Inter-professional Collaboration:Are You Doing Enough for you Clients?

3/26/17 Inter-professional Collaboration:Are You Doing Enough for you Clients? West Virginia Speech Language Hearing Association, 2017 Pam Holland Department of Communication Disorders Rania Karim School of Physical Therapy Amy Smith School of Medicine Karen McNealy Department of Communication Disorders The speakers have no relevant financial or nonfinancial relationships to disclose. 1

Learning Outcomes 1. Participants will identify the four domains of interprofessional competencies for collaborative practice. 2. Participants will differentiate multidisciplinary practice, interdisciplinary practice and interprofessional practice. 3. Participants will recognize the competencies within each of the Core Domains. 4. Participants will critically evaluate current practices of the core competencies within each of the four domains at one's own work place to effectively implement collaborative practice in the current healthcare or educational setting. Interprofessional Education (IPE) What is it? Interprofessional education occurs when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes. Once students understand how to work interprofessionally, they are ready to enter the workplace as a member of the collaborative practice team. This is a key step in moving health systems from fragmentation to a position of strength 1 Interprofessional Collaboration (IPC) What is it? Interprofessional Collaboration also known as Interprofessional practice occurs when multiple service providers from different professional backgrounds provide comprehensive healthcare or educational services by working with individuals and their families, caregivers, and communities to deliver the highest quality of care across settings. 1 2

Course Outcome #1 Participants will identify the four domains of interprofessional competencies for collaborative practice. Teams and team Work Value and Ethics IPE Competencies Interprofessional Communication Roles and Responsibilities Core Competencies More about each of the 4 Domains ( Refer to Handout ) Each of the four domains include sub-competencies which establish the Interprofessional Education Collaborative, (IPEC) This session will not focus on each one but will take time to allow for self-reflection to assist in determining the best way to start the process within your setting and discuss the possible challenges. Values/Ethics Core Competency ( 10 sub-competencies ) Work with individuals of other professions to maintain a climate of mutual respect and shared values. 3

Roles/Responsibilities Core Competency ( 10 sub-competencies ) Use the knowledge of one's own role and those of other professions to appropriately assess and address the health care needs of patients and to promote and advance the health of populations. Interprofessional Communication Core Competency ( 8 Sub-competencies ) Communicate with patients, families, communities, and professionals in health and other fields in a responsive and responsible manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease. Teams and Teamwork Core Competency ( 11 Sub competencies ) Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan, deliver, and evaluate patient/populationcentered care and population health programs and policies that are safe, timely, efficient, effective, and equitable. 4

Course Outcome # 2 Participants will differentiate multidisciplinary practice, interdisciplinary practice and interprofessional practice. AND MORE Intra, Cross and Trans. Intradisciplinary SILO Working within a single discipline Professionals working alone completing the tasks related to their perspective discipline EXAMPLE: Completing the discipline-specific tasks within a specific procedure. Doing what you do. Crossdisciplinary Perspective taking Viewing one discipline from the perspective of another Often confused with multidisciplinary as it involves more than one discipline EXAMPLE: Observing other disciplines complete their specific procedures 5

Multidisciplinary Additive Draws on knowledge from different disciplines but stays within the boundaries of their scope/silo Contrasts different disciplines in an additive manner Involves little interaction across professionals EXAMPLE: Professionals complete assessment and share reports with one another, professionals have access to the clinical documents. Interdisciplinary Between Combines two or more disciplines to create a new level of integration Component boundaries start to break down; it is no longer a simple addition EXAMPLE: Co-treatment Transdisciplinary Across, beyond, through Two or more disciplines perspectives transcend each other to form a holistic approach Creating a unity of framework beyond the individual disciplines The outcome will be completely different than with the additive perspective EXAMPLE: ASHA indicates that typically, one person is considered the lead or primary professional and all communication runs through them. Sometimes the collaboration that occurs in BTT can be described as Transdisciplinary with the Service Coordinator acting as the Lead. Marshall University Autism Assessment and Diagnostic Clinic 6

IPE/IPP BEST PRACTICE - Goal for 2025! Professionals practicing and learning FROM other disciplines WITH other disciplines and ABOUT other disciplines Professional maintaining the Certificate of Clinical Competence consider the CCCs: Consistently and Constantly Communicating Professionals practicing Patient/student-Centered Interprofessional Professionalism EXAMPLE: MU Feeding and Swallowing Clinic 3 Key Principles Principle #1. IPE/IPP is not a replacement for rigorous education specific to each health care profession. This indicates that interprofessional identity complements but does not replace professional identity. Principle #2. IPE/IPP represents one solution not all solutions to the problems of the health system. Principle #3. Experiential and team-based learning are the hallmarks of IPE/IPP. IPE.. Why Bother? The health care environment requires interprofessional interaction Health Care Reform Improve patient outcomes, satisfaction, and more effective utilization of resources requires effective communication among health care practitioners 7

