Collaborative Practice Assessment Tool Research Articles

Interprofessional collaboration practices: Health worker’s perceptions in private hospital Surabaya

Background: The quality of services provided by hospitals is the responsibility of a group of multi-professional teams working with different professional backgrounds, resulting in inter-professional conflicts that cause losses. To produce quality services, building Interprofessional Collaboration (IPC) among health workers is very important. One of the challenges that prevents the implementation of IPC from working efficiently is the varying opinions of health workers regarding interprofessional collaboration activities. Objective: The goal of this study was to investigate the attitudes of health workers concerning the practice of IPC in hospitals. Method: This research was an observational study employing a cross-sectional strategy. Health workers' impressions of interprofessional cooperation practices were analysed using the Collaborative Practice Assessment Tool for health workers. Result: This study involved 105 health professional respondents. The findings of the questionnaire analysis indicated significant differences in the domain of Relationship among Team Members (p 0.027), Team Relationship with the Community (p 0.012), Leadership (p 0.009), and Mission, Goals, and Objectives (p 0.001). Conclusion: Based on research findings, there are differences in perceptions among health workers because each professional competency domain is different. Therefore, interprofessional education is necessary to illustrate the implementation of collaborative practices across various professions.

What Is Working for Practitioners: A Mixed Method Analysis Using the Collaborative Practice Assessment Tool.

Interprofessional practice (IPP) is thought to increase coordination of care and provide numerous benefits for clients and practitioners. While the importance of interprofessional education and practice has been emphasized in the literature and by numerous organizations including the World Health Organization, understanding what is working for practitioners is still elusive. Using the World Health Organization's framework regarding IPP and the Interprofessional Education Collaborative (IPEC) guidelines and competencies, this research attempted to identify what is working for practitioners when it comes to IPP and where opportunities for growth are still evident. The Collaborative Practice Assessment Tool was distributed to practitioners across disciplines, with a focus on speech-language pathologists and behavior analysts, and both qualitative and quantitative measures were analyzed to determine what reported IPP strategies are in use. Results indicated that practitioners are more similar than they are different when it comes to what is working with regard to the IPEC competencies (i.e., values/ethics for interprofessional practice, roles/responsibilities, interprofessional communication, and teams and teamwork) and where change is needed. Discussion and suggestions relevant to clinical practice were identified and a call for development of IPP training across and within disciplines based on IPEC competencies is recommended.

An evaluation of the psychometric properties of the Australian Collaborative Practice Assessment Tool

Objectives This study aimed to validate the Collaborative Practice Assessment Tool (CPAT) in the Australian setting and provide a quality instrument in terms of psychometric properties that can be used to measure interprofessional outcomes for both healthcare practitioners and students. The outcomes evaluated include the capacity to work in an interprofessional team, good interprofessional communication skills, leadership skills, ensuring clear division of tasks and roles in a team, effective conflict management, and being actively involved with patients and their families/communities in care. Methods The COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) taxonomy and standards were used as guides for evaluating the psychometric properties of the Australian CPAT, which include evaluations regarding instrument development requirements of sample target and size, content validity, internal structure (structural validity, internal consistency reliability and measurement invariance), and hypotheses testing. CPAT Australia was developed through two stages involving pilot studies and a validation study, both of which included healthcare practitioners and students as participants. A pilot study examined content validity regarding item relevance, item comprehensibility, and instrument comprehensiveness. The validation study was carried out to assess the internal structure of CPAT Australia for aspects of structural validity, internal consistency reliabilities, and configural, metric and scalar measurement invariance. The structural validity was explored using the following three steps: exploratory, confirmatory, and multi-group factor analysis. Construct validity was evaluated to confirm direct and indirect paths of assumptions based on a previously validated model. Data collected between August 2021 and May 2022. Results The content validity evaluation confirmed that all items were relevant, understandable and comprehensive for measuring interprofessional collaborative care in Australia. Three hundred ninety-nine participants contributed to the validation study (n=152 practitioners; n=247 students). The original instrument model of 8-Factor 56-Item was improved in the Australian CPAT. Two items, Item 27 (Physicians assume the ultimate responsibility) and Item 49 (Final decision rest with the physician), were consistently rejected and therefore discarded. The internal structure of the 7-Factor 54-Item solution was confirmed as a suitable model with fit indices meeting COSMIN standards for a good model in practitioner and student cohorts. Configural, metric and scalar invariances were confirmed, indicating the invariance of the instruments when used for the practitioner and student cohorts. The construct validity evaluation indicated that 81.3% of direct and indirect assumptions were accepted, fulfilling the COSMIN requirement of >75% of proposed assumptions being accepted. Conclusion The Australian CPAT with a 7-factor 54-item solution was confirmed as a quality measure for assessing interprofessional education and collaborative practice for both healthcare practitioners and students in Australia with robust psychometric properties.

