Empowering Primary Care: Interprofessional Education for Chronic Conditions

1. “Enhancing the Primary Care Management of Patients with Multiple Chronic Conditions through Interprofessional Education" Bobby Lowery, PhD, FNP-BC, FAANP DNP Council, NCNA 11/14/14

2. Pirate Welcome….ARRGH!

3. Declaration of Interest Enhancing the Primary Care Management of Patients with Multiple Chronic Conditions through Interprofessional Education, East Carolina University College of Nursing, Greenville, N.C. • This project is supported in part by funds from the Division of Nursing (DN), Bureaus of Health Professions (BHPr), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS) under grant number D09HP25923-01-00, Advanced Nursing Education Grants, for $1,091,723. The information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by the Division of Nursing, BHPr, HRSA, DHHS or the U.S. Government.

4. Objectives; At the conclusion of this session the learner will be able to: • Define IPE/IPC and why it is important • Apply IPE/IPC to the Triple Aim framework • Define interprofessional teams • Discriminate between effective and ineffective interprofessional collaboration • Apply IPE Competencies in clinical settings • Describe examples of DNP leadership in interprofessional settings.

5. Recommended Reading • Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative. • Accessed 10/14/14 @ http://www.aacn.nche.edu/education-resources/ipecreport.pdf

6. Historical Context • Traced from World War II • President Johnson’s vision of The Great Society • Dewitt Baldwin, 2006 • Adapted with permission • Greer, A. (2014) “IPE (InterProfessional Education) in Health Sciences: Who’s in the Game? Current and Past Players”. Medical History Interest Group Presentation, East Carolina University, Greenville, NC.

7. International Historical Context • India (pre-1900) • Mission hospitals sent out teams of physicians, nurses and ‘auxiliaries’ to provide health services to remote communities. • England (1920)—Dawson Report, Great Britian • Advocated a ‘team approach’ to health care • PeckhamExperiment at London’s Pioneer Health Centre promoted the idea of collaborative health care teams • South Africa & Israel (1954) • Implemented the concept of primary health teams in their community-based health programs (1954). • Adapted with permission • Greer, A. (2014) “IPE (InterProfessional Education) in Health Sciences: Who’s in the Game? Current and Past Players”. Medical History Interest Group Presentation, East Carolina University, Greenville, NC.

8. US Historical Context Richard Cabot Dewitt (Bud) Baldwin, 2006 • Massachusetts General Hospital • ‘‘teamwork of the doctor, the educator, and the social worker’’ (Cabot, 1915). • Adapted with permission • Greer, A. (2014) “IPE (InterProfessional Education) in Health Sciences: Who’s in the Game? Current and Past Players”. Medical History Interest Group Presentation, East Carolina University, Greenville, NC.

9. Historical Nursing Context • Dorothy Rogers (1932) • Means of achieving professional acceptance for nursing and allied health • Rogers, D. (1932). ‘‘Teamwork Within the Hospital’’ American Journal of Nursing • Adapted with permission • Greer, A. (2014) “IPE (InterProfessional Education) in Health Sciences: Who’s in the Game? Current and Past Players”. Medical History Interest Group Presentation, East Carolina University, Greenville, NC.

10. Interprofessional Education—How do YOU define it? “When students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes” (WHO, 2010)

11. Why IPE? To prepare all health professions students deliberatively working together safer and better patient-centered and community/population orientedhealth care system.

12. IPE What is it & Why Do we Do It?Contemporary Linkages • 2002 IOM Health Professions Summit • 2009--IPEC • 2013 Josiah Macey Report • Triple Aim • Professionals Working Together • Patient-Centered

13. Triple AimBetter Care for Individuals, Better Health for Populations, Lower per capita costs • Safe • Effective • Patient Centered • Efficient • Timely • Equitable

14. Interprofessional Teams • Two or more disciplines • Common purpose • Work together collaboratively and interdependently • Serve a specific patient/client population and achieve the team’s and organization’s goals and objectives • Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative.

15. Enhancing the Primary Care Management of Patients with Multiple Chronic Conditions through Interprofessional Education Purpose Method IPE strategies/competencies in AGNP & FNP curriculum Interprofessional learning scenarios in VCCLE Didactic & clinical content in management MCC infused into OSCAE Promote/evaluate IPE competencies by clinicians/students in rural, underserved community serving diverse, ethnic minority population • HRSA Advanced Nursing Education Grant $1,091,723 over 3 yrs. • Address the health care needs of individuals in rural communities with multiple chronic conditions (MCC)

