Development of accreditation standards for interprofessional education: a Canadian Case Study.

BACKGROUND: Academic institutions worldwide are embedding interprofessional education (IPE) into their health/social services education programs in response to global evidence that this leads to interprofessional collaborative practice (IPC). The World Health Organization (WHO) is holding its 193 member countries accountable for Indicator 3-06 ('IPE Accreditation') through its National Health Workforce Accounts. Despite the major influence of accreditation on the quality of health and social services education programs, little has been written about accreditation of IPE. CASE STUDY: Canada has been a global leader in IPE Accreditation. The Accreditation of Interprofessional Health Education (AIPHE) projects (2007-2011) involved a collaborative of eight Canadian organizations that accredit pre-licensure education for six health/social services professions. The AIPHE vision was for learners to develop the necessary knowledge, skills and attitudes to provide IPC through IPE. The aim of this paper is to share the Canadian Case Study including policy context, supporting theories, preconditions, logic model and evaluation findings to achieve the primary project deliverable, increased awareness of the need to embed IPE language into the accreditation standards for health and social services academic programs. Future research implications are also discussed. CONCLUSIONS: As a result of AIPHE, Canada is the only country in the world in which, for over a decade, a collective of participating health/social services accrediting organizations have been looking for evidence of IPE in the programs they accredit. This puts Canada in the unique position to now examine the downstream impacts of IPE accreditation.

Renal Dietitians' Perceptions of the Value of Subjective Global Assessment: A Mixed Methods Study.

OBJECTIVE: The objective of this study is to assess how renal registered dietitians (RDs) in Canada perceive the value of Subjective Global Assessment (SGA) to assess protein-energy wasting for clients with chronic kidney disease. DESIGN AND METHODS: A sequential exploratory mixed method approach included 2 focus groups (n = 6 and 8) and a national survey (n = 54). Two online focus groups were conducted 1 month apart followed by an online survey. Participants included renal RDs working with Stage 5 chronic kidney disease (dialysis and non-dialysis) patients. RESULTS: Five main themes (consistency, organizational/environment, confidence, interpretation, and education) emerged. Renal RDs support using a tool to provide a standardized process for nutrition assessment and feel SGA is an effective educational tool; however, barriers such as time, privacy, confidence in the tool, as well as ability to perform physical assessment, interpretation, and subjectivity limit the use of SGA. Renal RDs feel that it is important to examine nutrition interventions in conjunction with SGA results. CONCLUSION: The main results of the study describing the limitations to the clinical use of the SGA tool revolve around RDs' time, confidence, ability to interpret the SGA tool, and how SGA is used by administration. The results support the need for educators and administrators to communicate the use of SGA results and provide education opportunities focusing on the use of validated, reliable, responsive tools to assess nutrition status as well as hands-on physical assessment. In some situations, an alternative validated version of SGA or screening tool may be appropriate.

Hydration Interventions for older people living in residential and nursing care homes: overview of the literature.

INTRODUCTION: Care home populations experiencing high levels of multi-morbidity and dementia require support from caregivers to meet their hydration requirements. This article provides an overview of literature related to hydration interventions and highlights gaps in knowledge. SOURCES OF DATA: This paper draws on UK-focused literature from Applied Social Sciences Index and Abstracts (ASSIA), CINAHL, Medline, Proquest Hospital Premium Collection, Cochrane Library and RCN databases on hydration interventions for older people living with multi-morbidity and dementia in care homes. AREAS OF AGREEMENT: Fluid intake is too low in care home residents, and no single hydration intervention is effective in addressing the complex problems that older residents present. AREAS OF CONTROVERSY: There is a lack of consensus about how much fluid an older person should consume daily for optimum health. There is also lack of agreement about what interventions are effective in supporting individuals with complex physical and cognitive problems to achieve daily fluid intake targets. GROWING POINTS: To improve hydration care for residents, care home teams should be competent in the delivery of hydration care, and work closely with integrated multi-professional healthcare specialists to provide proactive case management. AREAS TIMELY FOR DEVELOPING RESEARCH: There is a need for understanding of what hydration practices and processes are effective for care home residents and including these in multi-component interventions.