Feasibility testing of an interprofessional education intervention to support collaborative practice in home care for older stroke survivors with multiple chronic conditions

ABSTRACT This mixed-methods study examined the feasibility of implementing a new six-month, theory-based, interprofessional education intervention, and explored its effects and impact on collaborative practice among home care providers caring for older adult stroke survivors (≥65) with multiple chronic conditions. The evaluation utilized a qualitative descriptive and one group repeated measures design which included participant questionnaires, focus groups and field notes. Participants included 37 home care providers (registered nurses, physiotherapists, occupational therapists, personal support workers, care coordinators, and their supervisors) in Ontario, Canada. The intervention was feasible and acceptable to home care providers. Perceived benefits included improved communication and collaboration within teams, enhanced role understanding, increased learning with and from each other, and increased appreciation of all team members’ expertise. From 3 to 6 months post initial IPE training, there was a statistically significant improvement in three domains of collaborative practice as measured by the Collaborative Practice Assessment Tool (communication/information exchange; community linkage and coordination of care; decision-making and conflict management) and one domain of collaborative practice, as measured by the 19-item Team Climate Inventory (task orientation). Implications for implementing interprofessional education in home care practice settings are described. Further testing in other populations and settings is warranted.

Perception of healthcare personnel in interprofessional collaborations: A study in two “type c” hospitals in East Java

Background: The World Health Organization (WHO) describes Interprofessional Collaboration (IPC) as a comprehensive service provided by several health workers from different professional backgrounds, collaborating with patients, families and communities to provide quality services. Objective: To investigate the relationship between professions, gender, length of employment and age with IPC. Method: A cross-sectional study was conducted in two type C hospitals in East Java from June to July, 2022. The total sampling technique used involved doctors, pharmacists, nurses and nutritionists. Informed consent was given to all study participants. The Collaborative Practice Assessment Tool (CPAT) questionnaire used a five-point Likert scale which comprising eight domains. Results: From the lowest average results for each domain, significant differences were found in the education group with the domain "team relations with the community, namely the pharmacist profession". Conclusion: Doctors, pharmacists, nurses and nutritionists have different levels of IPC perception in eight domains but there were no significant differences.

Factors Influencing the Implementation of Interprofessional Collaborative Practice in Teaching Hospital Setting: A Mixed-Method Study.

