Innovative Interprofessional
Education and Collaborative
Practice Models
2013 AACP Annual Meeting, Chicago, IL
Presenters
• Dr. Abby A. Kahaleh
Roosevelt University College of Pharmacy • Dr. Jennifer Danielson
University of Washington College of Pharmacy • Dr. Kari L. Franson
University of Colorado School of Pharmacy University of Colorado School of Pharmacy • Dr. Wesley A. Nuffer
University of Colorado School of Pharmacy • Dr. Hoai-An Truong
University of Maryland Eastern Shore School of Pharmacy • Dr. Elena M. Umland
Program Description
The main purpose of this program is to examine effective strategies for establishing g g
interprofessional education (IPE) models for pharmacy students nationwide
Program Objectives
1. Describe the key concepts of the IPEC & IOM reports (Abby)
2. Evaluate teams and teamwork across an IPE curriculum (the University of Washington initiative) (Jennifer)
3. Examine student perceptions of professional roles and responsibilities across the IPE curriculum (Kari)( )
4. Describe IPE experiential experiences that were successfully implemented in Colorado (Wes)
5. Examine the challenges for implementing IPE collaborative practice model in Maryland and strategies to overcome them (Hoi-An) 6. Assessing IPE experiences (Elena)
Rationale
• Working on an interdisciplinary team as one
of five core competencies for health care professionals (IOM Report: Health Professions
Ed ti A B id t Q lit )
Education: A Bridge to Quality)
• Studies have shown improved patient
outcomes…when health care professionals
work together (AACP Issue Brief citing IOM’s
call for a new health system for 21stcentury for primary health care teams)
Interprofessional Education
Collaborative (IPEC) Sponsors
• American Association of Colleges of Pharmacy • American Association of Medical Colleges • American Association of Colleges of • American Association of Colleges of
Osteopathic Medicine
• American Association of Colleges of Nursing • American Dental Education Association • Association of Schools of Public Health
IPEC Report: Core Domains
I. Values and Ethics for Interprofessional Practice
II. Roles and Responsibilities III. Interprofessional Communication IV. Teams and Teamwork
Interprofessional Education Initiative University of Washington
Jennifer Danielson, PharmD, MBA, CDE Director of Experiential Education, Introductory
Practice Assistant Professor
IPE Activities
1. Acute Care Simulation ………..…….May
– MD, PharmD, BSN, PA
– High fidelity scenarios: SVT code, respiratory distress, post-partum hemorrhage
2. Medication Error Disclosure………..……March
– MD, PharmD, BSN, PA
– Role play scenario: team disclosure to family member
3. Team-Based Clinical Problem Solving………October
– MD, PharmD, BSN, PA, social work
– Technology enhanced active learning: difficult patient
• Common Book Discussions
• Volunteer/Student-driven service learning
• IPE Teaching Scholar Program
• Other selected programs, courses, activities, seminars
Strategic Vision
To create an integrated, collaborative learning system across the health and related professions that connects disciplines, promotes teamwork, fosters mutual understanding, strengthens research, and advances health for individuals and populations. Mechanisms
•Progressive integration into core curriculum •Progressive integration into core curriculum •Service learning/collaborative practice •Joint Curriculum Advisory Committee •Faculty development
Medicine (2ndand 3rd)
Nursing (BSN Juniors and Seniors)
( d h)
Pharmacy (3rdand 4th)
Physician Assistant (1st- 2nd)
Medicine (2ndand 3rd)
Nursing (BSN Juniors and Seniors)
( d h)
NPs?
