Collaborative Practice Model Research Articles

Measuring dynamic collaborations: Collaborative health assessment tool

AbstractThe changing nature of organisations in the public sector means that collaboration has become an imperative for many. Notwithstanding considerable scholarly agreement about factors contributing to successful collaboration, a broadly accepted model of collaborative practice has not coalesced. In this paper, we put forward an augmented collaboration assessment tool. Building on existing research, we argue that systems thinking can help us better account for the dynamic and multidimensional nature of collaboration – a process in which partner organisations are interconnected and organised in a way that seeks to achieve a common purpose that they could not have achieved alone. We tested the validity of our tool using a three‐stage, iterative mixed‐methods approach. Our research confirms the value of a diagnostic tool to assist collaboration partners navigate an often uncertain terrain. It further establishes the value of our tool in illuminating a collaboration's dynamic interactions as a means to evaluate ‘collaboration health’.

Integration of Authentic Leadership Lens for Building High Performing Interprofessional Collaborative Practice Teams.

Interprofessional collaborative practice (IPCP) models facilitate collaboration and teamwork across the health care continuum. Success of high performing IPCP teams is dependent on compassionate, authentic leaders who invest in helping their teams thrive amidst complexity. This article presents the integration of an authentic leadership lens for building high performing IPCP teams. Using their experience with implementation of an innovative IPCP model to improve health outcomes for an underserved patient population in the southeastern United States, the authors share targeted strategies using an authentic leadership lens to develop high performing teams. Data collected for 3 years reflect positive team performance outcomes related to collaboration and teamwork, which contributed to enhanced access to care, exceptional patient experience, improved physical and mental health outcomes, reduced hospital readmissions, and decreased cost of care. An innovative IPCP model of care is an effective approach to improve health outcomes and care transitions. However, it may not be fully successful if health care professionals practicing within these models cannot collaborate effectively or maintain personal well-being. The value of using an authentic leadership lens to guide IPCP team development cannot be underestimated.

Collaboration among registered nurses and practical nurses in acute care hospitals: A scoping review.

This study examined the extent, range, and nature of registered nurse (RN) and practical nurse (PN) collaboration in acute care hospitalsand identified research gaps in the existing literature. Optimal patient care requires collaboration between RNs and PNs. A lack of unity and unresolved tension among different types of nurses influences collaborationand has significant implications on practiceand the organizations where nurses work. Using Arksey and O'Malley's (2005) framework, a scoping review was undertaken to answer the research question: what is known from the existing literature about the structures, processes, and outcomes of RN-PN collaboration in hospitals? Twenty-nine studies were included with the majority coming from North America. Donabedian's model assisted with the identification of three themes: scope of practice, interpersonal skills, and nurse and patient-related outcomes. The findings demonstrate there is a paucity of research specific to RN-PN collaboration. Nurse administrators/managers play an important role in addressing the interpersonal skills of nurses and providing an ongoing education on collaboration in the practice setting. Additional studies should focus on the development of nursing collaborative practice models of patient care, the examination of interventions to improve RN-PN collaborative practice, and the assessment of outcomes relating to collaboration among nurses.

Twelve tips for conducting successful interprofessional teaching rounds

Inpatient bedside teaching rounds provide an opportunity to foster effective interprofessional collaboration between members of the healthcare team. Although effective interprofessional practice has been shown to improve patient satisfaction, patient outcomes, and job satisfaction, there is limited literature for successful implementation of interprofessional teaching rounds. To address this gap, we have compiled 12 tips for conducting effective interprofessional bedside teaching rounds. These tips offer strategies for creating a structured rounding system, with clear delineation of expectations, defined opportunities for learning across disciplines, and active engagement of and respect for all team members. By adopting and promoting this model of interprofessional collaborative practice, the quality and effectiveness of bedside teaching rounds can be improved for the benefit of patients, trainees, and the team as a whole.

The Overarching Themes From the CLER National Report of Findings 2018.

The Overarching Themes From the CLER National Report of Findings 2018.

Enhanced Child Psychiatry Access and Engagement via Integrated Care: A Collaborative Practice Model With Pediatrics.