Health service in the current global era requires health workers to provide qualified service, this also applies to teaching hospitals. Collaboration between several professions involved (doctors, nurses, and pharmacists) in an interprofessional collaboration system is needed in providing such service. Factors influencing interprofessional collaboration is unique to each health care center. The purpose of this study was to determine the factors that influence the implementation of interprofessional collaborative practice among health workers in Dr. Wahidin Sudirohusodo General Hospital. This is a mixed-method explanatory sequential design study, utilizing quantitative and qualitative data. Quantitative data were obtained from the Indonesian-validated Collaborative Practice Assessment Tool (CPAT) questionnaire. CPAT in Indonesian language has been validated in previous research by Findyartini, et al. in 2019 in Indonesian population. The questionnaire was internally validated with the study population with Cronbach alpha of 0.812. All health care professionals meeting the selection criteria were enrolled for the quantitative study. The questionnaire was given to 152 health professionals enrolled as research subjects, including nutritionists, nurses, doctors, pharmacists, and medical rehabilitation specialists serving in Dr. Wahidin Sudirohusodo Hospital for >3 years. Five participants with highest and lowest CPAT score from each profession were invited for FGD entitled "Exploring factors involved in interprofessional collaboration in Wahidin Sudirohusodo General Hospital" and divided into 2 groups according to the CPAT score. The score from each subscale in the questionnaire is obtained for each research subjects and the median is compared among each profession group using Kruskall-Wallis test significant to a p value of <0.05. Qualitative data as recording transcript is acquired from FGD; the transcript was then coded into several general themes by 2 of the authors and was discussed using thematic analysis using MaxQDA. Research subjects were predominantly women (121 respondents (79.6%)), 32.9% were nurses, and most of the healthcare professional (81 subjects (55.1%)) have been working for >10 years. Among profession groups (Doctors, Pharmacists, Medical Rehabilitation Specialists, Nutritionists, and Nurses), difference in score distribution (p<0.05) was found in relationships among team members (40 vs 39 vs 39.5 vs 36 vs 42, p<0.001), barriers to team collaboration (10 vs 18.5 vs 14 vs 18 vs 10, p<0.001), and leadership (20 vs 20 vs 23 vs 20 vs 20, p 0.045). From the FGD, factors influencing interpersonal collaborative practice are leadership factors, system/rule factors, and personal factors. This research showed that personal, system/organizational and leadership factors influence the implementation of interprofessional collaboration. In this study, there is a different perception regarding relationships among team members, barriers to team collaboration, and leadership among profession group.

Healthcare practitioners’ perceptions of inter-professional collaborative practices in hospitals

BackgroundIt is believed that positive interactions and exchanges of information within a healthcare team contribute to good quality care in any context. In Indonesia, there may be limitations on interaction and information exchange because of the hierarchical structure of organizations. Culture, hierarchy, and perceived rank affect how individuals behave and interact among professions in healthcare teams. This study aimed to identify the perceptions of each profession on the practice of inter-professional collaboration in their respective work units. MethodThe study was conducted among health care practitioners involved in antibiotic use in hospitals. Data were collected using the Collaborative-Practice Assessment Tool (CPAT) questionnaire of eight domains (53 questions). The correlation coefficient value for the 53 questions was >0.3, with a significance level of 5%. The reliability of the CPAT questionnaire was good, with Cronbach's alpha of 0.977. ResultThere were 261 respondents. The perception scores of each profession about inter-professional collaboration were 3.55–3.82. The domain that had the highest score was ‘the relationship between members'; and the lowest scores was ‘decision-making and conflict management’. A statistically significant difference was found in the perception towards the practice of inter-professional collaboration between pharmacists and other professions. ConclusionPerceptions of inter-professional collaboration of each profession in hospitals differ. Communication between professions in distributing tasks and roles when interacting is needed so that each profession can contribute optimally.

Reliability and validity of the Taiwanese version of the collaborative practice assessment tool: A pilot study.

To promote teamwork communication and collaboration between health-care professionals, educators emphasized proper training programs to develop interprofessional collaborative practice (IPCP) among postgraduate (PG) trainees. A literature review indicated that the faculty necessarily measured the competency in IPCP with structured and applicable assessment tools in collocation to training programs domestically. A cross-sectional psychometric study was conducted to construct a reliable assessment tool for measuring PG learning outcome in Taiwan through a bidirectional translation. The study aimed to assess the interprofessional team behavior of trainees using the Taiwanese version of the collaborative practice assessment tool (T-CPAT). The study recruited 43 participants to undergo a PG training program in a single institute and to complete T-CPAT. Data were analyzed using SPSS 22.0 software. We employed descriptive analysis of demographic variables. The validity of T-CPAT was analyzed by experts in different specialties and its availability was assessed by item-level analysis. Furthermore, the T-CPAT reliability was tested using Cronbach's α. The average score was 305.2 (standard deviation = 38.08), and the expert validity of the T-CPAT was 0.96. In the item-level analysis, there were no failure items in T-CAPT. Cronbach's α reached 0.94 (95% confidence interval = 0.90-0.96). The study demonstrated good reliability and validity for the T-CPAT. Thus, the T-CPAT can be used to accurately measure and assess the competence of IPCP in PG trainees in general medicine in Taiwan. The results were deemed sufficient to provide faculties with related arrangements for future teaching plans.

