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Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE)

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Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE) Carol Savrin, DNP, CPNP, APRN,BC Shirley Moore, PhD, RN, FAAN – PowerPoint PPT presentation

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Title: Partnership for Quality Education (PQE) Collaborative Interprofessional Team Education Initiative (CITE)


1
Partnership for Quality Education
(PQE) Collaborative Interprofessional Team
Education Initiative (CITE)
  • Carol Savrin, DNP, CPNP, APRN,BC
  • Shirley Moore, PhD, RN, FAAN

2
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.

3
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

4
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.

5
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

6
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7
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

8
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9
Teamwork In Action
No
Sees patient
Yes
7
10
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

11
Enhancers
  • Attention to the logistics
  • coordination of schedules, dedicated
  • space, structured agendas, incentives
  • Clear curriculum addressing
  • goals
  • skills
  • knowledge
  • attitudes

12
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13
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

14
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)

15
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

16
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17
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

18
Results
Lower scores are better
19
Results of ANCOVA
Time 1 Time 1 Time 2 Time 2 ANCOVA ANCOVA
C E C E F p
Interdisciplinary Collaboration 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 Skills 65.9 (7.3) 58.2 (9.8) 57.9 (6.9) 65.5 (8.8) 4.9 .04
Lower scores are better
20
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

21
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

22
Asthma ED Visits
23
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).

24
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
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