This study examined mental health service use outcomes for children receiving integrated care via a collaborative-practice model (CPM). The study hypothesis was that the delivery of intensively integrated clinical care within pediatrics, combined with community-based parent support from family support specialists (FSSs), would facilitate mental health or substance use disorder treatment access and engagement for youths at risk of experiencing disparities. The study sample consisted of 228 children referred by pediatricians for outpatient child psychiatry evaluation within an urban safety-net hospital system in 2013. In the pilot clinic, 32 youths were referred to the CPM intervention. Among the remaining seven clinics, 196 youths were referred to usual care (control group). Differences in treatment access and engagement between the intervention and control groups were assessed using propensity-score weighted logistic regression models. Holding all else constant, children receiving the CPM intervention had four times higher odds of accessing psychiatric evaluations than children in the usual care control group (adjusted odds ratio [AOR]=4.16, p<.01). The odds of engagement (i.e., participation in follow-up appointments) were seven times greater for youths in the CPM than youths in the control group (AOR=7.54, p<.01). Access and engagement were significantly higher for children receiving CPM than for usual care participants. This suggests that integrated CPM warrants further investigation as an approach for improving the odds that children and families will receive needed mental health or substance use disorder treatment.

Collaborative Practice Enriches Teams and Enhances Experiences for Future Providers

To develop a collaborative practice model of care that embraces the contributions of certified nurse-midwives, laborists, residents, midwifery students, and nursing staff, as outlined in the Joint Statement of Practice Relations Between Obstetrician-Gynecologists and Certified Nurse-Midwives/Certified Midwives from the American College of Obstetricians and Gynecologists and the American College of Nurse-Midwives.

Embedding learning development; a model for collaborative practice

In 2016, the Learning Development Team at St Mary’s University was awarded a prize for teaching excellence for its report on 'the collaborative delivery of embedded academic skills development programmes within subject modules’. The report detailed the planning and delivery of embedded activities across Schools in which academic skills were tailored to subject specific module content. The success of the report resulted in long-term investment in the Learning Development Team and positioned embedded academic learning as an integral part of the university’s corporate plan. This paper presents the results of a small-scale research study to evaluate an embedded academic skills module in Criminology and Sociology delivered at Level 4. The impact of this embedded module has been measured through semi-structured interviews with students, the subject lecturer and learning development lecturer. The final self-evaluation assessment was also analysed to understand more fully how students had developed over the course of the module. Results clearly demonstrate that embedding academic skills into the Criminology and Sociology programme had an impact on student confidence, belonging and retention. The outcome is an 'impact-tested' accredited skills module that can be adapted and used by other learning development teams.

Development of Team Cohesiveness Measurement Instruments in Interprofessional Collaborative Practice in Health Care

AbstractHealth care management has an obligation to always provide safe, sustainable, comprehensive, quality and satisfactory health care for both the service user and care provider. The management and culture are built through the Interprofessional Health Care Collaborative Practice Model (MPIPK), which are implemented through four model components, i.e. the clinical pathway of patient management, team management of patients, patient care integrated documentation, and interdisciplinary patient problem solving through interdisciplinary case conference forums. In order to realize interprofessional collaboration practices, a cohesive climate is required that supports group functions and performances, and an instrument is needed to measure the team cohesiveness of this model. This research was conducted to develop a team cohesiveness measurement instrument in the interprofessional collaboration of health care. The instrumentation research design was carried out through the following steps: 1) Preparations of the instrument design commenced from the synthesis theory related to collective culture and individual culture on four components of the model; 2) Validation of the contents of the instrument with related experts; 3) Construct validation with 237 healthcare practitioners in an accredited hospital setting. Expert judgment results on instrument relevance (CVI) ranged from 0.77 to 0.91, the essence of instrument contents (CVR) was in range (+) 0.27 - 0.63, CVI and CVR scores indicated the relevant and essential content of the instrument. Test results of all constructed items were valid (0.283 - 0.847) and reliable, α Cronbach on 4 components (0.792 - 0.963) so, it is feasible to be used to measure the team cohesiveness.

Using Two-Eyed Seeing to Explore Interagency Collaboration.