Pharmacy (3rdand 4th)
Physician Assistant (1st- 2nd)
Dentistry ? Social Work ? Public Health
? UW IPE Curriculum Phase 3 Figure adapted from Compton, L., & Davis, N. (2010). The impact of and key elements for a successful virtual early field experience. Contemporary Issues in Technology and Teacher Education, 10(3). http://www.citejournal.org/vol10/iss3/general/article1.cfm Phase 2 Phase 1
Phase 3 aculty Dev e lo pmen t UW IPE Curriculum Phase 1 Phase 2 F
Integrated Curriculum
5 6 7 1. Team-building (TeamSTEPPS)2. Team-based primary care
3. Inpatient clinical problem solving 4. Root cause analysis: hospital infection
1 2
3 4
5. Medication error disclosure 6. Dental emergencies 7. Post-deployment care Year 3 aculty Dev e lo pmen t UW IPE Curriculum Year 1 Year 2 F Service Learning
Year 3 aculty Dev e lo pmen t UW IPE Curriculum Research and Team Clinical Placements Year 1 Year 2 F and Scholarly Pursuit Service Learning Year 3 aculty Dev e lo pmen t Seminar UW IPE Curriculum Research and Team Clinical Placements Year 1 Year 2 Seminar F Seminar and Scholarly Pursuit Service Learning
IPE Evaluation Tools
• AMUSE1
– Attitudes, motivation, utility, self-efficacy • Semi-quantitative assessment of
learning about roles/responsibilities2
learning about roles/responsibilities – Measures movement in understanding of roles • Others in literature about attitudes and
collaboration in practice 1. Brock D, et al. Quality & Safety in Health Care 2013;0:1‐10.
2. McDonough K, et al. Interprofessional student case discussion increases understanding of other professions’ roles. AAMC WGSA/WGEA/WOSR Joint Meeting.
Longitudinal IPE using
small IPE group sessions
• Interprofessional orientation (1 day): 6 hours ofprofessional qualities and collaboration
• Interprofessional fundamentals (2 years): 12 hours of team work collaboration QI and safety
team work, collaboration, QI, and safety
• Interprofessional ethics (1 year): 20 hours of ethical theory, professional ethics, and interprofessional approaches to decision making
• Clinical transformations (1 year): 4 hours of video monitored simulation exercises of teamSTEPPS (Strategies and Tools to Enhance Performance and Patient Safety) process
IPEC competency:
Roles & responsibilities
Kari L. Franson, PharmD, PhD Associate Dean for Professional Education,
Department of Clinical Pharmacy
IPEC competency:
Roles & responsibilities
• Use the knowledge of one’s own role and those of other professions to appropriately assess and address the healthcare needs of
th ti t d l ti d
the patients and populations served • The Role Perception Questionnaire (RPQ)
Mackay S, J of Interprofessional Care 2004;18(3):289-302
Experiential Interprofessional Activities in Colorado APPE Site Communities
Wesley Nuffer, PharmD, BCPS, CDE Assistant Director of Experiential Programs
Assistant Professor
Experiential IPE- Colorado
• Focus on rural communities
– DSM centers available for student collaboration
Preferred student placement 48 weeks/year – Preferred student placement 48 weeks/year
• Funding for IPE activities through Kaiser Foundation
– Focused on 3 schools (Medicine, Dental Medicine, Pharmacy)
Goal of Project
• Placing students together to facilitate interprofessional activities in
rural/underserved areas
• Provide service to these areas while promoting interprofessional education
Coordination through AHEC
• Area Health Education Centers placed students in rural housing
– Received information from various programs regarding student placementg g p
– Coordination of students for local events
• Centralized coordination
– Getting students to the right places at the right times
– Putting students in touch with each other
Service Learning
Opportunities
• Health fairs, health screenings • School shows, career talks • Disease focused presentations • Disease-focused presentations
AHEC-Coordinated Events
Estimated Number of Rural Community Participants Involved in the Medical Student Community Service Learning Activity
Funding Year
Approximately how many people attended your activity/presentation?
