Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes (2015) / Chapter Skim
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Appendix A: Review: Measuring the Impact of Interprofessional Education (IPE) on Collaborative Practice and Patient Outcomes
Appendix A: Review: Measuring the Impact of Interprofessional Education (IPE) on Collaborative Practice and Patient Outcomes
Pages 67-134
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From page 67... ...
. While those studies did provide evidence that IPE interventions can produce positive outcomes, there remains a need to identify best practices for research that effectively link IPE interventions with measurable changes in practice processes and patient outcomes.
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From page 68... ...
Interactive learning requires active learner participation, and active exchange between learners from different professions." Types of Outcome Measures Outcome measures include • objectively measured patient/client outcomes (disease incidence; morbidity, mortality, readmission, and complication rates; length of stay; patient/family satisfaction) ; • objectively measured health care process measurements (changes in efficiency [resources, time, cost]
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From page 69... ...
Data Collection and Analysis Two of the review authors (EKP and JKM) jointly reviewed 2,347 abstracts retrieved by the searches to identify all those that indicated • an IPE intervention was implemented; • health care clinicians of various backgrounds were trained; and • patient outcomes (patient safety, patient satisfaction, quality of care, cost, clinical outcomes, community health outcomes, etc.)
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From page 70... ...
The following descriptions were used as general guidelines for rating: A - HIGH • Consistent, generalizable results • Sufficient sample size • Adequate control • Definitive conclusions • Consistent recommendations based on a comprehensive literature review that includes thorough reference to scientific evidence B - GOOD • Reasonably consistent results • Sufficient sample size for the study design • Some control • Fairly definitive conclusions
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From page 71... ...
There was also a sequential introduction of interventions in an effort to isolate the effect of the IPE intervention from numerous other practice changes introduced during the study period. However, while the trend in outcomes was calculated on a monthly basis, it is not clear from the analysis whether the team training alone significantly affected outcome trends.
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From page 72... ...
• Observation of provider performance using self-designed tools • Standardized patient outcome tools (e.g., Weighted Adverse Outcomes Scores, Press Ganey Patient Satisfaction Tool, Family Satisfaction in the intensive care unit (ICU)
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From page 73... ...
= 6 -- edTeams labor and delivery team coordination course = 1 M -- mergency team coordination course = 1 E -- omposite resuscitation team training = 1 C -- chwartz rounds = 1 S -- n-house design = 21 I • Format: All included some didactic and discussion; some included Web-based learning; in addition to TeamSTEPPS, four studies included simulations, and three trainings were in situ continued
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From page 74... ...
Patient outcome measures addressed many important issues in care quality, such as number of adverse events, specific indices of disease progression, length of stay, improvement in symptoms, morbidity, and mortality as derived from review of the clinical database for BA IPE interventions. Two studies assessed provider-with-patient communication skills (Brown et al., 1999; Helitzer et al., 2011)
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From page 75... ...
, and the rest based their conclusions on the average of before and after outcomes. Patient and Practice Outcome Tools The most commonly used measurement tool for both provider and p atient outcomes involved chart review/clinical database access for retrieving specific patient data, error/adverse event/incident reporting, and OR reports.
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From page 76... ...
The accuracy of these counts is limited because some of these participants may have been included in a broad description such as "ancillary personnel," "support personnel," "OR team," "health care team," and "health care assistants." The number of patient and provider outcomes measured in each study also varied widely. For example, one study reported patient outcomes for only 21 patients ( Helitzer et al., 2011)
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From page 77... ...
For most of these studies, team training was implemented as one part of a more comprehensive approach to practice changes (e.g., procedure manuals, mandatory OR briefings, checklists, new reporting systems)
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From page 78... ...
; • lack of clarity as to whether those trained together actually worked as a team in the practice setting; • lack of evidence that teamwork training resulted in improved team work behaviors prior to assessment of clinical outcomes; and • lack of adequate description of the type and quality of the IPE intervention as significant variables influencing outcomes. DISCUSSION The number of studies that link IPE with changes in practice and p atient outcomes is growing.
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From page 79... ...