16. Enhancing the Primary Care Management of Patients with Multiple Chronic Conditions Through Interprofessional Education B. Lowery, PhD, FNP-BC, FAANP; C. King, DNP, FNP-BC, K. Faser, M. Skipper, DNP, FNP-BC, E. Feldhousen, PhD, LMFT College of Nursing East Carolina University Greenville, North Carolina Lowerybo@ecu.edu GOAL Objective #1: Infused IPE competencies (values/ethics, roles and responsibilities, interprofessional communication, and teams and teamwork) throughout the AGNP and FNP curriculum The overall goal of this project is to graduate AGNP and FNP students who can provide evidence-based primary care to individuals with MCC within an interprofessional framework to clients living in rural underserved communities through the processes outlined in the objectives. Objective #4: Promote IPE competencies used by clinicians, faculty, and students practicing in a rural, underserved community serving a diverse, ethnic minority population METHODOLOGY The objectives of this proposal are to: • Infuse IPE competencies (values/ethics, roles and responsibilities, interprofessional communication, and teams and teamwork) throughout the AGNP and FNP curriculum; • Create case-based interprofessional learning scenarios in the VCCLE that address the IPE core competencies in the management of individuals with MCC, including those due to occupational causes; • Develop and expand clinical and didactic content in the management of individuals with MCC living in rural communities through interprofessional OSCAE experiences; and • Promote and evaluate IPE competencies used by clinicians, faculty, and students practicing in a rural, underserved community serving a diverse, ethnic minority population. Objective #2: Case-based interprofessional learning scenarios in the VCCLE in the management of individuals with MCC, including those due to occupational causes As leaders in complex health settings, NPs must understand and apply IPEC core competencies for interprofessional practice to ensure consumer access to high quality primary health care, especially in rural, underserved settings. This work focuses on educating teams and integrating advanced practice providers in the clinical practice environment. Process and outcome evaluation of IPE will utilize the four core interprofessional competencies that are linked to the five IOM core competencies for all health professionals. RECOMMENDATIONS Practice IPC in health care delivery Funding priorities/Incentives for IPE models of care Education IPE Technology as a methodology of teaching IPE Academic centers supporting IPE Research Academic centers supporting IPE Economic impact and sustainability of IPE Impact of technology and IPE on healthcare outcomes Objective #3: Standardized IPC OSCAE experiences CLINICAL PARTNERS We have partnered with Robeson Healthcare Corporation (RHCC), a long-term partner in providing clinical education opportunities interprofessional students to provide comprehensive healthcare across the life cycle for culturally diverse clients living with MCCs. It is our goal to place students in the RHCC sites every semester of years two and three. . This project is supported in part by funds from the Division of Nursing, Bureaus of Health Professions, Health Resources and Services Administration, Department of Health and Human Services under grant number D09HP25923-01-00. ACKNOWLEDGEMENT

17. “Virtual Clinic - Opening the Clinic Door to Interprofessional Education and Practice” • VCCLE can transform an online course medium into a high-quality, exciting distance learning experience. • Interprofessional cooperation maximizes fiscal and human resources in support of student learning. • Lowery, B., Corbett, R. W., King, C. A., Brown, S. T., & Faser Jr., K. E. (2014). Virtual Clinic—Opening the clinic door to interprofessional education and practice. The Journal for Nurse Practitioners, 10(10), e69-e76. doi:http://dx.doi.org/10.1016/j.nurpra.2014.08.021

18. Interprofessionality “the process by which professionals reflect on and develop ways of practicing that provides an integrated and cohesive answer to the needs of the client/family/population… It involves continuous interaction and knowledge sharing between professionals, organized to solve or explore a variety of education and care issues all while seeking to optimize the patient’s participation… Requires a paradigm shift, since interprofessional practice has unique characteristics in terms of values, codes of conduct, and ways of working. These characteristics must be elucidated” (D’Amour and Oandasan, 2005, p. 9).

19. Role Clarity • The specific role of each team member is vitally important • Enables increased collaboration • Role Clarity and overlap • Common roles in primary care settings • How the DNP can provide leadership in role clarity.

20. Constructs in the Measurement of IPE: The IPEC Core Competencies for Interprofessional Collaborative Practice

21. Office of Clinical Skills Assessment & Education (OSCAE) Standardized IPE experience

22. What are Standardized Patients? • A person who has been coached to accurately and consistently portray • History • Physical Findings • Personality • Emotions • Behavior

23. What’s an OSCE? • Objective Structured Clinical Examination • Learners have limited time to gather and share information, make decisions and foster the relationship. • Script/Scenario: • The patient’s story and background information used to standardize the portrayal. • Standard Scenarios: global content that can support multiple disciplines (“as is” or customized). • Pilot Scenarios: developed for grants, research and licensure preparation. • Checklist • A faculty driven compilation of history, communication skills and/or physical exam items that a learner is expected to explore as they confirm/refute the differential diagnoses (“as is” or customized).