Approximately how many people that attended your activity/presentation were… Adults Children/ Adolescents Under-represented Minorities 2009-2010 7,512 4,041 3,654 1,584 2010-2011 7,296 2,755 4,537 1,962 2011-2012 7,312 4,215 3,021 2,304 Total Participants (n) 22,120 11,011 11,212 5,850
Interdisciplinary Contacts Occurring during Community Service Learning Projects (10/2011 – 5/2012)
Osteopathy Pharm PT Public Health PA OT
Social
Work Speech Dental Nurs Total
2010-11
19 35 15 22 18 15 15 15 15 30 199
2011-12 44 68 44 49 52 41 57 43 43 98 539
Total 63 103 59 71 70 56 72 58 58 128 738
Evolution of Services
• Shift from service-learning activities to patient-care activities
– Begin to focus on objectives/outcomes
• Roles & responsibilities • Roles & responsibilities • Interprofessional communication • Teams & teamwork
– Integrate preceptors into teams
• Promotes interprofessionalism at each practice site • Not necessarily same demographic location
Outcomes of Collaborative
• More unified site selection
– Focus on similar geographic locations – Cross-recruitmentCross recruitment
• Appreciation of logistical challenges – Site placement, clinical rotations vary
across schools
– Demands from on-site faculty/preceptors – Many barriers overcome
Challenges to Experiential IPE
• Scheduling
– Rotation blocks varied
– Identifying mutual time to collaborate – Avoid placing burden on site
• Student placement
– Overlapping sites within a community – Overlapping times for student placement – Mutual goal for promoting IPE activity
Interprofessional Collaborative Model in Maryland for Clinical Practice and Experiential Education Opportunities
Hoai-An Truong, PharmD, MPH Associate Professor of Pharmacy Practice
Assistant Dean for Professional Affairs University of Maryland Eastern Shore School of Pharmacy and Health Professions
“making healthcare happen”
Acknowledgement of Partners & Team Members: Primary Care Coalition of Montgomery County
Mercy Health Clinic ALFA Specialty Pharmacy University of Maryland Baltimore School of Pharmacy University of Maryland Eastern Shore School of Pharmacy
Maryland Pharmacists Association Delmarva Foundation Quality Improvement Organization
Rosemary Botchway, MS HCA
Director, Center for Medicine Access Primary Care Coalition of Montgomery County
Nancy Ripp, MD
Medical Director Mercy Health Clinic
40
Diem-Thanh (Tanya) Dang
Coordinator, Center for Medicine Access Primary Care Coalition of Montgomery County
Heather B. Congdon, PharmD, BCPS, CDE
Assistant Dean & Assistant Professor University of Maryland School of Pharmacy
Faramarz and Fariborz Zarfeshan, RPh
Co-Owners and MTM Pharmacists ALFA Specialty Pharmacy
Donna Romer, RN
Nurse Mercy Health Clinic
Howard Schiff, PD
Executive Director Maryland Pharmacists Association
Jennifer Thomas, PharmD
Pharmacy Services Manager Delmarva Foundation QIO
Partnership Roles
• Primary Care Coalition of Montgomery County
– Facilitates project and serves as liaison between Primary Care Clinics and pharmacists for MTM services
• Mercy Health Clinic
– Provides the patient population receiving MTM and experiential rotation site for pharmacy students and residents
rotation site for pharmacy students and residents • University of Maryland Baltimore School of Pharmacy
– Provides faculty pharmacist’s expertise and time for MTM and facilitates experiential rotations for students and residents • University of Maryland Eastern Shore School of pharmacy
– Provides faculty pharmacist’s expertise and time for MTM and facilitates experiential rotations for students and residents • ALFA Specialty Pharmacy
– Provides pharmacist’s expertise and time for MTM and precepts students
Partnership Roles
• Maryland Pharmacists Association
– Promotes and supports pharmacists professional development to enhance patient care and health outcomes
• Delmarva Foundation for Medical Care QIO
W k ith t ll ti f d t ti d l i
– Works with teams on collection of data, aggregation and analysis of data, provides reports for HRSA and CMS, supports quality improvement process, and provides other technical assistance
Challenges
• Patient identification and referral • Availability of interpretation service • Availability of physician for consult • Availability of physician for consult • Funding and resources
• Experiential preceptor/site development
Strategies
• Academic/physician detailing
• Model for improvement and change packet • Pilot implementation for 6 monthsp
• Leadership and staff support
• Multiple partnerships and collaborations • Patient navigator and reminder
• MTM Documentation and Outcomes Tracking Tools (MTM-DOTT)
HRSA Patient Safety and Clinical Pharmacy Services Collaborative (PSPC)
• Aim to save and enhance thousands of lives a year by:
Achieving optimal – Achieving optimal
health care outcomes – Eliminating adverse drug events – Increasing clinical pharmacy services http://www.hrsa.gov/publichealth/clinical/ patientsafety/index.html
What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that
will result in improvement? Model for Improvement
Act Plan
Study Do
G. Langley et al. (1996),
The Improvement Guide: A Practical Approach to Enhancing Organizational Performance,
Jossey-Bass Publishers, San Francisco.