Rapid evaluation for health and social care innovations: challenges for "quick wins" using interrupted time series.

BACKGROUND: Rapid evaluation was at the heart of National Health Service England's evaluation strategy of the new models of care vanguard programme. This was to facilitate the scale and spread of successful models of care throughout the health & social care system. The aim of this paper is to compare the findings of the two evaluations of the Enhanced health in Care Homes (EHCH) vanguard in Gateshead, one using a smaller data set for rapidity and one using a larger longitudinal data set and to investigate the implications of the use of rapid evaluations using interrupted time series (ITS) methods. METHODS: A quasi-experimental design study in the form of an ITS was used to evaluate the impact of the vanguard on secondary care use. Two different models are presented differing by timeframes only. The short-term model consisted of data for 11 months data pre and 20 months post vanguard. The long-term model consisted of data for 23 months pre and 34 months post vanguard. RESULTS: The cost consequences, including the cost of running the EHCH vanguard, were estimated using both a single tariff non-elective admissions methodology and a tariff per bed day methodology. The short-term model estimated a monthly cost increase of £73,408 using a single tariff methodology. When using a tariff per bed day, there was an estimated monthly cost increase of £14,315. The long-term model had, using a single tariff for non-elective admissions, an overall cost increase of £7576 per month. However, when using a tariff per bed-days, there was an estimated monthly cost reduction of £57,168. CONCLUSIONS: Although it is acknowledged that there is often a need for rapid evaluations in order to identify "quick wins" and to expedite learning within health and social care systems, we conclude that this may not be appropriate for quasi-experimental designs estimating effect using ITS for complex interventions. Our analyses suggests that care must be taken when conducting and interpreting the results of short-term evaluations using ITS methods, as they may produce misleading results and may lead to a misallocation of resources.

Acceptability and Feasibility of a Shared Decision-Making Model in Work Rehabilitation: A Mixed-Methods Study of Stakeholders' Perspectives.

Purpose To establish the acceptability and feasibility of implementing a shared decision-making (SDM) model in work rehabilitation. Methods We used a sequential mixed-methods design with diverse stakeholder groups (representatives of private and public employers, insurers, and unions, as well as workers having participated in a work rehabilitation program). First, a survey using a self-administered questionnaire enabled stakeholders to rate their level of agreement with the model's acceptability and feasibility and propose modifications, if necessary. Second, eight focus groups representing key stakeholders (n = 34) and four one-on-one interviews with workers were conducted, based on the questionnaire results. For each stakeholder group, we computed the percentage of agreement with the model's acceptability and feasibility and performed thematic analyses of the transcripts. Results Less than 50% of each stakeholder group initially agreed with the overall acceptability and feasibility of the model. Stakeholders proposed 37 modifications to the objectives, 17 to the activities, and 39 to improve the model's feasibility. Based on in-depth analysis of the transcripts, indicators were added to one objective, an interview guide was added as proposed by insurers to ensure compliance of the SDM process with insurance contract requirements, and one objective was reformulated. Conclusion Despite initially low agreement with the model's acceptability on the survey, subsequent discussions led to three minor changes and contributed to the model's ultimate acceptability and feasibility. Later steps will involve assessing the extent of implementation of the model in real rehabilitation settings to see if other modifications are necessary before assessing its impact.

Interprofessional Education for Internationally Educated Health Professionals: Pathways to Licensure.

In response to the shortage of healthcare professionals, the Canadian government has supported two innovative health workforce planning strategies: interprofessional education for interprofessional collaboration and recruiting internationally educated health professionals (IEHPs). Interprofessional collaboration is increasingly expected by Canadian-educated healthcare professionals; IEHPs must also be oriented to this practice model. An environmental scan and iterative assessments and evaluations informed the development of an online interprofessional competency toolkit aimed at training and assessing interprofessional collaboration for IEHPs. This paper outlines the complex licensure pathways for seven healthcare professions and confirms "collaboration" is a required competency, further validating the need for the toolkit.