24. Interprofessional OSCAE Experiences • September 25, 2014 • December 11, 2014 • NP • Medicine • Dietetics • Social Work • Physician Assistants • PT, Dentistry do not use OSCAE

25. Missed Opportunities • ACO/Medical Home • Pre-Huddle • Use of the four IPEC Core Competencies for Interprofessional Collaborative Practice for EHR /IT templates

26. Interprofessional teamwork: The levels of cooperation, coordination and collaboration characterizing the relationships between professions in delivering patient-centeredcare

27. Interprofessional team-based care Intentionally created, usually relatively small work groups in health care • recognized by others as well as by themselves • collective identity and shared responsibility • for a patient or group of patients • rapid response team, palliative care team, • primary care team, operating room team

28. IPE Reflection • http://www.youtube.com/watch?v=ARkCWuhuYbA • Reflection on IPE • DNPs can (and must) LEAD interprofessional teams in clinical practice.

29. What we’ve discussed • Define IPE/IPC and why it is important • Apply IPE/IPC to the Triple Aim framework • Define interprofessional teams • Discriminate between effective and ineffective interprofessional collaboration • Apply IPE Competencies in clinical settings • Describe examples of DNP leadership in interprofessional settings.

30. Websites American Interprofessional Health Collaborative: http://www.aihc-us.org/ Canadian Interprofessional Health Collaborative: http://www.cihc.ca/ Centre for the Advancement of Interprofessional Education: http://caipe.org.uk/ Interprofessional Education Collaborative: https://ipecollaborative.org/ WHO Framework for Action on Interprofessional Education and Collaborative Practice: http://www.who.int/hrh/resources/framework_action/en/index.html

31. Centers for Interprofessional Education Thomas Jefferson UniversityUniversity of California San FranciscoUniversity of KansasUniversity of MinnesotaUniversity of Washington

32. References Abu-Rish et al. (2011). Current trends in interprofessional education of health sciences students: A literature review. Journal of Interprofessional Care, 26, 444-451. Baldwin, D.C. Jr., (1996). Some historical notes on interdisciplinary and interprofessional education and practice in health care in the USA. Journal of Interprofessional Care, 1996; 10(2): 173-187. Barr, H., Koppel, I., Reeves, S., Hammick, M. & Freeth, D. (2005). Effective interprofessional education. Argument, assumption, and evidence. Malden, MA: Blackwell Publishing. Curran V., Hollet, A., Casimiro, L.M., et al. (2011). Development and validation of the Interprofessional Collaborator Assessment Rubric (ICAR). Journal of Interprofessional Care, 25, 339-44. D’Amour, D. & Oandasan, I. (2005). Interprofessionality as the field of interprofessional practice and interprofessional education: An emerging concept. Journal of Interprofessional Care, 19 (Supplement 1), 8-20. Greer, A. (2014) “IPE (InterProfessional Education) in Health Sciences: Who’s in the Game? Current and Past Players”. Medical History Interest Group Presentation, East Carolina University, Greenville, NC. Giddens, J., Fogg, L., & Carlson-Sabelli, L. (2010). Learning and engagement with a virtual community by undergraduate nursing students. Nursing Outlook, 58(5), 261-267. DOI: 10.1016/j.outlook.2010.08.001 Institute of Medicine. (2003). Health Professions Education: A Bridge to Quality. Washington, DC: The National Academies Press. Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative. King, S. et al. (2012). Developing interprofessional health competencies in a virtual world. Medical Education Online, 17, http://dx.doi.org/10.3402/meo.v17i0.11213. Kolb, D. (1981). Learning styles and disciplinary differences. In A.W. Chickering & Associates (Eds.), The modern American college: Responding to new realities of diverse students and a changing society (p. 232-255). San Francisco: Jossey-Bass. Langdon, H. (2009). Interprofessional education in higher education institutions: models, pedagogies, and realities. In P. Bluteau & A. Jackson (Eds.), Interprofessional education. Making it happen (p. 37-58). Hampshire, England: Palgrave Macmillan. Lowery, B., Corbett, R. W., King, C. A., Brown, S. T., & Faser Jr., K. E. (2014). Virtual Clinic—Opening the clinic door to interprofessional education and practice. The Journal for Nurse Practitioners, 10(10), e69-e76. doi:http://dx.doi.org/10.1016/j.nurpra.2014.08.021 Luke, R. et al. (2009). Online interprofessional health sciences education: From theory to practice. Journal of Continuing Education in the Health Sciences, 29, 161-167. Walsh, M. & van Soeren, M. (2012). Interprofessional learning and virtual communities: An opportunity for the future. Journal of Interprofessional Care, 26, 43-48.

33. Questions? • Comments? • Thank You!!! B. Lowery

34. Bobby Lowery, PhD, FNP-BC, FAANPDirector DNP Program, ECU3166F Health Science BuildingGreenville, NC 27858Lowerybo@ecu.edu252-744-6363 B. Lowery, ECU CON