Exploring Intra and Interorganizational Integration Efforts Involving the Primary Care Sector - A Case Study from Ontario.

Background:The primary care sector is uniquely positioned to lead the coordination of providers and organizations across health and social care sectors. This study explores whether intraorganizational (professional) integration within a primary care team might be related to interorganizational integration between primary care and other community partners involved in caring for complex patients.Methods:Two care coordination initiatives (Health Links) were selected – one led by a primary care team with a high level of intraorganizational integration as assessed by the Collaborative Practice Assessment Tool (CPAT), and the other led by a primary care team with a low level of intraorganizational integration. A case study design involving a social network approach was used to assess interorganizational integration across six types of relationships including regular contact, perceived level of integration, referrals, information sharing, joint care planning, and shared resources.Results:Compared to the high-CPAT led case, the low-CPAT led case had higher density (more ties among organizations) in terms of regular contact, integration, and sharing of resources, whereas the opposite was true for the referral, information sharing, and joint care planning networks. Network centralization (extent to which network activity is influenced by one or a group of organizations) was higher for the high-CPAT case compared to the low-CPAT case in the integration, referrals, and joint care planning networks, while the low-CPAT case had higher centralization with regard to regular contact, information sharing, and shared resources.Conclusion:The interplay between intra and interorganizational integration remains unclear. We found no consistent differences in the patterns of ties across the six types of networks examined between the two cases. Assessing changes in network metrics for different organizations in each case over time, and supplementing network findings through in-depth interviews with network members are key next steps to consider.

Validation of the Collaborative Practice Assessment Tool (CPAT) to assess the degree of inter-professional collaboration (IPC) in a Community Hospital in Singapore

The Collaborative Practice Assessment Tool (CPAT) is a self-administered questionnaire that can be used to measure the degree of inter-professional collaboration (IPC) within a healthcare team. However, the CPAT has not been validated in Singapore, and there is currently no validated instrument to measure the degree of IPC among healthcare professionals in Singapore. To validate the CPAT in a community hospital (CH) in Singapore. Data was collected prospectively from 148 participants from a CH in Singapore from October 2019 to April 2020. Using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) framework, we assessed content validity, construct validity, internal consistency and test-retest reliability of the CPAT. We started by assessing content validity through cognitive interviews with healthcare professionals. We assessed construct validity by testing 12 a priori hypotheses on the correlation of CPAT domain scores with global impression and Assessment of Inter-professional Team Collaboration Scale (AITCS). We assessed internal consistency using Cronbach's alpha and assessed test-retest reliability using intraclass correlation coefficient (ICC) between responses at 2 time points (baseline and 2 weeks). From the responses of the 148 participants, we established construct validity by meeting >75% of the hypotheses formulated a priori. We showed high internal consistency in 7 domains (Cronbach's alpha >0.7) of the CPAT, and moderate internal consistency in one domain (Cronbach's alpha = 0.63) of the CPAT. We also demonstrated acceptable test-retest reliability in seven domains of the CPAT (ICC >0.5). This study provides support for the content validity, construct validity, internal consistency and test–retest reliability of the CPAT to measure the degree of inter-professional collaboration in a community hospital in Singapore. This enables clinicians and researchers to use the CPAT to measure the interventions to enhance inter-professional collaboration in Singapore.

Effective Clinical Pathway Improves Interprofessional Collaboration and Reduces Antibiotics Prophylaxis Use in Orthopedic Surgery in Hospitals in Indonesia.

