Interprofessional Care Research Articles

EHealth profile and care coordination of primary care physicians

Abstract Background Digital health or eHealth is a vast field encompassing mobile health (mHealth), health information technology, wearable devices, telehealth, and telemedicine, and is changing the practice of medicine. While it holds promise for enhancing care coordination, its adoption is hindered by various barriers, including at the healthcare professional level. We assessed the eHealth profile of primary care physicians and its relationship with care coordination. Methods As part of the Commonwealth Fund 2022 IHP survey of primary care physicians, 1114 physicians in Switzerland completed a questionnaire on their digital health use, and care coordination practices. Based on their responses, we built a digital health score, summarizing physicians’ use of digital health tools, and a care coordination score. Associations between both scores were assessed using stratified analyses and multiple linear regression. Results Among 1114 participants (46% women, mean age 52), 83% used electronic patient records, 96% used teleconsultations for less than 5% of consultations, and 63% never used connected health tools for the monitoring of patients with chronic diseases. A total of 16% allowed for online appointments, 20% for online medical prescriptions, 52% for communicating electronically lists of medications with other healthcare professionals, and 89% the possibility of e-mail or web communications with the patient. The eHealth score was positively associated with the number of weekly working hours, being an internal medicine specialist or practicing physician, the number of full-time equivalents in the practice, and with being in a group practice setting. The higher the eHealth profile score, the higher was the care coordination score. Conclusions Physicians’ use of digital health tools was positively associated with care coordination. This could underscore the potential benefits of digital health in enhancing collaborative and interprofessional care practices. Key messages • In a large survey of primary care physicians, the use of digital health tools and care coordination were correlated. • Digital health could enhance collaborative and interprofessional care practices.

Health Professions Students' Reflections About Principles of Interprofessional Collaboration after Shadowing Interprofessional Palliative Care Rounds.

Future healthcare professionals are educated on collaborative practice methods through interventions that may include shadowing. While shadowing allows students to learn from and about other health professions, it often fails to offer an opportunity for the student to work and collaborate with other health professionals. This study sought to investigate themes regarding interprofessional students' experiences during a palliative care shadowing activity and their understanding of collaborative patient-centered care, social determinants of health, and health disparities. Twenty-eight students representing 13 health professions from the Interprofessional Palliative Care program at Jefferson Center for Interprofessional Practice and Education at Thomas Jefferson University submitted reflection essays at the conclusion of their shadowing experience. Four hundred ninety-eight sentences from 28 essays were analyzed via qualitative directed content analysis. Coding categories were determined a priori using definitions of collaborative practice from the 2023 Interprofessional Education Collaborative (IPEC) competencies and definitions of social determinants of health from Healthy People 2030. Thirty-two percent of sentences described IPEC competencies, 18% described social determinants of health/ health disparities, 4% included student emotional reactions, and 2% included student descriptions of the development of their professional role. These results suggest that shadowing offers an opportunity to identify and learn interprofessional competencies in interprofessional palliative care curricula, as made evident through student reflection assignments.

Naloxone Distribution Models in the United States: A Scoping Review.

Increasing naloxone distribution is a high priority means to mitigating opioid overdose rates in the United States. Since a variety of naloxone distribution models exist, with differences in infrastructure and funding between states and health-systems, it is important to review their differences and understand the strengths and barriers to widespread implementation of each model. The following 4 databases were searched for articles reporting on naloxone distribution models: (1) PubMed/Medline (National Library of Medicine), (2) Embase (Elsevier), (3) Scopus (Elsevier), and (4) the Cochrane library. Reports from all years written in English that discussed naloxone distribution models in the United States were included, as were all study designs. Of 5825 articles initially identified, 173 were selected for full text review. Of these, 49 met full criteria and were included for data extraction and analysis. Most distribution models occurred in community-based opioid education and naloxone distribution programs and in community pharmacies via a standing order/statewide protocol. Most programs reported strengths related to feasibility, but frequently reported cost as a limitation. Fewer studies described distribution models in ambulatory care or hospital settings, though these studies also highlighted strengths related to feasibility, particularly with support from working partners, and when utilizing an interprofessional care approach. Few studies reported health/economic outcomes data associated with naloxone distribution, such as changes in the number of patient/layperson access, the number of opioid overdose reversals, or cost-savings. This review outlines the many ways in which naloxone is distributed in the United States and emphasizes a need for improved outcomes data collecting/reporting in the various settings where naloxone is distributed. This would allow for future studies to evaluate which distribution model factors are associated with improvements in health outcomes, such as increased layperson access, and lower opioid overdose/mortality rates.

