Geriatric Interdisciplinary Team Training Research Articles

Geriatric Interprofessional Team Transformation for Primary Care overview.

The Geriatric Interprofessional Team Transformation for Primary Care (GITT-PC) is a model developed to deliver optimal care to older adults in primary care. GITT-PC is an expansion of the John A. Hartford Foundation Geriatric Interdisciplinary Team Training (GITT) program developed at New York University and funded from 1995 to 2002 (Fulmer et al., 2004). GITT was designed to create training models that reflect the needs of the changing health care system and the challenge of caring for older adults with complex conditions (Fulmer et al., 2005). The GITT-PC model builds on the lessons learned from GITT and the development of curricula and training materials based on best practices. Implementation of GITT-PC is accomplished through systems and practices that meet the needs and preferences of patients and their families and that are implemented by teams of health professionals and community service providers. GITT-PC is focused on four core components of high-quality geriatric care: (1) health promotion and prevention, (2) chronic disease management, (3) advanced care planning, and (4) transitional care management, each component corresponding to a Medicare-reimbursable visit. Implementation of these reimbursable services enables practices to provide evidence-based geriatric care while realizing a potential significant return on investment. The GITT-PC model has evolved from an academic training program to a financially sustainable model that serves to improve the care of older adults through a systematic team transformation process that makes a clear business case for primary care (Tabbush et al., 2021). The GITT-PC training program can be implemented in primary care practices with a focus on improving or expanding delivery of annual wellness visits (AWVs) and, potentially, registered RN-led AWVs.

Effective and Evidence-Based: How the 4Ms Age-Friendly Framework Can Result in Improved Care in a Rural Primary Care Clinic

As healthcare providers struggle to reframe aging, framing Age-Friendly care is also occurring. The Arkansas Geriatric Education Collaborative (AGEC) is a HRSA Geriatric Workforce Enhancement Program with an objective to improve clinical health outcomes of older adults (OA) in primary care settings. As a member of the 2020 Institute for Healthcare Improvement (IHI) Age-Friendly cohort, the AGEC has partnered with ARcare, an AR federally qualified healthcare clinic network, to implement the 4Ms in 4 rural clinics over 3 years. AGEC’s first goal of working with rural primary care clinics is to improve their knowledge of best practices of caring for OA. This was started by providing Geriatric Interdisciplinary Team Training to clinic staff, obtaining baseline data of common health related indicators for OA and starting regular geriatric focused training. Training on the 4Ms (Matters, Medication, Mentation Mobility) framework was next and completed followed by planning and implementation. The process was well received and results are promising. Year 1 data in one clinic show incremental improvements over baseline data in several areas including assessing Mobility with fall screens which has improved over 50% in one year and annual wellness visits (where all 4Ms are reviewed) have increased 30%. However, several areas of opportunities for improvement have also been noted and turned into quality improvement projects (QI). This includes an opportunity to improve depression screens for the clinic’s Mentation measure, which dropped almost 30% in one year. QI projects are ongoing to improve each of the elements of becoming age-friendly.

Commentary on State of the Science: Interprofessional Approaches to Aging, Dementia, and Mental Health.

