Partnership for Quality Education (PQE) Partnership for Quality Education (PQE) Collaborative...

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Partnership for Partnership for Quality Education Quality Education (PQE (PQE ) ) Collaborative Interprofessional Team Education Initiative (CITE) Carol Savrin, DNP, CPNP, APRN,BC Shirley Moore, PhD, RN, FAAN

Transcript of Partnership for Quality Education (PQE) Partnership for Quality Education (PQE) Collaborative...

Page 1: Partnership for Quality Education (PQE) Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE) Carol.

Partnership for Partnership for Quality Education Quality Education (PQE(PQE))Collaborative Interprofessional Team Education Initiative (CITE)

Carol Savrin, DNP, CPNP, APRN,BC Shirley Moore, PhD, RN, FAAN

Page 2: Partnership for Quality Education (PQE) Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE) Carol.

Study Purpose and Design The project was designed to

create, implement and evaluate a model educational experience in which trainees (pediatric residents, nurse practitioner students, and pharmacy residents) faculty and staff learn to work as part of an interprofessional team to assess and improve the care and outcomes of children.

Page 3: Partnership for Quality Education (PQE) Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE) Carol.

Catalyst for Kids Intervention Process Improvement/CQI

- Trainees learn in an interprofessional team to implement collaborative process improvements

Teamwork-in-Action- Provide efficient interprofessional collaborative

care to appropriate patients in an efficient and effective manner using visit-based team care

Page 4: Partnership for Quality Education (PQE) Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE) Carol.

Design

The morning clinics were used as control clinics, functioning as usual

Afternoon clinics were the experimental clinics, with the interprofessional teams and collaborative care being practiced

The project was phased in beginning with the Monday clinics and then moving to the clinics in the rest of the week.

Page 5: Partnership for Quality Education (PQE) Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE) Carol.

Teamwork in Action Interprofessional, collaborative team meets at

noon prior to clinics and the project is discussed Providing efficient interprofessional collaborative care

to appropriate patients in an efficient and effective manner

Teamwork taught and supported by trained facilitator Teamwork as an interprofessional team to chose,

create, and implement collaborative process improvement projects

Didactic training in teamwork and process improvement done in three half day workshops over a 9-month period

Page 6: Partnership for Quality Education (PQE) Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE) Carol.
Page 7: Partnership for Quality Education (PQE) Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE) Carol.

Teamwork In Action At-risk patients are identified The Nurse Practitioner student and Medical

Resident simultaneously see the patient. One doing the history while the other performs the exam

The Pharmacy Resident meanwhile assesses the patient’s current medications

All share their findings and collaboratively determine a comprehensive

Page 8: Partnership for Quality Education (PQE) Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE) Carol.
Page 9: Partnership for Quality Education (PQE) Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE) Carol.

Teamwork In Action

PharmD reviews data

remotely

Determine if patient needs to be

seen

Pt. identified in patient

discussion

Identify and free-up other

applicable clinical team members

MD examines patient and

asks PRN Hx

Pt. identified during clinic visit

NP St/Res. Obtains

extended Hx

A

No

Yes

Sees patient

7

Page 10: Partnership for Quality Education (PQE) Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE) Carol.

Barriers

Old habits die hard Most faculty preceptors need to be trained

in these new competencies along with the trainees

Current documentation systems don’t support the documentation of “group decisions”

Juggling the workload

Page 11: Partnership for Quality Education (PQE) Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE) Carol.

Enhancers Attention to the logistics

coordination of schedules, dedicated

space, structured agendas, incentives Clear curriculum addressing

goals

skills

knowledge

attitudes

Page 12: Partnership for Quality Education (PQE) Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE) Carol.
Page 13: Partnership for Quality Education (PQE) Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE) Carol.

Results Determine the effectiveness of the Catalyst for Kids Model

on trainees’ attitudes and knowledge of teamwork A two-group pretest-posttest design

to measure the impact on teamwork

Variables interdisciplinary collaboration appropriate use of authority in teams attitudes toward teamwork knowledge of teamwork skills

Page 14: Partnership for Quality Education (PQE) Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE) Carol.