Referral pathway and competency profiles of primary care physiotherapists and kinesiologists for physical activity interventions for diabetes: a modified Delphi study

BackgroundHigh quality diabetes care is an essential service in primary care settings since the prevalence and associated complications of diabetes is increasing. Physical activity is effective for the prevention and management of diabetes yet is underutilized in diabetes care. Exercise professionals have specialized skills to deliver physical activity interventions, but effective interprofessional collaboration for diabetes care requires role clarity. This study established the competencies of entry-level physiotherapists and kinesiologists for physical activity interventions for diabetes care in primary care settings and used these competencies to develop clinical tools to promote role clarity in interprofessional care teams.MethodsWe used a modified Delphi process. Eleven physiotherapy and three kinesiology subject matter experts participated in two rounds of Delphi surveys to develop discipline and context specific competencies. These competencies were used to draft competency profiles and a referral pathway tool. Eleven of the participants then participated in a focus group for member-checking of the tools. Descriptive statistics and content analysis were used to analyze quantitative and qualitative data respectively.ResultsThe modified Delphi process resulted in 38 physiotherapy and 27 kinesiology competencies that identify the distinct roles of physiotherapists and kinesiologists in delivering physical activity interventions for diabetes care. The physiotherapy competencies describes their unique role in supporting people with all types of diabetes to engage in physical activity despite complex medical or physical barriers. The kinesiology competencies indicate where these professionals may require additional training, especially when working with people living with type 1 diabetes or who are pregnant. All developed tools had good face validity and were seen to be potentially useful tools by the subject matter experts.ConclusionsThe findings highlight that both physiotherapists and kinesiologists have fundamental skills and abilities to deliver physical activity interventions to people living with diabetes, but that different exercise professionals may be needed depending on the complexity of the clinical profile. The developed clinical tools support improved interprofessional collaboration by clarifying physiotherapy and kinesiology roles in delivering physical activity interventions for diabetes care and highlighting how the two distinct professions can contribute to addressing the growing diabetes epidemic in primary care.

Practices and Perception of Paediatric Obstructive Sleep Apnea Among Orthodontists and Paediatric Dentists in Brazil: A Mixed-Methods Study.

To explore orthodontists' (OTs) and paediatric dentists' (PDs) practices and perceptions regarding the screening and management of paediatric obstructive sleep apnea (OSA). This explanatory sequential mixed methods design included OTs and PDs with active clinical practice in Brazil and encompassed a quantitative phase followed by a qualitative phase. In the quantitative phase, a survey assessing OSA screening and management practices was administered to OTs and PDs practicing in Brazil. Information-rich OTs and PDs were interviewed in the qualitative phase. Descriptive statistics and the chi-square test were used to analyse the survey data, while inductive content analysis was applied to the interview data. The results from both phases were integrated and reported narratively. Three hundred eighty-one OTs and PDs completed the survey, and ten of them were interviewed. Nearly half of OTs and PDs administered sleep questionnaires and demonstrated some knowledge about paediatric OSA signs and symptoms. PDs and OTs primarily offered rapid maxillary expansion and functional mandibular advancement for managing selected children with OSA, with OTs being more frequently involved in this task than PDs. OTs and PDs identified several barriers and expressed the need for support regarding access to reliable screening tools and interprofessional care. Brazilian OTs and PDs were aware of the main signs and symptoms of paediatric OSA and were somewhat involved in offering oral appliance management options. To further define the role of these professionals, increasing support for dental professionals in OSA management and updating existing clinical guidelines is warranted.

