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Weppner WG, Singh MK, Wipf JE, Shunk R, Woodard L, Brienza R. Culture change and lessons learned from ten years in the VA centers of excellence in primary care education. BMC MEDICAL EDUCATION 2024; 24:457. [PMID: 38671440 PMCID: PMC11047004 DOI: 10.1186/s12909-024-05390-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/03/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Team-based care is critical to achieving health care value while maximizing patient outcomes. Few descriptions exist of graduate-level team training interventions and practice models. Experience from the multisite, decade-long Veterans Affairs (VA) Centers of Excellence in Primary Care Education provides lessons for developing internal medicine training experiences in interprofessional clinical learning environments. METHODS A review of multisite demonstration project transforming traditional silo-model training to interprofessional team-based primary care. Using iterative quality improvement approaches, sites evaluated curricula with learner, faculty and staff feedback. Learner- and patient-level outcomes and organizational culture change were examined using mixed methods, within and across sites. Participants included more than 1600 internal medicine, nurse practitioner, nursing, pharmacy, psychology, social work and physical therapy trainees. This took place in seven academic university-affiliated VA primary care clinics with patient centered medical home design RESULTS: Each site developed innovative design and curricula using common competencies of shared decision making, sustained relationships, performance improvement and interprofessional collaboration. Educational strategies included integrated didactics, workplace collaboration and reflection. Sites shared implementation best practices and outcomes. Cross-site evaluations of the impacts of these educational strategies indicated improvements in trainee clinical knowledge, team-based approaches to care and interest in primary care careers. Improved patient outcomes were seen in the quality of chronic disease management, reduction in polypharmacy, and reduced emergency department and hospitalizations. Evaluations of the culture of training environments demonstrated incorporation and persistence of interprofessional learning and collaboration. CONCLUSIONS Aligning education and practice goals with cross-site collaboration created a robust interprofessional learning environment. Improved trainee/staff satisfaction and better patient care metrics supports use of this model to transform ambulatory care training. TRIAL REGISTRATION This evaluation was categorized as an operation improvement activity by the Office of Academic Affairs based on Veterans Health Administration Handbook 1058.05, in which information generated is used for business operations and quality improvement (Title 38 Code of Federal Regulations Part 16 (38 CFR 16.102(l)). The overall project was subject to administrative oversight rather Human Subjects Institutional Review Board, as such informed consent was waived as part of the project implementation and evaluation.
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Affiliation(s)
- William G Weppner
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA.
- School of Medicine, University of Washington, Boise VAMC, MSO-111, 500 W. Fort St, 83702; 208.695.0454, Boise, ID, USA.
| | - Mamta K Singh
- Primary Care Service, VA Northeast Ohio Health Care System, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Joyce E Wipf
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Rebecca Shunk
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - LeChauncy Woodard
- Tilman J. Fertitta Family College of Medicine, Humana Integrated Health System Sciences Institute, University of Houston, Houston, TX, USA
| | - Rebecca Brienza
- Division of General Internal Medicine, Yale School of Medicine, West Haven, CT, USA
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Deschenes S, Kunyk D, Scott SD. Developing an evidence-and ethics-informed intervention for moral distress. Nurs Ethics 2024:9697330241241772. [PMID: 38518739 DOI: 10.1177/09697330241241772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
The global pandemic has intensified the risk of moral distress due to increased demands on already limited human resources and uncertainty of the pandemic's trajectory. Nurses commonly experience moral distress: a conflict between the morally correct action and what they are required or capable of doing. Effective moral distress interventions are rare. For this reason, our team conducted a multi-phase research study to develop a moral distress intervention for pediatric critical care nurses. In this article, we discuss our multi-phase approach to develop a moral distress intervention-proactive, interdisciplinary meeting. Our proposed intervention is a sequential compilation of empirical work couched within a relational ethics lens thus should point to enhanced potential for intervention effectiveness.