Clinical pathways can improve the quality of health services. The effectiveness and impact of implementing clinical pathways are controversial. The preparation of clinical pathways not only enacts therapeutic guidelines but requires mutual agreement in accordance with the roles, duties, and contributions of each profession in the team. This study aimed to investigate the perception of interprofessional collaboration practices and the impact of clinical pathway implementation on collaborative and Defined Daily Dose (DDD) prophylactic antibiotics per 100 bed-days in orthopedic surgery. The Collaborative Practice Assessment Tool (CPAT) questionnaire was used as a tool to measure healthcare’ perceptions of collaborative practice. The clinical pathway (CP) in this study was adapted from existing CPs published by the Indonesian Orthopaedic Association (Perhimpunan Dokter Spesialis Orthopaedi dan Traumatologi Indonesia, PABOI) and was commended by local domestic surgeons and orthopedic bodies. We then compared post-implementation results with pre-implementation clinical pathway data using ANCOVA to explore our categorical data and its influence towards CPAT response. ANOVA was then employed for aggregated DDD per 100 bed-days to compare pre and post intervention. The results showed that the relationships among members were associated with the working length. Six to ten years of working had a significantly better relationship among members than those who have worked one to five years. Interestingly, pharmacists’ leadership score was significantly lower than other professions. The clinical pathway implementation reduced barriers in team collaboration, improved team coordination and organization, and reduced third-generation cephalosporin use for prophylaxis in surgery (pre: 59 DDD per 100 bed-days; post: 28 DDD per 100 bed-days). This shows that the clinical pathway could benefit antibiotic stewardship in improving antibiotic prescription, therefore reducing the incidence of resistant bacteria.

MASA KERJA DAN USIA BERHUBUNGAN DENGAN PRAKTIK KOLABORASI INTERPROFESIONAL PADA RAWAT INAP RUMAH SAKIT

Background: The practice of interprofessional collaboration is one of the elements that determines the quality of inpatient services. As a result of dysfunctional or non-existent interprofessional collaborative health practices is a medical error, which is the leading cause of death worldwide.&#x0D; Objective: to analyze factors related to interprofessional health collaboration in hospital hospitalization.&#x0D; Methods: Survey research methods, with cross sectional approach. The sample of this study were doctors and health workers who provided care for 58 inpatients at PKU Muhammadiyah Gamping Hospital in June-July 2019 determined by consecutive sampling. Data was collected by filling out the Collaborative Practice Assessment Tool (CPAT) questionnaire. Data analysis with chi-square.&#x0D; Results: the practice of interprofessional collaboration in hospitalization is mostly good (mean index = 3.00). Years of service and age are significantly related to the practice of interprofessional collaboration in hospital hospitalization. Type of profession, gender, education, marital status and income are not related to the practice of interprofessional collaboration in hospital hospitalization.&#x0D; Conclusion: The higher the work period and age of the healthcare professional, the better the practice of interprofessional collaboration in hospital hospitalization.

Examining the extent and factors associated with interprofessional teamwork in primary care settings

ABSTRACT Despite growing emphasis on adopting team-based models of primary care to facilitate patient access to a diverse range of care providers, our understanding of team functioning within primary care teams remains limited. This study examined interprofessional teamwork within primary care practices (Family Health Teams [FHT] and Community Health Centers – [CHC]) in Ontario and explored team-level and organizational factors associated with interprofessional teamwork. Interprofessional teamwork was measured using the Collaborative Practice Assessment Tool (CPAT), which was completed by providers in each participating team. The CPAT responses of 988 providers representing on average 12 professions (sd = 2.1) across 66 teams (44 FHTs and 22 CHCs) were included in the analysis. The average CPAT score was 46.6 (sd = 2.5). CHCs had significantly higher CPAT scores than FHTs (mdiff = 1.7, p = .02). Using diverse communication mechanisms to share information, increasing quality improvement capacities, and age of practice, had a statistically significant positive association with CPAT scores. Increasing team size, using centralized administrative processes, a high level of information exchange, and having a mixed governance board were significantly negatively associated with CPAT score. Findings illustrate factors associated with interprofessional teamwork and offer insight into the comparative performance of two team-based primary care models in Ontario.