Background Health-care environments influence service delivery; approaches need to be more wholistic and culturally competent requiring effective interagency collaboration to bridge traditional Indigenous and mainstream health services. Despite considerable research on collaboration, the concept remains misunderstood, at worst, and formative, at best. Within the nexus of these two diverse health services, there is limited information on how collaborations could be created and sustained effectively. Purpose To explore the perspectives/experiences of collaboration of select Saskatchewan health professionals practicing across these diverse services to understand the concept from their perspectives. Methods This qualitative study explored collaboration through observation and interviews to elicit perspectives (two-eyed seeing) of health professionals working within the context of a traditional-mainstream health services partnership. Results Individual- and system-level factors and accountabilities are needed for successful cross-cultural collaboration and can be enabled by embedding the virtues of Indigenous and values of mainstream health services along with building and maintaining relationships, valuing difference, creating supportive environments and wholistic approaches, having the right people at the table, and making a change for impactful outcomes. Conclusion Findings support the need for implementing contextually relevant collaborative practice models for productive, wholistic health services. Two-eyed seeing provides the ability to capture and catalyze the tremendous value and strengths of both worlds, potentiating complementary aspects to meet the needs of clients and communities.

Test of an interprofessional collaborative practice model to improve obesity-related health outcomes in Michigan

Abstract The purpose of the study was to test the effectiveness of an interprofessional collaborative practice (IPCP) education program on clinicians' and students' knowledge and attitudes toward IPCP and to determine the effectiveness of an IPCP weight loss program in two nurse-managed centers. The study team used the Midwest Interprofessional Practice, Education, and Research Center (MIPERC) collaborative practice education program that consists of online learning modules followed by daily huddles and collaborative care planning. The obesity intervention program was implemented by faculty and staff practitioners and students in two clinics with very different patient populations (community residents and college students). Staff/faculty practitioners and students demonstrated statistically significant knowledge gains as a result of online learning modules (Introduction to IPE p .05). The study demonstrated the potential of an IPCP program to affect weight loss in two populations.

Interprofessional Education: Opportunities and Challenges for Psychology

This manuscript is an outgrowth of an invited panel presentation at the national Association for Psychologists in Academic Health Centers Conference in 2017 on Interprofessional Education (IPE). IPE is a structured and transformative educational strategy designed to provide active learning experiences where trainees from diverse healthcare professions gain shared content knowledge plus collaboration skills as they learn about, from, and with each other. Collaboration skills include understanding professional role distinctions and overlap, effective team-based communication, shared values/ethics and respect for each other's expertise, and teamwork dynamics. It is increasingly important to expand training beyond the intraprofessional activities in which psychology trainees engage to prepare them to participate in interprofessional collaborative care. As healthcare systems move to team-based collaborative practice and value-based reimbursement models, the profession of psychology needs leaders at every academic health center to facilitate the design and/or implementation of IPE activities. The panel of psychologists presented roles that psychologists play in IPE institutional program design and implementation, graduate training programs, and the perspectives of an early career psychologist and psychology trainee. Opportunities and challenges are highlighted, culminating in a call to action. Psychologists must embrace their identity as health professionals and engage their learners in IPE so that the emerging cognitive schemata of healthcare that is developed includes the profession of psychology. Otherwise, healthcare teams and health professionals will not understand the value, roles, or potential contributions of psychologists in enhancing patient care outcomes, ultimately jeopardizing psychologists' referrals, involvement in healthcare delivery, and career opportunities.

Improving Population Health Among Uninsured Patients with Diabetes.

Diabetes is a leading cause of morbidity and mortality; prevalence of diabetes is especially high in the southeastern United States among minority populations and those from lower socioeconomic sectors without access to health care services. The purpose of this project was to evaluate the clinical and financial outcomes of a nurse-led, interprofessional collaborative practice model that provides care coordination and transitional care for uninsured patients with diabetes. Data for this study were collected and evaluated from medical records of patients seen at the Providing Access to Health Care (PATH) Clinic between August 1, 2015, through May 30, 2017. Clinical outcomes were evaluated by comparing hemoglobin A1c (HbA1c) values before and after referral to the PATH Clinic. Cost savings to the academic medical center were evaluated by comparing costs associated with inpatient or emergency department encounters before and after referral to the PATH Clinic. A significant decrease in HbA1c (P < .0005) was noted for patients attending the PATH Clinic. In addition, financial analyses revealed a 55% decrease in pre to post PATH Clinic patients' direct costs. Similarly, a 42% decrease in the pre to post PATH Clinic patients' direct cost per encounter was noted. Average length of stay also was reduced when these patients were readmitted to the academic medical center. Results from this study support the effectiveness of the PATH Clinic model in caring for uninsured patients with clinically complex medical and social needs, often with behavioral health problems, who incur high health care spending and are often readmitted.