All 11 of the long-term studies included in this review document a sustained impact on provider or patient outcomes, although the effects tended to decay over time. This is consistent with a 2007 comprehensive analysis of the effectiveness of continuing medical education (CME)
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From page 80... ...
. Observation of actual changes in team behaviors provides stronger evidence for the link between team training and measureable changes in practice and patient outcomes (Morey and Salisbury, 2002)
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From page 81... ...
Yet it is important to note that the majority of studies in this review found improvements in care processes, patient outcomes, or both. While the diversity of approaches and methodologic limitations make it difficult to draw clear conclusions with respect to best practices for linking IPE with patient and practice outcomes, this limited review suggests that the characteristics of those studies with the most significant improvements in outcomes include • high learner participation rates or self-selection to intervention group, • combination of IPE and goal-specific education (teamwork + taskwork)
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From page 82... ...
2011. Team training can improve operat ing room performance.
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From page 83... ...
2014. Improving code team performance and survival outcomes: Implementation of pediatric resuscitation team training.
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From page 84... ...
2011. Didactic and simu lation nontechnical skills team training to improve perinatal patient outcomes in a com munity hospital.
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From page 85... ...
2007. Effect of crew resource management on diabetes care and patient outcomes in an inner-city primary care clinic.
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From page 86... ...
, regular staff training) , patient satisfaction, identification rates of battered women
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From page 87... ...
culture criteria, and implementation of routine Teams were asked patient satisfaction. screening averaged 10 to meet before No significant months.
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From page 88... ...
88 MEASURING THE IMPACT OF INTERPROFESSIONAL EDUCATION TABLE A-2 Continued Outcome Measurement Type of Study Score Measures Tool Study Sample Size Helitzer IA Provider- Roter Interaction RCT 26 clinicians = et al., 2011 with-patient Analysis System 22 MDs, 2 PAs, communication 2 NPs; 21 patient proficiency in visits simulated and actual patient visits using Roter Interaction Analysis System (RIAS) coding of patient centeredness communication skills plus coding of 21 additional communication proficiencies Hoffmann IB Primary Assessment RCT 60 practices, et al., 2014 outcome was of quality randomized indicator error indicators and to one of two management; safety incident groups = MDs, secondary reporting health care outcomes were assistants indicators of patient safety culture, data on patient safety climate and volume and quality of incident reporting
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From page 89... ...
But study groups (FraTrix) , then patient safety were self-selected; three facilitated culture indicators, intervention group might team sessions over and safety climate have already been more 9 months using the scales.
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From page 90... ...
90 MEASURING THE IMPACT OF INTERPROFESSIONAL EDUCATION TABLE A-2 Continued Outcome Measurement Type of Study Score Measures Tool Study Sample Size Nielson IB Patient outcomes: Clinical Cluster 15 hospitals of et al., 2007 proportion of documentation RCT various types, deliveries at ≥20 + 11 clinical 1,307 personnel weeks in which ≥1 process measures = MDs, RNs; adverse maternal 28,536 birth or neonatal outcomes outcomes occurred; process measures: time from registration to provider assessment, registration to maternal fetal assessment, registration to induction, group B streptococci antibiotic order to first dose, epidural request to initiation, scheduled C-section start time to incision, immediate C-section decision to incision, urgent C-section decision to incision, registration to delivery nullipara, registration to delivery multipara, delivery to end of care in labor and delivery (L&D)
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From page 91... ...
Community One 4-hour No statistically Large study. Lacked labor and standardized significant sufficient description of delivery teamwork training.
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From page 92... ...
, knowledge sharing, closed-loop communication, conflict resolution, debriefing, and threats to patient outcomes) Riley et al., IB Ten weighted Weighted Cluster 3 hospitals; 2011 perinatal outcome Adverse RCT 135 clinicians measures Outcomes Scores = MDs, RNs, (WAOS)
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From page 93... ...
Would have been hospital received training as compared interesting to measure the TeamSTEPPS with control; no behaviors in simulated didactic training statistical difference setting pre- and post program with in TeamSTEPPS intervention to tease out in situ simulation didactic only and how one TeamSTEPPS training. control.
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From page 94... ...