Introducing the individual Teamwork Observation and Feedback Tool (iTOFT): Development and description of a new interprofessional teamwork measure.

The individual Teamwork Observation and Feedback Tool (iTOFT) was devised by a consortium of seven universities in recognition of the need for a means of observing and giving feedback to individual learners undertaking an interprofessional teamwork task. It was developed through a literature review of the existing teamwork assessment tools, a discussion of accreditation standards for the health professions, Delphi consultation and field-testing with an emphasis on its feasibility and acceptability for formative assessment. There are two versions: the Basic tool is for use with students who have little clinical teamwork experience and lists 11 observable behaviours under two headings: 'shared decision making' and 'working in a team'. The Advanced version is for senior students and junior health professionals and has 10 observable behaviours under four headings: 'shared decision making', 'working in a team', 'leadership', and 'patient safety'. Both versions include a comprehensive scale and item descriptors. Further testing is required to focus on its validity and educational impact.

Operationalizing a shared decision making model for work rehabilitation programs: a consensus process.

PURPOSE: The objective of this study was to design and operationalize shared decision making (SDM) rehabilitation model for worker rehabilitation programs. SDM has previously been shown to improve decision outcomes in patient-health care professional relationships. To date, SDM has not yet been adapted to work rehabilitation, although it could be a valuable approach to better understand and agree on return-to-work decisions. METHODS: We designed a preliminary model for return-to-work decisions for workers suffering from pain due to musculoskeletal injuries. We submitted the preliminary model and a questionnaire to expert health care professionals. Using the Technique for Research of Information by Animation of a Group of Experts method, a group consensus process was used to discuss and refine the experts' responses to operationalize a model adapted for rehabilitation. RESULTS: Eleven occupational therapists (three were clinical coordinators) and four psychologists participated in three group consensus sessions. The final version of the model included one general longitudinal objective (the maintenance of a working alliance and assuring mutual comprehension among all stakeholders), and 11 specific objectives: establishing a working alliance, seven in the deliberation phase of the SDM process, and three in the implementation of the decision. Participants also reached consensus on between 1 and 8 indicators per objective. CONCLUSION: We developed and operationalized an SDM rehabilitation model intended for a return-to-work implementation plan. The next step will be to document its feasibility among the main stakeholders (employer, union, insurer and worker) taking part in decisions about return to work.

Improved outcomes for elderly patients who received care on a transitional care unit.

OBJECTIVE: To determine whether providing elderly alternate level of care (ALC) patients with interdisciplinary care on a transitional care unit (TCU) achieves better clinical outcomes and lowers costs compared with providing them with standard hospital care. DESIGN: Before-and-after structured retrospective chart audit. SETTING: St Joseph's Hospital in Comox, BC. PARTICIPANTS: One hundred thirty-five consecutively admitted patients aged 70 years and older with ALC designation during 5-month periods before (n = 49) and after (n = 86) the opening of an on-site TCU. MAIN OUTCOME MEASURES: Length of stay, discharge disposition, complications of the acute and ALC portions of the patients' hospital stays, activities of daily living (mobility, transfers, and urinary continence), psychotropic medications and vitamin D prescriptions, and ALC patient care costs, as well as annual hospital savings, were examined. RESULTS: Among the 86 ALC patients receiving care during the postintervention period, 57 (66%) were admitted to the TCU; 29 of the 86 (34%) patients in the postintervention group received standard care (SC). All 86 ALC patients in the postintervention group were compared with the 49 preintervention ALC patients who received SC. Length of stay reduction occurred among the postintervention group during the acute portion of the hospital stay (14.0 days postintervention group vs 22.5 days preintervention group; P < .01). Discharge home or to an assisted-living facility increased among the postintervention group (30% postintervention group vs 12% preintervention group; P < .01). Patients' ability to transfer improved among the postintervention group (55% postintervention group vs 14% preintervention group; P < .01). At discharge, 48% of ALC patients in the postintervention group were able to transfer independently compared with 17% of ALC patients in the preintervention group. Hospital-acquired infections among the postintervention group decreased during the acute phase (14% postintervention group vs 33% preintervention group; P < .01) and in the ALC phase of hospital stay (16% postintervention group vs 31% preintervention group; P = .011). Antipsychotic prescriptions decreased among the postintervention group (45% postintervention group vs 66% preintervention group; P = .026). Despite greater use of rehabilitation services, TCU costs per patient were lower ($155/d postintervention period vs $273/d preintervention period). CONCLUSION: Elderly ALC patients experienced improvements in health and function at reduced cost after the creation of an interdisciplinary TCU, to which most of the nonpalliative ALC patients were transferred. Although all the postintervention ALC patients (those admitted to the TCU and those who received SC) were analyzed together, it is very likely that the greatest gains were made in the ALC patients who received care in the TCU.

