1 Barbara F. Brandt, PhD Director Associate Vice President for Education University of Minnesota The National Center for Interprofessional Practice and

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Barbara F. Brandt, PhDDirectorAssociate Vice President for EducationUniversity of Minnesota

The National Center for Interprofessional Practice and Education is supported by a Health Resources and Services Administration Cooperative Agreement Award No. UE5HP25067. In addition, the Josiah Macy Jr. Foundation, the Robert Wood Johnson Foundation (RWJF), the Gordon and Betty Moore Foundation, and the John A Hartford Foundation have collectively committed up to $8.6 million in grants over five years to support and guide the Center, which will work to accelerate team work and collaboration among doctors, nurses and other health professionals— as well as patients—and break down the traditional silo-approach to health professions education.

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It‘s “scope” of practice!

It’s health professions

education system

It’s the paym

ent

system!It’s the health

delivery system!

More primary care !!

There is no problem our system is great!

Team Training!!

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PreventiveMedicine

MedicationRefills Acute Care

Nursing

Test Results

Master Builder

DOCTOR

Practice transformation away from episode of care

Source: Southcentral Foundation, Anchorage AK

BehavioralHealth

CaseManager

MedicalAssistants

Chronic DiseaseMonitoring

Paul Grundy MD MPHIBM Director Healthcare TransformationDirector Patient Centered Primary Care Collaborative

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PopulationHealth

System Integrator

PatientExperience

The System Integrator

Creates a partnership across the medical neighborhood

Drives PCMH primary care redesign

Offers a utility for population health and financial

management

Per Capita Cost

Prouctivity

Triple Aim


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Framework for Action on Interprofessional Education and Collaborative Practice, World Health Organization, 2010

Interprofessional education occurs when “students” from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes.Interprofessional education is a necessary step in preparing a “collaborative practice-ready” health workforce that is better prepared to respond to local health needs.A collaborative practice-ready health worker is someone who has learned how to work in an interprofessional team and is competent to do so.Collaborative practice happens when multiple health workers from different professional backgrounds work together with patients, families, carers, and communities to deliver the highest quality of care.It allows health workers to engage any individual whose skills can help achieve local public health goals.

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Inteprofessional Practice and Educationbefore the Nexus

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Interprofessional Collaborative

Practice =About, from &

with

Primary Care

Access to Care

Patient Safety / Quality

Integrative Health

Healthcare/Medical Homes

Service-Learning

High functioning

teams

Teams / Teamwor

k

Acute Care

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IntegratedHealth care & Higher EdSystem Transformation

IntegratedHealth care & Higher EdSystem Transformation

Access to careAccess to care

TeamworkTeamwork

Patient Safety/QualityPatient Safety/Quality

Workforce DevelopmentWorkforce Development

Imp

roved

Health

and

Learn

ing

Ou

tcom

esIm

pro

ved H

ealth an

d L

earnin

g O

utco

mes

Driving Costs Out of SystemsDriving Costs Out of Systems

Getting to know each otherGetting to know each other

IPE: Opportunities for Community-Campus Partnerships linked to Health

Community Health OutcomesCommunity Health Outcomes

Brandt, B.F. (2009). IPE: Past, Present & Future. Presentation to HRSA Advisory Committee on Community-based Interdisciplinary Linkages.

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IPEC Competencies

Values & Ethics for Interprofessional PracticeRoles & responsibilitiesInterprofessional CommunicationTeams and teamwork

Other Needed Competencies

Population Health, including social determinantsPatient-center decision-makingEvidence-based decision-makingCost-effective practicesQuality improvement and safe practiceStewardshipSystems Thinking

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National Center For Interprofessional Practice and Education

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The National Center for InterprofessionalPractice and Education

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The Nexus:

Education aligned and integrated with the process of care to:1. Reduce cost and add value to the alignment2. Improve the quality of the user and learner experience, and to3. create shared responsibility

Leading to Partnerships with

A. New System Competencies 1.Team trained and experienced 2. Patient centered decision-making 3. Engaged in evidenced-based decision making, quality improvement and safe practice 4.Knowledgeable in population health, including social determinants 5.Practices in cost-effectiveness, adding value, stewardship and systems thinking

B. Strategies for achieving and implementing competent teamsC. Organizational models of shared resources, governance, management and accountabilityD. Value added business case and plan agreed to and implemented

