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Using Interprofessional Education to Improve Care for Patients with Multiple Chronic Conditions

This Interprofessional Education (IPE) program uses simulation, standardized patients, unfolding case studies, and distance education to integrate interprofessional education. This type of experience fosters future collaborations among health care providers.

Health Resources and Services Administration (HRSA)
7/1/2013 – 6/30/2016

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Abstract

Washington State University (WSU)’s College of Nursing has received funding from the Health Resources and Services Administration. The 3-year grant is titled “Using Interprofessional Education to Improve Care for Patients with Multiple Chronic Conditions Initiative (IPE Initiative)”. Through the IPE initiative, WSU College of Nursing has assembled an interprofessional (IP) cohort of faculty across disciplines to provide training and education on innovative approaches to interprofessional education. Faculty are being trained on methods around collaborative care for patients with multiple chronic conditions as well as teamwork and skills through the TeamSTEPPS program.

As part of the grant, faculty teach advanced students (masters and doctoral) using the following Interprofessional strategies:

  1. Standardized patients (SPs) for case-based teaching and learning via simulations;
  2. Video conferencing technology to allow access to the training for students from multiple campuses and rural locations;
  3. Didactic/interactive case-based sessions with IP student teams;
  4. Clinical placement of IP student teams at Federally Qualified Health Centers in rural areas to receive practical experience in treating patients with MCC using an IP collaborative approach to care.

Through this initiative, 380 students from nursing, medicine, pharmacy, social work, and nutrition and exercise physiology programs are being educated using IPE approaches.

This project is supported in part by funds from the Division of Nursing, Bureaus of Health Professions, Health Resources and Services Administration. The information and content and conclusions are those of the author and should not be construed as official positions or policy of, nor should any endorsements be inferred by the Division of Nursing HRSA, Bureaus of Health Profession, HHS or the US Government.

Investigators
Grant Team Members & Additional Investigators

About the IPE
Patient care, particularly the care of patients with multiple chronic conditions, requires collaboration across health care disciplines as well as the inclusion of the patient in the planning of care. IPE involves shared learning experiences among health profession students across disciplines, with the goals of building strong clinical teams and improving health outcomes. IPE is an effective way to enhance the preparation of the healthcare workforce and optimize care delivery.

Program Goals & Delivery

Goals

The goals of the HRSA-supported IPE program are to:

  1. Enhance preparation for advanced practice nurses as part of a comprehensive, case-based interprofessional education program.
  2. Prepare workforce ready clinicians by providing interprofessional clinical training opportunities for advance practice nurses and other health profession students.

Program Delivery

The multi-campus configuration at WSU College of Nursing uses distance delivered technology to provide innovative, case-based interprofessional educational opportunities. We initially approached the IPE collaboration by addressing improving communication and team dynamics through TeamSTEPPS, a series of interdisciplinary team building exercises (http://teamstepps.ahrq.gov/). We then used face-to-face and distance-delivered training across multiple campuses to have students across health professions assess simulated patients at risk for multiple chronic conditions and determine appropriate care interventions. Specific focus of care is for patients with diabetes and behavioral health issues including depression.

Aims, Methods, & Outcomes (TAB 5)
To address mandates for interprofessional education, our faculty designed and implemented a longitudinal team-based program for students in five health sciences programs.

Aims

The aims for phase one of the IPE program were for students to:

  1. Appreciate the benefits of interprofessional team-based care
  2. Understand roles of team members
  3. Learn strategies for delivering patient-centered care
  4. Develop a skill set for effective interprofessional practice
  5. Practice team-based, patient-centered care

Methods

Students in medicine, pharmacy, nutrition, social work, and family and psychiatric nurse practitioner programs (N=82) on two campuses formed 12 teams to participate in activities designed to meet project aims. For some activities, teams worked connected asynchronously online; for others, they used videoconferencing to work face-to-face in a virtual classroom. Over one academic year, students engaged in structured opportunities to practice team building and collaborative care in a series of four simulated clinical encounters using an unfolding case study and standardized patients. With each encounter, students applied a collaborative approach to practice assessment, diagnosis, care planning, communication, and documentation skills. As the case unfolded, the patient’s care became more complex and student autonomy increased. Each encounter provided opportunities for teams to conduct or witness a care conference with the standardized patient.

Evaluation

Program evaluation was multifaceted. Three instruments administered to students at multiple time points measured changes in knowledge, behaviors, and attitudes towards interprofessional practice. Student skills and behaviors during the simulated patient encounters were evaluated using a faculty-developed collaborative care worksheet and large group debriefing. Standardized patients evaluated student teams using a published tool. Finally, written assignments were evaluated using faculty-developed rubrics.

Final Phase of Project

In the final phase of this project, we are assigning each team to an actual patient to follow in either home-based or clinic care, depending on the needs of the patient. This community-based activity is being designed to challenge each interprofessional team to establish a patient-centered, primary-care relationship with a patient similar in chronic care needs to the standardized patient they encountered during four case-based learning activities. Faculty are working with collaborating agencies to identify patients with multiple chronic conditions similar to the standardized patients described in the unfolding case. We anticipate that together these activities will help students develop core competencies as well as clinical reasoning.

Publications/Disseminations
Caines, K., & Fitzgerald, C. (2015). Culminating an Interprofessional Education Initiative National Organization of Nurse Practitioner Faculty 41st Annual Meeting. April 25, 2015. [Podium]

Kobayashi, R., & Fitzgerald, C. Asserting social work’s role in developing an Interprofessional Education Project. Journal of Social Work Education. Manuscript in review.

Purath, J. Fitzgerald, C., Ward, L., & Caines, K. (2015). Interprofessional education to improve health outcomes. (2015). National Organization of Nurse Practitioner Faculty 41st Annual Meeting. April 25, 2015. [Podium]

Purath, J. (2015). Implementing interprofessional education into nurse practitioner curricula: Faculty education and engagement. National Organization of Nurse Practitioner Faculty 41st Annual Meeting. April 25, 2015 [Podium]

Richardson, B., & Bray, B. & Woodard, L.J. (2015) Preparing teams for collaborative practice using a series of primary care standardized patient simulations. Collaborating Across Borders V, Roanoke, VA. Sept. 30, 2015. [Podium].

Richardson, B., & Bray, B. (2015) Using longitudinal primary care simulations to improve students’ collaborative care of patients with multiple chronic conditions. Victoria University’s Interprofessional Health, Education, and Practice International Conference, Melbourne, Victoria, Australia. October 7, 2015 [Podium]

Richardson, B., Bray, B., Caines, K., Odom-Maryon, T., Stevens, K., Willson, M., & Kobayashi, R. (2015). Learning to provide patient and family centered care in a non-acute setting: A longitudinal interprofessional collaboration. National Academies of Practice Annual Forum, Engaging the Patient and Family in Patient-Centered Care: An Interprofessional Approach. Alexandria, VA. April 17, 2015. [Poster]

Ward, L. (2015). Implementing Interprofessional Education into nurse practitioner curricula: A case study. National Organization of Nurse Practitioner Faculty 41st Annual Meeting. April 25, 2015. [Podium]

Ward, L.D., Bray, B.S, Odom-Maryon T., Richardson, B., Purath, J., Woodard, L. Kobayaski, R., Beary, J. Willson, M.N. Clauser, J.M., Fitzgerald, C. (2015).Development, Implementation and Evaluation of a Longitudinal Interprofessional Education Project. Journal of Interprofessional Education. In review

Primary Investigator

Cindy Fitzgerald
Cindy Fitzgerald, PhD