Is Project ECHO the transformational silver lining for interprofessional and interorganizational collaboration?

The globally disruptive impact of the COVID-19 pandemic on both healthcare systems and health profession education has created an opportunity for a reassessment of methods for delivering interprofessional practice education (IPE). A good candidate for consideration is Project ECHO (Extension for Community Healthcare Outcomes). Its unique combination of structural design in connecting specialist and community-based clinical sites, foundational education theories, and didactic and case-based learning methods present an innovative and promising new method of promoting both interprofessional and interorganizational collaboration. This paper first provides a description of Project ECHO, its major features, recent expansion during the pandemic, and IPE-related research history. Second, the educational concepts and theories underlying its use and their implications for interprofessional and interorganizational collaboration are reviewed. These include community of practice and single and double-loop learning. Third, the expression of these concepts in how key elements of ECHO are utilized - including the didactic presentation; the case study presentation, discussion, and tele-mentoring; and the power of community and tele-networking - will be explored. Finally, implications and applications for the expansion of ECHO into promoting competency-based education and innovative interprofessional and interorganizational collaboration will be presented.

Growing older with intellectual and developmental disabilities: implementing and evaluating a project ECHO for dementia education.

The needs of the rapidly expanding population of adults growing older with intellectual and developmental disabilities (IDD) and their families span both the IDD and the aging service systems. The use of Project ECHO (Extension for Community Healthcare Outcomes) for professional education can bridge gaps and span boundaries between them at the macro, meso, and micro levels. A series of 10 ECHO sessions over 12 months was developed, incorporating key content on IDD and AD/ADRD for 145 providers in over 20 agencies. Impacts were assessed by a follow-up survey sent to participants after each program. The evaluation included quantitative assessment of ECHO features and a retrospective pre- and posttest of knowledge acquisition; a separate item assessed intention to apply information. Qualitative data were collected from open-ended items. The case presentation and discussion were the most effective ECHO components. Knowledge acquisition was significant for all sessions; most important uses included providing better care to clients/patients, training staff, and educating family and/or caregivers. Participants were aligned with two distinct groups, one with a predominant knowledge focus, the other with an emphasis on networking. Project ECHO can bridge gaps and span boundaries between the IDD and aging care systems at multiple levels, improving interprofessional collaboration and care by addressing both knowledge and networking needs of providers.

Beyond knowledge and confidence: a mixed methods evaluation of a Project ECHO course on dementia for primary care.

Primary care clinicians have an important role in the management of dementia and have expressed interest in continuing education. The authors describe a model they used for providing dementia education in primary care, Project ECHO (Extension for Community Healthcare Outcomes), and an overview of its major features. A partnership including academic institutions and a national healthcare association is then outlined, including the unique features of the ECHO model developed through this partnership. A mixed-methods methodology was used for programmatic evaluation. This use of mixed methods adds vital new knowledge and learner perspectives that are key to planning subsequent ECHO courses related to dementia and primary care. The discussion includes an exploration of the significance of these findings for understanding the motivations of primary care providers for participation in the educational program, as well as the limitations of the current study. A final section explores the next steps in the continued development of the model and its implications for geriatrics education in dementia care, especially the supportive role that ECHO courses can play in meeting the challenges of dementia care.

Potentials and pitfalls of networking in interdisciplinary education: Taking on the challenges in Gerontology and Geriatrics.

Gerontology and geriatrics are quintessentially interdisciplinary fields. To understand aging, an interdisciplinary perspective is necessary; to provide quality care to older adults with complex, chronic conditions, an interprofessional team is required. Academic, clinical, and community-based settings - with their vertical organizational structures - need bridging strategies to create networks that support interdisciplinary education in both classroom and experiential settings. Taking on these challenges requires emphasizing the importance of key competencies that integrate the unique perspectives, contributions, and roles of different disciplines, and creating the connections critical for promoting interdisciplinary education. First, this paper develops a theoretical foundation for networking to construct and maintain educational and service provider partnerships. Second, the organizational and institutional requirements for successful networking are explored, based on both empirical research and principles from the theoretical framework. Finally, practical recommendations for the development of key strategies for implementing and sustaining interdisciplinary and academic-clinical-community partnerships are summarized.