Evaluation of an innovative dementia care competency model among physical and occupational therapy students

ABSTRACT The rising prevalence of dementia calls for a competent workforce capable of delivering quality dementia care. A standard for assessing dementia-care-specific competencies is necessary to guide curriculum development and implementation in a competency-based educational framework during academic training. This study evaluated the psychometric properties of the Dementia Care Competency Model (DCCM) among students enrolled in physical (PT) and occupational therapist (OT) programs. Eighty PT and OT students completed the DCCM by rating the 11 sub-competencies using the National Institute of Health Proficiency Likert Scale. The Exploratory Factor Analysis yielded a Kaiser-Meyer-Olkin of 0.878 and Bartlett’s test significance value of < 0.001, which indicates that the data were very good for factor analysis. The Eigenvalues and scree plot derived two factors with an excellent internal consistency (Cronbach’s alpha = 0.936). When examining the grouping of sub-competencies, the two factors that emerged were patient-centered and interprofessional collaborative care. The DCCM version 2.0 can guide educators in designing learning experiences that target the essential competencies in dementia care, ensuring that PT and OT graduates are well-prepared to work with individuals living with dementia. Future research should refine the model by exploring additional sub-competencies within each domain and expanding the model’s applicability across multiple healthcare disciplines.

Analyzing the roles, workflows, and communication dynamics of social workers within interprofessional care teams

ABSTRACT Social workers frequent interprofessional healthcare teams, but few studies examine the day-to-day experiences of these providers on interprofessional teams. Our study utilized semi-structured interviews with 54 medical social workers practicing on interprofessional healthcare teams. A thematic analysis was used to analyze the day-to-day functions of these social workers. The analysis resulted in three primary themes: 1) Social Workers’ Self-Perceptions of their Roles within Interprofessional Teams, 2) Social Workers Shifting Roles on Interprofessional Teams, and 3) Interprofessional Team Dynamics that Impact the Role of a Social Worker. Social workers perceived their primary roles as contributing a unique systems approach to interprofessional healthcare teams while emphasizing patient self-determination. These self-perceptions influenced their shifting roles on interprofessional healthcare teams (e.g. clinician, case manager, bridge builder). In addition to individual self-perceptions, the healthcare system infrastructure influenced social work roles. For example, social workers in outpatient settings more frequently assumed the role of a mental health practitioner compared to those in inpatient settings. Last, there was variation in interprofessional communication and workflow assignment based on the healthcare infrastructure. Future research should examine the education and training efforts of social workers and other allied health professions for interprofessional healthcare teams.

An Interprofessional Ambulatory Care Simulation for Health Professions Students.

An Interprofessional Ambulatory Care Simulation for Health Professions Students.

Interprofessional Care: An Approach to Enhance Care for Children With Autism Spectrum Disorders by Enhancing Interprofessional Competencies

BackgroundInterprofessional practice is an essential component of healthcare delivery, addressing health conditions requiring multidisciplinary approach. An interprofessional team working together, utilizing the skills and interprofessional competencies is needed to perform the function seamlessly. Interprofessional education is therefore essential to develop a “practice-ready workforce”. AimThis study is aimed at designing and validating an interprofessional education module to integrate interprofessional competencies among students to care for children with autism. MethodsQuasi-experimental study done among 49 students. Module was prepared using scientific methods and implemented. Data collection was conducted using questionnaires and observation checklist. Using the mean, frequency and percentage, and t-test, data were analyzed. ResultsThere was increase in the knowledge (pretest mean 9.43±2.92; post-test mean 12.27±2.98) and competency (pretest mean 76.98±7.55; post-test mean 91.88±5.31) scores with moderately positive correlation between knowledge and competencies (p≥0.05). The study aligned with promotion of Sustainable Developmental Goals 3 “good health and well-being”, 4 “quality education” and 17 “partnerships for the goals”. ConclusionStudy showed that the prepared module was successful in improving the interprofessional competencies of students.

Evaluating ExpandED: Evaluating the effectiveness of a serious game expansion pack in teaching health professional students about interprofessional care.

