IPE is not an end in itself but is one strategy to achieve the goals of (1) patient-centered care, (2) optimal care experiences for patients and their families, (3) patient safety, (4) improved quality of care, (5) enhanced health throughout the population, and (6) reduced costs of care. The value and success of interprofessional care is measured by how well it achieves these aims.
- US DHHS Advisory Committee on Training in Primary Care Medicine and Dentistry, 2013
Interprofessional education at UNE: From classroom to point of care
UNE’s commitment to interprofessional education (IPE) began in 2000 with its interdisciplinary health and healing initiative (I2H2), developed in response to the growing understanding among health care leaders that high-quality health care is the result of effective teamwork across health professions. The UNE Interprofessional Education Collaborative (IPEC) was established in 2010 to provide all UNE health professions students with a foundational knowledge of IPE, and soon began to realize its vision of becoming a nationally recognized leader in campus-to-community interprofessional education, practice and research.
By 2015, UNE’s IPE leaders and Colleges of Osteopathic Medicine and Pharmacy had collaborated to establish two primary care-based IPE clinical partnerships, and the UNE Center for Excellence in Health Innovation was created to expand UNE health professions student teams’ education in patient care settings, with particular emphasis on serving rural, vulnerable and clinically complex populations.
The center’s evolving clinical IPE initiatives are expected to result not only in positive attitudes and regarding collaborative patient care within student teams, but ultimately to impact health care’s Triple Aim of improving patient outcomes, reducing costs and improving patient experience of care.
Clinical interprofessional partnerships
UNE currently trains student interprofessional teams within two Maine-based clinical IPE partnerships: the MaineGeneral Health Family Medicine Institute IPE program and the Eastern Maine Medical Center Family Medicine IPE program. Both partnerships feature shared medical/pharmacy care management activities, including team home visits for clinically complex patients that may also include a staff social worker or RN. UNE also piloted an IPE project in 2015 with Greater Portland Health (formerly Portland Community Health Center) to offer interprofessional flu vaccine clinics, and another in 2016 with Mercy Pain Center to provide interprofessional pain care management.
Most recently, Penobscot Community Health Care and UNE began to develop a medical/physician assistant/pharmacy IPE program with a dual focus on care management and population health competencies. UNE’s Clinical Interprofessional Curriculum will serve as the framework for IPE programs going forward, ensuring that student training is aligned with practices’ priorities in addressing Patient Centered Medical Home standards of comprehensive team-based care, as well as with HRSA Primary Care Training and Enhancement competencies in Interprofessional Education, Social Determinants of Health, Oral Health, Health Literacy and Shared Decision Making.
Finally, recognizing the need to address oral health needs within comprehensive primary care, UNE is currently developing a medical/dental IPE care model for implementation in 2017.
Planning questions for your practice
- Which health professions should be included in our IPE care model?
- Practices wishing to start by pairing medical and pharmacy students can benefit from several years’ combined lessons learned at two established Maine IPE sites. However, your practice’s unique patient profile, staffing pattern (or clinicians outside your practice but within your community!) and unique strengths and needs should shape your own IPE program.
- How will implementing onsite IPE enhance current quality of care at our practice?
- This question can serve as the foundation for selection of your IPE care model. Relevant quality areas may include: Achieving PCMH standards related to team-based care, care management and population health; improving adult HEDIS, CAHPS and/or ACO metrics related to preventive care, control of chronic conditions, medication review and management and patient experience; and reducing high service utilization and related costs of care.
- What current interprofessional processes and strengths does our practice have to build on?
- Examples may include: local Community Care Teams (CCTs); multiple professions and/or interprofessional processes already onsite; existing preceptorships with students of two or more health professions students; clinicians trained in IPE, or IPE champions; etc.) The Practice Readiness for IPE assessment tool may be useful in helping you to plan.
- How can pre-visit team briefings and post-visit debriefings be built into our student teams’ IPE experience? Who will facilitate these discussions?
- While visit briefings help student teams to align their role-based perspectives and objectives regarding an upcoming patient visit, debriefings help teams to “examine…the role of various providers in delivering services, gaps in available services, the involvement of clients, the level of collaboration between providers, systems issues, etc. Asking thought-provoking and critical questions about client care and team functioning becomes integral to the students’ learning.” (Deutschlander and Suter, 2011). These team discussions may be led either by clinical preceptors or by medical educators.