Becoming and being an Age-Friendly University (AFU): Strategic considerations and practical implications.

Becoming and being an Age-Friendly University (AFU) require developing a strategic plan for enlisting support across campus for the AFU principles and embarking on an ongoing process for continuing to promote them as an academic community. Throughout this process, the use of a conceptual framework for change in academic settings can be helpful. The University of Rhode Island (URI) recently became an AFU after a campus-wide process of identifying activities that already supported AFU principles and enlisting key sources of support for embracing them. In particular, an emerging emphasis within URI on developing lifelong-learning and intergenerational programs provided a firm foundation upon which to build the case. This paper proposes a conceptual framework for developing a strategy for change in an academic setting, and then illustrates how URI has utilized it to move forward with becoming more "aging friendly." Implications for continuing development consistent with the AFU principles will be discussed.

Why gerontology and geriatrics can teach us a lot about mentoring.

Gerontology, geriatrics, and mentoring have a lot in common. The prototype of this role was Mentor, an older adult in Homer's The Odyssey, who was enlisted to look after Odysseus' son, Telemachus, while his father was away fighting the Trojan War. Portrayed as an older man, the name "mentor" literally means "a man who thinks," which is not a bad characterization generally for faculty members in gerontology! In particular, gerontological and geriatrics education can teach us a lot about the importance of mentoring and provide some critical insights into this role: (1) the importance of interprofessional leadership and modeling, (2) the application of the concept of "grand-generativity" to mentoring, (3) "it takes a community" to be effective in mentoring others, and (4) the need to tailor mentorship styles to the person and the situation. This discussion explores these topics and argues that gerontological and geriatrics educators have a particularly important role and responsibility in mentoring students, colleagues, and administrators related to the very future of our field.

Gerontology across the professions and the Atlantic: Development and evaluation of an interprofessional and international course on aging and health.

The need for interprofessional teamwork and the global challenges for health care systems of dramatically increasing numbers of older adults have received increased recognition in gerontological and geriatrics education. The authors report on the pilot development of a hybrid course on aging and health for graduate-level health professions students from Norway, Canada, and the United States. International faculty from partnering universities developed, taught, and evaluated the course. Course assignments included online forum postings, reflections, and a problem-based learning group assignment and presentation. Directed readings and discussion included topics related to health care systems and services in the three participating countries, teamwork, and patient-centered care. To evaluate the course, quantitative and qualitative data were collected and analyzed. Results indicate a significant impact on student learning outcomes, including understanding of issues in international aging and health, attitudes and skills in teamwork, and application to clinical practice. This course clearly established the importance of developing innovative interprofessional educational experiences that respond to the increasingly universal impacts of aging populations on health and social care systems around the world.

Narrative in interprofessional education and practice: implications for professional identity, provider-patient communication and teamwork.

Health and social care professionals increasingly use narrative approaches to focus on the patient and to communicate with each other. Both effective interprofessional education (IPE) and practice (IPP) require recognizing the various values and voices of different professions, how they relate to the patient's life story, and how they interact with each other at the level of the healthcare team. This article analyzes and integrates the literature on narrative to explore: self-narrative as an expression of one's professional identity; the co-creation of the patient's narrative by the professional and the patient; and the interprofessional multi-vocal narrative discourse as co-constructed by members of the healthcare team. Using a narrative approach to thinking about professional identity, provider-patient communication, and interprofessional teamwork expands our thinking about both IPE and IPP by providing new insights into the nature of professional practice based on relationships to oneself, the patient, and others on the team. How professionals define themselves, gather and present information from the patient, and communicate as members of a clinical team all have important dimensions that can be revealed by a narrative approach. Implications and conclusions for the further development of the narrative approach in IPE and IPP are offered.

