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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
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.
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
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.
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
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
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
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
Enhancers Attention to the logistics
coordination of schedules, dedicated
space, structured agendas, incentives Clear curriculum addressing
goals
skills
knowledge
attitudes
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
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)
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
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
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
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
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
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
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
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).
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