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Nagel DA, Penner JL, Halas G, Philip MT, Cooke CA. Exploring experiential learning within interprofessional practice education initiatives for pre-licensure healthcare students: a scoping review. BMC MEDICAL EDUCATION 2024; 24:139. [PMID: 38350938 PMCID: PMC10863283 DOI: 10.1186/s12909-024-05114-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/30/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Interprofessional collaborative team-based approaches to care in health service delivery has been identified as important to health care reform around the world. Many academic institutions have integrated interprofessional education (IPE) into curricula for pre-licensure students in healthcare disciplines, but few provide formal initiatives for interprofessional practice (IPP). It is recognized that experiential learning (EL) can play a significant role supporting IPP education initiatives; however, little is known of how EL is used within education for IPP in healthcare settings. METHODS We conducted a scoping review to map peer-reviewed literature describing IPP education initiatives involving EL for pre-licensure students in healthcare disciplines. A literature search was executed in MEDLINE, CINAHL, EMBASE, ERIC, PsycINFO, Scopus, and Social Services Abstracts. After deduplication, two independent reviewers screened titles and abstracts of 5664 records and then 252 full-text articles that yielded 100 articles for data extraction. Data was extracted using an Excel template, and results synthesized for presentation in narrative and tabular formats. RESULTS The 100 included articles represented 12 countries and IPP education initiatives were described in three main typologies of literature - primary research, program descriptions, and program evaluations. Forty-three articles used a theory, framework, or model for design of their initiatives with only eight specific to EL. A variety of teaching and learning strategies were employed, such as small interprofessional groups of students, team huddles, direct provision of care, and reflective activities, but few initiatives utilized a full EL cycle. A range of perspectives and outcomes were evaluated such as student learning outcomes, including competencies associated with IPP, impacts and perceptions of the IPP initiatives, and others such as client satisfaction. CONCLUSION Few educational frameworks specific to EL have been used to inform EL teaching and learning strategies to consolidate IPE learning and prepare students for IPP in healthcare settings. Further development and evaluation of existing EL frameworks and models would be beneficial in supporting robust IPP educational initiatives for students in healthcare disciplines. Intentional, thoughtful, and comprehensive use of EL informed by theory can contribute important advances in IPP educational approaches and the preparation of a future health care workforce.
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Affiliation(s)
- Daniel A Nagel
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Jamie L Penner
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Gayle Halas
- Rady Chair in Interprofessional Collaborative Practice, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Mark T Philip
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Carol A Cooke
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Canada
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Papermaster AE, Whitney M, Vinas EK. Interprofessional Case Conference Enhances Group Learning and the Quality, Safety, Value, and Equity of Team-Based Care. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:4-11. [PMID: 36849427 DOI: 10.1097/ceh.0000000000000485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 11/07/2022] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Patients seeking treatment for complex conditions require coordinated care from interprofessional clinicians. Collaborative engagement in an interprofessional community of practice is crucial to the collective competence of a team and the provision of high-quality, safe health care leading to improved patient outcomes. The objective of this descriptive, cross-sectional study was to describe interprofessional communication, coordination, and collaboration of participants in an integrated practice unit that was structured to include weekly case conferences as part of routine practice. METHODS Data were collected from October 2019 to February 2020. Web-based surveys were administered to a convenience sample that included 33 questions and followed the CHERRIES checklist for reporting results. Items focused on team knowledge, impact on patient care, and communication, and conference focus and effectiveness. Descriptive and survey item analysis included frequency, percentage, means and standard deviation, Chi-square, and Pearson correlation analysis. Patient outcome data were collected via a Patient Global Impression of Improvement scale and were analyzed using a paired sample t test. RESULTS Survey respondents (n = 161) included clinicians and administrative staff. Results demonstrated that interprofessional case conferences improved the collective competence of the team, including team knowledge and communication. Participants viewed case conferences as a means to enhance care delivery quality, value, safety, and equity. In the study period, there was also a statistically significant improvement between the patient's first follow-up and last visits. CONCLUSION Survey respondents indicated that case conferences were an effective means to deliver high-quality, patient-centered care through interprofessional collaboration and education.