Growth and impact of Project ECHO for workforce development in age-friendly care.

BACKGROUND: Use of the Project ECHO® (Extension for Community Healthcare Outcomes) model in geriatrics has increased dramatically largely because of the Health Resources and Services Administration-funded Geriatrics Workforce Enhancement Programs (GWEP) utilizing it as a key tool for age-friendly, interprofessional workforce development. This manuscript describes the scope and impact of geriatrics ECHOs under the GWEP. METHODS: A survey of GWEPs was conducted to measure the reach, foci, evaluation methods, and other characteristics of ECHO networks. RESULTS: All 48 (100%) GWEPs responded to the survey, and 30 (63%) reported using ECHO. GWEP ECHOs have both rural and urban-underserved reach across the United States, and their hub teams include many health professions. Age-friendly care is incorporated through multiple methods and is taught across foci including primary care, dementia, long term care, and novel topics. GWEP ECHOs have many academic and community partners including Area Agencies on Aging, and reach varied health professions, trainees, and caregivers. Geriatrics ECHOs collect outcomes across the evidence continuum including the community-level outcome of Age-Friendly Health System designation. CONCLUSIONS: The ECHO model has been widely adopted by GWEPs as a key approach for workforce training in age-friendly care. Project ECHO is a valuable tool to expand interprofessional training for the geriatrics workforce, particularly for interprofessional teams in rural and underserved areas.

Toward a transtheoretical model of interprofessional education: stages, processes and forces supporting institutional change.

The history of interprofessional education (IPE) in the USA is a checkered one, characterized by boom and bust cycles of advancement and retrenchment, expansion and contraction. The successful development, implementation and continuation of IPE in health and social care in US higher education institutions all depend on a number of factors related to how individuals and organizations do or do not support it in the academic setting. Deliberate and planned change to advance IPE requires a comprehensive theoretical framework to guide it and insure its success. A transtheoretical model (TTM) of institutional change is proposed as a comprehensive framework of the stages, processes and forces that can facilitate and maintain change in support of IPE. The TTM framework recognizes the complexity of change, and captures and organizes important elements from different organizational theories. It also provides a structure for conceptualizing the multiple dimensions needed for change, offering intervention strategies and leverage points to be used by leaders in promoting and maintaining it. Finally, the TTM model suggests that the stabilization of IPE programs over the long term is dependent on a real and significant shift in institutional values in response to forces from both within and without the organization.

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 brave new world of GEC evaluation: the experience of the Rhode Island Geriatric Education Center.

In 2007, the Health Resources Services Administration introduced new mandates that raised the standards on program evaluation for Geriatric Education Centers. Described in this article are the primary and secondary evaluation efforts undertaken for one program within the Rhode Island Geriatric Education Center (RIGEC), the findings from these efforts, and the modifications to assessment that ensued in response to the increased accountability requirements. The evaluation focused on RIGEC's series of continuing education, day-long workshops for health and social service professionals, the completion of all seven of which leads to a Certificate in Interdisciplinary Practice in Geriatrics.

The Longitudinal Association Between Physical Activity and Physical Function in Older Women.

