interprofessional education & collaborative practice. Geneva, 2010.

Learning Assessment

• A learning assessment is required for CE credit.

• A question and answer period will be conducted at the end of this presentation.

UMN North Memorial Family Medicine Residency

Introduction/Terms Increasing emphasis on interprofessional

collaboration for improving health care quality

Interprofessional education (IPE) is a means to prepare professionals to engage in such collaboration

WHO definition of IPE: “Two or more professions learning with, from and about each other to improve collaboration and quality of care.”


Background IOM’s 2001 Report- “Crossing the Quality Chasm: A New

Health System for the 21st Century” Health care redesign Preparing the workforce

Interdisciplinary training among health professions

WHO 2010- “Framework for Action on Interprofessional Education and Collaborative Practice” WHO recognizes “interprofessional collaboration in

education and practice as an innovative strategy that will play an important role in mitigating the global health workforce crisis.”

Nearly universal support from professional organizations for IPE


World Health Organization, 2010. Framework for Action on Interprofessional Education & Collaborative Practice. WHO. Geneva, p. 9.


Background IPE Collaborative practice Optimizes health services and

improves health outcomes Evidence for improved:

Access to health services Chronic disease outcomes Patient safety Appropriate use of clinical resources

Also a decrease in: Hospital admissions, length of stay, hospital complications Clinical error rates Mortality1-5

1. Reeves S et al. Interprofessional education:effects on professional practice and health care outcomes. Cochrane Database of SystematicReviews, 2008, Issue 1.

2. Reeves S. A systematic review of the effects of interprofessional education on staff involved in the care of adults with mental health problems. Journal of Psychiatric Mental Health Nursing, 2001, 8:533–542.

3. McAlister FA et al. Multidisciplinary strategies for the management of heart failure patients at high risk for admission. Journalof the American College of Cardiology, 2004, 44:810–819.

4. Mickan SM. Evaluating the effectiveness of health care teams. Australian Health Review, 2005, 29(2):211-217. 5. Lemieux-Charles L et al. What do we know about health care team effectiveness? A review of the literature. Medical Care Research and Review, 2006, 63:263–300.


Collaborative Practice and the Triple Aim Healthcare Triple Aim1 as the overarching

framework to fix the U.S. healthcare system: Quality Cost Experience

IPE/Collaborative practice interwoven in all three aims


Problem

Widespread, systematic implementation of IPE has not yet occurred in the U.S. “A quick scan of most health professions schools

today reveals a collection of siloed educational structures, working in parallel with little dialogue, integration, or collaboration between them.”

-B. Brandt and M. Earnest

More success in other countries

Previously documented structural, cultural, organizational, and interactional barriers to IPE

Earnest M, Brandt B. Aligning practice redesign and interprofessional education to advance triple aim outcomes. J Interprof Care. 2014 Nov;28(6):497-500

http://www.ncbi.nlm.nih.gov.ezp3.lib.umn.edu/pubmed/25029535

http://www.ncbi.nlm.nih.gov.ezp3.lib.umn.edu/pubmed/25029535


The challenges Integration of longitudinal IPE activities

within primary care training sites

Evaluating IPE curriculum effectiveness to prepare professionals to engage in collaborative practice


Evolution of IPE Evaluation IPE concepts around since 1970s

Linked to healthcare delivery and outcome improvement processes

Resurgence of IPE initiatives in response to the Affordable Care Act


Evolution of IPE Evaluation Prior evaluation of IPE activities largely

based on learner self-assessment of:

Attitudes towards other professions and IPE activities

Readiness to work collaboratively in a healthcare team

Intent to practice in an interprofessional setting


IPE Competencies

2011 IPE Collaborative Core Competencies Based on WHO definitions of collaborative

practice 38 competencies within 4 domains of IPE


The Age of Milestones ACGME Family Medicine Milestone Project

Developmentally-based assessment of demonstrable attributes and behaviors throughout residency training

Linked to domains essential for family medicine physician competency


Our Story Who we are

Our IPE Curriculum

Our evaluation methods


North Memorial Family Medicine Residency Program

A University of Minnesota residency program, 10-10-10

Affiliated with a community hospital Broadway Family Medicine, our clinic, is

located in North Minneapolis Patient-Centered Medical Home Longstanding interprofessional culture

preceding the era of IPE initiatives


Staff Faculty

MD and DO physicians Clinical pharmacists Behavioral medicine (LMFT) NP

Residents MD/DO PharmD Behavioral health interns


Other Staff Care coordinators (LICSW, RN) Triage RN

Various students from different health professions programs


IPE Initiatives Team meetings Care plans Student pairings Resident pairings Video recording


Interprofessional Team Meetings:A venue for multidisciplinary input on the integrated physical and mental health needs of complex patients.