Engagement studios: students and communities working to address the determinants of health.

BACKGROUND: This article presents an innovative model for interprofessional community-oriented learning. The Engagement Studios model involves a partnership between community organizations and students as equal partners in conversations and activities aimed at addressing issues of common concern as they relate to the social determinants of health. METHODS: Interprofessional teams of students from health and non-health disciplines work with community partners to identify priority community issues and explore potential solutions. RESULTS: The student teams work with a particular community organization, combining their unique disciplinary perspectives to develop a project proposal, which addresses the community issues that have been jointly identified. Approved proposals receive a small budget to implement the project. DISCUSSION: In this paper we present the Engagement Studios model and share lessons learned from a pilot of this educational initiative.

Rural rehabilitation practice: perspectives of occupational therapists and physical therapists in British Columbia, Canada.

BACKGROUND: Providing rehabilitation services to address the health needs of rural residents requires overcoming the challenges of geography, limited referral options and a shortage of occupational therapists (OTs) and physical therapists (PTs). However, little is known about how rehabilitation professionals in rural areas enact their practice to meet and overcome these challenges. To address this gap and contribute to enhancing health for rural residents, this study was designed to explore rural rehabilitation practice from the perspectives of OTs and PTs in rural British Columbia (BC). METHODS: A purposive sample of OTs and PTs in rural communities (population <15 000) in northern BC was recruited for this qualitative study. Potential participants received an invitation mailed to workplaces and were selected to ensure a variety of work experiences, roles and practice settings. In semi-structured interviews, participants were asked to describe the skills and knowledge they perceived as unique to rural practice and strategies they used to overcome challenges. Guided by interpretive description, transcripts were analysed inductively using broad-level coding, and findings were collapsed into interpretive categories. Interpretations and implications for education, practice and policy were reviewed with participants to ensure relevance to rural practice. RESULTS: From interviews with 6 OTs and 13 PTs, serving a total of 15 rural communities, rehabilitation practice and participants' definition of health were understood to be substantially shaped by rurality or the contextual features of geography, determinants of health and access to services. Participants considered general practice 'a specialty' requiring advanced skills in assessment. They described 'stretching their role' and 'participating in, and partnerships with, community' as ways to overcome resource shortages. Reflective practice, networking and collaboration were deemed essential to maintaining competence. Rural clinical placements, mentoring and improving access to continuing professional development were regarded as central to the recruitment and retention required to sustain optimal levels of service to residents. CONCLUSION: The research findings illustrate the unique influence that the rural context has on the practice of OTs and PTs in BC. They underscore the importance of facilitating learning about rural health within professional training programs and of providing accessible professional development resources to address health human resource shortages and meet the rehabilitation needs of rural residents.

The power of prepositions: a taxonomy for interprofessional education.