Purpose: The age-related decline in physical function is ameliorated by physical activity; however, less is known about changes in physical function in active vs. inactive older women. The purpose of this study was to determine the longitudinal associations between physical activity and physical function in community-dwelling older women. Methods: 238 participants (age 79.0 ± 5.1) were dichotomized into two activity groups [inactive (IG); n = 144 or active (AG); n = 94] based on self-reported exercise at baseline. Repeated measures ANCOVA, controlling for age, measured differences in physical function between activity groups at baseline and 48-months using the Timed Up and Go, 30-s chair stand, and 30-second arm curl. Differences in Timed Up and Go classification [normal (≤ 8.23 s); preclinical limitations/limited physical function (>8.23 s)] were analyzed using chi-square tests for activity group and for activity-age group (AG, <80 years; AG, ≥ 80 years; IG, <80 years; IG, ≥ 80 years). Results: The repeated measures ANCOVA yielded a significant main effect for activity group for the Timed Up and Go (p = 0.006), 30-s chair stand (p = 0.002) and 30 s arm curl (p = 0.007) and a significant time main effect for the Timed Up and Go (p = 0.016). There were no significant group by time interactions. A larger proportion of the IG than the AG (58.2 vs. 86.5%, respectively) had Timed Up and Go scores >8.23 s (p < 0.001). At 48-months, individuals in the AG were more likely to have normal Timed Up and Go scores compared to those in the IG in both age groups [ χ ( 3 ,   N = 236 ) 2 = 42.56, p < 0.001]. Conclusion: Older women who engaged in regular exercise at baseline had higher levels of objectively measured physical function and were less likely to have abnormal Timed Up and Go scores. These findings help illustrate the long-term benefit of exercise on physical function in older women.

Examining the interface between interprofessional practice and education: lessons learned from Norway for promoting teamwork.

Promoting teamwork in health and social care requires an understanding of the interface between interprofessional practice (IPP) and interprofessional education (IPE). A study with two parts, one qualitative and one quantitative, examined this interface in Norway. The first used focus groups to assess IPP rewards, barriers, and facilitating factors among practitioners in clinical settings. The second utilized an online survey to measure IPE attitudes, barriers, and facilitating factors among senior administrators in the educational system. Results of Part 1 indicate that providers report many intrinsic rewards of IPP; however, the more extrinsic impacts of collaborative practice on patient care need to be emphasized to system managers. Results of Part 2 suggest strong general support by academic deans and directors for IPE, though addressing specific potential barriers to its implementation has become increasingly important. Overall, bridging the IPP-IPE gap requires educating leaders in both settings about the resources needed for teamwork, linking clinical and educational settings through continuing professional development, and generally advocating more effectively for both IPP and IPE.

The devil is in the details: the seven deadly sins of organizing and continuing interprofessional education in the US.

In spite of increased calls for expanding interprofessional practice (IPP) in the US health care system to address concerns about patient safety and quality of care, there has not been a corresponding dramatic growth in interprofessional education (IPE) programs. Indeed, the history of IPE in the US has been a roller-coaster ride of gains and losses, successes and failures. Understanding why this has been so requires the development of a personal and political economy framework, based on an understanding of the structural, ideological, and economic factors and forces that characterize IPE in American higher education. Using a metaphor of the seven deadly sins (lust, pride, greed, gluttony, envy, sloth, and wrath), this discussion focuses on both things that should not be done (sins of commission) and those that should be done but are not (sins of omission) to create successful and sustainable IPE programs. Taken together, these factors help to frame a perspective on IPE that highlights the essential knowledge, attitudes, and skills needed by faculty and administrators to create, implement, and - most importantly - sustain successful programs. Implications of this framework for promoting increased IPE are discussed, particularly with respect to insuring its successful continuation into the future.

Looking Below the Surface of Interprofessional Education: Uncovering Organizational Factors and Forces.

There has been a dramatic expansion in the development of models and methods for interprofessional education (IPE) in health and social care. This achievement calls for a corresponding development of methods to critically examine the unique organizational contexts of academic institutions that are critical for designing strategies to promote and sustain IPE. Organizational theories and their application to IPE have become increasingly important in providing new perspectives on how to promote it, and particularly approaches that uncover underlying factors and forces in the academic setting. This discussion first develops an integrated analytic framework based on both political and moral economy and force field analysis crucial for understanding the drivers and barriers for IPE. Secondly, it explores the IPE academic arena and how conflicting forces have shaped efforts to promote IPE in higher educational institutions. Thirdly, it reviews how universities in the US have been shaped by the growing corporatization of higher education and the specific implications for IPE. Finally, to put theory into practice, reflections and conclusions based on the framework for promoting and sustaining IPE within educational systems are offered.