Purpose:1. Learn and practice a biopsychosocial approach to patient care2. Increase learner ability to provide interprofessional care to increase quality and continuity of care3. Provide opportunities to practice new skills:

Conducting a family meeting

Motivational interviewing or counseling skills

Structuring a medical visit

4. Provide time for substantive case discussions:

Increase understanding of “whole person” in context

Assess relationship with patient

Develop treatment/interactive approaches

Evaluate treatment effectiveness


Participants in Team Meetings Include:

4 Resident teams (7-8 residents per team) 1-2 MD faculty 3 Behavioral health (mental health) faculty (LMFT,

LICSW) or Intern 1 PharmD faculty and/or resident 1 Triage nurse (occasionally) 1 Care coordinator 1 Patient advocate 1 Front desk staff (occasionally) Patient Family Community support (PHN, social worker, etc.) Observers (students)


Who are “Team Patients”? Team members bring patients that are

“complex”: Multimorbidity Mental Health diagnoses Any combination (biopsychosocial) Communication problems “Dreaded” patient Uncertain diagnosis or treatment plan “Practice” interactions Need for collaborative care between

multiple providers


Team Meetings Logistics:

Each team meets one morning per week from 8-8:40 am followed by team clinic until noon 30-45 minutes: Case discussion and

consultation with team members; debrief/updates from last team patient visits

3 hours: Patients seen by any combination of team members (each resident given one 40 minute slot for a “team” patient)


Care Plan Team


Interprofessional Paired Visits Designed as a developmental step to prepare

learners to collaborate effectively as a team Ultimately, this will happen asynchronously

(warm hand-offs, etc.) in the real world First learners need orientation to the other

professions’ strengths and assets First step is a paired visit with 2 learners from

different professions learning “from, about, and with” each other during real patient encounters


Student Interprofessional Pairings Started in 2009 Pair students on 2 half days a week Previously evaluated change in attitudes

towards IPE with pre and post questionnaire Readiness for Interprofessional Learning

Scale Validated questionnaire Overall, positive attitudes towards IPE both

before and after paired visits


Resident Interprofessional Pairings Started in 2010 Pair residents on 1 half day a week Initially MD and PharmD residents, now including

behavioral health interns Previously evaluated:

Individual feedback and perception of value Amount of contribution to patient care tasks by

each team member as viewed by other member

Shared decision-making by team during visit11. Lounsbery JL, Moon JY, Prasad S. Assessing collaboration between family medicine residents and pharmacy residents during an interprofessional paired visit. Fam Med. 2015;47(5):397-400.


Video Review A/V capabilities in clinic to capture patient

encounters Used originally to assess individual family

medicine resident communication and exam skills during quarterly video review with faculty

Videos captured of paired interprofessional (IP) visits to evaluate both team and individual performance in IPE competencies


Current Evaluation Process Development of an evaluation tool to assess

IPE competencies during video review Ideal tool attributes:

To have demonstrable behavioral anchors for assessment of IPE competencies within each domain

Can assess both individual and team performance in relation to IPE competencies

Can be used both for formative team feedback and longitudinal tracking of an individual learner’s progress with IPE competencies


Example Video of a Paired IP Visit Assess effectiveness of visit, team

dynamic, patient-centeredness, IPE competencies: Values/ethics for interprofessional practice Roles/responsibilities Interprofessional communication Teams and teamwork

During video think about evaluation strategy Team and individual evaluation? Formative and summative evaluation

capabilities?


Discussion What do you think of the paired visits? Comments on IPE curriculum? Suggestions or challenges in evaluating

IPE competencies during video review process?

Next steps


Questions?

Session Evaluation

Please complete and return theevaluation form to the classroom

monitor before leaving this session.

Thank you!

Documents

Interprofessional Education in Practice: Teaching and Evaluating Collaborative Practice Among Interprofessional Learners at a Family Medicine Residency