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Affiliation(s)
- Amy E Papermaster
- Dr. Papermaster: Assistant Professor, School of Nursing, The University of Texas at Austin, Austin, TX, and Assistant Professor, Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, TX. Dr. Whitney: Assistant Professor, Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, TX. Ms. Vinas: Assistant Professor and Associate Chair of Education, Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, TX
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Lamparyk K, Williams AM, Robiner WN, Bruschwein HM, Ward WL. Interprofessional Education: Current State in Psychology Training. J Clin Psychol Med Settings 2021; 29:20-30. [PMID: 33689102 DOI: 10.1007/s10880-021-09765-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2021] [Indexed: 10/21/2022]
Abstract
Healthcare reform has led to the consideration of interprofessional team-based, collaborative care as a way to provide comprehensive, high-quality care to patients and families. Interprofessional education is the mechanism by which the next generation health professional workforce is preparing for the future of health care-team-based, collaborative care. This literature review explored the extent and content of published studies documenting Interprofessional Education (IPE) activities with psychology trainees across learner level. A systematic review following PRISMA guidelines was conducted of studies describing IPE involving psychology learners. Electronic databases (MEDLINE, CINAHL, PsychINFO, and EMBASE) were searched for the following terms: inter/multi-professional education/practice, inter/multidisciplinary education/practice, and psychology/psychologists. Thirty-seven articles were identified that included psychology in clinical outcome studies or other reviews of interprofessional education initiatives. The review addresses the nature of current IPE learning activities, the impact of IPE activities on participating trainees, opportunities for, and challenges of, involving psychology trainees in IPE, and future directions for research. This review illuminates the relative paucity of the literature about IPE in psychology training. Given the trend toward increasing team-based collaborative care, the limited inclusion of psychology in the IPE literature is concerning. The next generation of health professional trainees is learning about, from, and with each other with the objective of building collaboration and teamwork. Given the few articles documenting psychology trainees' involvement in IPE, future health professionals quite possibly will have limited understanding of, and contact with, psychologists. Our findings are a call to action for greater psychology involvement in IPE.
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Affiliation(s)
- Katherine Lamparyk
- Cleveland Clinic Children's Hospital, 9500 Euclid Avenue/R3, Cleveland, OH, 44195, USA.
| | | | | | | | - Wendy L Ward
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
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Hirakawa Y, Aita K, Nishikawa M, Arai H, Miura H. Facilitating Advance Care Planning for Patients With Severe COPD: A Qualitative Study of Experiences and Perceptions of Community Physicians, Nurses, and Allied Health Professionals. Home Healthc Now 2021; 39:81-90. [PMID: 33662966 PMCID: PMC7934328 DOI: 10.1097/nhh.0000000000000945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity worldwide. Patients with severe COPD often fail to receive adequate palliative care and are subject to undesired hospital transfers and cardiopulmonary resuscitation. Although promoting advance care planning (ACP) in the community can help ensure the optimal delivery of palliative care for patients with COPD, the key challenges to routinely implementing ACP are not known. The aim of this study was to identify the perception of healthcare professionals with regard to ACP for adults living with severe COPD and the challenges to facilitating ACP. A multicenter qualitative study design was used. In-depth semistructured interviews were held involving 38 healthcare professionals from 19 institutions in Japan. Text data were analyzed by content analysis. Five main themes capturing the challenges to routine implementation of ACP were identified: daily decision-making; sense of ethical decision-making; in-depth interviewing skills; collaborative information sharing among team members; and knowledge dissemination regarding ACP. The model demonstrates the complexity inherent in ACP facilitation for community-dwelling adults with severe COPD, with all the elements required for successful ACP implementation. We recommend an approach that recognizes the importance of stakeholder education, particularly educating professionals to develop the knowledge, attitudes, and skills required for ACP facilitation: in-depth interviewing, collaborative information sharing, and ethical analysis, focusing on decision-making concerning everyday life support.