World Health Organization (WHO) Framework for Action IPE Advantages IPE-Advantages 2 8

IPE Advantages IPE Advantages Driving Forces for IPE and IPP Health Care Reform Patient Protection and Affordable Care Act Movement towards large health care systems vs individual physicians Switch from volume-based fee-for-service à Value based pay for performance (outcomes driven) Health care providers are now incentivized to improve quality and patient outcomes 9

Main Goal of Coordinated Care Models for Interprofessional Care Teams Centers for Medicare and Medicaid Services (CMS) implemented pilot programs for interprofessional care team models of care Purpose: Coordination of care and education for patients Improve overall patient health Promote self-care Identify and treat health conditions sooner rather than later Effective management of chronic health conditions (COPD, Diabetes, Asthma, CHF) Models for Interprofessional Care Teams 1. Accountable Care Organizations (ACOs) 2. Patient Centered Medical Homes (PCMHs) 10

Accountable Care Organizations 3 Accountable Care Organizations- groups of doctors, hospitals and other health care providers who come together voluntarily to provide coordinated high quality care to their Medicare patients. Participation is voluntary Financial incentives are made available to ACO providers for avoiding readmissions, preventable complications and duplication of services. Patient Centered Medical Home 4 Patient Centered Medical Home- (PCMH) Physician-led practice: Patients have access to a personal physician who leads the care team within a medical practice Whole-person orientation: The care team provides comprehensive care, including acute care, chronic care, preventative services, and end-of-life care, at all stages Integrated and coordinated care: Practices take steps to ensure that patients receive the care services the need from the medical neighborhood, in a culturally and linguistically appropriate manner Focus on quality and safety: Practices use the quality improvement process and evidence-based medicine to continually improve patient outcomes Access: Practices commit to enhancing patients access to care ACO? HMO? PCMH? What s the Difference? 5 ACO vs HMO In an ACO, providers are held DIRECTLY RESPONSIBLE for the health of their patients and are evaluated based on their effectiveness. ACOs need to define processes to promote evidence based medicine, report on quality and cost measures and coordinate care ACOs utilize primary care physicians but they are not required, pt can go to a specialists without a referral AND can go outside of the ACO ACO vs PCMH PCMH has the primary care physician leads the care delivery team ACO may consists of many coordinated practices while a medical home is a single practice 11

One Last Model: Bundle Payments 6 Traditionally Medicare makes separate payments to providers for each individual services they furnish to beneficiaries for a single illness or course of treatment. Bundle Payments- models of care which link payments from multiple services beneficiaries received during an episode of care. Organizations enter into payment arrangements that include financial and performance accountability for episodes of care Research shows that bundled payments can align incentives for providers, hospitals, post-acute care providers, physicians and other practitioners. Different models of bundle payments being tested Bundled Payments: Diagnoses 6 Primarily for Health Care Acute MI Amputation COPD/CHF Diabetes Stroke Esophagitis, gastroenteritis and other digestive disorders Renal failure Sepsis Joint replacement Dementia UTI Autism Dyslexia Cerebral Palsy Bundled Payment-Comprehensive Joint Replacement Program 7 Basic idea: CMS establishes a lump payment target for total episode of knee and hip replacements (from admissions to 90 days post discharge) CMS compares what hospitals spend in total on care with what Medicare thinks they should be spending If total spending is less than the Medicare target, the hospitals may be eligible to receive additional payment from Medicare If total spending is more than the Medicare target, the hospitals could be required to pay back Medicare for some portion of the difference. 12

Interprofessional Practice Patient story #1 An attending physician on rounds strides into a hospital room with an entourage of medical students and asks his patient this question.. How can we do a better job of caring for you? Interprofessional Practiced Patient Story #1 continued The patient, a 15 year-old boy named Kevin, has been in and out of the hospital 30 or 40 times for treatment of short bowel syndrome, a condition in which nutrients are not absorbed properly and is commonly caused by the need for surgical removal of the small intestine. This veteran of the health care system says he s been very happy with the care he has received over the years, but, when pressed, says this.. I have great doctors and nurses here-but can you please talk to each other? Donald Berwick, M.D., M.P.P. Bottom line Of course money matters but let s not forget patient-centered care and outcomes. 13

