Bobby Lowery, PhD, FNP-BC, FAANP
NPSS, April 1, 2015
10:30AM-11:30AM
“Enhancing the Primary Care
Management of Patients with
Multiple Chronic Conditions through
Interprofessional Education"
Pirate Welcome….arrGH!
Declaration of Interest
Enhancing the Primary Care Management of Patients with Multiple Chronic Conditions through Interprofessional Education, East Carolina University College of Nursing, Greenville, N.C.
This project is supported in part by funds from the Division of Nursing (DN), Bureaus of Health Professions (BHPr), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS) under grant number D09HP25923-01-00, Advanced Nursing Education Grants, for $1,091,723. The information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by the Division of Nursing, BHPr, HRSA, DHHS or the U.S. Government.
Objectives
• At the conclusion of this session the learner will be
able to:
1. Understand and apply IPEC core competencies for
interprofessional practice.
2. Recognize the process of educating interprofessional
teams to improve healthcare.
3. Identify the four core interprofessional competencies
that are linked to the five IOM core competencies for all health professionals.
Nursing and Interprofessional
Healthcare
Patient Pharmacy Medicine Nutrition Rehab Radiology Social Work Mental Health Informatics HousekeepingRecommended Reading
• Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative. – Accessed 10/14/14 @ http://www.aacn.nche.e du/education-resources/ipecreport.pdfHistorical Context of
Interprofessional Education
• Traced from World War II
• President Johnson’s vision of The Great
Society
– Dewitt Baldwin, 2006
– Adapted with permission
• Greer, A. (2014) “IPE (Interprofessional Education) in
Health Sciences: Who’s in the Game? Current and Past Players”. Medical History Interest Group Presentation, East Carolina University, Greenville, NC.
International Historical Context
• India (pre-1900)
– Mission hospitals sent out teams of physicians, nurses and
‘auxiliaries’ to provide health services to remote
communities.
• England (1920)—Dawson Report, Great Britain
– Advocated a ‘team approach’ to health care
– Peckham Experiment at London’s Pioneer Health Centre
promoted the idea of collaborative health care teams
• South Africa & Israel (1954)
– Implemented the concept of primary health teams in their
community-based health programs (1954).
US Historical Context
Richard Cabot• Massachusetts General Hospital
• ‘‘teamwork of the doctor, the educator, and the social worker’’ (Cabot, 1915).
Historical Nursing Context
• Rogers, Dorothy (1932).
Teamwork within the
Hospital. The American
Journal of Nursing. Vol.
32, No. 6 (Jun., 1932),
pp. 657-659
•
http://www.jstor.org/st
able/3410854
• Means of achieving
professional acceptance
for nursing and allied
health.
Evolutions In Healthcare
Need for Healthcare Leadership!
Interprofessional Education—How
do YOU define it?
“When students from two or
more professions learn
about, from and
with each other to enable effective collaboration and
improve health outcomes” (WHO, 2010)
Why IPE?
To prepare all health professions students
• Deliberatively working together
• Safer and better patient-centered and
community/population oriented
health care
system.
Interprofessionality
• “The process by which professionals reflect on and develop
ways of practicing that provides an integrated and cohesive
answer to the needs of the client/family/population… It
involves continuous interaction and knowledge sharing between professionals, organized to solve or explore a variety of education and care issues all while seeking to
optimize the patient’s participation…
• Requires a paradigm shift, since interprofessional practice
has unique characteristics in terms of values, codes of conduct, and ways of working. These characteristics must be elucidated” (D’Amour and Oandasan, 2005, p. 9).
IPE: Contemporary Linkages
• 2002 IOM HealthProfessions Summit
• 2009—IPEC
• 2010 – IOM Report FON
• 2010 Cronenwett & Dzau
• 2012 IOM - Best Practice Innovation Collaborative
• 2013 Josiah Macey Report – Triple Aim
– Professionals Working Together
– Patient-Centered
Triple Aim
Better Care for Individuals, Better Health for Populations, Lower per capita costs
• Safe
• Effective
• Patient Centered
• Efficient
• Timely
• Equitable
Interprofessionality Communication Roles and Responsibilities Teams and Teamwork Values and EthicsConstructs in the Measurement of IPE: The IPEC Core Competencies for Interprofessional Collaborative Practice
IPC—Effective/Ineffective?