The emergency department (ED) is a challenging fast-paced environment with high-acuity, undifferentiated patients who often require extensive interdisciplinary care. This paper introduces ExpandED, an expansion pack to the serious board game GridlockED, designed to enhance players' understanding of interprofessional collaboration in the ED and the diverse scope of practice of different ED professionals including physicians, residents, registered nurses, registered practical nurses, social workers, occupational therapists, and physiotherapists. This investigation evaluates the effectiveness of ExpandED as a teaching tool for medical and allied health professions students about interprofessional collaboration in the ED. A program evaluation harnessing a playtest framework was employed. Participants completed pre- and postgame surveys including quantitative measures (e.g., Likert scales) and qualitative free-text feedback that focused on participant familiarity with ED functioning, valuation of interprofessional collaboration before and after playing, and feedback on game usability and effectiveness. Recruitment was open to students in all health care and allied health professional programs at the institution. Forty-five participants were recruited from medical doctor, nursing, physiotherapy, and speech language pathology programs. ExpandED enhances participants' understanding of ED workflow (p < 0.001) and provides an enjoyable playing experience. However, participants' valuation of interdisciplinary teamwork did not change significantly before and after game play (p = 0.17). Participants expressed satisfaction with the game's accuracy in simulating the ED environment and appreciated the opportunity to collaborate with peers from different disciplines. Challenges reported included some tension among players, potential biases, and limitations of fidelity to a real-life ED. While this study has limitations regarding participant sampling and duration of gameplay sessions, it highlights the potential of ExpandED for teaching interprofessional collaboration in the ED. These findings will guide further development to optimize the expansion pack's effectiveness and its implementation into health care curricula.

“I get the referral because nobody else wants to work with this person”: A critical realist analysis of social workers providing care to people living with borderline personality disorder

Borderline personality disorder (BPD) is a mental health condition characterized by unstable relationships, self-image, and emotions, as well as impulsive behaviors and high rates of morbidity and mortality. Provider-based stigmatization of individuals with BPD is associated with poor health outcomes and increased mortality risk. However, little is known about social workers' experiences in providing care to people living with BPD (PLBPD). This study explored social workers' perspectives on the impact of stigma on care for PLBPD. Between April 2020 and January 2021, qualitative semi-structured interviews were conducted with 41 social workers practicing across the continuum of care (e.g., community services and hospitals) in Ontario, Canada. Data were analyzed using Critical Realist Analysis. Four primary themes emerged: (1) stigmatization of PLBPD due to the complexity of their needs (e.g., avoidance, blame, name-calling by providers); (2) lack of BPD-specific training and education in social work curricula; (3) observed stigmatization of PLBPD by social workers and other professionals (e.g., psychologists and physicians); and (4) suggestions for improving care experiences for PLBPD. Results suggest that provider-based stigma remains a significant quality of care issue affecting PLBPD. Further research is needed to understand the scope of these issues among diverse PLBPD populations, within social work practice, and across interprofessional care settings.

Interprofessional Management of (Risk of) Malnutrition and Sarcopenia: A Grounded Theory Study from the Perspective of Professionals.

As our global population ages, malnutrition and sarcopenia are increasingly prevalent. Given the multifactorial nature of these conditions, effective management of (risk of) malnutrition and sarcopenia necessitates interprofessional collaboration (IPC). This study aimed to understand primary and social care professionals' barriers, facilitators, preferences, and needs regarding interprofessional management of (risk of) malnutrition and sarcopenia in community-dwelling older adults. We conducted a qualitative, Straussian, grounded theory study. We collected data using online semi-structured focus group interviews. A grounded theory data analysis was performed using open, axial, and selective coding, followed by developing a conceptual model. We conducted five online focus groups with 28 professionals from the primary and social care setting. We identified five selective codes: 1) Information exchange between professionals must be smooth, 2) Regular consultation on the tasks, responsibilities, and extent of IPC is needed; 3) Thorough involvement of older adults in IPC is preferred; 4) Coordination of interprofessional care around the older adult is needed; and 5) IPC must move beyond healthcare systems. Our conceptual model illustrates three interconnected dimensions in interprofessional collaboration: professionals, infrastructure, and older adults. Based on insights from professionals, interprofessional collaboration requires synergy between professionals, infrastructure, and older adults. Professionals need both infrastructure elements and the engagement of older adults for successful interprofessional collaboration.