94 MEASURING THE IMPACT OF INTERPROFESSIONAL EDUCATION TABLE A-2 Continued Outcome Measurement Type of Study Score Measures Tool Study Sample Size Strasser IB Patient functional The FIM Cluster 227 clinicians in et al., 2008 improvement as (Functional RCT 15 intervention measured by three Independence teams and 237 patient outcomes: Measure) clinicians in 16 (1)
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From page 95... ...
Veterans Six months of For both stroke Large study, randomized, Health training over patients and all clear outcome Administration three phases on patients, there was a measurement related (VHA) team dynamics, significant difference directly to the IPE problem solving, in improvement of intervention, robust use of feedback functional outcomes training.
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From page 96... ...
96 MEASURING THE IMPACT OF INTERPROFESSIONAL EDUCATION TABLE A-2 Continued Outcome Measurement Type of Study Score Measures Tool Study Sample Size Thompson IA Practice: physician Validated RCT 60 practices et al., recognition Hospital Anxiety and 21,409 2000a of depression and Depression patients/59 patients: (HAD) Scale primary care proportion practices of patients (29/30)
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From page 97... ...
play. Educators Outcomes of Practice outcome remained available depressed patients measurement related only to practices as a whole at 6 to physicians, not clear if for ~9 months weeks or 6 months anyone else had a role in after seminars after assessment affecting patient outcomes.
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From page 98... ...
98 MEASURING THE IMPACT OF INTERPROFESSIONAL EDUCATION TABLE A-2 Continued Outcome Measurement Type of Study Score Measures Tool Study Sample Size Thompson IB Baseline and 9 Validated RCT 5 clinics (exp. et al., months: Provider provider survey 2, control 3)
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From page 99... ...
Community One-year Four of the Unclear whether "team primary care intervention six provider training" actually focused composed of survey domain on teamwork rather than two half-day scores improved specific practice process training sessions, from baseline changes (many other extra training for to 9 months in changes over the year of leaders, bimonthly intervention group. the study in addition to newsletter, clinic Improvements in team training)
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From page 100... ...
100 MEASURING THE IMPACT OF INTERPROFESSIONAL EDUCATION TABLE A-2 Continued Outcome Measurement Type of Study Score Measures Tool Study Sample Size Barceló IIB Patient: Clinical database Controlled 307 patients; et al., 2010 meeting quality and Assessment before-and- 43 primary improvement of Chronic Illness after (CBA) care teams; goals in A1C, Care evaluation MDs, RNs, cholesterol, blood nutritionist, pressure (BP)
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From page 101... ...
Mexico public Three learning Proportion of While 81 percent of health centers sessions using patients achieving patients in intervention breakthrough series A1C <7 percent group participated, only (BTS) methodology; increased 32 percent participated includes strategies significantly among in usual care group.
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From page 102... ...
102 MEASURING THE IMPACT OF INTERPROFESSIONAL EDUCATION TABLE A-2 Continued Outcome Measurement Type of Study Score Measures Tool Study Sample Size Janson et IIB Clinical Clinical database CBA 384 patients: al., 2009 assessments and 148 learners processes of care: = medical complete (A1C, residents, low-density NP students, lipoprotein pharmacy [LDL] , BP, urine students; 28 microalbumin, residents were smoking control group assessment, foot exams)
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From page 103... ...
Academic Chronic illness Intervention patients Many simultaneous primary care curriculum received significantly interventions; difficult to simultaneous more assessments determine whether any quality of glycosylated change is due specifically improvement (QI) hemoglobin, to IPE intervention.
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From page 104... ...
ED Staff MDs, RNs, Attitude and technicians Opinion Survey, and (4) Patient Satisfaction Survey Rask et al., IIB Detailed 24-item process- CBA 42 nursing 2007 process-of-care of-care audit homes/19 documentation, tool and clinical intervention, number of falls, database 23 control; use of restraints RNs, OTs, certified nursing assistants (CNAs)
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From page 105... ...
Community Team training Teamwork and Large study, well emergency curriculum quality of team controlled. Team department (Emergency Team behaviors improved Dimensions Rating Form Coordination significantly in the not validated for health Course [ETCC]
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From page 106... ...