Physical and mental health-related correlates of physical function in community dwelling older adults: a cross sectional study.

BACKGROUND: Physical function is the ability to perform both basic and instrumental activities of daily living, and the ability of older adults to reside in the community depends to a large extent on their level of physical function. Multiple physical and health-related variables may differentially affect physical function, but they have not been well characterized. The purpose of this investigation was to identify and examine physical and mental health-related correlates of physical function in a sample of community-dwelling older adults. METHODS: Nine hundred and four community dwelling older men (n = 263) and women (n = 641) with a mean (95% Confidence Interval) age of 76.6 (76.1, 77.1) years underwent tests of physical function (Timed Up and Go; TUG), Body Mass Index (BMI) was calculated from measured height and weight, and data were collected on self-reported health quality of life (SF-36), falls during the past 6 months, number of medications per day, depression (Geriatric Depression Scale; GDS), social support, and sociodemographic variables. RESULTS: Subjects completed the TUG in 8.7 (8.2, 9.2) seconds and expended 6,976 (6,669, 7,284) Kcal.wk-1 in physical activity. The older persons had a mean BMI of 27. 6 (27.2, 28.0), 62% took 3 or more medications per day, and 14.4% had fallen one or more times over the last 6 months. Mean scores on the Mental Component Summary (MCS) was 50.6 (50.2, 51,0) and the Physical Component Summary (PCS) was 41.3 (40.8, 41.8).Multiple sequential regression analysis showed that, after adjustment for TUG floor surface correlates of physical function included age, sex, education, physical activity (weekly energy expenditure), general health, bodily pain, number of medications taken per day, depression and Body Mass Index. Further, there is a dose response relationship such that greater degree of physical function impairment is associated with poorer scores on physical health-related variables. CONCLUSIONS: Physical function in community-dwelling older adults is associated with several physical and mental health-related factors. Further study examining the nature of the relationships between these variables is needed.

Reflecting on reflection in interprofessional education: implications for theory and practice.

Interprofessional education (IPE) involves learning, and learning requires reflection. Educators need to "reflect more on reflection" if they are to be effective teachers in ensuring the learning outcomes essential for teamwork and interprofessional practice (IPP), including incorporating both theory and practice into the development of educational interventions. First, this discussion surveys the IPE-relevant literature on reflection, and then defines and refines the multidimensional concept of reflection as it relates to IPE in developing and implementing teamwork learning programs and experiences. Second, specific methods to promote reflection are presented and explored, including self-assessments, journaling, and written papers. Actual samples from student journals and assignments provide examples of the impacts of using these methods on participant reflection and learning. Finally, implications for an expanded understanding and application of reflection for IPE will be discussed, and recommendations made for educational practice and research in this area.

Trajectories of Maintenance and Resilience in Healthful Eating and Exercise Behaviors in Older Adults.

OBJECTIVE: Our objective was to describe behavioral change trajectories for healthful eating and exercise in a group of community-dwelling older adults. A secondary aim was to determine predictors of maintenance and resilience. METHOD: Subjects were participants in the Study of Exercise and Nutrition in Older Rhode Islanders (SENIOR) I study who had achieved postaction stage of change for at least one behavior by its end. They were recruited for SENIOR II, a 48-month study with annual assessments on demographic, anthropometric, cognitive, psychosocial, and behavioral variables. RESULTS: Maintainers generally had higher levels of healthy behaviors and better cognitive function. Resilient older adults were similar to maintainers but were older and had greater functional limitations. DISCUSSION: Findings suggest that both physical health and psychological capital provide important resources upon which to draw as older adults grow even older. The trajectory model can provide useful information for developing resilience interventions for older adults.