Development and Testing of an Instrument to Measure Professionalism in Nursing.

Background and Purpose: Evaluation of professionalism in nursing has proven challenging as no objective measurement tool exists. The purpose of this study was to develop and test the Professionalism in Nursing Scale (PNS) for reliability and validity, which will facilitate evaluation of the constructs of professionalism in nursing. Participants were senior nursing students and registered nurses with at least a baccalaureate degree and a minimum of 3 years of experience working either in academia at an accredited university or in a practice setting in a Magnet hospital. Methods: Methodological research was used to design an instrument that measures professionalism in nursing. Phase 1 included item development, scaling, and evaluation of the content validity index, using 10 content experts. Phase 2 included pilot and field testing using participants meeting the inclusion criteria. Questionnaires were sent electronically to evaluate the relevance of each attribute of professionalism using a Likert scale. Phase 3 was scale evaluation, including reliability and validity of the PNS. Results: Final results of exploratory factor analysis supported a 33-item five-factor model. The factors were named Ethics and Interprofessional Collaboration, Excellence, Professional Engagement, Caring, and Self-Awareness. The overall reliability rate of the PNS was 0.97. Findings demonstrated the reliability and validity of the PNS for measuring professionalism in academic and clinician nurses and nursing students. Conclusions: Measuring professionalism in nursing can assist driving improvement of patient care, accountability, and team collaboration. A discussion of the PNS within the context of academia and clinical practice, along with implications for research, practice, education, and policy will be presented.

Addressing challenges in diagnosis and management of rare disease through interprofessional education

Rare diseases represent a significant public health challenge due to their complexity and lack of resources. One way to improve care for patients with rare disease is to educate healthcare professionals on the diverse and unique needs of patients with rare disorders. An interprofessional education (IPE) event was created for healthcare students based on the Interprofessional Education Collaborative’s ‘IPE Core Competencies', mainly targeting two specific competencies: (1) interprofessional communication and (2) teams and teamwork. The IPE event included direct instruction, case-based learning, and narrative medicine components using the rare disease nephropathic cystinosis as a model of a rare complex disorder. Pre- and post-event survey data were collected to assess the participants' knowledge acquisition and perceived confidence in caring for patients with a rare disease as part of an interprofessional healthcare team and included open-ended questions regarding qualities of an interprofessional team member, and key takeaways from the event. Enrollment included 163 graduate-level healthcare students from nine different disciplines. The survey data showed improved understanding of the importance of rare disease research (p < 0.001), ability to identify supportive resources for patients (p < 0.001), confidence in being part of an interprofessional team caring for a patient with rare disease (p < 0.001) and value of education about rare disease (p = 0.009). When asked to describe features of effective interprofessional teams, common traits included strong communication skills, empathy, compassion, understanding, collaboration, and respect. This work demonstrates that utilizing an interprofessional model in educating health professional students about rare diseases successfully enhanced learners’ confidence in their ability to be part of an interprofessional team caring for patients and families impacted by rare disease, and given the total prevalence of rare diseases, may have a significant impact on healthcare as a whole.

Registered Dietitian Nutritionists’ Attitudes Toward Interprofessional Health Care Teams: A Cross-Sectional Survey

