Advanced Practice Nurse-led Interprofessional Collaborative Practice: Outcomes and Model Evaluation
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1 Advanced Practice Nurse-led Interprofessional Collaborative Practice: Outcomes and Model Evaluation 10 th ICN NP/APN Conference Presentation Rotterdam, The Netherlands August 27, 2018 Bonnie Pilon, PhD, RN-BC, FAAN
2 Disclosure presenter
3 Acknowledgements The work described in this presentation was supported by funding from the US Department of Health and Human Services. UD7HP25064 ( ) UD7HP30932 ( )
4 Our Clinic Team
5 Patient Demographics 2017 Patient Demographics 2017 N=936 Age Male Female Total Percentage % % > % Race Ethnicity Total % White % Black or African American % Hispanic 0% White Hispanic or Latino % Black Hispanic or Latino % Other Race Hispanic or Latino % American Indian or Alaska Native % Asian % Pacific Islander 3 3 0% Refuse to Report % Total % Other Public Housing Homeless last 12 months Income below 200% Poverty Uninsured % % % %
6 Patient Visits: The Clinic at Mercury Courts Patient Visits Insured Uninsured Total Medical Visits
7 Key Quality Metrics: Key Quality Measures (N= total patients eligible for measure) 2012 (N) 2013 (N) 2014 (N) 2015 (N) 2016 (N) 2017 (N) Behavioral Health Measures # Behavioral Health Referral Chronic Disease Management Measures DM with A1c (HP2020 Goal 71.1%) 15% (27) 57% (53) 87% (98) 87% (101) 85% (121) 84% (119) DM with Control Hga1c < 7% (HP2020 Goal 53.1%) 2% (27) 28% (53) 47% (98) 52% (101) 58% (121) 56% (119) Controlled HTN (HP2020 Goal 61.2%) 18% (102) 32% (209) 42% (267) 47% (304) 58% (324) 59% (287) Self-Management Goal (DM, HTN, CVD) 0% (131) 27% (293) 67% (392) 76% (431) 82% (502) 81% (487) Tobacco Use Screening 10% (280) 90% (642) 99% (896) 99% (915) 99% (938) 100% (936) Tobacco Use Disorder 79% (280) 68% (642) 61% (896) 48% (915) 47% (938) 45% (936)
8 Key Quality Metrics, continued Key Quality Measures (N= total patients eligible for measure) 2012 (N) 2013 (N) 2014 (N) 2015 (N) 2016 (N) 2017 (N) Pharmacy Consultation Measures Appropriate Asthma (Persistent Asthma) N/A 46% (22) 78% (32) 77% (51) 76% (48) 79% (46) Appropriate ASA (CAD) N/A 58% (11) 92% (17) 94% (22) 90% (27) 93% (25) Appropriate Statin (Hyperlipidemia) N/A 50% (32) 87% (51) 88% (68) 84% (72) 82% (81) Clinical Pharmacy Consultation Rate (All Patients) N/A 52% (642) 89% (896) 91% (915) 84% (938) 91% (936) Cancer Screening and Prevention Measure Mammogram (Female, age >49) 0% (21) 15% (69) 31% (87) 58% (109) 63% (134) 62% (170) Colorectal (age <49) 3% (101) 7% (182) 23% (247) 37% (310) 36% (348) 35% (352) Cervical (Female, age 21-65) 12% (87) 57% (315) 64% (413) 70% (392) 74% (408) 78% (453)
9 Social Service Quality Metrics: Key Quality Measures (N= total patients eligible for measure) 2012 (N) 2013 (N) 2014 (N) 2015 (N) 2016 (N) 2017 (N) Social Service Patient Pharmacy Assistance/Cover RX New Measure for Housing Service Referrals N/A Emergency Food Box Distributed N/A Insurance New Measure for Assistance with Food Stamps New Measure for Assistance with Benefits New Measure for Other 'Emergent Needs New Measure for Operational Measures 2012 (N) 2013 (N) 2014 (N) 2015 (N) 2016 (N) 2017 (N) Total Unique Patients Total Patient Encounters Percentage Uninsured 78% 67% 61% 58% 56% 58%
10 Introduction of Behavioral Health Services: 2018 Active Caseload Statistics Number (#) of active patients on caseload Percent (%) of active patients with 1+ contacts this month Percent (%) of active patients with PHQ < 5 or -50% (response/remission rate) Jan '18 Feb '18 Mar '18 Apr '18 May '18 Jun ' % 92% 80% 90% 80% 90% 5% 29% 23% 42% 28% 31% Relapse Prevention Inactive Total Percent (%) of active patients not improved and without psych consult Percent (%) of active patients in relapse prevention status Number (#) of patients discharged to date Total number (#) of patients enrolled to date (Active + Inactive) 24% 4% 6% 0% 0% 4% 0% 8% 14% 19% 16% 17%
11 BHI Registry Trends Current Patients Cumulative Jan '18 Feb '18 Mar '18 Apr '18 May '18 Jun '18
12 Current Patient Volume: Jan present BHI Program Totals BHI Enrolled Total BHI Current Patient BHI "Relapse Prevention" BHI "Graduated" BHI "Lost to Follow-up"
13 Suicidality Screening: Jan present Time frame: Jan-Jun 2018 Count Percentage Behavioral Health and Suicide Screening Process Measures Total Unique Patients seen at the CMC 448 Total Unique with BHI Screened last 6 months (N=448) % Total Clinic Visits 1120 Total # of Visit with BHI screening done (N=1120) % Suicidality Measures Total # of Patients Screened Positive for Suicidality (N=448) % Total # of Positive Screens (N=1120) Note: patients can screen % positive multiple times Safety Assessment Performed by BHI 64 Clinic Intervention and Safety Plan Initiated (N=64) % % Crisis referral required based on Safety Assessment (N=64) % No intervention required based on Safety Assessment (N=64)
14 Team Development Measure Scores Over Time Time point Average TDM score Team Stage Winter Stage 4 Summer Stage 4 Winter Stage 4 Summer Stage 4 Winter Stage 4 Winter Fully Developed Winter Fully Developed
15 Student Rotations: Extended Clinical Rotation Type Students Family Nurse Practitioners 42 Psychiatric/Mental Health Nurse Practitioners 3 Acute Care Nurse Practitioners 1 BSN Nursing students 1 Physician Assistants 18 Pharmacy students 75 Pharmacy Residents 6 Master of Social Work Students 12 Counseling (PhD students) 5 Medical Students 11 Internal Medicine Residents 1 Law students 1 Divinity students 4 MBA students 4 Medical Assistant students 3 Total 189
16 Student Metrics: Snapshot 22 current students surveyed pre/post in Readiness for Interprofessional Learning (RIPLS) tool used Students rotations < 20 full days on site Statistically significant increase in scores after their rotations
17 Graduated Student Feedback 53 graduated students surveyed No statistical differences among the professions Score range on RIPLS was Lower scores indicate more positive attitudes toward interprofessional learning (tool range ) Graduates open ended comments also indicated high satisfaction with IPCP model of care
18 Questions? Thank you! Contact:
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