•
https://www.youtube.c
om/watch?v=CtdNQ-sfKg8
Interprofessionality – Communication – Roles and Responsibilities– Teams and Teamwork – Values and Ethics
IPC—Effective/Ineffective?
•
https://www.youtube.c
om/watch?v=fsazEArBy
2g&list=PLECF674CD5E
0ECD1F
Interprofessionality – Communication – Roles and Responsibilities
– Teams and Teamwork – Values and Ethics
Interprofessionality Communication Roles and Responsibilities Teams and Teamwork Values and Ethics
Constructs in the Measurement of IPE: The IPEC Core Competencies for Interprofessional Collaborative Practice
Interprofessional Teams
• Two or more disciplines• Common purpose • Work together collaboratively and interdependently • Serve a specific patient/client population and achieve the team’s and organization’s goals and objectives
• Interprofessional Education Collaborative Expert Panel. (2011). Core
competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative.
Interprofessional teamwork:
The levels of cooperation, coordination
and collaboration characterizing the
relationships
between professions
in
delivering
patient-centered
care
Interprofessional
team-based care
Intentionally created
, usually
relatively small
work groups in health care
1. recognized by others as well as by
themselves
2. collective identity and shared responsibility
3. for a patient or group of patients
rapid response team, palliative care team,
primary care team
, operating room team
Role Clarity
– The specific role of each team member is vitally important – Enables increased
collaboration – Role Clarity and overlap – Common roles in primary
care settings – How the NP can provide
leadership in role clarity.
Enhancing the Primary Care Management of Patients with Multiple Chronic Conditions through Interprofessional Education
Purpose
• HRSA Advanced Nursing Education Grant $1,091,723 over 3 yrs.
• Address the health care needs of individuals in rural communities with multiple chronic conditions (MCC)
Method
1. IPE strategies/competencies in
AGNP & FNP curriculum
2. Interprofessional learning
scenarios in VCCLE
3. Didactic & clinical content in
management MCC infused into OSCAE
4. Promote/evaluate IPE
competencies by clinicians/students in rural, underserved community serving diverse, ethnic minority population
Enhancing the Primary Care Management of Patients with Multiple Chronic Conditions Through Interprofessional
Education
B. Lowery, PhD, FNP-BC, FAANP; C. King, DNP, FNP-BC, K. Faser, M. Skipper, DNP, FNP-BC, E. Feldhousen, PhD, LMFT
M E T H O D O L O G Y G O A L
C L I N I C A L PA R T N E R S
The overall goal of this project is to graduate AGNP and FNP students who can provide evidence-based primary care to individuals with MCC within an interprofessional framework to clients living in rural underserved communities through the processes outlined in the objectives.
The objectives of this proposal are to: 1) Infuse IPE competencies (values/ethics, roles and responsibilities,
interprofessional communication, and teams and teamwork) throughout the AGNP and FNP curriculum; 2) Create case-based interprofessional learning scenarios in the
VCCLE that address the IPE core competencies in the management of individuals with MCC, including those due to occupational causes;
3) Develop and expand clinical and didactic content in the management of individuals with MCC living in rural communities through interprofessional OSCAE experiences; and 4) Promote and evaluate IPE competencies used by clinicians, faculty,
and students practicing in a rural, underserved community serving a diverse, ethnic minority population.
As leaders in complex health settings, NPs must understand and apply IPEC core competencies for interprofessional practice to ensure consumer access to high quality primary health care, especially in rural, underserved settings. This work focuses on educating teams and integrating advanced practice providers in the clinical practice environment. Process and outcome evaluation of IPE will utilize the four core interprofessional competencies that are linked to the five IOM core competencies for all health professionals.