It is expected that, by 2050, there will be 83.7 million adults aged 65 and older in the United States1 and 1.6 billion world-wide.2 Already there exists an unrecognized crisis in dementia and mental health care for this rapidly growing population.3 Further, the workforce with expertise in aging, dementia, and mental health/substance use (MH/SU) continues to decline, contributing to health disparities.3 As noted by both the Institute of Medicine (IOM)4 and the World Health Organization (WHO),5 interprofessional teams can play an important role in the improvement of population health outcomes for older adults. Interprofessional teams are not new to geriatrics and gerontology.6 Over the past decade, emerging strategies and models of care for interprofessional education and collaboration have built on foundations laid by several organizations.4 For example, the WHO generated the widely accepted definition and framework for interprofessional education and collaboration.5 For over 50 years, the IOM4,7–8 has supported interprofessional education and collaboration and raised awareness of workforce needs for older adults with MH/SU.3 The National Center for Interprofessional Practice and Education9 has partnered with the Robert Wood Johnson Foundation,10 the Josiah Macy Jr. Foundation,9 the John A. Hartford Foundation,9,11 and the Gordon and Betty Moore Foundation,9 to further the work of the Geriatric Interdisciplinary Team Training and Geriatric Interdisciplinary Teams in Practice programs.6,9,11 The Partnership for Health and Aging (PHA)12 developed competencies for geriatrics and gerontology. Finally, the PHA and the American Geriatrics Society13 published a position statement to support team training. Yet, despite longstanding and broad support for interprofessional education and collaboration in the care of older adults, physical and mental health disparities persist. In this supplement, Farrell et al.14 recommend a unified effort to integrate geriatric and gerontology competencies, content and principles into interprofessional curricula that are aligned with objectives for health systems science.15 Those objectives aim to transform curricula to improve population health, team-based care, high-value care, leadership, quality improvement, patient safety and health policy.15 Farrell et al.14 posit that an intentional, systematic approach by health science educators, health care systems leaders and clinicians is essential to advancing innovation for positive outcomes around aging, dementia and MH/SU. Guided by the Interprofessional Learning Continuum (IPLC) model4 (see Farrell et al.,14 Figure 1), this Commentary reinforces and extends the Farrell et al.14 recommendations by highlighting national and international innovations in interprofessional geriatrics and gerontology, especially related to dementia and mental health. The comprehensive IPLC model grew out of recognition in the IOM’s “Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes”4 that curriculum reform and collaborative practice redesign are prerequisite to improving health and system outcomes.16 In that context, this Commentary provides a discussion of curriculum reform, collaborative practice redesign and their linkages to health and systems outcomes15,16 and concludes with a brief global perspective17 on interprofessional education and practice as they relate to aging, dementia and MH/SU in older adults. Innovation exemplars in interprofessional education aim to challenge and stimulate leadership in interprofessional geriatrics and gerontology.

Teambuilding across healthcare professions: The ELDER project

BackgroundThe key to ensuring quality care for older adults is a nursing workforce that collaborates across professions and provider levels (Wright M.C., Phillips-Bute, B.G., Petrusa, E.R., Griffin, K.L., Hobbs, G.W., & Taekman, J.M. (2008). Assessing teamwork in medical education and practice: Relating behavioural teamwork ratings and clinical performance. Med Teach, 29, 1-9). PurposeTo improve communication and teamwork among interprofessional health care providers (HCPs) by using innovative teambuilding activities over three years. MethodsParticipants: 97 multi-disciplinary HCPs from five long term or home care agencies in an underserved region of New England. Participants attended six interactive sessions focused on teambuilding skills through the use of role play, case studies, games, exercises and teambuilding strategies. The J. A. Hartford Foundation's (John A. Hartford Foundation. (2001). The John A. Hartford Foundation Geriatric Interdisciplinary Team Training (GITT) Program. Available at: http://www.nygec.org/index.cfm?section_id=26&sub_section_id=18&page_id=98) Geriatric Interdisciplinary Team Training (GITT) instrument and Interdisciplinary Teamwork IQ test were used to measure changes in knowledge and attitudes. ResultsT tests performed on matched pre/post GITT instruments (n=26) revealed no significant change, although scores improved slightly from pre: (71%) to post test (73.3%) (p=.39). Teamwork IQ scores also improved slightly though not significantly. Qualitative data gathered suggest that teambuilding exercises were helpful in practice and allowed for better understanding of other provider roles. ConclusionsRarely is a variety of health care disciplines invited to participate in educational opportunities together. The interprofessional small group methodology used is a replicable model with potential to overcome barriers in communication and teamwork skills.

Geriatric Interdisciplinary Team Training Program

Geriatric interdisciplinary team training has long been a goal in health education with little progress. In 1997, the John A. Hartford Foundation funded eight programs nationally to create Geriatric Interdisciplinary Team Training (GITT) programs. Faculty trained 1,341 health professions students. The results of the evaluation, including presentation of new measures developed to assess interdisciplinary knowledge, are presented, and the implications of the program as a model of interdisciplinary education are discussed. Evaluation data from 537 student trainees are presented. At posttest, GITT trainees demonstrated improvement on all measures of attitudinal change, no change on the geriatric care planning measure, and a change in some of the questions on the test of team dynamics that varied by discipline. Changes were greatest for all the attitudinal measures with the self-reported Team Skills Scale indicating the most significant change--a change that is significant across medicine, nursing, and social work trainees.