MTM Documentation and Outcomes Tracking Tools (MTM-DOTT): Medication History
Source: Truong HA, Groves CN, Congdon HB, Botchway R, Dang DT, Clark NR, Zarfeshan F. Interprofessional collaborative model for medication therapy management (MTM) services to improve health care access and quality for underserved populations. Journal of Health Care for the
Poor and Underserved. 2012; 23(3):114–124.
MTM Documentation and Outcomes Tracking Tools (MTM-DOTT): Subjective & History Info.
MTM Documentation and Outcomes Tracking Tools (MTM-DOTT): Assessment and Plan
49
Source: Truong HA, Groves CN, Congdon HB, Botchway R, Dang DT, Clark NR, Zarfeshan F. Interprofessional collaborative model for medication therapy management (MTM) services to improve health care access and quality for underserved populations. Journal of Health Care for the
Poor and Underserved. 2012; 23(3):114–124.
MTM Documentation and Outcomes Tracking Tools (MTM-DOTT)
50
Source: Truong HA, Groves CN, Congdon HB, Botchway R, Dang DT, Clark NR, Zarfeshan F. Interprofessional collaborative model for medication therapy management (MTM) services to improve health care access and quality for underserved populations. Journal of Health Care for the
Poor and Underserved. 2012; 23(3):114–124.
Medication-Related Problems
Prevalence
Interventions: 36-Months Result (10/1/2009 to 9/30/2012)
# of patients: 215
# medications at visits: 1723 [average 8 meds/pt. visit]
# chronic conditions: 965 [average 4.5 conditions/pt.]
Medication-related problems: 554 [average 2 6 MRPs/pt ]
A Collaborative Effort Between the Patient and the Pharmacist
Wh t th P ti t
52
• What the Patient
Need to Do Now?
Changes Leading to Impact
• Implementation of MTM Documentation and Outcomes Tracking Tools (MTM-DOTT) • Provider-Identified Referrals
• Validation of Scheduled Appointments • Validation of Scheduled Appointments • Application of MTM model and process • Interprofessional Collaboration • Multiple Partnerships
Assessment of IPE
Experiences
El M U l d Ph D
Elena M. Umland, PharmD Associate Dean for Academic Affairs
Professor of Pharmacy Practice Jefferson School of Pharmacy
Thomas Jefferson University
Thomas Jefferson University The Health Mentors Program
• The basics
– Two-year, required longitudinal experience for all couples and family therapy, medical, nursing, occupational therapy, pharmacy and physical therapy students beginning in their first year
– Student teams are assigned a health mentor – First cohort matriculated in the Fall of 2007 • Program goals
Ill t t th l f th t ib ti d b h b f th – Illustrate the value of the contributions made by each member of the
interprofessional healthcare team
– Show the importance of the patient’s perspective and the value patient-centered care
– Provide the opportunity for students to observe how a person’s health conditions and/or impairments interact with personal and environmental factors
• Four modules over 2 years – Comprehensive life and health history – Wellness planning
– Patient safety
– Self-management support and healthy behavior
Health Mentors Program Assessment Tools • Cohorts 1 and 2
– Chronic Illness Survey (CIS) [C. Arenson and colleagues, 2008]
– Interdisciplinary Education Perception Scale (IEPS) [R. Luecht and colleagues, 1990] – Readiness for Interprofessional Learning Scale (RIPLS) [G. Parsell and J. Bligh, 1999] – Physician – Nurse Collaboration Tool [M. Hojat and colleagues, 1999] • Cohort 3
– Added…
• Attitudes Towards Healthcare Teams [G.D. Heinemann and colleagues, 1999]
• Roles of Health Professions [G. Nisbet and colleagues, 2008]
• Reflection papers using prompts
– Minimized…
• IEPS and Attitudes Towards Healthcare TeamsIEPS and Attitudes Towards Healthcare Teams
– Removed…