College of Nursing East Carolina University Greenville, North Carolina [email protected] R E C O M M E N D AT I O N S
Objective #3: Standardized IPC OSCAE experiences Objective #2: Case-based interprofessional learning scenarios in the VCCLE in the management of individuals with MCC, including those due to occupational causes
Objective #1: Infused IPE competencies (values/ethics, roles and responsibilities, interprofessional communication, and teams and teamwork) throughout the AGNP and FNP curriculum
Practice IPC in health care delivery Funding priorities/Incentives for IPE models of care Education
IPE Technology as a methodology of teaching IPE Objective #4: Promote IPE competencies used by clinicians, faculty, and students practicing in a rural, underserved community serving a diverse, ethnic minority population
“
Virtual Clinic - Opening the Clinic Door to Interprofessional Education and Practice”• VCCLE can transform an online course medium into a high-quality, exciting distance learning experience.
• Interprofessional cooperation maximizes fiscal and human resources in support of student learning.
• Lowery, B., Corbett, R. W., King, C. A., Brown, S. T., & Faser Jr., K. E. (2014). Virtual Clinic—Opening the clinic door to interprofessional education and practice. The Journal for Nurse Practitioners, 10(10), e69-e76.
doi:http://dx.doi.org/10.1016/j.nurpra.2014.08.021
Standardized IPE experience
Office of Clinical Skills
Assessment & Education (OSCAE)
What’s an OSCAE?
• Objective Structured Clinical Examination
– Learners have limited time to gather and share information, make decisions and foster the relationship.
• Script/Scenario:
– The patient’s story and background information used to standardize the portrayal.
• Standard Scenarios: global content that can support multiple disciplines (“as is” or customized).
• Pilot Scenarios: developed for grants, research and licensure preparation.
• Checklist
– A faculty driven compilation of history, communication skills and/or physical exam items that a learner is expected to explore as they confirm/refute the differential diagnoses (“as is” or customized).
Standardized Patients
• A person who has been
coached to accurately
and consistently portray
– History – Physical Findings – Personality – Emotions – Behavior
• Portrays these
parameters.
• Evaluates
pre-determined
IPEC
for a
given case for
standardized
evaluation.
Interprofessional OSCAE
Experiences
• September 25, 2014
• December 11, 2014
– NP – Medicine – Nutrition – Social Work – Physician Assistants• PT, Dentistry do not use OSCAE
Interprofessional Education and Collaboration
Partnership
Robeson Healthcare Corporation
Thomas E. Maynor, II, MD, MPH Deputy CEO/ Chief Operating Officer
Julian T. Pierce Health Center, Pembroke
Allison Jacobs, FNP
Lumberton Health Center Robin Peace, MD Sonia Duggal, MD Elena Hierseman, PA Shawana Faulk, FNP-C Maxton Medical Center
Eugene Nor, MD Thomas Rinkacs FNP
South Robeson Medical Center, Fairmont
Brenda Allen, FNP
Leslie Oxendine, FNP
Robin Yolanda Peace, MD Vice President/Chief Medical
Officer
Interprofessional Education Competencies
|Collaboration Opportunities|Missed Opportunities
– ACO/Medical Home
• Pre-Huddle
– Use of the four IPEC Core Competencies for Interprofessional Collaborative Practice for EHR /IT templates
First Ebola Case in US
• How IPEC could have
made a difference
– 9/25/14—Duncan goes to ER
• Nurse Documents Africa Travel
• Information never makes it to the Attending – 9/26/14—Discharged – 9/27/14—Returns to ER – 9/28/14—Blame Game
IPE Reflection
• A solution of siloed
practice
• Reflection on IPE
– What did/did not work? – Does it address the
Triple Aim?
• NPs can (and must)
LEAD interprofessional
teams in clinical
practice.
Future Trends:
Transition To Practice
• Current discussion of
transition programs
– Assist with transitioning from student role to APRN role/IPEC – Mentoring Relationships
• TTP in DNP programs • Post-grad. TTP
– (not supported as a
REQUIREMENT for entry
• What is
YOUR
study
• Share with elected
officials
– Invite to your practice – Demonstrate APRN
leadership on interprofessional teams.
