Barbara F. Brandt

Measuring the impact of interprofessional education on collaborative practice and patient outcomes.

Interest in interprofessional education (IPE) and collaborative practice continue to grow (Frenk et al., 2010; Cox & Naylor, 2013) but whether IPE improves clinical outcomes is uncertain. A recent ...

A scoping review of interprofessional collaborative practice and education using the lens of the Triple Aim

Abstract The Triple Aim unequivocally connects interprofessional healthcare teams to the provision of better healthcare services that would eventually lead to improved health outcomes. This review of the interprofessional education (IPE) and collaborative practice empirical literature from 2008 to 2013 focused on the impact of this area of inquiry on the outcomes identified in the Triple Aim. The preferred reporting items for systematic reviews and meta-analyses methodology were employed including: a clearly formulated question, clear inclusion criteria to identify relevant studies based on the question, an appraisal of the studies or a subset of the studies, a summary of the evidence using an explicit methodology and an interpretation of the findings of the review. The initial search yielded 1176 published manuscripts that were reduced to 496 when the inclusion criteria were applied to refine the selection of published manuscripts. Despite a four-decade history of inquiry into IPE and/or collaborative practice, scholars have not yet demonstrated the impact of IPE and/or collaborative practice on simultaneously improving population health, reducing healthcare costs or improving the quality of delivered care and patients’ experiences of care received. We propose moving this area of inquiry beyond theoretical assumptions to systematic research that will strengthen the evidence base for the effectiveness of IPE and collaborative practice within the context of the evolving imperative of the Triple Aim.

Effective teaching and learning strategies

Over the past decade, leaders in pharmacy education and the profession in the United States focused on responding to the role of the pharmacist in the rapidly changing health care environment. This response included moving to the Doctor of Pharmacy as the entry‐level degree in the profession. Less understood and often overlooked are pharmacys responses to equally dramatic changes in the national higher education environment. One trend in higher education is the use of active teaching and learning methodologies, many of which are based on cognitive science research on human learning. The primary purpose of this paper is to focus on teaching and learning by describing the philosophy and policy changes of the new American Council on Pharmaceutical Education accreditation standards advocating active teaching and learning strategies, by discussing the implications for pharmacy faculty teaching roles and responsibilities, and by providing examples of active teaching and learning strategies and relevant literature embedded in the standards.

Renewed focus in the United States links interprofessional education with redesigning health care.