106 MEASURING THE IMPACT OF INTERPROFESSIONAL EDUCATION TABLE A-2 Continued Outcome Measurement Type of Study Score Measures Tool Study Sample Size Weaver IIB (1) Trainee (1)
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From page 107... ...
Increases were also found in perceptions of patient safety culture and teamwork attitudes. continued
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From page 108... ...
treatment RNs, case processes through managers, MDs, qualitative administrators interview; general competencies, assessment and treatment competencies, rehabilitation competencies, skill advocacy, overall competency, recovery orientation Hanbury IIB Adherence to Surveys and Interrupted 49 attended, et al., 2009 national suicide clinical record time series 21 completed prevention audit (ITS) questionnaire; guideline for did not describe community how many mental health chart audits; professionals "all community health professionals," RNs and MDs
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From page 109... ...
Community Education, Intervention High clinician turnover; primary care clinician–client group's scores on only 72 percent completed dialogues, technical 10 competencies follow-up interview. assistance, support improved Strength was focus on of self-help.
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From page 110... ...
venous thromboembolism [VTE] prophylaxis, beta blocker administration, patient satisfaction)
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From page 111... ...
Significant Strength in measuring six operating improvements patient outcomes over room in antibiotic 5-year period. Study issues: administration, MDs were trained using VTE prophylaxis, an abbreviated program; and beta blocker full team was not trained administration; together.
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From page 112... ...
, physical therapists (PTs) , nutritionists, techs, assistants, MDs Bliss et al., IIB Qualitative: NSQIP tool used BA 2,079 historical 2012 communication, by a trained controls, 246 decision making, observer + expert cases without equipment review of clinical list, 73 cases availability, database with checklist equipment use; type of malfunction, clinicians and disruptive sample size behavior, process/ not specified, flow, sterility; but discussion Quantitative: suggests RNs completion and MDs of individual participated checklist items, 30-day morbidity (adverse events)
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From page 113... ...
Academic Three 60-minute Comparison of Prospective cohort design operating team training 30-day morbidity with historical controls. room sessions focused demonstrated Large study, training on communication significant reduction provided to all OR and orienting in overall adverse personnel and compared participants event rates from with historical controls.
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From page 114... ...
, intubation, OR, and/or Sonography; time in ED; hospital LOS; intensive care unit (ICU) LOS; complications; mortality Deering IIB Safety incidents, Safety incident BA >3,000 trained, et al., 2011 including reports but not clear medication and how many were transfusion errors, at the one center communication- where outcomes related errors, were measured; needlestick MDs and RNs incidents
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From page 115... ...
improvements in time staff knew they patient outcomes were being evaluated. such as LOS, Convenience sample of complication rate, or resuscitations observed.
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From page 116... ...
pediatric code team performance
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From page 117... ...
, and it is difficult to draw conclusions about the lack of impact on patient outcomes since compliance with debriefings does not describe the quality of those interactions or the presence of true teamwork. Academic Composite Intervention group Historical control averaged intensive care Resuscitation patients statistically over 4 years of data, unit Team Training more likely to Training of code team over 6-month survive than control occurred during the period.
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From page 118... ...
of patients less events; rate of observation tool clear; MDs, nosocomial (communication, RNs, RTs infections leadership, situation monitoring, mutual support) ; clinical timing data; clinical infection data
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From page 119... ...
Free-standing Team training Significant reduction One facility, intervention MRI facility in rapport, in number of not well described, sample communication patients who could not well described, but with patients, and not complete their included because of the self-hypnosis for MRI. unusual and important patients.
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From page 120... ...
120 MEASURING THE IMPACT OF INTERPROFESSIONAL EDUCATION TABLE A-2 Continued Outcome Measurement Type of Study Score Measures Tool Study Sample Size Neily et al., IIB Surgical mortality Clinical database BA 108 facilities; 2010 MDs, RNs, technicians
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From page 121... ...
VHA Medical Team Significant reduction Very large study; Training (MTT) in surgical mortality.