What we have discussed
1. Understand and apply
IPEC core competencies
for
interprofessional practice.
– Effective and ineffective interprofessional collaboration
2. Recognize the process of educating
interprofessional teams
to improve healthcare.
– NP leadership in interprofessional settings.
3. Identify the four core
interprofessional
competencies
that are linked to the five IOM core
competencies for all health professionals.
Websites
• American Interprofessional Health Collaborative:
http://www.aihc-us.org/
• Canadian Interprofessional Health Collaborative:
http://www.cihc.ca/
• Centre for the Advancement of Interprofessional Education:
http://caipe.org.uk/
• Interprofessional Education Collaborative:
https://ipecollaborative.org/
• WHO Framework for Action on Interprofessional Education and Collaborative Practice:
http://www.who.int/hrh/resources/framework_action/en/ind ex.html
Centers for Interprofessional Education
Thomas Jefferson University
University of California San Francisco
University of Kansas
University of Minnesota
University of Washington
References
1. Abu-Rish et al. (2011). Current trends in interprofessional education of health sciences students: A literature review. Journal of Interprofessional
Care, 26, 444-451.
2. Baldwin, D.C. Jr., (1996). Some historical notes on interdisciplinary and interprofessional education and practice in health care in the USA.
Journal of Interprofessional Care, 1996; 10(2): 173-187.
3. Barr, H., Koppel, I., Reeves, S., Hammick, M. & Freeth, D. (2005). Effective interprofessional education. Argument, assumption, and evidence. Malden, MA: Blackwell Publishing.
4. Curran V., Hollet, A., Casimiro, L.M., et al. (2011). Development and validation of the Interprofessional Collaborator Assessment Rubric (ICAR).
Journal of Interprofessional Care, 25, 339-44.
5. D’Amour, D. & Oandasan, I. (2005). Interprofessionality as the field of interprofessional practice and interprofessional education: An emerging concept. Journal of Interprofessional Care, 19 (Supplement 1), 8-20.
6. Greer, A. (2014) “IPE (Interprofessional Education) in Health Sciences: Who’s in the Game? Current and Past Players”. Medical History Interest Group Presentation, East Carolina University, Greenville, NC.
7. Giddens, J., Fogg, L., & Carlson-Sabelli, L. (2010). Learning and engagement with a virtual community by undergraduate nursing students.
Nursing Outlook, 58(5), 261-267. DOI: 10.1016/j.outlook.2010.08.001
8. Institute of Medicine. (2003). Health Professions Education: A Bridge to Quality. Washington, DC: The National Academies Press. 9. Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an
expert panel. Washington, D.C.: Interprofessional Education Collaborative.
10. King, S. et al. (2012). Developing interprofessional health competencies in a virtual world. Medical Education Online, 17,
http://dx.doi.org/10.3402/meo.v17i0.11213.
11. Kolb, D. (1981). Learning styles and disciplinary differences. In A.W. Chickering & Associates (Eds.), The modern American college: Responding to
new realities of diverse students and a changing society (p. 232-255). San Francisco: Jossey-Bass.
12. Langdon, H. (2009). Interprofessional education in higher education institutions: models, pedagogies, and realities. In P. Bluteau & A. Jackson (Eds.), Interprofessional education. Making it happen (p. 37-58). Hampshire, England: Palgrave Macmillan.
13. Lowery, B., Corbett, R. W., King, C. A., Brown, S. T., & Faser Jr., K. E. (2014). Virtual Clinic—Opening the clinic door to interprofessional education and practice. The Journal for Nurse Practitioners, 10(10), e69-e76. doi:http://dx.doi.org/10.1016/j.nurpra.2014.08.021 14. Luke, R. et al. (2009). Online interprofessional health sciences education: From theory to practice. Journal of Continuing Education in the Health
Sciences, 29, 161-167.
15. Walsh, M. & van Soeren, M. (2012). Interprofessional learning and virtual communities: An opportunity for the future. Journal of
Interprofessional Care, 26, 43-48.
B. Lowery 44