Correspondence: Barbara F. Brandt, Academic Health Center, University of Minnesota, MN, USA. E-mail: brandt@umn.edu No scholars and practitioners are more aware of the research and debate about interprofessional education (IPE) and interprofessional collaborative care (IPCC) than the readers of this Journal. Since the 1970s, interest in IPE and IPCC in the United States (U.S.) has been characterized by peaks and lows as the major issues in health care have shifted. So, it is exciting to describe what may be a new window of opportunity in the U.S. to fully develop and test this evolving concept that, for so long, has been an exception rather than the “norm”. This new opportunity is emerging along with the opening of U.S. health care delivery to team-based care approaches and potentially transformational change processes, spurred by widespread recognition of safety, quality, cost and access issues (Institute of Medicine, 2000, 2001; The Commonwealth Fund, 2011; U.S. Department of Health and Human Services, 2011). Recognition is increasing that not one provider profession or model can move the process of care in a new direction or address these issues independently. The provider professions need to work together to achieve the “Triple Aim” of improving the health of the population, enhancing the patient experience of care (quality, access and reliability) and controlling the per capita cost of care (Berwick, Nolan, & Whittington, 2008). This realization is stimulating new discussions among the health professions that the time to reinvigorate and accelerate mainstreaming interprofessional education (IPE) in collaboration with practice is now. Indeed, communities of health, encompassing health systems, academic and consumer communities are transforming health care (The Commonwealth Fund, 2011). Various IPCC models and combinations of clinicians such as physicians, nurses, pharmacists and other providers have met with varying degrees of documented success in improving the outcomes of care delivery (e.g. Baker, Gustafson, Beaubien, Salas, & Barach, 2005; Chisholm-Burns et al., 2010; Cooper & Fishman, 2003; Neily et al., 2010). We can continue to learn from these existing and new interprofessional practice models how to deploy health professionals to use their education to the fullest, develop better teamwork skills, and improve the process of care through coordination and innovation. At the same time, we need to move beyond “care delivery” professionals to incorporate patients and communities in improving and assuring health. As workforce diversity evolves, new skill sets for team functioning will need to be defined and mastered. On the other hand, the documentation of the relevancy of IPE to practice is more limited (Reeves et al., 2010). Over the past 40 years, some IPE initiatives in the U.S. survived from an earlier period of focused effort (e.g., Advisory Committee on Interdisciplinary, Community-based Linkages, 2008; Heinemann & Zeiss, 2002; Holmes & Osterweis, 1999). What is lacking in the renewed focus is to ensure relevancy through wide-spread integrated, institution-wide curricular efforts in health professions education that are coordinated with the practice community. The newly emerging IPE efforts need to incorporate rigor by defining metrics that establish linkages to practice and health outcomes. Learning together to enhance performance and achieve better outcomes needs to become an integral component of the education of health professionals as well as clinical care delivery and public health. This education, extending into lifelong learning, needs to impart a common base of knowledge, attitudes, skills, and experience to continue the development of IPCC in redirecting the process of care toward improving health. Several milestone events and publications in the U.S. are representative of the renewed focus on IPE (e.g. Institute of Medicine, 2003, 2010, 2011; AACN & AAMC, 2011). In 2009, six health professions education associations, the American Association of Colleges of Nursing, American Association of Colleges of Osteopathic Medicine, American Association of Colleges of Pharmacy, American Dental Education Association, Association of American Medical Colleges, and Association of Schools of Public Health, established the Interprofessional Education Collaborative (IPEC) (AACOM, 2011). In 2010, working with an appointed chair, IPEC charged two representatives each among its members to identify the interprofessional competencies needed for successful IPCC. Additionally, they were to suggest learning experiences and educational strategies for achieving those competencies, especially at the pre-licensure/pre-credentialing level. The intent of this effort was to publish consensus interprofessional competencies to drive the design and implementation of IPE that was responsive to practice needs. In February 2011, the Health Resources and Services Administration (HRSA), in partnership with the American Board of Internal Medicine Foundation, the Josiah Macy Jr. Guest editorial

Aligning practice redesign and interprofessional education to advance triple aim outcomes

Achieving the goals of health care reform – described by the Institute for Healthcare Improvement as the “Triple Aim” – will place new demands on the health care workforce. Interprofessional team-based care, quality and process improvement, and population health management are not skills that have been emphasized in traditional health professions education and training. Preparing health professionals to meet these demands will require significant changes in education and training – changes that can only occur if educational institutions align with practices, health systems and the communities they serve. Together they must define the knowledge and skills required for better care, added value, and improved health outcomes, and together they must align and integrate health professions education with the reformation and redesign of health systems that are currently underway. This commentary describes a case example of what such change could look like, reviews current opportunities and challenges to progress, and offers a review of current initiatives and opportunities to move forward toward an optimal alignment of practice and education that will improve population health, reduce costs, and improve the quality of care.

Reflections from the intersection of health professions education and clinical practice: The state of the science of interprofessional education and collaborative practice