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Interprofessional collaborative practice (IPCP) in high-quality healthcare is contextual and dynamic. Objectives: The study aimed to identify the perceptions of the current workforce towards IPCP and to explore the challenges and barriers associated with socio-cultural values and other factors that could potentially affect the implementation of IPCP.This study adopted a mixed-methods -explanatory sequential design. Participants: Participants were health professionals in primary health care setting who voluntarily participate in the study and recruited using systematic random sampling.A 53-item validated Collaborative Practice Assessment Tool (CPAT) with 8 subscales was administered in the quantitative stage and focus group discussions were completed in the subsequent stage.A total of 303 health professionals participated (61.8% response rate), from which 290 completed questionnaires were eligible for further analysis. Based on the collaborative practice assessment tool, the mean score = 204.05 with highest possible = 265. Nine focus group discussions involving 73 health professionals were held. Comparative analyses based on group demographics on quantitative data and thematic analyses for qualitative data, were conducted. Between the physicians and other groups, there were score differences in the leadership and vision–mission–aims subscales, as well as the decision-making (based on length of work experience) and patient-involvement subscales (based on age). The semantic thematic analysis resulted five themes: structures, supporting factors, inhibiting factors, perceived benefits and challenges of IPCP.The respondents’ perceptions towards interprofessional collaborative practice were positive. There are differences which could be attributed to professional background, the length of work experience and age. Factors at the organisational, group and individual levels contributed in IPCP at the primary care setting. They include socio-cultural factors such as uncertainty avoidance tendency, power differentials, and collectivist culture.

Interprofessional collaborative practice in primary healthcare settings in Indonesia: A mixed-methods study

Abstract Background Interprofessional collaborative practice (IPCP) in high-quality healthcare is contextual and dynamic. Objectives: The study aimed to identify the perceptions of the current workforce towards IPCP and to explore the challenges and barriers associated with socio-cultural values and other factors that could potentially affect the implementation of IPCP. Design This study adopted a mixed-methods -explanatory sequential design. Participants: Participants were health professionals in primary health care setting who voluntarily participate in the study and recruited using systematic random sampling. Methods A 53-item validated Collaborative Practice Assessment Tool (CPAT) with 8 subscales was administered in the quantitative stage and focus group discussions were completed in the subsequent stage. Results A total of 303 health professionals participated (61.8% response rate), from which 290 completed questionnaires were eligible for further analysis. Based on the collaborative practice assessment tool, the mean score = 204.05 with highest possible = 265. Nine focus group discussions involving 73 health professionals were held. Comparative analyses based on group demographics on quantitative data and thematic analyses for qualitative data, were conducted. Between the physicians and other groups, there were score differences in the leadership and vision–mission–aims subscales, as well as the decision-making (based on length of work experience) and patient-involvement subscales (based on age). The semantic thematic analysis resulted five themes: structures, supporting factors, inhibiting factors, perceived benefits and challenges of IPCP. Conclusion The respondents’ perceptions towards interprofessional collaborative practice were positive. There are differences which could be attributed to professional background, the length of work experience and age. Factors at the organisational, group and individual levels contributed in IPCP at the primary care setting. They include socio-cultural factors such as uncertainty avoidance tendency, power differentials, and collectivist culture.

Healthcare professionals’ perceptions regarding interprofessional collaborative practice in Indonesia