- What types of training might our preceptors need to serve as IPE facilitators?
- The Interprofessional Facilitation Scale can be used to gauge your practice’s level of expertise with facilitating interprofessional teams’ learning activities. (Additional IPE facilitation resources are listed below under “Key Elements of Successful IPE Models”.)
- How will our practice assess the impact of interprofessional care on students, the practice and/or patients?
- While UNE evaluates the impact of each of its clinical partners’ IPE activities on student knowledge of and attitudes toward team-based care, you may wish to measure the impact of IPE on practice-specific measures.
- For more information about IPE evaluation, please contact UNE Research Associate/IPE Evaluator Ruth Dufresne, SM at firstname.lastname@example.org.
Key elements of successful clinical IPE models
- Begin with personal/social interprofessional team building time. Facilitators and preceptors of IPE teams have found that teams benefit greatly from “get to know you” time prior to working with patients. This team-building time may include activities such as having each student create and share a “things you should know about me” profile, or developing team activities regarding things in common (children, food, interests, etc.). It may also include less formal activities such as building shared social time into clinical clerkships and rotations.This time is important for developing psychological safety for all members of the IPE team and results in improved communication in clinical settings.
- Provide TeamSTEPPS training for all team members. Ideally, all student team members, preceptors and facilitators should receive TeamSTEPPS training. Student teams using St. Louis University’s TeamSTEPPS online modules should view and discuss videos as a team, with each viewing and discussion taking an average of eight minutes. (If face to face TeamSTEPPS training is preferred, this may be available via UNE; please contact Ian Imbert, MPH at email@example.com for information.)
- Clarify team roles, responsibilities and “ground rules." Shadow team members to get a better understanding of their roles and responsibilities; Discuss your scopes of practice; Agree upon a strategy to deal with concerns before they escalate; Develop a team agreement that outlines roles and expectations, including communicating about patients, meeting attendance; encouraging and respectfully listening to alternative points of view; etc.
Team Roles and Responsibilities Resources
Team Facilitation Resources for Preceptors/Facilitators
- Select and define an interprofessional care model and workflow. Selection of an IPE model and workflow should be based on (1) the professions that will make up your student team, and (2) your practice’s clinical priorities. UNE’s clinical IPE partners have most experience to date with pairing medical and pharmacy students for care management activities; this student pair, sometimes joined by a social worker, has been effective at two sites in addressing complex patient needs in both office and in-home settings. (Both practices also intend to add social work students when possible to address behavioral health needs.) A medical/pharmacy or medical/pharmacy/social work team can have an impact on key quality measures such as high ER use; admissions and re-admissions; medication management; and chronic condition control measures such as BP, LDL and HbA1c. Clinical IPE sites in Maine are now measuring the impact of IPE on these outcomes. IPE models have also been developed outside UNE in areas such as geriatrics/functional status, chronic pain/substance use, oral-systemic health and wound care. Such care teams might include physical therapy, occupational therapy, nursing and/or nutrition students in addition to primary care, pharmacy and social work students.
- IPE workflow development should include well-defined processes for:
- Patient identification
- Chart review by all team members prior to visits
- Pre-visit team briefing to set visit agenda and goals, and to establish roles, such as team leader
- Structuring visits, including any assessment or care planning tools used
- Team debriefing and self-reflection, including reflection tools used
Follow-up steps such as call back, home visit, or referral
- Interprofessional assessment and care planning resources:
- Eastern Maine Medical Center: IPE Orientation Folder developed in partnership with the Beacon Community Care Team
- Interprofessional home visits to diabetic patients: South Dakota University
- Interprofessional fall risk assessments: Creighton University
- Interprofessional pain management: University of Kentucky
- Interprofessional medication management: University of British Columbia
- Smiles for Life: Integrating oral health and primary care
- IPE Oral Health Success Stories: New York University
- National Center for IPE: University of Minnesota
- IPE workflow development should include well-defined processes for:
- Assess your clinical IPE activities. As your practice gains experience with IPE, a “plan to study act” approach can be used to improve your program based on evaluation data (qualitative and/or quantitative) as well as participant perceptions of IPE challenges and successes. Questions about assessing your IPE program can be directed to Ruth Dufresne, SM at: firstname.lastname@example.org. Several validated assessment tools are also available from the National Center for Interprofessional Practice and Education.