University-Community Relationships in the Development of a Geriatric Interdisciplinary Team Training Certificate

In this article, the authors take a systematic look at transaction costs and barriers to a university-community partnership during the design and implementation of a Geriatric Interdisciplinary Team Training Certificate. The development of the authors’ university-community partnership was fueled by a funding source that enabled the Virginia Geriatric Education Center to work with three large health care systems. The purpose of the grant was to develop a geriatric interdisciplinary team curriculum for community-based health care professionals. The interdisciplinary planning committee, consisting of both university-based educators and community-based practitioners, designed a 50-hour curriculum that covered diverse clinical topics with an interactive format. In the process, the authors identified within-site, across-site, and between-partner barriers that need to be addressed for successful implementation.

A Professional Development Program in Geriatric Interdisciplinary Teamwork: Implications for Managed Care and Quality of Care

This study investigated the effectiveness of a multiyear geriatric interdisciplinary team training (ITT) program conducted by a geriatric education center in cooperation with three large health care systems. Approximately 40 half-day training sessions were planned and implemented by the university-community partnership. The training sessions included core content on team processes and substantive clinical material on geriatric concerns and disease states (dementia, diabetes, etc.). Statistical analyses revealed that a critical amount of training is necessary to induce positive changes in team skills and attitudes about geriatric health care teams. Results also indicated that maturity, practical experience, and some previous formal training in geriatrics or gerontology are predisposing factors contributing to the effectiveness of geriatric ITT. Because resources to implement these kinds of comprehensive training programs are often limited, more focused educational interventions are advisable.

Disciplinary Split: A Threat to Geriatrics Interdisciplinary Team Training

In 1995, the John A. Hartford Foundation launched an initiative to strengthen geriatric interdisciplinary team training (GITT) for advanced practice nursing and masters-level social work students and residents in internal medicine and family practice. As part of the national evaluation of the initiative, case-study and cross-case designs were employed using quantitative and qualitative data to examine the influence of cultures, regulations, and attitudes of individual disciplines on interdisciplinary training efforts at the first eight GITT programs. This evaluation found that attitudinal and cultural traditions of the different health professions faculty and students (disciplinary split) remain as important obstacles to creating an optimal interdisciplinary team-training experience. In general, physician trainees participated least enthusiastically in GITT. In part, this lower level of enthusiasm may have been the result of inconsistent medicine faculty support of the program. At all but one program, physician trainees also had shorter GITT training experiences than other disciplines. In addition, the disparity in level of training by discipline of GITT participants may have contributed to attitudinal barriers to interdisciplinary training. Discipline-specific regulatory and accreditation barriers also impede interdisciplinary training. Nevertheless, GITT experiences at some clinical sites, especially home visits, appeared to promote interdisciplinary training. Some barriers to creating and implementing GITT programs may be best approached at the level of accrediting agencies and certifying organizations. Others will require local and national efforts of leaders in the different disciplines to model and support good team care.

The Geriatric Interdisciplinary Team Training (GITT) Program

ABSTRACT Geriatric interdisciplinary team training (GITT) is an initiative funded by the John A. Hartford Foundation since 1995. Building from the substantial knowledge gained from the Veteran's Administration project in interdisciplinary team training and lessons from the Pew Foundation initiative, GITT was reconceived by the Foundation to address the need for teams in the care of older adults in the new era of managed care and health care cost containment. This training program has served to help us understand attitudes toward teams, how teams function, and how teams should be trained in the changing health care environment, where length of stay is dramatically different from the earlier team training projects. This introductory paper provides an overview of GITT, and the companion papers give detail of the GITT curricula, measures and lessons learned.