BackgroundRegistered dietitian nutritionists (RDNs) are important members of interprofessional health care teams; yet, there is limited research of RDN perspectives of interprofessional teams. ObjectiveTo examine associations between the characteristics of RDNs and their attitudes of team-based care (TBC). DesignA cross-sectional electronic Qualtrics survey encompassing demographic questions, the Attitudes Toward Interdisciplinary Health Care Teams (ATIHCT) scale, and additional interprofessional-related items was distributed to RDNs during January 2020. Participants/settingA total of 5018 RDNs from various regions/specialties in the United States were recruited primarily via direct email from a random list of RDNs obtained through the Commission on Dietetic Registration. The final sample was N = 616; 12.3% of RDNs and 88.1% of RDNs who initiated the survey. Main outcome measuresATIHCT subscale scores, which measure attitudes regarding efficiency of TBC and service quality of TBC. Statistical analyses performedMultiple linear regression modeled area of specialty, time with RDN credential, location, sex, frequency of TBC, and how valued the RDN perceived him or herself to be as independent variables, with ATIHCT subscales as outcome variables. Data were subjected to confirmatory factor analysis to determine appropriate use of the ATIHCT scale in the sample. ResultsFoodservice (β = –1.48; P = .004) and sports nutrition RDNs (β = –2.58; P = .014) had lower scores for attitudes regarding efficiency of TBC (subscale 1) than clinical RDNs. Greater perceived value of the RDN was associated with higher scores for attitudes regarding efficiency (β = .66; P < .001). Greater perceived value of the RDN (β = .13; P = .03) was associated with higher scores for attitudes regarding service quality of TBC (subscale 2). ConclusionsSpecialty and perceived RDN value are associated with more favorable interprofessional attitudes among RDNs. To support positive attitudes regarding interprofessional collaboration, efforts should be honed to foster appreciation and clarity of the RDN’s role in TBC.

Ethical aspects in the context of extracorporeal life support systems (ECLS): consensus paper of the DGK, DGTHG and DGAI

Extracorporeal life support systems (ECLS) are life-sustaining measures for severe cardiovascular diseases, serving as bridging treatment either until cardiovascular function is restored or alternative treatment, such as heart transplantation or the implantation of permanent ventricular assist devices is performed. Given the insufficient evidence and frequent urgency of implantation without initial patient consent, the ethical challenges and psychological burden for patients, relatives and the interprofessional intensive care team are significant. As with any treatment, an appropriate therapeutic goal for ECLS treatment based on the indications and patient informed consent is mandatory. In order to integrate the necessary ethical considerations into everyday clinical practice, astructured algorithm for handling ECLS is proposed here, which takes ethical aspects into due account.

Abstract 26: An Effective mHealth Intervention to Close the Guideline-to-Practice Gap in Hypertension Treatment: mGlide RCT

Background: Suboptimal HTN control is a widespread problem particularly among minorities and socioeconomically disadvantaged groups. Objective: To determine if a mobile health (mHealth) intervention facilitating an active partnership between inter-professional care teams (including pharmacists) and patients improves HTN control in patients with uncontrolled HTN. Methods: mGlide is an NIH-funded, 2-arm RCT evaluating HTN control between a mHealth intervention (mGlide) vs. state-of-clinical-care (comparison) groups using a PROBE (Prospective Randomized Open Blinded End-point) design. Table 1 shows intervention components. High CVD risk patients with uncontrolled HTN identified by EHR query were randomized 1:1 to either mGlide or to comparison for a 6-month intervention followed by a 6-month observation period. Recruitment sites include primary care clinics and specialty stroke service in an integrated health system, community clinics (CC) and federally qualified health centers (FQHC). The FQHC and CC serve low income and minority (Hmong and Latino) patients. The primary aim tested clinical effectiveness of mGlide in reducing SBP at 6 months. Secondary outcomes include resource utilization, adverse events and medication side-effects. Results: Recruitment started in 2019. N=395 participants enrolled by August 2023. The pandemic impacted enrollment; however enrollment recovered after vaccine availability (Figure). Primary outcome was available in March 2024 on everyone except in those lost to follow-up (n=38; 9.6%). We used multiple imputation for those missing 6 month SBP. Baseline mean SBP was 143.2 vs. 143.6 mm Hg in mGlide vs. comparison. The intervention led to better HTN control (Table 2). Mean 6-month SBP was 128.1 (mGlide) vs. 134 mm Hg (comparison). Adjusting for baseline SBP and study strata, 6-month mean SBP was 5.7 mm Hg (95% CI 2.9-8.4; p = 0.0001) lower in mGlide vs. comparison. The odds of HTN control defined as “alive and SBP &lt; 130 mm Hg”, was 60% higher in the mGlide arm (OR 1.6; 95% CI 1.03-2.48; p=0.035). There was one death in each study arm. The mGlide arm had fewer ER visits (16% vs. 25%; p=0.024), fewer hospitalizations (7% vs. 13%; p=0.044) and more medication side effects (39% vs. 26%, p=0.008). Conclusions: An inexpensive mHealth intervention that used the patient’s own phone (Table 1) was implemented in diverse health systems and significantly reduced SBP and was associated with less resource utilization at 6 months (Table 2).