Participants 20 health professions trainees (13 pediatric

residents; 5 advanced practice nursing students; 2 pharmacy residents)

Practicing in 10 primary care pediatric clinics (5 control; 5 intervention)

Clinics were conveniently assigned to study groups

13 participants in intervention group; 7 in control group

13 women; 7 men Mean age = 29 yrs (range 21-39)

Page 15: Partnership for Quality Education (PQE) Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE) Carol.

Measures Interdisciplinary Collaboration – 6 items Use of Authority in Teamwork – 4 items Attitudes toward Teamwork – 10 items Knowledge of ID Teamwork Skills – 17

items Analysis of Covariance (ANCOVA) was

used to test for group differences at completion of the program controlling for pretest scores

Page 16: Partnership for Quality Education (PQE) Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE) Carol.
Page 17: Partnership for Quality Education (PQE) Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE) Carol.

Findings

Significant differences were found between residents and nursing students’ attitudes toward teamwork at T1 (nursing students had more positive attitudes toward teamwork); no differences at T2

There was minimal inverse relationship of age to team skills of age related to team skills

Page 18: Partnership for Quality Education (PQE) Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE) Carol.

Results

17.9

11.2

16.819.2

12.6

15.1

20.4

11.8

15.4

19.8

10.4

16.1

0

5

10

15

20

25

InterdisciplinaryCollaboration

Authority in Teams Team Attitudes*

pre E

post E

pre C

post C

*Lower scores are better

Page 19: Partnership for Quality Education (PQE) Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE) Carol.

Results of ANCOVATime 1 Time 2 ANCOVA

C E C E F p

InterdisciplinaryCollaboration

20.4(1.9)

17.9(2.4)

19.8(1.9)

19.2(3.7)

.65 .43

Authority in Teams

11.8(2.1)

11.2(2.1)

10.4(1.5)

12.6(1.9)

7.9 .01

Team Attitudes* 15.4(3.7)

16.8(3.0)

16.1(4.5)

15.1(3.4)

1.5 .24

Team Skills65.9(7.3)

58.2(9.8)

57.9(6.9)

65.5(8.8)

4.9 .04

*Lower scores are better

Page 20: Partnership for Quality Education (PQE) Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE) Carol.

Outcomes Measures

In 2000 the MHMC Pediatric Primary Care practice treated 7515 pts of which 7197 encounters in the ED (11%)

1431 (20%) of these were for asthma related concerns

If we improve asthma care pts and families will be happier, there will be fewer ED visits for asthma, and we can stretch resources further

Page 21: Partnership for Quality Education (PQE) Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE) Carol.

Outcomes Measures

Asthma ED visits were tracked for each clinic for 2 years – a year before and a year after the intervention

AM clinics were the control clinics PM clinics were the experimental clinics An index of ED visits per pediatric asthma

patient was compiled for each clinic each study year

Page 22: Partnership for Quality Education (PQE) Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE) Carol.

Asthma ED VisitsED Visits per Ped Asthma Patient

2.22

1.80

2.70

3.36

2.55

1.001.20

0.60

1.141.00

1.71

2.54

2.29

2.00

2.28

2.00

1.08

0.570.69

0.83

0

0.5

1

1.5

2

2.5

3

3.5

4

Monday Tuesday Wednesday Thursday Fr iday

ED

Vis

its

per

Pat

ien

t

Before PM After PM

Before AM After AM

Page 23: Partnership for Quality Education (PQE) Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE) Carol.

Results In four of the five clinics, there was a greater

drop in the number of ED visits in the experimental group than the control group from the year prior to the intervention to the year following the intervention.

The Monday PM experimental clinic had the most dramatic decrease in ED visits compared to the control clinic (Monday AM clinic). This is interesting in that the Monday afternoon clinic had a longer exposure to the intervention (had served as a pilot group).

Page 24: Partnership for Quality Education (PQE) Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE) Carol.

Conclusions

Catalyst for Kids model shows promise an as effective training program to enhance knowledge of teamwork skills and use of authority in teamwork

Our findings show that team care has a positive effect on pediatric asthma visits in the primary care setting