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From page 122... ...
of safety events Phipps et IIB Adverse Clinical database, BA 186 providers al., 2012 Outcomes Hospital Survey at outset = Index -- number on Patient Safety MDs, midwives, of deliveries with Culture (HSPSC) RNs, CRNAs, adverse events; secretaries; frequency of event number of reporting; surveys patients unclear on safety culture
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From page 123... ...
. Adverse Outcomes But only 120 completed Index declined postintervention surveys.
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From page 124... ...
124 MEASURING THE IMPACT OF INTERPROFESSIONAL EDUCATION TABLE A-2 Continued Outcome Measurement Type of Study Score Measures Tool Study Sample Size Pingleton IIC VTE incidence, Clinical database BA 24 clinicians et al., 2013 insertion of (chart review) = MDs, RNs, peripheral central PharmDs; 261 catheters patients
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From page 125... ...
Insertion if the training had any an education plan; of peripheral central independent impact on a podcast was catheters dropped outcomes, or it was the placed on hospital from almost 360 simultaneous process intranet describing insertions to fewer changes. This kind of IPE VTE risks; and than 200 insertions/ outcome is positive, but a patient safety month.
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From page 126... ...
126 MEASURING THE IMPACT OF INTERPROFESSIONAL EDUCATION TABLE A-2 Continued Outcome Measurement Type of Study Score Measures Tool Study Sample Size Sax et al., IIB Preoperative Clinical database; BA 857 clinicians 2009 checklist OR reports' trained; MDs, use; error Web-based error RNs, "ancillary self-reporting reporting system personnel" Shaw et al., IIB Family Family BA 98 clinicians 2014 Satisfaction Satisfaction in = MDs, RNs, metrics the ICU 24 tool SWs, chaplains, (validated) case managers, PharmDs, RTs; 3 ICUs (36 beds)
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From page 127... ...
Improvements in self-reporting of errors more encouraging. Community Self-developed team Multiple measures Uncontrolled but intensive care training program of family satisfaction interesting study on the unit including articles, with communication effect of training on didactic, simulation, improved.
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From page 128... ...
; key elements of exemplars done MDs, RNs, RTs, primary survey by trained ED technicians and associated observers labs, time of entry during actual and exit from ED, resuscitations) number and type of procedures, units of blood transfused, avoidable delays to patient transfer Tapson IIB Practice: Review of a BA 128 providers; et al., 2011 Appropriate random sample 100 patient administration of of 100 surgical charts both VTE prophylaxis patient charts pre- and post to at-risk for listed intervention; patients, timing performance MDs, RNs, of treatment, measures PharmDs, duration of both pre- and technicians treatment postintervention inpatient, duration of prophylaxis beyond discharge; Patient: incidence of VTE, readmission rates because of VTE, bleeding events
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From page 129... ...
. that completed >7 patient outcomes after key tasks (out of improvement in team 8)
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From page 130... ...
admission; postintervention increased frequency of nursing observations, seniority of medical review, patient transfer to high-dependency care prior to PICU admission; Patient outcomes: sickness on admission (PIM2 score) , LOS, mortality Wolf et al., IIB Case delays, Clinical database; BA 4,836 surgeries; 2010 case scores: definition of number of handoff issues, "case score" not clinicians equipment issues/ clear trained not delays, adherence given; MDs, to guidelines CRNAs, RNs, for antibiotic technicians administration
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From page 131... ...
Britain Weekly IPE training Improvements in Implemented new PMET academic (4-10 sessions per time to response, structure simultaneously intensive care year) introduced frequency of nursing with team training, so unit simultaneously with observations, impact of training is not creation of new consultant review, clear.
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From page 132... ...
132 MEASURING THE IMPACT OF INTERPROFESSIONAL EDUCATION TABLE A-2 Continued Outcome Measurement Type of Study Score Measures Tool Study Sample Size Young-Xu IIB Veterans VASQIP clinical BA 74 facilities; et al., 2011 Affairs (VA) database 119,383 surgical Surgical Quality procedures; Improvement "OR teams" Program (not described)
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From page 133... ...
VHA VA MTT Significant decrease Large retrospective (communication in morbidity rate cohort study with in the OR and in trained facilities contemporaneous control teamwork; as compared with group. Self-selection checklists, pre- contemporaneous for intervention groups and postoperative control group.
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