Abstract Background Effective interprofessional collaborative practice can strengthen and optimise healthcare. Objective assessment of collaborative practice using a valid instrument is important in a healthcare setting for assessing the effectiveness of a team's interprofessional collaborative practice. One of the instruments that can be used for this purpose is the Collaborative Practice Assessment Tool (CPAT). This study aims to evaluate the interprofessional collaborative practice of healthcare practitioners in Indonesia using CPAT. Method This was a cross sectional study conducted from March to June 2017. The CPAT questionnaire was validated and the subscales were identified through factor analysis. The Cronbach alpha of the Indonesian version of the CPAT questionnaire, with a total of 53 questions, was very good (0.916). Result The study involved 304 respondents drawn from the medical and healthcare personnel at Cipto Mangunkusumo Hospital. This study used the Indonesian version of CPAT that has been validated in the Indonesian context. The Indonesian version of CPAT consists of eight components: 1) relationships among team members, 2) barriers to team collaboration, 3) team relationships within the community, 4) team coordination and organisation, 5) decision making and conflict management, 6) leadership, 7) missions, goals and objectives and 8) patient involvement, responsibility and autonomy. There were no significant differences in the total score for perceived collaborative practice according to age, gender, professional background or length of work experience in the profession. However, there was a significant difference in the team barrier component based on the profession, age and length of work experience in the profession. The significant difference in the team barrier component was evident in the professional groups of doctors and nurses (p = 0.008). Moreover, the result showed that age group may contribute to the different perceptions of the team barriers: between 20-30 years and 31–40 years (p = 0,026), between 20 and 30 years and >50 years (p = 0,000), and between 31 and 40 years and >50 years (p = 0.001). Finally, there was a significant difference in the team barrier component based on the length of work experience: between those who had been working for 1–5 years with 5–10 years (p = 0.016) and those who had worked for >10 years (p = 0.006). Conclusion This study showed that nurses perceived more barriers in practicing interprofessional collaborative care than other professionals. Staff in the younger age group with a shorter length of work experience perceived more obstacles than older people with longer lengths of work experience. Further research is needed to explore factors that may support or hinder interprofessional collaborative practice in Indonesia.

Measuring the extent and drivers of integration within primary care teams

Introduction: Given its core attributes as the gateway to the health system, the primary care sector is increasingly emphasized as a key player in the integration of care across providers and settings. Ontario’s primary care sector has evolved considerably with the introduction of new inter-disciplinary models of primary care, including Family Health Teams FHTs and Community Health Centres CHC. However, our understanding of the specific features that enable integration within primary care teams is limited. This study sought to examine the extent and drivers of intra-organizational integration collaboration within team-based primary care models in Ontario specifically FHTs and CHCs. Methods: Organizational features i.e., information technology [IT] capacities, information exchange, and rurality etc. and team characteristics size and provider attributes were assessed via the Organizational Profile Questionnaire, which was completed by the Executive Director for each CHC/FHT. Intra-organizational integration was measured using the Collaborative Practice Assessment Tool CPAT - a validated survey instrument, designed to measure collaboration within healthcare teams. All providers involved in care delivery were invited to complete the CPAT. A multi-variate linear regression analysis was conducted to explore the drivers of CPAT scores. Results: A total of 44/73 CHCs 60% participation rate participated in this study, and 738 providers from a broad range of disciplines completed the CPAT. The response rate across CHCs was 45%, and 10% of respondents were male. Average age and length of employment were 43 years and 7 years respectively, and roster/panel size was approximately 4600 patients. The average CPAT score for CHCs was 47.21 SD = 1.97, Median: 47.25, Min: 43.74 and Max: 52.01. Regression analyses revealed that rurality, number of years in operation, roster/panel size, number of practice locations, IT capacity and information exchange were statistically significant predictors of CPAT scores. Data collection in FHTs is underway. Discussion: The negative association between roster/panel size and CPAT score reflects qualitative insights around time constraints faced by providers in their effort to collaborate effectively within teams. Increasing the number of practice locations was associated with a lower CPAT score indicating challenges associated with dispersion, whereas rurality was associated with a higher CPAT score. A high level of IT capacity was associated with a higher CPAT score - illustrating the role of technology in promoting integration efforts. In contrast, high levels of information exchange were associated with a lower CPAT score. Conclusions: A narrow distribution of CPAT scores was observed for CHCs. Organizational features, specifically IT capacity, rurality and years in operation are important enablers of integration within CHCs. Lessons learned: Team characteristics including size and provider attributes were not associated with CPAT scores. The inverse relationship between information exchange and CPAT score indicates possible gaps in perceptions of information exchange between executive leadership and individual providers. Limitations: Since participation was optional there is potential for selection bias. Given the cross-sectional study design, changes in intra-organizational integration over time cannot be ascertained. Suggestions for future research: Examining the association between integration within primary care teams and key system and patient-level outcomes are important next steps.