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Fujino H, Matsumura T, Saito T, Fujimura H, Imura O. Psychological Case Conference Following the Death of a Patient With Neuromuscular Disease: A Source of Emotional Support for Participating Medical Staff. J Patient Exp 2020; 7:713-716. [PMID: 33294606 PMCID: PMC7705834 DOI: 10.1177/2374373519892413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Healthcare professionals involved in the treatment and care of patients with intractable diseases, such as muscular dystrophy, increasingly encounter situations that can elicit emotional distress for them as well as the patients. Therefore, medical professionals also need support. This article describes a psychological case conference of multidisciplinary professionals involved in the treatment of a deceased patient with Duchenne muscular dystrophy. The conference aimed to support medical professionals in reflecting on and sharing their thoughts, feelings, and conflicts. Such a practice could support medical professionals in reflecting patients' thoughts and sharing their personal experiences with other staff members, which may alleviate emotional and personal conflicts. Reflecting on their interactions and dealings with patients serves this supportive function. Psychological case conferences for medical staff may serve as an opportunity for participants to feel emotionally supported and may perhaps help prevent burnout.
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Affiliation(s)
- Haruo Fujino
- Department of Special Needs Education, Oita University, Oita, Japan.,Graduate School of Human Sciences, Osaka University, Osaka, Japan
| | - Tsuyoshi Matsumura
- Department of Neurology, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Toshio Saito
- Division of Child Neurology, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Osaka, Japan
| | - Harutoshi Fujimura
- Department of Neurology, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Osamu Imura
- Graduate School of Human Sciences, Osaka University, Osaka, Japan.,Faculty of Social Studies, Nara University, Nara, Japan
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Experiences of Patient-Centered Medical Home Staff Team Members Working in Interprofessional Training Environments. J Gen Intern Med 2020; 35:2976-2982. [PMID: 32728958 PMCID: PMC7573084 DOI: 10.1007/s11606-020-06055-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Evidence is growing that interprofessional team-based models benefit providers, trainees, and patients, but less is understood about the experiences of staff who work beside trainees learning these models. OBJECTIVE To understand the experiences of staff in five VA training clinics participating in an interprofessional team-based learning initiative. DESIGN Individual semi-structured interviews with staff were conducted during site visits, qualitatively coded, and analyzed for themes across sites and participant groups. PARTICIPANTS Patient-centered medical home (PCMH) staff members (n = 32; RNs, Clinical and Clerical Associates) in non-primary care provider (PCP) roles working on teams with trainees from medicine, nursing, pharmacy, and psychology. APPROACH Benefits and challenges of working in an interprofessional, academic clinic were coded by the primary author using a hybrid inductive/directed thematic analytic approach, with review and iterative theme development by the interprofessional author team. KEY RESULTS Efforts to improve interprofessional collaboration among trainees and providers, such as increased shared leadership, have positive spillover effects for PCMH staff members. These staff members perceive themselves playing an educational role for trainees that is not always acknowledged. Playing this role, learning from the "fresh" knowledge imparted by trainees, and contributing to the future of health care all bring satisfaction to staff members. Some constraints exist for full participation in the educational efforts of the clinic. CONCLUSIONS Increased recognition of and expanded support for PCMH staff members to participate in educational endeavors is essential as interprofessional training clinics grow.