Let s talk about IPP in the Schools Educational System ( PreK-12 ) It is not just about Health Care The assistant secretary for Educational Research and Improvement in the U.S. Department of Education, Grover Whitehurst described best practices in education as the integration of professional wisdom with the best available empirical evidence in making decisions about how to deliver instruction (see State Education Resource Center website). High Performing Schools What is their mission? Create a clear, common focus Provide supportive, personalized, and relevant learning that is both rigorous and meaningful Engage in monitoring, accountability, and assessment of student progress Offer curriculum and instruction that actively engage students in their own learning 14

Common Core Does it equal Interprofessional Practice? The Common Core State Standards (NGA & CCSSO, 2010) provide a guide for what students should be learning at each grade level, so that every parent and educator across disciplines can support students learning. The Common Core State Standards seek to achieve a shared understanding of goals, with all relevant parties working together to achieve these goals. How are students learning about IPP and what do they expect when entering professional practice with you? Interprofessional Education at Marshall University History, Updates and Data Students are ready to achieve the 2015-2025 Challenge! Are you? 15

IPE at Marshall University Purpose To provide students pursuing healthcare careers with a forum to learn from each other, with each other and about discipline specific scope of practice so that they enter the health care field with interprofesional practice skill sets. Who is Involved? 350 + students 1. College of Health Professions School of Physical Therapy Dept. of Communication Disorders School of Nursing Dept. of Social Work Dietetics Dept. 2. Joan C. Edwards School of Medicine 3. School of Pharmacy 4. Dept. of Psychology IPE-Marshall University How are the students learning about IPE? 2 Sessions Interprofessional Teams Created Utilized Patient Cases Preparatory activities and surveys Post activities and surveys Standardized patients/caregivers 16

3/26/17 Percentage of Students IPE - Marshall University Patient Cases Utilized paper case as a vehicle for interaction Same teams Same case Cases evolved from session 1 to session 2 Addressed 1 or more themes from the 2011 IPE Collaborative Practice General Competency Domains IPEC- Interprofessional Education Collaborative Formed in 2009 21 institutional members. American SpeechLanguage Association approved in 2016/2017 17

Patient Cases Competency Domains Addressed IPE Marshall University Preparatory Activities and Surveys YouTube Videos Assigned Readings ( articles and books ) The Spirit Catches You and You Fall Down UpStream Doctors Self Assessments Interprofessional Attitudes Scale (IPAS) Readiness for Interprofesional Learning Scale (RIPLS) Reflections IPE Marshall University Interprofessional Attitudes Scale (IPAS) 8 Authors- Norris J, Carpenter K, Eaton J, Guo J, Lassche M, Pret M, Blumenthal D. Description- Scale designed to assess attitudes that relate to the 2011 Core Competencies for Interprofessional Collaborative Practice. Consists of 27 items in 5 subscales 1. Teamwork, Roles and Responsibilities 2. Patient Centeredness 3. Interprofessional Bias 4. Diversity and Ethics 5. Community-Centeredness All items assessed using 5-level Likert scale ( strongly disagree to strongly agree ) 18

IPE Marshall University Readiness for Interprofessional Learning (RIPLS) Questionnaire 9 Purpose- To examine the attitudes of heath and social care students and professionals towards interprofessional learning. Description- 19 item tool with a 5 point Likert Scale strongly agree to strongly disagree 3 Subscales 1. Teamwork and Collaboration 2. Negative and Positive Professional Identity 3. Roles and Responsibilities IPE Marshall University Session 1 Communication, Collaboration and Scope of Practice Students explain their scope of practice in patient care Students review and discuss the case. Each student is to participate in the discussion Group question/answer period. Students begin discussing and asking for any clarification of each disciplines roles and responsibilities. Wrap Up with a Plan of Care IPE Marshall University Discipline Specific Plan of Care Worksheet 10 1. Is there further discipline specific information you need? 2. Summarize your discipline specific priorities. 3. What other information would you like to have for this case from the other disciplines? 4. Is there information presented in the case provided by other disciplines that you don t understand? 5. What are your thoughts on discharge location? 6. Can you predict any equipment needs or support this patient may need at discharge? Adapted from: Riley N., Frank L. Inter-Professional Clinical Reasoning Event. Academy of Neurological Physical Therapy, Inc. American Physical Therapy Association. 19