Using Case Studies to Evaluate Students' Ability to Develop a Geriatric Interdisciplinary Care Plan

ABSTRACT The Geriatric Interdisciplinary Team Training (GITT) program, an educational intervention funded by The John A. Hartford Foundation of New York City, has trained more than 1800 health care professions students and clinicians throughout the United States. Evaluating the effectiveness of this training intervention has proven to be quite a challenge. Core measures were collected pre-and post-GITT training to evaluate student development as a result of GITT. This paper focuses on one of these core measures, the Test of Geriatric Interdisciplinary Care Planning (TGICP). This instrument, developed for the GITT program, is one mechanism created to test trainees' ability to develop an interdisciplinary plan of care. Using a case study methodology, this two-part instrument provides an innovative approach to quantifying and correlating responses from an interdisciplinary cohort of students. This paper will describe the development of the TGICP, including the creation and validation of the case studies, the framework for the questionnaire, and the coding and scoring mechanism created to evaluate trainee responses.

Using Scripted Video to Assess Interdisciplinary Team Effectiveness Training Outcomes

ABSTRACT As part of the Geriatric Interdisciplinary Team Training (GITT) Program funded by the John A. Hartford Foundation, the authors of this article worked to create an instrument, the Trainee Test of Team Dynamics, to assess health care trainees' understanding of team dynamics. The Trainee Test of Team Dynamics is a five-question written test designed to capture GITT trainees' knowledge of team process and skills in addressing conflict that is administered after watching a five-minute videotape of a simulated interdisciplinary health care team meeting. The test was created to measure health professions students' abilities to recognize effective geriatric health care teams, to respond to effective and ineffective team behaviors, and to determine whether or not the team meeting achieved its purpose: to meet the patient's needs for an interdisciplinary care plan. Scripts and test items developed and tested by practitioners in social work, medicine, public health, nursing and others assured a product that compensated for differences in educational level and occupation, yet captured accurate and appropriate responses. The results reported here include an analysis of 740 trainees' baseline responses from the multi-site educational programs to determine the construct validity of the new measure.

Organizational Structure, Team Process, and Future Directions of Interprofessional Health Care Teams

ABSTRACT For a nationwide Geriatric Interdisciplinary Team Training (GITT) program evaluation of 8 sites and 26 teams, team evaluators developed a quantitative and qualitative team observation scale (TOS), examining structure, process, and outcome, with specific focus on the training function. Qualitative data provided an important expansion of quantitative data, highlighting positive effects that were not statistically significant, such as role modeling and training occurring within the clinical team. Qualitative data could also identify “too much” of a coded variable, such as time spent in individual team members' assessments and treatment plans. As healthcare organizations have increasing demands for productivity and changing reimbursement, traditional models of teamwork, with large teams and structured meetings, may no longer be as functional as they once were. To meet these constraints and to train students in teamwork, teams of the future will have to make choices, from developing and setting specific models to increasing the use of information technology to create virtual teams. Both quantitative and qualitative data will be needed to evaluate these new types of teams and the important outcomes they produce.

Institutionalizing a Multi-Faceted Approach to Geriatric Interdisciplinary Team Training

ABSTRACT The process of needs assessment, program design, implementation, and institutionalization of a Geriatric Interdisciplinary Team Training Program is examined. Three program components target health care professionals and students/pre-professionals: a video-based geriatric interdisciplinary team training course that has portability and is appropriate for training in a variety of settings; a system of identifying, enhancing, and evaluating geriatric placements in interdisciplinary teamwork; and a series of training units leading to a Geriatric Interdisciplinary Team Training Certificate. Over the three-year program development period, 40 students completed the graduate course, 12 new clinical training sites were developed for training in interdisciplinary teamwork, and 39 half-day Geriatric Interdisciplinary Team Training sessions were developed, offered, and evaluated for 537 health professionals. Fifteen health-care professionals were certified through the 50-hour geriatric interdisciplinary team training program and three health-care professionals took the 40-hour program.

A Definition of Geriatric Interdisciplinary Teams Through the Application of Concept Mapping

The purpose of this study is to operationally define the more qualitative aspects of geriatric interdisciplinary team training, based on the use of concept mapping. Previous literature provides little information with which to foster understanding of a geriatric interdisciplinary team, because of the different ways that the construct is described and the different ways in which central questions could be posed. Participants of the Geriatric Interdisciplinary Team Training (GITT) program, funded by the John A. Hartford Foundation (n = 114), took part in a modified concept mapping exercise. From multidimensional scaling and cluster and factor analyses of the data, a definition of what constitutes geriatric interdisciplinary teams was constructed. Implications of the data suggest that the view of the functions of geriatric interdisciplinary teams is fairly uniform across specialty subgroups.