Producing Positive Impact on Triple Aim Outcomes

1. Health of the Population Improved a. communities engaged in achieving health b. coordinated engagement regarding social determinants of health c. Implemented effective prevention, wellness and disease management programs d. mental health programs developed and implemented e. established metrics and measurement

2. Increasing value apparent a. improved per capita/system quality of care b. reduced per capita cost of care c, established metrics and measurements

3. Individuals, families, communities engaged in achieving health a. individuals behaving as consumers in the marketplace b. Individuals achieving well-being c. easy access to services needed d. ease of access to information e. engaged in the health of the community

Vision of the Transformed Approach to Health

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Stakeholders Have Important Functions in the Transformation

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Public Health Prevention

Specialists

PCMH in Action

Community Care Team

Nurse CoordinatorSocial Workers

DieticiansCommunity Health

WorkersCare Coordinators

Public Health Prevention

HEALTH WELLNESS

Hospitals

PCMH

PCMH

Health IT Framework

Global Information Framework

Evaluation Framework

Operations

A Coordinated Health System


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36.3% Drop in hospital days32.2% Drop in ER use 12.8% Increase Chronic Medication use -15.6% Total cost 10.5% Inpatient specialty care costs down18.9% Ancillary costs down 15.0% Outpatient specialty down

Outcomes of Implementing Patient Centered Medical Home Interventions: A Review of the Evidence from Prospective Evaluation Studies in the US - PCPCC Oct 2012

Smarter Healthcare


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Perinatal Safety: Reducing Adverse Obstetric Events

A. Perinatal Safety Initiative 1. Evidence-based approach 2. Formalized interprofessional team training with emphasis on communication 3. Standardized, competency documented electronic fetal monitoring 4. High-risk obstetrical emergency simulation program 5. Integrated educational program disseminated among all providersB. Outcomes 1. Eleven adverse outcome measures were longitudinally followed 2. Individual components of the program were evaluated• Results 1. Within the first year, the Adverse Outcome Index was significantly and meaningfully reduced and maintained throughout the two year study period 2. Significant and meaningful reductions in: a. Rates of return to operating room

b. Birth trauma 3. Significant improvements in: a. Staff perceptions of safety b. Patient perceptions of the effectiveness how the team worked together c. Documentation and management of abnormal fetal heart rate tracings d. Documentation of obstetric hemorrhage

Wagner B, et al Journal of Healthcare Quality 2011

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IPECP in a Transitional Care Unit

Lynn A. Blewett PhD,1 Kelli Johnson MBA,2 Teresa McCarthy MD,3 Thomas Lackner PharmD,4 and Barbara Brandt PhD,5 Improving geriatric transitional care through inter-professional care teams, Journal of Evaluation in Clinical Practice 16 (2010) 57–632 Lynn A. Blewett PhD,1 Kelli Johnson MBA,2 Teresa McCarthy MD,3 Thomas

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Interprofessional education: effects on professional practice and healthcare outcomes (update) (Review) Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M

http://www.thecochranelibrary.com

The Latest Cochrane Collaboration Analysis

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Limitations of Traditional Training

• Variable clinical experience amongst individuals during training• Limited experience of managing rare events• Ethical considerations of using patients for learning• Current environment difficult to discuss and learn from mistakes• Limited opportunities to acquire proficiency of skills in procedures

Kathleen Gallo Ph.D, MBA, RN, FAAN Senior Vice PresidentChief Learning Officer

North Shore LIJ

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Simulation: Important part of the Solution

• Use simulation whenever possible for healthcare education• Train in teams, those who are expected to work in teams

• Create new and realistic methods of learning

without putting patients at risk


North Shore LIJ

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North Shore LIJ

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Advantages of Simulation

• Deliberate practice of high risk, low incident events• Fosters the development of leadership, interpersonal skills and team behaviors• Minute by minute video and audio recording for reflective debriefing sessions and immediate feedback• Higher level of learning

- Teamwork- Communication- Critical Thinking- Technical Skills


North Shore LIJ

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Interprofessional Education (IPE)

Interprofessional education occurs when learners from the

health professions and related disciplines learn together

about the concepts of health care and the provision of

healthcare services toward improving the effectiveness and

quality of healthcareEssential Elements:• Collaboration• Respectful communication• Reflection• Application of knowledge and skills• Experience in interprofessional teams


North Shore LIJ

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Documents

1 Barbara F. Brandt, PhD Director Associate Vice President for Education University of Minnesota The National Center for Interprofessional Practice and