Interprofessional Education/Moving to Team Based Care and Interprofessional Practice

Building Academic and Community Partnerships for

Innovation and Change

June 11, 2015

Leo E. Rouse, D.D.S., F.A.C.D. Dean and Professor of Clinical Dentistry Howard University College of Dentistry

LEADERS who GET IT are on the front lines not the sidelines as champions for IPE. They do not delegate, relegate or abdicate the responsibility. Leaders hold themselves personally accountable for results because of their fervent belief that IPE is not only good for patient-centered care but it is critical to improving quality, safety and increasing access to health care services for everyone.

AACN 2012 Spring Annual Meeting March 24, 2012

The Increasing Importance of IPE and

Collaboration

Revisiting the Role of Health Professions Education Can our graduates who do not value Interprofessional

working, know little about each other, many never have communicated with each other, haven’t been taught collaboration skills, and have no shared clinical experience as students be expected to practice effectively in the emerging health care system?

Madeline Schmitt, PhD, RN, FAAN, Professor Emerita University of Rochester School of Nursing

Significant Documents on IPE/IPP

Measuring the impact of Interprofessional Education on

collaborative Practice and Patient Outcomes – IOM, 2015 Lessons from the Field: Promising Interprofessional

Collaborative Practices – Robert Wood Johnson Foundation, 2015 Recommendations from a Conference on: Advancing

Compassionate, Person-and Family-Centered Care Through Interprofessional Education for Collaborative Practice – The Schwartz Center for Compassionate Healthcare – 2014

Measuring the impact of Interprofessional Education on collaborative Practice and Patient Outcomes – IOM, 2015 Summary of Findings: Recommendation 1: Linking IPE with changes in Collaborative Behavior Recommendation 2: Improving Research Methodologies

Lessons from the Field: Promising Interprofessional Collaborative Practices – Robert Wood Johnson Foundation, 2015 Guiding Principles: ^ it takes time ^ relationships matter ^ pockets of IPP already exist ^ name it ^ start small ^ creating a culture of IPC requires multiple reinforcing practice (“this is just how we do things around here” – a definition of culture) “you have to change the culture. that’s where leadership is important. teamwork has to become the norm.”-women and infants hospital-Providence Hospital RI

Recommendations from a Conference on: Advancing Compassionate, Person-and Family-Centered Care Through Interprofessional Education for Collaborative Practice – The Schwartz Center for Compassionate Healthcare – 2014 “Triple C”: compassionate, collaborative care..about

supporting the whole person it…. is essential, if we are to achieve the “The Triple Aim” of improving health and experiences of care while controlling costs… “Quadruple Aim” : supporting providers

Revisiting the Role of Health Professions Education In recent years, one of the most prominent ways to address

our strategic direction related to teaching and learning is through support of IPE as a foundation for preparing students, residents and fellows to provide patient-centered care.

Dr. R. Valachovic, President and CEO, American Dental Education Association (ADEA) – 2012 ADEA Executive Directors Report

What is IPE?

Interprofessional education: “When students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes” WHO, 2010”

What is IPCP?

“Interprofessional Collaborative Practice: “When multiple health workers from different professional backgrounds work together with patients, families, caregivers, and communities to deliver the highest quality of care” WHO, 2010

What is IP Teamwork?

“Interprofessional teamwork: the levels of cooperation, coordination and collaboration characterizing the relationships between professions in delivering patient-centered care”

Interrelationships of Interprofessional Practice and Education

• Collaborative practice initiatives enhance patient outcomes • Educational initiatives enhance learner outcomes (preparing a

workforce for collaborative practice)

IPEC DOMAIN 1 Values/Ethics for Interprofessional Practice: Work with individuals of other professions to maintain a climate of mutual respect and shared values in total

health initiatives

IPEC DOMAIN 2

• Roles/Responsibilities: Use the knowledge of one’s own role and those of other professions who share in delivering total health interventions to appropriately assess and address the healthcare needs of the patients and population served.

IPEC DOMAIN 3

• Interprofessional Communication: Communicate with patients, families, communities, and other health professionals in a responsive and responsible manner that supports a team approach to the maintenance of health and the treatment of health problems.

The importance of IPE concepts in primary care, advanced and continuing education, and team-based care across the health professions….

An attending physician on rounds strides into a hospital room with an entourage of medical students and asks his patient this questions: “ How can we do a better job of caring for you?” The patient, a 15 year old boy named Kevin, has been in and

out of the hospital for 30 or 40 times for treatment of short bowel syndrome. Kevin says he’s been very happy with the care he has received but when pressed, says this: I have great doctors and nurses here – but can you please talk to each other. Donald Berwick, M.D., MPP, Former Administrator CMS

IPEC DOMAIN 4

• Teams and Teamwork (apply relationship-building values and the principles of team dynamics to perform effectively in different health team roles to plan and deliver patient-population-centered health care that is safe, timely, efficient, effective, and equitable)

IPE and Collaboration “Dentistry’s Perspective” “Dentists own Dentistry but not

Oral Health Care”

Oral Health/Total Health and Dentistry: Common Ground and Distinctions

• Oral health disparities are a major public health problem…according to the U.S. Surgeon General.

• Significant consequences from neglected oral disease include poor growth and nutrition, spread of infection from decayed teeth, pain, time lost from school and work.

• Caries most common disease of children and adults. Oral Health in America…Surgeon General 2000

Oral Health/Total Health and Dentistry: Common Ground and Distinctions

•All Health Care Providers can help prevent oral disease…but lack the knowledge to do so.

Oral Health/Total Health and Dentistry: Common Ground and Distinctions

• A Competency Matrix for Global Oral Health:* • Eight Domains:

• General Oral Health Screening • Dental Caries • Periodontal Disease • Oral Cancer and Prevention • Oral-Systemic Health Interactions • Public Health • Emergency Care • Medical Dental Interface * Consortium of Universities for Global Health; Oral Health Competencies Working Group –

funding sponsored in part by HRSA Grant [AAMC] – Published in JDE, April 2015

Oral Health and Dentistry: Common Ground and Distinctions/Total

• Caries – • Knowledge: the caries process, impact of untreated caries

(pain, abscess, cellulitis, airway, other systemic impacts) • Attitudinal: caries is an important problem, providers

should help prevent/identify caries and be collaborative with dentists

• Competencies: can screen for caries on exam, can assess risk factors for caries (i.e., socioeconomic status, diet, hygiene, lack of fluoride, caries in mom, lack of access to care), can counsel mother about transmission of cariogenic bacteria to infants and need for maternal OH care, can recommend regular dental care, refer to dentists.

Oral Health/Total Health and Dentistry: Common Ground and Distinctions

• Periodontal Disease – • Knowledge: pathogenesis of periodontal disease, impact of

periodontal disease (tooth loss, systemic sequelae), how to prevent periodontal disease

• Attitudinal: periodontal diseases are important, providers should help prevent/identify periodontal disease, providers should collaborate with dentists

• Competencies:, can counsel about periodontal disease prevention (smoking/tobacco, oral hygiene including brushing and flossing, role of medication in treating, can counsel patients about systemic importance of periodontal disease (diabetes, heart disease, counsel for the need of regular check up during pregnancy)

“We must become the

change we want to see” Gandhi

Together We Can Work to Improve Access to Oral Health Care for All

We Shall Never Forget!