Partnership for Quality Education (PQE) Partnership for Quality Education (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 patients 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 dont 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 *Lower scores are better

Results of ANCOVA Time 1Time 2ANCOVA CECEFp Interdisciplinary Collaboration 20.4 (1.9) 17.9 (2.4) 19.8 (1.9) 19.2 (3.7) Authority in Teams 11.8 (2.1) 11.2 (2.1) 10.4 (1.5) 12.6 (1.9) Team Attitudes*15.4 (3.7) 16.8 (3.0) 16.1 (4.5) 15.1 (3.4) Team Skills 65.9 (7.3) 58.2 (9.8) 57.9 (6.9) 65.5 (8.8) *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 Visits

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