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Edwards ST, Hooker ER, Brienza R, O’Brien B, Kim H, Gilman S, Harada N, Gelberg L, Shull S, Niederhausen M, King S, Hulen E, Singh MK, Tuepker A. Association of a Multisite Interprofessional Education Initiative With Quality of Primary Care. JAMA Netw Open 2019; 2:e1915943. [PMID: 31747038 PMCID: PMC6902823 DOI: 10.1001/jamanetworkopen.2019.15943] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Studies have shown that interprofessional education (IPE) improves learner proficiencies, but few have measured the association of IPE with patient outcomes, such as clinical quality. OBJECTIVE To estimate the association of a multisite IPE initiative with quality of care. DESIGN, SETTING, AND PARTICIPANTS This study used difference-in-differences analysis of US Department of Veterans Affairs (VA) electronic health record data from July 1, 2008, to June 30, 2015. Patients cared for by resident clinicians in 5 VA academic primary care clinics that participated in the Centers of Excellence in Primary Care Education (CoEPCE), an initiative designed to promote IPE among physician, nurse practitioner, pharmacist, and psychologist trainees, were compared with patients cared for by resident clinicians in 5 regionally matched non-CoEPCE clinics using data for the 3 academic years (ie, July 1 to June 30) before and 4 academic years after the CoEPCE launch. Analysis was conducted from January 18, 2018, to January 17, 2019. MAIN OUTCOMES AND MEASURES Among patients with diabetes, outcomes included annual hemoglobin A1c, poor hemoglobin A1c control (ie, <9% or unmeasured), and annual renal test; among patients 65 years and older, outcomes included prescription of high-risk medications; among patients with hypertension, outcomes included hypertension control (ie, blood pressure, <140/90 mm Hg); and among all patients, outcomes included timely mental health referrals, primary care mental health integrated visits, and hospitalizations for ambulatory care-sensitive conditions. RESULTS A total of 44 527 patients contributed 107 686 patient-years; 49 279 (45.8%) were CoEPCE resident patient-years (mean [SD] patient age, 59.3 [15.2] years; 26 206 [53.2%] white; 8073 [16.4%] women; mean [SD] patient Elixhauser comorbidity score, 12.9 [15.1]), and 58 407 (54.2%) were non-CoEPCE resident patient-years (mean [SD] patient age, 61.8 [15.3] years; 43 912 [75.2%] white; 4915 [8.4%] women; mean [SD] patient Elixhauser comorbidity score, 13.8 [15.7]). Compared with resident clinicians who did not participate in the CoEPCE initiative, CoEPCE training was associated with improvements in the proportion of patients with diabetes with poor hemoglobin A1c control (-4.6 percentage points; 95% CI, -7.5 to -1.8 percentage points; P < .001), annual renal testing among patients with diabetes (3.2 percentage points; 95% CI, 0.6 to 5.7 percentage points; P = .02), prescription of high-risk medications among patients 65 years and older (-2.3 percentage points; 95% CI, -4.0 to -0.6 percentage points; P = .01), and timely mental health referrals (1.6 percentage points; 95% CI, 0.6 to 2.6 percentage points; P = .002). Fewer patients cared for by CoEPCE resident clinicians had a hospitalization for an ambulatory care-sensitive condition compared with patients cared for by non-CoEPCE resident clinicians in non-CoEPCE clinics (-0.4 percentage points; 95% CI, -0.9 to 0.0 percentage points; P = .01). Sensitivity analyses with alternative comparison groups yielded similar results. CONCLUSIONS AND RELEVANCE In this study, the CoEPCE initiative was associated with modest improvements in quality of care. Implementation of IPE was associated with improvements in patient outcomes and may potentiate delivery system reform efforts.
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Affiliation(s)
- Samuel T. Edwards
- Section of General Internal Medicine, Veterans Affairs Portland Health Care System, Portland, Oregon
- Department of Family Medicine, Oregon Health and Science University, Portland
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Oregon Health and Science University, Portland
| | - Elizabeth R. Hooker
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Rebecca Brienza
- Center of Excellence in Primary Care Education, Veterans Affairs Connecticut Health Care System, West Haven
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Bridget O’Brien
- Center of Excellence in Primary Care Education, Veterans Affairs San Francisco Health Care System, San Francisco, California
- Department of Medicine and Office of Medical Education, University of California, San Francisco
| | - Hyunjee Kim
- Center for Health Systems Effectiveness, Oregon Health and Science University, Portland
| | - Stuart Gilman
- Office of Academic Affiliations, Veterans Health Administration, Washington, DC
| | - Nancy Harada