Creating Interdisciplinary Training for Health Care Professionals: The Challenges and Opportunities for Home Health Care

Training health care professionals to work together in managing the problems of elderly patients is an area where the home health care industry can make a crucialand substantial contribution. Since 1996, Rush Home Care Network, an affiliate agency of Rush-Presbyterian-St. Luke’s Medical Center in Chicago, has served as a clinical training site for an interdisciplinary education program. This program, the Rush Geriatric Interdisciplinary Team Training Program, was initially funded in 1996 through a grant from the John A. Hartford Foundation. Trainees from medicine, nursing, socialwork, pharmacy, occupationaltherapy, physicaltherapy, and clinical nutrition observe and work with Rush home care teams. They participate in team meetings, home visits, patient assessment and counseling, and in-service training. The Rush home care experience in interdisciplinary team training can be viewed as a modelfor other home health care organizations interested in becoming clinical training sites for team care.

Educational Approaches for Preparing Social Work Students for Interdisciplinary Teamwork on Geriatric Health Care Teams

ABSTRACT Interest in teamwork has fluctuated over the last several decades, with recent renewed interest. As social workers become more involved in working with older people in the coming years, their success will hinge on collaboration with other health providers. Schools of social work and clinical sites must address this through the development of educational curricula and clinical programs which prepare social workers to work on interdisciplinary geriatric health care teams. Based on the experience of the national Geriatric Interdisciplinary Team Training (GITT) Program, this article presents an overview of the necessary team skills for social workers, educational methods for teaching teamwork developed at the GITT sites, and some teaching challenges.

Measuring attitudes related to interdisciplinary training: revisiting the Heinemann, Schmitt and Farrell 'attitudes toward health care teams' scale

Summary Findings from an exploratory factor analysis on the 21 item 'attitudes towards health care teams' (Heinemann et al. , 1999) are reported. Using data collected as part of an innovative educational program on geriatric team training program in the United States we report an exploratory factor analyses for 913 student trainees. The geriatric interdisciplinary team training (GITT) program funded by a United States philanthropic foundation, The John A. Hartford Foundation of New York City, requires medicine, nursing, and social work students to learn about geriatric teams. A 3-factor solution with all 21-items is obtained. These factors are labeled to reflect normative team constructs: team value, team efficiency and shared leadership. Though conceptually these factors map onto those identified by Heinemann et al. (1999), some important philosophical and methodological differences are noted. Implications for interdisciplinary education and for the construct validity of this scale are discussed.

Geriatric Interdisciplinary Team Training

Geriatric Interdisciplinary Team Training

Measuring attitudes related to interdisciplinary training: revisiting the Heinemann, Schmitt and Farrell attitudes toward health care teams scale

Summary Findings from an exploratory factor analysis on the 21 item 'attitudes towards health care teams' (Heinemann et al. , 1999) are reported. Using data collected as part of an innovative educational program on geriatric team training program in the United States we report an exploratory factor analyses for 913 student trainees. The geriatric interdisciplinary team training (GITT) program funded by a United States philanthropic foundation, The John A. Hartford Foundation of New York City, requires medicine, nursing, and social work students to learn about geriatric teams. A 3-factor solution with all 21-items is obtained. These factors are labeled to reflect normative team constructs: team value, team efficiency and shared leadership. Though conceptually these factors map onto those identified by Heinemann et al. (1999), some important philosophical and methodological differences are noted. Implications for interdisciplinary education and for the construct validity of this scale are discussed.

Cross-Disciplinary Approaches to Teaching Interdisciplinary Teamwork and Geriatrics

The Mount Sinai Medical Center Geriatric Interdisciplinary Team Training Program prepares future health professionals to work on geriatrics interdisciplinary health care teams through structured educational and training experiences. This article describes the Program's educational goals and teaching methods. A number of cross-disciplinary approaches have been developed to facilitate learning, including team teaching, a seminar series, workshops, journaling, standardized patients, “real time” experiences, and other program enhancements. The Program has had considerable impact at the trainee, faculty, management and institutional levels, but issues and challenges to cross-disciplinary team training remain. Suggestions for overcoming learning, professional culture, and implementation barriers are given.