MEASURING THE IMPACT OF
ON COLLABORATIVE PRACTICE AND
Committee on Measuring the Impact of Interprofessional Education on
Collaborative Practice and Patient Outcomes
Board on Global Health
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This activity was supported by contracts between the National Academy of Sciences and the Academic Consortium for Complementary and Alternative Health Care, the Academy of Nutrition and Dietetics, the Accreditation Council for Graduate Medical Education, the Aetna Foundation, the Alliance for Continuing Education in the Health Professions, the American Academy of Family Physicians, the American Academy of Nursing, the American Association of Colleges of Nursing, the American Association of Colleges of Osteopathic Medicine, the American Association of Colleges of Pharmacy, the American Association of Nurse Anesthetists, the American Association of Nurse Practitioners, the American Board of Family Medicine, the American Board of Internal Medicine, the American College of Nurse-Midwives, the American Congress of Obstetricians and Gynecologists/American Board of Obstetrics and Gynecology, the American Council of Academic Physical Therapy, the American Dental Education Association, the American Medical Association, the American Occupational Therapy Association, the American Psychological Association, the American Society for Nutrition, the American Speech–Language–Hearing Association, the Association of American Medical Colleges, the Association of American Veterinary Medical Colleges, the Association of Schools and Colleges of Optometry, the Association of Schools and Programs of Public Health, the Association of Schools of the Allied Health Professions, the Atlantic Philanthropies, the China Medical Board, the Council of Academic Programs in Communication Sciences and Disorders, the Council on Social Work Education, Ghent University, the Josiah Macy Jr. Foundation, Kaiser Permanente, the National Academies of Practice, the National Association of Social Workers, the National Board for Certified Counselors, Inc. and Affiliates, the National Board of Medical Examiners, the National League for Nursing, the Office of Academic Affiliations of the Veterans Health Administration, the Organization of Associate Degree Nursing, the Physician Assistant Education Association, the Robert Wood Johnson Foundation, the Society for Simulation in Healthcare, the Uniformed Services University of the Health Sciences, and the University of Toronto. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the organizations or agencies that provided support for the project.
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Suggested citation: IOM (Institute of Medicine). 2015. Measuring the impact of interprofessional education on collaborative practice and patient outcomes. Washington, DC: The National Academies Press.
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
Advising the Nation. Improving Health.
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
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COMMITTEE ON MEASURING THE IMPACT OF INTERPROFESSIONAL EDUCATION ON COLLABORATIVE PRACTICE AND PATIENT OUTCOMES
MALCOLM COX (Chair), Adjunct Professor, Perelman School of Medicine, University of Pennsylvania
BARBARA F. BRANDT, Director, National Center for Interprofessional Practice and Education, University of Minnesota
JANICE PALAGANAS, Director of Educational Innovation and Development, Center for Medical Simulation, Massachusetts General Hospital, Harvard Medical School
SCOTT REEVES, Professor in Interprofessional Research, Centre for Health and Social Care Research, Kingston University and St George’s, University of London
ALBERT W. WU, Professor and Director, Center for Health Services and Outcomes Research, Johns Hopkins Bloomberg School of Public Health
BRENDA ZIERLER, Co-Director, Center for Health Sciences Interprofessional Education, Practice and Research, University of Washington
VALENTINA L. BRASHERS, Founding Co-Director of the Center for ASPIRE, University of Virginia
MAY NAWAL LUTFIYYA, Senior Research Scientist, National Center for Interprofessional Practice and Education
NELSON SEWANKAMBO, Principal and Professor, Makerere University College of Health Sciences
RONA BRIERE, Consultant Editor
PATRICIA A. CUFF, Senior Program Officer
MEGAN M. PEREZ, Research Associate
BRIDGET CALLAGHAN, Research Assistant (from January 2015)
AEYSHA CHAUDRY, Intern
CHRISTIE BELL, Financial Officer (from January 2015)
ROSALIND GOMES, Financial Associate (until December 2014)
PATRICK W. KELLEY, Senior Board Director, Board on Global Health
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This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:
HUGH BARR, University of Westminster, UK
MOLLY COOKE, University of California, San Francisco
SUSAN HASSMILLER, Robert Wood Johnson Foundation
LANA SUE KA’OPUA, University of Hawai‘i-Mānoa
EDUARDO SALAS, University of Central Florida
JILL THISTLETHWAITE, University of Technology Sydney, Australia
MERRICK ZWARENSTEIN, Western University, London, Ontario
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the report’s conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by CAROL PEARL HERBERT, University of British Columbia, Vancouver, BC, and Western University, London, Ontario, and SUSAN J. CURRY, University of Iowa.
Appointed by the Institute of Medicine and the National Research Council, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
Collaboration is an active and ongoing partnership, often involving people from diverse backgrounds who work together to solve problems, provide services, and enhance outcomes.
Collaborative patient-centered practice is a type of arrangement designed to promote the participation of patients and their families within a context of collaborative practice.
Continuing education encompasses all learning (e.g., formal, informal, workplace, serendipitous) that enhances understanding and improves patient care.
Continuing professional development is self-directed learning that ensures continuing professional competence throughout one’s health professional career.