IPE Marshall University Session 2 - Standardized Patients and Caregivers Standardized Patients- (SP) is a person carefully recruited and trained to take on the characteristics of a real patient thereby affording the student an opportunity to learn and to be evaluated on learned skills in a simulated clinical environment. 11 Discharge Planning Meeting RESULTS Significant changes in Self-assessment of communication Understanding of roles and responsibilities Ability to collaborate across disciplines No significant changes Attitudes towards interprofessional healthcare (-) Knowledge of specific disciplines 20

Course Objectives # 3 & # 4 Ready to reflect and apply Participants will recognize the competencies within each of the Core Domains. Participants will critically evaluate current practices of the core competencies within each of the four domains at one's own work place to effectively implement collaborative practice in the current healthcare or educational setting. IPEC Core Competency Refer to your handout Review the 4 Domains: Value/Ethics, Roles/Responsibilities, Interprofessional Communication and Teams & Teamwork Examine the Sub-competencies that you þ or ý Create a list of professionals that you believe will assist you in developing an educational process for your setting Challenges What will be the biggest obstacle in your setting? What can you do? 21

Strategies Suggestions from ASHA and from the panel Start by asking questions What do you need? Who do you influence to get buy in? Investment and buy in essential What infrastructure do you need to make it work? Model it start small Educate others some just don t understand Create a weekly/monthly case study group for challenging clients/patients/students Strategies Suggestions from ASHA and from the panel Identify a competency to develop or enhance in your current practice Share what you learned with a colleague Read other IPE literature Discuss this with your administrator Complete ASHA s webinar and earn 2 Free CEUs https://www.youtube.com/watchv=jz3kbbxy_qw&feature=youtu.be Questions and Ideas? 22

One last take away IPE/IPP Professionals practicing and learning FROM other disciplines WITH other disciplines and ABOUT other disciplines Professional maintaining the Certificate of Clinical Competence consider the CCCs: Consistently and Constantly Communicating Professionals practicing Patient/student-Centered, Nonhierarchical Interprofessional Professionalism References 1. World Health Organization (WHO). Framework for action on interprofessional education and collaborative practice. Geneva: World Health Organization. 2010. Available at http://whqlibdoc.who.int/hq/2010/who_hrh_hpn_10.3_eng.pdf. Accessed 03/01/17. 2. Grant RW, Finocchio LJ, and the California Primary Care Consortium Subcommittee on Interdisciplinary Collaboration. Interdisciplinary collaborative teams in primary care: a model curriculum and resource guide. San Francisco, CA: Pew Health Professions Commission. 1995. 3. Centers for Medicare and Medicaid Services. Accountable Care Orgnizations. Cms.gov. 2015. Available at https://www.cms.gov/medicare/medicare-fee-for-service-payment/aco/index.html Accessed 03/02/17. 4. American Family Physician, American Academy of Pediatrics, American College of Physicians, American Osteopathic Association. Joint Principles of the Patient-Centered Medical Home. 2007. Available at http://www.aafp.org/dam/aafp/documents/practice_management/pcmh/initiatives/pcmhjoint.pdf. Accessed on 03/02/17. 5. Fickenscher K. Accountable care organization and medical home differences. KevinMD.com. 2017. Available at http://www.kevinmd.com/blog/2010/12/accountable-care-organization-acomedical-home-differences.html. Accessed on 03/02/17. 6. Centers for Medicare and Medicaid Services. Bundled Payments for care improvement initiative: general information. CMS.gov. 2017. Availible at https://innovation.cms.gov/initiatives/bundledpayments/index.html. Accessed 03/02/17. 7. American Physical Therapy Association. Expanded CMS bundling programs with payment incentives- ready to launch in 2017. PTinMotion News. 2016. 8. Norris J, Lassche M, Eaton J, Guo J, Preet M, Blumenthal D. The development and validation of the interprofessional attitudes scale: assessing the interprofessional attitudes of students in the health professions. Academic Medicine. 2015, 90:1394-1400. 9. Curran V, Sharpe D, Forristall J, Flynn K. Attitudes of health sciences students towards interprofessional teamwork and education. Learning in Health Science and Social Care. 7(3);146-156. 2008. 10. Riley N., Frank L. Inter-Professional Clinical Reasoning Event. Academy of Neurological Physical Therapy, Inc. American Physical Therapy Association. 11. Johns Hopkins Medicine. Standardized Patient Program. Available at http://www.hopkinsmedicine.org/simulation_center/training/standardized_patient_program/index.html. Accessed on 03/08/17. 12. http://www.asha.org/uploadedfiles/2016-interprofessional-practice-survey-results.pdf 13. http://www.asha.org/practice/interprofessional-education-practice/ 14. http://www.asha.org/uploadedfiles/ipe-ipp-reader-ebook.pdf Thank you 23