Building interprofessional team effectiveness in a nurse-led rural health center

Abstract Background Interprofessional team care is a model that demonstrates positive effects on the triple aim of improving quality of care, improving health and reducing costs. Nurse-led practices are well suited for these models. Archer Family Health Care (AFHC) is a nurse-led practice that utilizes interprofessional team care. Purpose To describe interprofessional team training at AFHC and evaluate effects of training on perceived team functioning. Methods The AFHC team participated in TeamSTEPPS® guided trainings throughout the three year grant period. All staff and providers were included in the team trainings. Training consisted of participation in team retreats, training modules and focus group discussions on team functionality, goal setting and workflow analysis and revision. Standardized assessment of the team competencies was completed five times over three years using the TeamSTEPPS® Team Perceptions Questionnaire (T-TPQ), the Collaborative Practice Assessment Tool (CPAT), and the Team Competencies (TC) questionnaire. Results identified perceived strengths and weaknesses of interprofessional team and served to guide team training activities. Discussion Improvements occurred over time for several measures, including teamwork, team performance, communication, and decision-making. Conclusion Standardized evaluation of team competencies is a useful tool to enhance perceived functioning of a nurse-led interprofessional team. Results support the need for ongoing interprofessional team evaluation and training.

Improving outcomes in adults with diabetes through an interprofessional collaborative practice program

ABSTRACTIn 2014, the Midwest Interprofessional Practice, Education and Research Center partnered with a Federally Qualified Health Center (FQHC) to implement an interprofessional collaborative practice (IPCP) education program to improve the health of adult patients with diabetes and to improve practice efficiency. This partnership included integrating an interprofessional team of students with the practice team. Twenty-five students and 20 staff engaged in the IPCP program, which included completion of educational modules on IPCP and implementation of daily huddles, focus patient visits, phone calls, team-based case presentations, medication reconciliation, and student-led group diabetes education classes. This study used a sequential mixed methods design. Tools used for collecting data from staff and students included demographic forms, the Interdisciplinary Education Perception Scale (IEPS), the Entry-level Interprofessional Questionnaire, the Collaborative Practice Assessment Tool, and pre/post module knowledge tests completed at baseline and at one-year post implementation. Patient clinical indicators included HgbA1c, glucose, lipid panel laboratory assessments, body mass index, blood pressure, and documentation of annual dental, foot, and eye examinations. Practice efficiency was measured by the average number of patients seen per provider per hour. Both students and staff showed significant knowledge gains in IPCP on Team Dynamics and Tips for Behavioural Changes knowledge tests (p < .05). Patients who had an HgbA1c of ≥ 7% significantly decreased their HgbA1c (p < .05) and glucose (p < .01). However, BMI and annual dental and eye examinations did not improve. Providers demonstrated an increase in the number of patients seen per hour. This IPCP intervention showed improvement in practice efficiencies and select patient outcomes in a family practice clinic.

Perceptions of interprofessional collaborative practice and patient/family satisfaction

Abstract Interprofessional providers of healthcare services need to function effectively as a team to deliver patient-focused interventions that are safe, of high quality, and clinically effective to generate improved patient outcomes. An academic pediatric hospital conducted a descriptive, correlational study to (a) describe clinicians' perceptions of interprofessional (IP) collaboration and to (b) identify the relationship between Collaborative Practice Assessment Tool (CPAT) scores with selected items from the Press Ganey ® (PG) patient satisfaction survey. The results of the study indicated a moderately high perception of IPCP (M = 5.51, SD = 0.75), with the highest perceptions noted in the domains of Patient Involvement (M = 6.18, SD = 0.95) and Decision Making (M = 4.53, SD 0.82). There was no relationship between average CPAT scores and responses on PG ( r = 0.009, p = 0.964). Results of this study provide baseline data for future research and can be used to develop strategies that further enhance interprofessional collaborative team practices.