Entrustable professional activities is a “concept that allows faculty to make competency-based decisions on the level of supervision required by trainees.” (ten Cate, 2013).
1 Unless otherwise noted, these definitions are based on the work of Barr et al. (2005) and Reeves et al. (2010). Note that this glossary includes only terms that appear in the report. The committee recognizes that many definitions for these terms exist and that some definitions evolve over time.
Evaluation refers to the systematic gathering and interpretation of evidence enabling judgment of effectiveness and value and promoting improvement. Evaluations can have either formative or summative elements or both.
Interprofessional collaboration is a type of interprofessional work involving various health and social care professionals who come together regularly to solve problems, provide services, and enhance health outcomes.
Interprofessional education “occurs when two or more professions learn with, about, and from each other to enable effective collaboration and improve health outcomes.” (WHO, 2010)
Interprofessional learning is learning arising from interaction involving members or students of two or more professions. It may be a product of interprofessional education, or it may occur spontaneously in the workplace or in education settings and therefore be serendipitous.
Interprofessional teamwork is a type of work involving different health or social care professionals who share a team identity and work together closely in an integrated and interdependent manner to solve problems, deliver services, and enhance health outcomes.
One Health recognizes that the health of humans, animals, and ecosystems is interconnected.
Profession refers to an occupation or career that requires considerable training and specialized study.
Quality improvement is defined by Batalden and Davidoff (2007, p. 2) as “the combined and unceasing efforts of everyone—healthcare professionals, patients and their families, researchers, payers, planners and educators—to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development.”
Realist evaluation is a method developed by Pawson and Tilley (1997) for analyzing the social context in which an intervention does or does not achieve its intended outcome.
Team-based care is an approach to health care whereby a group of people work together to accomplish a common goal, solve a problem, or achieve a specified result.
Workplace learning is different from formal educational activities, and can be viewed as untapped opportunities for learning and change that are part of everyday practice and often go unrecognized as “learning.”
Barr, H., I. Koppel, S. Reeves, M. Hammick, and D. Freeth. 2005. Effective interprofessional education: Argument, assumption, and evidence. Oxford and Malden: Blackwell Publishing.
Batalden, P. B., and F. Davidoff. 2007. What is “quality improvement” and how can it transform healthcare? Quality & Safety in Health Care 16(1):2-3.
Pawson, R., and N. Tilley. 1997. Realistic evaluation. London: Sage Publications.
Reeves, S., S. Lewin, S. Espin, and M. Zwarenstein. 2010. Interprofessional teamwork for health and social care. London: Wiley-Blackwell.
ten Cate, O. 2013. Nuts and bolts of entrustable professional activities. Journal of Graduate Medical Education 5(1):157-158.
WHO (World Health Organization). 2010. Framework for action on interprofessional education and collaborative practice. Geneva: WHO.
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In 2002, the Institute of Medicine (IOM) convened a summit of diverse stakeholders who made the case for reforming health professions education to improve the quality and safety of health care. While many of their recommendations remain relevant today, much has changed over the past decade, necessitating new thinking. Innovators at that time stressed the importance of “patient-centered care,” while today they think of patients as partners in health promotion and health care delivery. Patients are integral members of the care team, not solely patients to be treated, and the team is recognized as comprising a variety of health professionals. This changed thinking is the culmination of many social, economic, and technological factors that are transforming the world and forcing the fields of both health care and education to rethink long-established organizational models.
This report examines the evidence linking interprofessional education to patient and health system outcomes and provides general guidance on approaches to strengthening this evidence base in the future. Although this was the study committee’s primary focus, however, it became clear early in the committee’s deliberations that there are two essential prerequisites for the successful completion of this important task. First, efforts to reform education of the health care workforce and redesign practice in the health care system need to be better aligned. Because change in one of these interacting systems inevitably influences the other, efforts to improve interprofessional education or collaborative practice independently have fallen short. Second, widespread adoption of a model of interprofessional education across the learning continuum is urgently needed. An ideal model would retain the tenets of professional identity formation while provid-
ing robust opportunities for interprofessional education and collaborative care. Such a model also would differentiate between learning outcomes per se and the individual, population, and system outcomes that provide the ultimate rationale for ongoing investment in health professions education. And it would take into account the many enabling or interfering influences on learning and these more distal outcomes.
The committee hopes its appraisal of the evidence linking interprofessional education to enhanced health and system outcomes will catalyze additional studies that provide a stronger rationale for interprofessional education and collaborative care than is presently available. The committee likewise hopes that the presentation of an outcomes-based model of interprofessional education will stimulate the model’s further refinement and thereby promote improvements in study design and execution.
Once tested, such a model could be adapted to fit the particular needs of higher- and lower-resource settings around the globe. It is no longer acceptable to think of either health or education in isolation. The final model must accommodate the reality of today’s globalized community. It is through this lens that this report is intended to be read. In essence, the committee asks readers of this report to consider how all health professionals and all countries might learn and work together to maximize the health and well-being of individuals and populations around the world.
Malcolm Cox, Chair
Committee on Measuring the Impact of Interprofessional Education on Collaborative
Practice and Patient Outcomes