This informed reflection, from the intersection of health professions education and clinical practice, takes stock of the state of the field of interprofessional education (IPE) and collaborative practice (CP) (together IPECP) by answering the following three questions: (1) As a field of study, where is IPECP? (2) As a research enterprise, what are the current analytical gaps? (3) Scientifically, what needs to be done going forward? While IPE and CP, as well as IPECP, have been areas of scholarly inquiry for nearly 50 years, they have collectively and individually had a limited sphere of influence. Analytical gaps identified include little research dealing with big picture health-related outcomes; mixed results on the effectiveness of health care teams; increasing recognition that additional IPECP competencies might be needed; a gap between the identification and application of educational best practices; and the need for sound, reliable, and validated tools for measuring IPECP. The authors outline the work of the National Center for Interprofessional Practice and Education at the University of Minnesota, which is focused on filling the identified analytical gaps by way of strategic actions organized around three domains—(1) developing an IPECP research agenda, (2) nurturing IPECP intervention research grounded in comparative effectiveness research study designs and the assumptions of critical realism, and (3) the creation of a sound informatics platform. The authors argue that filling these gaps is important because if the effectiveness of IPE on CP and of CP on health outcomes is ever to be ascertained, generalizable findings are paramount.

Setting a research agenda for interprofessional education and collaborative practice in the context of United States health system reform

ABSTRACT Interprofessional education (IPE) and collaborative practice (CP) have been prolific areas of inquiry exploring research questions mostly concerned with local program and project assessment. The actual sphere of influence of this research has been limited. Often discussed separately, this article places IPE and CP in the same conceptual space. The interface of these form a nexus where new knowledge creation may be facilitated. Rigorous research on IPE in relation to CP that is relevant to and framed by health system reform in the U.S. is the ultimate research goal of the National Center for Interprofessional Practice and Education at the University of Minnesota. This paper describes the direction and scope for a focused and purposive IPECP research agenda linked to improvement in health outcomes, contextualized by health care reform in the U.S. that has provided a revitalizing energy for this area of inquiry. A research agenda articulates a focus, meaningful and robust questions, and a theory of change within which intervention outcomes are examined. Further, a research agenda identifies the practices the area of inquiry is interested in informing, and the types of study designs and analytic approaches amenable to carrying out the proposed work.

Improving geriatric transitional care through inter-professional care teams

OBJECTIVES The aim of this study was to examine the impact of the use of an inter-professional care team on patient length of stay and payer charges in a geriatric transitional care unit. METHODS An analysis of de-identified administrative records for transitional care patients for the 12-month period (2003-2004) cared for by the inter-professional team (n = 163) and cared for by traditional single provider care model (n = 176) was carried out. We conducted logistic regression on length of stay and charges controlling for patient demographics and acuity levels. RESULTS The inter-professional care team patients had significantly shorter lengths of stay, fewer patient days and lower total charges. Patient diagnosis and acuity were similar across groups. CONCLUSION This study provides empirical evidence of the impact of an inter-professional care model in providing cost-effective transitional care in a nursing home setting. Evidence of shorter lengths of stay, shorter patient days and lower charges suggests benefit in the development and financing of inter-professional care teams for transitional care services.

The Readiness for Interprofessional Learning Scale: To RIPLS or not to RIPLS? That is only part of the question

We live in two inter-related worlds of interprofessional education and collaborative practice (IPECP) by simultaneously implementing and evaluating the University of Minnesota IPECP program, across...

Creating the Evidence through Comparative Effectiveness Research for Interprofessional Education and Collaborative Practice by Deploying a National Intervention Network and a National Data Repository

Background: There is currently a resurgence of interest in interprofessional education and collaborative practice (IPECP) and its potential to positively impact health outcomes at both the patient level and population level, healthcare delivery, and health professions education. This resurgence of interest led to the creation of the National Center on Interprofessional Collaborative Practice and Education in October 2012. Methods: This paper describes three intertwined knowledge generation strategies of the National Center on Interprofessional Practice and Education: (1) the development of a Nexus Incubator Network, (2) the undertaking of comparative effectiveness research, and (3) the creation of a National Center Data Repository. Results: As these strategies are implemented over time they will result in the production of empirically grounded knowledge regarding the direction and scope of the impact, if any, of IPECP on well-defined health and healthcare outcomes including the possible improvement of the patient experience of care. Conclusions: Among the motivating factors for the National Center and the three strategies adopted and addressed herein is the need for rigorously produced, scientifically sound evidence regarding IPECP and whether or not it has the capacity to positively affect the patient experience of care, the health of populations, and the per capita cost of healthcare.