Collaborative Practice Model: Improving the Delivery of Bad News.

Ideal bad news delivery requires skilled communication and team support. The literature has primarily focused on patient preferences, impact on care decisions, healthcare roles, and communication styles, without addressing systematic implementation. This article describes how an interdisciplinary team, led by advanced practice nurses, developed and implemented a collaborative practice model to deliver bad news on a unit that had struggled with inconsistencies. Using evidence-based practices, the authors explored current processes, role perceptions and expectations, and perceived barriers to developing the model, which is now the standard of care and an example of interprofessional team collaboration across the healthcare system. This model for delivering bad news can be easily adapted to meet the needs of other clinical units. .

Conceptual model of collaborative pharmaceutical practice in healthcare and social care for the elderly

Background/Aim. In the new millennium, the focus has been increasingly shifting to optimisation by enhancing the collaborative (common, joint) practice of healthcare professionals, for the purpose of achieving effectiveness and efficiency. Pharmacists are the last link in the healthcare services providing chain. The aim of this study was to present a critical analysis of the published models of the collaborative pharmacy practice along with development of a conceptual model of collaborative pharmacy practice in the healthcare and social care for the elderly population. Methods. Using two search algorithms that were created to search articles published in English, a comprehensive search of the bibliographic databases Web of Science and PubMed was undertaken (up to June 2015). Afterwards, articles were independently assessed by two authors, against predetermined inclusion and exclusion criteria. Results. Regulations on pharmacy collaboration are present in many developed countries. However, the implementation of the collaborative practice is still not widespread. Therefore, a conceptual model of the collaborative healthcare and social care of the elderly provides an insight into a multi-layer structure that has to be established in order to achieve a functioning system of the collaborative healthcare practice. The model concluded that aspirations towards teamwork, communication and above all ? the system of regulators and payers, who acknowledge a healthcare collaboration, are crucial for establishment of a collaborative healthcare practice. Conclusion. This research provides a tool in the form of a guide and check-list for decision-makers and policy-makers in order to achieve the preferred effects generated from the collaborative practice by selecting the models and activities that need to be undertaken for implementation of the collaborative healthcare and social care of the elderly that is best suited for their country.

Pharmacist-physician collaborative care model and time to goal blood pressure in the uninsured population.

Pharmacist-physician collaborative practice models (PPCPMs) improve blood pressure (BP) control, but their effect on time to goal BP is unknown. This retrospective cohort study evaluated the impact of a PPCPM on time to goal BP compared with usual care using data from existing medical records in uninsured patients with hypertension. The primary outcome was time from the initial visit to the first follow-up visit with a BP <140/90mm Hg. The study included 377 patients (259=PPCPM; 118=usual care). Median time to BP goal was 36days vs 259days in the PPCPM and usual care cohorts, respectively (P<.001). At 12months, BP control was 81% and 44% in the PPCPM and usual care cohorts, respectively (P<.001) and therapeutic inertia was lower in the PPCPM cohort (27.6%) compared with usual care (43.7%) (P<.0001). Collaborative models involving pharmacists should be considered to improve BP control in high-risk populations.

An Interprofessional Education and Collaborative Practice Model for Dentistry and Pharmacy.