This is the second paper in a two-part series. The first paper presented a study that provided a more contextual description of the commonly applied definition of interprofessional education (IPE) offered in 2002 by the Centre for the Advancement of Interprofessional Education (CAIPE) in the UK. The study's results confirm and consolidate key characteristics of IPE by exploring the meaning of with, from and about. This second paper presents a proposed taxonomy for IPE that may serve to inform emerging applications for IPE in the context of education, service delivery and policy. This paper contributes to an emerging understanding of IPE that will support competency development and sound curriculum design, continuing professional development and evaluation of the impact of IPE and collaboration on health outcomes.

Health Care Team Challenges: an international review and research agenda.

Academic institutions worldwide have been tasked with embedding interprofessional education (IPE) into the curricula of health and human service professions. There are few internationally shared examples of interprofessional (IP) learning activities reported in the literature. This report describes the formation of an international IPE research network and provides a summary of the implementation and evaluation of one such shared IPE example, the Health Care Team Challenge™ (HCTC™). We outline the format, key features and evaluation strategies of the HCTC™ IPE. An international research agenda to test cases and assess learning processes are described, and directions for dissemination and sustainability are proposed.

IN-2-THEORY--Interprofessional theory, scholarship and collaboration: a community of practice.

Theoretical awareness is essential in the development and delivery of effective interprofessional education and collaborative practice (PECP). The objective of this paper was to explain the origins and purpose of an international network, IN-2-THEORY--interprofessional theory, scholarship and collaboration: a community of practice (CoP) that aims to build theoretical rigor in IPECP. It explains why the network is viewed as a CoP and lays out the way forward for the community based on the principles for developing a CoP outlined by Wenger, McDermott, and Snyder (2002).

The power of prepositions: learning with, from and about others in the context of interprofessional education.

This paper is the first of a two-part series. It presents a research study that aimed to provide a more contextual description of the commonly applied definition of interprofessional education (IPE) offered in 2002 by the Centre for the Advancement of Interprofessional Education (CAIPE) in the UK: "when two or more professions learn with, from and about each other to improve collaboration and quality of care." The study confirmed and consolidated key characteristics of IPE by exploring the meaning of with, from and about. The words with, from and about were regarded as complex. Words describing learning with each other included active engagement, co-location and equally valued. Concepts linked to learning about included knowing about people outside their professional role and interaction. Learning from others was characterized by trust, respect and confidence in others' knowledge. Although learning about others was described as the first part of learning with, from and about, there were mixed views on whether learning with or from formed the second part of the definition. Based on this work, the second paper in this series presents a proposed taxonomy for IPE that may serve to inform emerging applications for IPE in the context of education, service delivery and policy. This research contributes to an emerging understanding of IPE that will support competency development and sound curriculum design, continuing professional development and evaluation of the impact of IPE and collaboration on health outcomes.

Can interprofessional collaboration provide health human resources solutions? A knowledge synthesis.

Many studies examine the impact of interprofessional (IP) interventions on various health practice and education outcomes. One significant gap is the lack of research on the effects of IP interventions on health human resource (HHR) outcomes. This project synthesized the literature on the impact of IP interventions at the pre- and post-licensure levels on quality workplace, staff satisfaction, recruitment, retention, turnover, choice of employment and cost effectiveness. Forty-one peer-reviewed articles and five IECPCP project reports were included in the review. We found that IP interventions at the post-licensure level improved provider satisfaction and workplace quality. Including IP learning opportunities into practice education in rural communities or in less popular healthcare specialties attracted a higher number of students and therefore may increase employment rates. This area requires more high quality studies to firmly establish the effectiveness of IP interventions in recruiting and retaining future healthcare professionals. There is strong evidence that IP interventions at the post-licensure level reduced patient care costs. The knowledge synthesis has enhanced our understanding of the relationships between IP interventions, IP collaboration and HHR outcomes. Gaps remain in the knowledge of staff retention and determination of staffing costs associated with IP interventions vis-à-vis patient care costs. None of the studies reported long-term data on graduate employment choice, which is essential to fully establish the effectiveness of IP interventions as a HHR recruitment strategy.