- Office of Academic Affiliations, Veterans Health Administration, Washington, DC
- David Geffen School of Medicine, University of California, Los Angeles
| | - Lillian Gelberg
- David Geffen School of Medicine, University of California, Los Angeles
- Center of Excellence in Primary Care Education, Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, California
| | - Sarah Shull
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Meike Niederhausen
- Oregon Health and Science University–Portland State University School of Public Health, Oregon Health and Science University, Portland
| | - Samuel King
- Office of Academic Affiliations, Veterans Health Administration, Washington, DC
| | - Elizabeth Hulen
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Mamta K. Singh
- Center of Excellence in Primary Care Education, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
- Case Western University School of Medicine, Cleveland, Ohio
| | - Anaïs Tuepker
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Oregon Health and Science University, Portland
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Nikiforova T, Spagnoletti CL, Rothenberger SD, Jeong K, Hasley PB. Implementation of Case Conferences to Improve Interprofessional Collaboration in Resident Continuity Clinic. South Med J 2019; 112:520-525. [PMID: 31583411 DOI: 10.14423/smj.0000000000001025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Residents must be trained in skills for interprofessional collaboration and team-based care in the outpatient setting, and successful models are needed to achieve this aim. A longitudinal curriculum was developed to enhance residents' knowledge of interprofessional team members' roles, residents' attitudes toward team-based care, and patient referrals to team members. METHODS Postgraduate year 1 through postgraduate year 3 internal medicine residents with continuity clinic at a large hospital-based practice received the curriculum. Residents with continuity clinic at another site did not receive the curriculum and served as controls. Intervention residents attended five small-group conferences during the course of 1 year, each dedicated to a specific interprofessional discipline: pharmacy, psychology, diabetes/nurse education, social work, and case management. Conferences involved interactive, case-based discussions of patients who benefit from an interprofessional approach. Control and intervention residents were surveyed with pre- and posttests. The rates of patient referrals to interprofessional team members were assessed. RESULTS Seventy-one residents received the curriculum. Intervention residents' knowledge of team members' names and roles, indications for patient referral, and communication methods improved after curriculum implementation. Attitudes toward team-based care did not change but were positive at baseline. Following curriculum implementation, new patient referrals increased for the pharmacist (0.1-1/100 patient visits, P = 0.015) and psychologist (1.1-2.2/100 patient visits, P = 0.032). CONCLUSIONS Case-based interprofessional conferences improved residents' knowledge regarding interprofessional care and increased referrals to team members. This curriculum addresses barriers to team-based care experienced by residents in continuity clinic and is adaptable to other clinic settings.
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Affiliation(s)
- Tanya Nikiforova
- From the Department of Medicine, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Carla L Spagnoletti
- From the Department of Medicine, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Scott D Rothenberger
- From the Department of Medicine, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kwonho Jeong
- From the Department of Medicine, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Peggy B Hasley
- From the Department of Medicine, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Weppner WG, Davis K, Tivis R, Willis J, Fisher A, King I, Smith CS. Impact of a complex chronic care patient case conference on quality and utilization. Transl Behav Med 2018; 8:366-374. [DOI: 10.1093/tbm/ibx082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- William G Weppner
- Boise VAMC Center of Excellence in Primary Care Education, , Medical Service, Boise, ID, USA
- University of Washington School of Medicine, Department of Medicine, Seattle, WA, USA
| | - Kyle Davis
- St. Luke’s Health System, Behavioral Health Department, Boise, ID, USA
| | - Rick Tivis
- Boise VAMC Center of Excellence in Primary Care Education, , Medical Service, Boise, ID, USA
- Idaho State University, Division of Health Sciences, Meridian, ID, USA
| | - Janet Willis
- Boise VAMC Center of Excellence in Primary Care Education, , Medical Service, Boise, ID, USA
| | - Amber Fisher
- Boise VAMC Center of Excellence in Primary Care Education, , Medical Service, Boise, ID, USA