The aims of this study were to evaluate the feasibility of an interprofessional education and collaborative practice model (IECPM) developed by the School of Dentistry (SOD) and College of Pharmacy (COP) for the University of Minnesota dental clinics and to report results of the needs assessment using specific primary care metrics and medication histories gathered through use of the model in 2015-16. Planning focused on establishing a workflow to implement the IECPM by the SOD and COP. The interprofessional team that provided patient care for the study consisted of 50 dental students, ten dental therapy students, one pharmacy student, one pharmacy resident, one faculty pharmacist, one dental assistant, one faculty dental hygienist, and two dentists. The team selected 190 patients in the SOD clinic for the study based on the inclusion criteria: patients with two or more chronic medical conditions who were taking medications. The 190 patients received a comprehensive dental exam, review of social and medical history, and medication therapy management assessment by the interprofessional team. Specific core primary care metrics (blood pressure, pulse, tobacco use, and diabetes status) and identification of drug therapy problems (DTPs) were monitored and/or screened for during the dental visit. The results showed that the IECPM helped identify that this cohort of patients presented with chronic conditions: 64% had hypertension, 34% had diabetes, and 10.5% reported smoking cigarettes. Several DTPs were identified, of which "needs additional drug therapy" was the most common. This cohort was taking multiple medications (2-34 per patient) to address a variety of medical conditions. The study concluded that the IECPM with the SOD and COP helped address a primary care need that often goes unmet in dental clinics.

The mental health community: An underserved and undertreated population: Encouraging research but challenges remain

The mental health community: An underserved and undertreated population: Encouraging research but challenges remain

The Effects of an In-office Pharmacy on the Treatment and Management of Hepatitis C

Introduction: The introduction of direct-acting antiviral regimens has revolutionized the treatment of HCV, however many challenges to the treatment of HCV remain including patient adherence, management of complications, and patient access. Methods: An in-office pharmacy played a critical role in solving medication compliance issues. The pharmacist was able to freely contact the practitioner and office staff to accelerate drug approvals. Patients approved for HCV drug therapy were carefully followed by the prescribing office practitioner and the pharmacist to be sure that adverse side effects, office visits, procedures, and labs were completed in a timely fashion. Drug interactions were also evaluated and communicated with the prescriber. Patient assistance was also coordinated. Adverse effects were reported to the pharmacist and/or the practitioner. Refills on the medications were timed to match office visits to minimize costs and maximize convenience. Drug studies typically represent those patients who completed treatment. In clinical practice, most patients often are not consistent in their adherence to medical regimens. It became clear that insurance companies would only pay once for these costly HCV treatments, therefore adherence was imperative. An intensive medication consultation was provided by an experienced pharmacist who was versed in HCV medications. This was a face-to-face consultation at the initial prescription pick-up and with subsequent refills. Results: 52 patients are included in this evaluation. 2 patients died during treatment from complications of end-stage liver disease and 1 patient refused to finish treatment. 1 patient required 2 separate drug regimens to achieve an undetectable viral load. 1 patient in 50 subjects was non-adherent (2%, where N=50). There was a statistically significant improvement in adherence using a collaborative practice approach with practitioner and pharmacist interaction p < 0.001 as compared to other HCV adherence studies where non-adherence percentages were as high as 52%. Conclusion: Patient medication adherence is superior using a collaborative practice model when compared to traditional methods of treatment. Positive outcomes were also noticed in the management of drug interactions, patient side-effects, patient co-pay assistance, and the decreased time required to resolve such issues. Further study is needed to evaluate the benefits of such a collaborative care model.

Juvenile offender rehabilitation in Estonia: interprofessional collaboration in written assessments and specialists’ perceptions

ABSTRACTQualitative and quantitative research methods were used to study an interprofessional assessment model in rehabilitation services and its implementation in Estonia based on (1) a sample of rehabilitation plans for 160 juvenile offenders aged 7–18 and (2) expert interviews with 10 members of an interprofessional assessment team. Each specialist’s role was compared with the assessments. While each team member is assigned a discrete role based on discipline, in practice, the disciplines’ work overlapped considerably during the assessment process. The overlap seems to occur because team members conduct their assessments individually, rather than following the collaborative best practice model for interprofessional teams described in the literature. The expert interviews indicate that rehabilitation specialists perceive the individual-level elements of interprofessional teamwork to be consistent with the ideals articulated in the Perception of Interprofessional Collaboration Model, while the substantial overlap in assessments that occurred in practice could be related to lack of interprofessional collaboration at group and organizational levels. Recommendations to improve the functioning of teams serving juvenile offenders include establishing an interprofessional education system, increasing the flexibility of the legal framework for service provision, and improving the interprofessional assessment instrument.