Inter-professional collaboration as a health human resources strategy: moving forward with a western provinces research agenda.

The current gap in research on inter-professional collaboration and health human resources outcomes is explored by the Western Canadian Interprofessional Health Collaborative (WCIHC). In a recent research planning workshop with the four western provinces, 82 stakeholders from various sectors including health, provincial governments, research and education engaged with WCIHC to consider aligning their respective research agendas relevant to inter-professional collaboration and health human resources. Key research recommendations from a recent knowledge synthesis on inter-professional collaboration and health human resources as well as current provincial health priorities framed the discussions at the workshop. This knowledge exchange has helped to consolidate a shared current understanding of inter-professional education and practice and health workforce planning and management among the participating stakeholders. Ultimately, through a focused research program, a well-aligned approach between sectors to finding health human resources solutions will result in sustainable health systems reform.

A study to introduce National Early Warning Scores (NEWS) in care homes: Influence on decision-making and referral processes.

AIM: Early warning scores are commonly used in hospital settings, but little is known about their use in care homes. This study aimed to evaluate the impacts of National Early Warning Scores alongside other measures in this setting. DESIGN: Convergent parallel design. METHODS: Quantitative data from 276 care home residents from four care homes were used to analyse the relationship between National Early Warning Scores score, resident outcome and functional daily living (Barthel ADL (Barthel Index for Activities of Daily Living)) and Rockwood (frailty). Interviews with care home staff (N = 13) and care practitioners (N = 4) were used to provide qualitative data. RESULTS: A statistically significant link between National Early Warning Scores (p = .000) and Barthel ADL (p = .013) score and hospital admissions was found, while links with Rockwood were insignificant (p = .551). Care home staff reported many benefits of National Early Warning Scores, including improved communication, improved decision-making and role empowerment. Although useful, due to the complexity of the resident population's existing health conditions, National Early Warning Scores alone could not act as a diagnostic tool.

Active patient involvement in the education of health professionals.

CONTEXT: Patients as educators (teaching intimate physical examination) first appeared in the 1960s. Since then, rationales for the active involvement of patients as educators have been well articulated. There is great potential to promote the learning of patient-centred practice, interprofessional collaboration, community involvement, shared decision making and how to support self-care. METHODS: We reviewed and summarised the literature on active patient involvement in health professional education. RESULTS: A synthesis of the literature reveals increasing diversity in the ways in which patients are involved in education, but also the movement's weaknesses. Most initiatives are 'one-off' events and are reported as basic descriptions. There is little rigorous research or theory of practice or investigation of behavioural outcomes. The literature is scattered and uses terms (such as 'patient'!) that are contentious and confusing. CONCLUSIONS: We propose future directions for research and development, including a taxonomy to facilitate dialogue, an outline of a research strategy and reference to a comprehensive bibliography covering all health and human services.

Nurturing social responsibility through community service-learning: Lessons learned from a pilot project.

BACKGROUND: Community service-learning (CSL) has been proposed as one way to enrich medical and dental students' sense of social responsibility toward people who are marginalized in society. AIM: We developed and implemented a new CSL option in the integrated medical/dental curriculum and assessed its educational impact. METHODS: Focus groups, individual open-ended interviews, and a survey were used to assess dental students', faculty tutors' and community partners' experiences with CSL. RESULTS: CSL enabled a deeper appreciation for the vulnerabilities that people who are marginalized experience; students gained a greater insight into the social determinants of health and the related importance of community engagement; and they developed useful skills in health promotion project planning, implementation and evaluation. Community partners and faculty tutors indicated that equal partnership, greater collaboration, and a participatory approach to course development are essential to sustainability in CSL. CONCLUSIONS: CSL can play an important role in nurturing a purposeful sense of social responsibility among future practitioners. Our study enabled the implementation of an innovative longitudinal course (professionalism and community service) in all 4 years of the dental curriculum.