- Idaho State University, Division of Health Sciences, Meridian, ID, USA
| | - India King
- Boise VAMC Center of Excellence in Primary Care Education, , Medical Service, Boise, ID, USA
- Idaho State University, Division of Health Sciences, Meridian, ID, USA
| | - C Scott Smith
- Boise VAMC Center of Excellence in Primary Care Education, , Medical Service, Boise, ID, USA
- University of Washington School of Medicine, Department of Medicine, Seattle, WA, USA
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Sordahl J, King IC, Davis K, Tivis R, Smith SC, Fisher A, Willis J, Gordon T, Weppner WG. Interprofessional case conference: impact on learner outcomes. Transl Behav Med 2018; 8:927-931. [DOI: 10.1093/tbm/ibx018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - India C King
- Psychology Faculty, Boise VA Medical Center of Excellence for Primary Care Education, VISN 20 Virtual IMPACT HUB, Boise, ID, USA
- Idaho State University, School of Pharmacy, Meridian, ID, USA
| | - Kyle Davis
- St. Luke’s Health System, Boise, ID, USA
| | - Rick Tivis
- Boise VA Medical Center of Excellence for Primary Care Education, Boise, ID, USA
- Idaho State University, Meridian, ID, USA
| | - Scott C Smith
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA
- Department of Veterans Affairs, Office of Academic Affiliations, Centers of Excellence in Primary Care Education, Washington, DC, USA
| | - Amber Fisher
- Idaho State University, School of Pharmacy, Meridian, ID, USA
- Boise VA Medical Center of Excellence for Primary Care Education, Boise, ID, USA
| | - Janet Willis
- Boise VA Medical Center of Excellence for Primary Care Education, Boise, ID, USA
- Northwest Nazarene University, Nampa, ID, USA
| | - Timothy Gordon
- Boise VA Medical Center of Excellence for Primary Care Education, Boise, ID, USA
| | - William G Weppner
- Boise VA Medical Center of Excellence for Primary Care Education, Boise, ID, USA
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA
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Kaminetzky CP, Beste LA, Poppe AP, Doan DB, Mun HK, Woods NF, Wipf JE. Implementation of a novel population panel management curriculum among interprofessional health care trainees. BMC MEDICAL EDUCATION 2017; 17:264. [PMID: 29273028 PMCID: PMC5741920 DOI: 10.1186/s12909-017-1093-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 12/04/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Gaps in chronic disease management have led to calls for novel methods of interprofessional, team-based care. Population panel management (PPM), the process of continuous quality improvement across groups of patients, is rarely included in health professions training for physicians, nurses, or pharmacists. The feasibility and acceptance of such training across different healthcare professions is unknown. We developed and implemented a novel, interprofessional PPM curriculum targeted to diverse health professions trainees. METHODS The curriculum was implemented annually among internal medicine residents, nurse practitioner students and residents, and pharmacy residents co-located in a large, academic primary care site. Small groups of interprofessional trainees participated in supervised quarterly seminars focusing on chronic disease management (e.g., diabetes mellitus, hypertension, or chronic obstructive pulmonary disease) or processes of care (e.g., emergency department utilization for nonacute conditions or chronic opioid management). Following brief didactic presentations, trainees self-assessed their clinic performance using patient-level chart review, presented individual cases to interprofessional staff and faculty, and implemented subsequent feedback with their clinic team. We report data from 2011 to 2015. Program evaluation included post-session participant surveys regarding attitudes, knowledge and confidence towards PPM, ability to identify patients for referral to interprofessional team members, and major learning points from the session. Directed content analysis was performed on an open-ended survey question. RESULTS Trainees (n = 168) completed 122 evaluation assessments. Trainees overwhelmingly reported increased confidence in using PPM and increased knowledge about managing their patient panel. Trainees reported improved ability to identify patients who would benefit from multidisciplinary care or referral to another team member. Directed content analysis revealed that trainees viewed team members as important system resources (n = 82). CONCLUSIONS Structured interprofessional training in PPM is both feasible and acceptable to trainees across multiple professions. Curriculum participants reported improved panel management skills, increased confidence in using PPM, and increased confidence in identifying candidates for interprofessional care. The curriculum could be readily exported to other programs and contexts.