• RIPLS
• Cohort 4 – Added…
• Team Performance Survey [B.M. Thompson and colleagues, 2009] • Peer and self evaluations
– Removed…
• IEPS
• Cohort 5 – Added…
• Student Stereotypes Rating Scale [D. Barnes and colleagues, 2000] • Student interviews
– Removed
• CIS
Health Mentors Program Assessment Tools
Cohorts 1 and 2
Cohort 3 Cohort 4 Cohort 5 Cohort 6 CIS
IEPS RIPLS Reflection Papers Attitudes
Roles Revised Roles
Tool
Peer/Self Evaluations TPS
SSRQ Student Interviews
Assessment Tools Linkage with Core
Competencies
IEPS Attitudes Roles Peer/ Self Evaluations TPS Reflection Papers Values/ Ethics X X Roles/ Responsibilities X X X X X Interprofessional Communication X X X X X Teams & Teamwork X X X X X
Reflections on the Health Mentors Assessment Program
• Robust…but
– did it address what we needed it to address? was it ‘too much’?
– was it too much ?
– how is it all being managed?
Reflections on the Health Mentors Assessment Program
• Robust…and we learned that our students – ARE ready for IPE
– DO learn about and better understand each others’ professions (as well as their own) others professions (as well as their own) – DO value the patient and the patient’s role in
their care
– DO have room to grow in better appreciating and respecting each others’ professions – DO want to provide patient-centered,
collaborative care
Moving Forward: Assessment of IPE at Thomas Jefferson University
• Ensuring that there is ‘connection’ between what we are teaching and the practice sites where our students receive their clinical/practical education
• Creation / addition of questions on preceptor evaluations of students and student evaluations of preceptor/ site
Moving Forward: Assessment
of IPE Globally
• How do we know that, as a result of XYZ, our graduates will be competent in providing patient-centered collaborative care?
• Are we realizing improvements in patient outcomes as a result?
Assessment References
• Arenson CA, Rattner S, Borden C, et al. Cross-sectional assessment of medical andnursing students’ attitudes toward chronic illness at matriculation and graduation. Academic Medicine 2008;83(10):S93-S96.
• Luecht RM, Madsen MK, Taugher MP, et al. Assessing professional perceptions: design and validation of an interdisciplinary education perception scale. J Allied Health 1990;19:181-91.
• Parsell G, Bligh J. The development of a questionnaire to assess the readiness for healthcare students for interprofessional learning (RIPLS). Medical Education 1999;33:95-100.
• Hojat M Fields SK Veloski JJ et al Psychometric properties of an attitude scale • Hojat M, Fields SK, Veloski JJ, et al. Psychometric properties of an attitude scale
measuring physician-nurse collaboration. Evaluation and the Health Professions1999;22:208-220.
• Heinemann GD, Schmitt MH, Farrell MP, et al. Development of an attitudes toward health care teams scale. Evaluation and the Health Professions 1999;22:123-142. • Nisbet G, Hendry GD, Rolls G, et al. Interprofessional learning for pre-qualification health
care students: an outcomes-based evaluation. J Interprof Care 2008;22(1):57-68. • Thompson BM, Levine RE, Kennedy F, et al. Evaluating the quality of learning-team
processes in medical education: development and validation of a new measure. Academic Medicine 2009;84(10):S124-S127.
• Barnes D, Carpenter J, Dickinson C. Interprofessional education for community mental health: attitudes to community care and professional stereotypes. Social Work Education 2000;19:564-583.
Interactive Session
• SWOT Analyses: • Strengths • Strengths • Weaknesses • Opportunity • ThreatConcluding remarks
• Common themes among national IPE programs
• Standardized assessment toolsStandardized assessment tools • ACPE Guidelines