Digital Innovation to Grow Quality Care Through an Interprofessional Care Team (DIG IT) Among Underserved Patients With Hypertension.

The impact of digital health on medically underserved patients is unclear. This study aimed to determine the early impact of a digital innovation to grow quality care through an interprofessional care team (DIG IT) on the blood pressure (BP) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk score of medically underserved patients. This was a 3-month, prospective intervention study that included patients aged 40 years or more with BP of 140/90 mmHg or higher who received care from DIG IT from August through December 2021. Sociodemographic and clinical outcomes of DIG IT were compared with historical controls (controls) whose data were randomly extracted by the University of California Data Warehouse and matched 1:1 based on age, ethnicity, and baseline BP of the DIG IT arm. Multiple linear regression was performed to adjust for potential confounding factors. A total of 140 patients (70 DIG IT, 70 controls) were included. Both arms were similar with an average age (SD) of 62.8 (9.7) years. The population was dominated by Latinx (79.3%) persons, with baseline mean BP of 163/81 mmHg, and mean ASCVD risk score of 23.9%. The mean (SD) reduction in systolic BP at 3 months in the DIG IT arm was twice that of the controls (30.8 [17.3] mmHg vs 15.2 [21.2] mmHg; P <.001). The mean (SD) ASCVD risk score reduction in the DIG IT arm was also twice that of the controls (6.4% [7.4%] vs 3.1% [5.1%]; P = .003). The DIG IT was more effective than controls (receiving usual care). Twofold improvement in the BP readings and ASCVD scores in medically underserved patients were achieved with DIG IT.

Advancing the Art and Science of Professional Nursing Practice With the Virtually Integrated CareSM Model.

The purpose of this article is to share the transformative vision of 2 nurse executives and how this vision paved the way for the development of a revolutionary model that changed care delivery. The CommonSpirit Health Virtually Integrated Care Team operationalized the vision by leveraging technology to develop a team-based care model that seamlessly integrates a virtual nurse as part of the care team. This article will discuss the spark that created the impetus for the creation of this metamorphic, interprofessional care delivery model and how this model unburdens the workload of the nurses to idealize the art and science of professional nursing practice.

Creating Optimal Clinical Learning Environments Through Interprofessional Bedside Rounding Models: Lessons From the iPACE Story.

The Interprofessional Partnership to Advance Care and Education (iPACE) model was developed and implemented at Maine Medical Center in 2016 as part of the Accreditation Council for Graduate Medical Education's Pursuing Excellence in Clinical Learning Environments (CLE) demonstration project. The model is based on the belief that, in optimal CLEs, residents are trained in team-based, interprofessional collaborative care and use clinical care experiences to innovate in the areas of patient safety and quality of care. The model's inclusion of systems engineering principles, such as design thinking, allows teams to design, customize, and iteratively improve their own iPACE model.The iPACE model was further developed and disseminated with support from an American Medical Association Reimagining Residency grant and from the MaineHealth health system's medical education and clinical leadership. iPACE started as a small pilot project on a single inpatient unit and has evolved to become the standard for inpatient team rounds at the bedside. iPACE has received positive feedback from patients, demonstrated benefits to care team members and resident education, and proven its value to the health system through sustained reductions in length of stay and cost of care metrics. The iPACE project has fulfilled MMC's original goal of intentionally redesigning its CLEs to expose residents to high-functioning interprofessional teams with the goal of improving patient care and safety. The model has shown direct learner benefits through increased faculty observation and improved quality of feedback. Interprofessional bedside rounding models like iPACE have the potential to imprint learners with the skills and behaviors essential to provide collaborative patient-centered care. Strategies exist that improve resident and faculty engagement in bedside rounding models like iPACE and should be employed to encourage teaching and learning at the bedside.