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Affiliation(s)
- Catherine P. Kaminetzky
- VA Puget Sound Health Care System, Seattle, WA USA
- Division of General Internal Medicine, University of Washington, Seattle, WA USA
| | - Lauren A. Beste
- VA Puget Sound Health Care System, Seattle, WA USA
- Division of General Internal Medicine, University of Washington, Seattle, WA USA
| | - Anne P. Poppe
- VA Puget Sound Health Care System, Seattle, WA USA
- Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA USA
| | - Daniel B. Doan
- VA Puget Sound Health Care System, Seattle, WA USA
- Division of General Internal Medicine, University of Washington, Seattle, WA USA
| | | | - Nancy Fugate Woods
- Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA USA
- de Tornyay Center for Healthy Aging, University of Washington School of Nursing, Seattle, WA USA
| | - Joyce E. Wipf
- VA Puget Sound Health Care System, Seattle, WA USA
- Division of General Internal Medicine, University of Washington, Seattle, WA USA
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O'Brien BC, Patel SR, Pearson M, Eastburn AP, Earnest GE, Strewler A, Gager K, Manuel JK, Dulay M, Bachhuber MR, Shunk R. Twelve tips for delivering successful interprofessional case conferences. MEDICAL TEACHER 2017; 39:1214-1220. [PMID: 28685632 DOI: 10.1080/0142159x.2017.1344353] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Interprofessional case conferences (ICCs) offer an interactive, practical way to engage members of two or more health professions in discussions that involve learning and working together to improve patient care. Well-orchestrated ICCs provide opportunities to integrate interprofessional (IP) education into routine clinical practice. The authors provide 12 tips to support the conceptualization, planning, implementation, facilitation, evaluation, and sustainability of ICCs. They draw from extensive experience as IP educators and facilitators of ICCs and from literature on IP education, case-based learning, small-group facilitation, peer-assisted learning, and learner engagement - all of which offer insights into ICCs but have not been integrated and applied to this context.
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Affiliation(s)
- Bridget C O'Brien
- a San Francisco Veterans Affairs Medical Center , San Francisco , CA, USA
- b Department of Medicine, School of Medicine , University of California , San Francisco , CA , USA
| | - Shalini R Patel
- a San Francisco Veterans Affairs Medical Center , San Francisco , CA, USA
- b Department of Medicine, School of Medicine , University of California , San Francisco , CA , USA
| | - Meg Pearson
- a San Francisco Veterans Affairs Medical Center , San Francisco , CA, USA
- b Department of Medicine, School of Medicine , University of California , San Francisco , CA , USA
| | - Abigail P Eastburn
- a San Francisco Veterans Affairs Medical Center , San Francisco , CA, USA
- b Department of Medicine, School of Medicine , University of California , San Francisco , CA , USA
| | - Gillian E Earnest
- a San Francisco Veterans Affairs Medical Center , San Francisco , CA, USA
- b Department of Medicine, School of Medicine , University of California , San Francisco , CA , USA
| | - Anna Strewler
- a San Francisco Veterans Affairs Medical Center , San Francisco , CA, USA
- c Department of Community Health Systems , School of Nursing, University of California , San Francisco , CA , USA
| | - Krista Gager
- a San Francisco Veterans Affairs Medical Center , San Francisco , CA, USA
- c Department of Community Health Systems , School of Nursing, University of California , San Francisco , CA , USA
| | - Jennifer K Manuel
- a San Francisco Veterans Affairs Medical Center , San Francisco , CA, USA
- d Department of Psychiatry, School of Medicine , University of California , San Francisco , CA , USA
| | - Maya Dulay
- a San Francisco Veterans Affairs Medical Center , San Francisco , CA, USA
- b Department of Medicine, School of Medicine , University of California , San Francisco , CA , USA
| | - Melissa R Bachhuber
- a San Francisco Veterans Affairs Medical Center , San Francisco , CA, USA
- b Department of Medicine, School of Medicine , University of California , San Francisco , CA , USA
| | - Rebecca Shunk
- a San Francisco Veterans Affairs Medical Center , San Francisco , CA, USA
- b Department of Medicine, School of Medicine , University of California , San Francisco , CA , USA
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Sklar DP. Interprofessional Education and Collaborative Practice-If Not Now, When? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:747-749. [PMID: 27218897 DOI: 10.1097/acm.0000000000001179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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