Indiana University Interprofessional Collaborative Practice (IPCP)

Transcription

1 Indiana University Interprofessional Collaborative Practice (IPCP) Julie LaMothe, MSN, CPNP, RN, Grant Project Manager, Indiana University School of Nursing Jennifer Dunscomb, MSN, RN, CCRN IU Health Methodist Director of Professional Nursing Practice and Quality Judith A. Halstead, PhD, RN, ANEF, FAAN, Principle Investigator Professor of Nursing, Indiana University School of Nursing Funded by Health Resources Services Administration (HRSA) Grant #UD7HP26050 Nurse Education, Practice, Quality, and Retention (NEPQR)

2 Objectives 1) Describe the application of interprofessional collaborative practice in an urban acute medical care setting by refining an existing Accountable Care Unit (ACU) model. 2) Describe the application of interprofessional collaborative competencies in rural community based primary care settings.

3 Objectives 3) Develop emerging nurse leaders prepared to practice in IPCP environments in acute and primary healthcare settings through a nursing leadership program at IUSON 4) Increase the number of interprofessional education and clinical opportunities in urban and rural IPCP environments for nursing students, medical students/residents, and other selected health professional students

4 Why Interprofessional Collaborative Practice

5 GRANT BACKGROUND 3 year federally funded grant through Health Resources and Services Administration(HRSA),Nurse Education, Practice, Quality and Retention (NEPQR) July 2013-July 2016 $1.22 million Judith Halstead, PhD, RN,ANEF, FAAN- Author and recipient of Grant, Consultant Susan Hendricks EdD, RN,CNE Current PI Chad Priest JD,MSN, RN CO-I

6 INTERPROFESSIONAL COLLABORATIVE PRACTICE

7 Collaboration Leveraging partnerships between IU Health, IU School of Nursing, IU School of Medicine

8 GRANT OBJECTIVES Objective 1: Cultivate IPCP environments in an urban acute medical care setting by refining an existing Accountable Care Unit (ACU) model to improve efficiency, quality and costeffectiveness of care among targeted patient populations

9 OBJECTIVE 1: SUB OBJECTIVES Establish a steering committee Form IPCP teams on identified clinical units and implement educational development activities for fostering team competence in national IPCP core competencies Develop ACU-based patient outcome indicators

10 Accountable Care Unit Foundational Elements Accountable Care Unit (ACU): A geographically defined care team (Inpatient, ED, OR) accepting accountability, responsibility, and ultimately ownership for patient outcomes Geographic cohorting of patients & care providers Inpatient physician/provider and specialty comanagement Daily interdisciplinary huddles Patient centered care Distributive leadership & management Collaborative RN/provider/patient bedside rounding Data-driven decision making guided by monthly review of unit-level performance data

11 Geographic Cohorting Patients cohorted by specialty or disease state within existing units Staffing & patient assignments transitioned from provider-centric & service line-based focus patient-centered geographic focus Respiratory Therapy; Care Management; Social Work; Rehab Services; Pharmacy Inpatient physicians/providers Intensivists 5 units 10/2012 Hospitalists 8 units 2/2013 Hospitalists 3 additional units 4/2013

12 Daily Interprofessional Huddles & Patient Centered Collaborative Rounding Daily Interprofessional Huddle every patient, every day Patient Centered Collaborative Rounding Patient & family + direct care RN + Provider Focus: discharge barriers, readmission risks, transition plans Clinical progress, plan of care, & goals lines, foleys, VTE prophylaxis safety concerns

13 Distributive Leadership & Management A Collaborative Unit-Based Leadership Team Provider Leadership Unit based + Subspecialty Nurse Leadership Clinical Manager & CNS Integrated Care Management CM & Social Work Allied Health Services Pharmacy Nutritional Services Rehab Services Unit management and decision making providing operational and quality/safety performance improvement guided by unit level performance outcomes

14 Unit-Level Performance Data Transparent Cascade of Data System level -> facility level -> unit level Interactive electronic ACU data dashboard 30+ quality & efficiency metrics Filtered by unit, attending service, and base DRGs ACU outcomes focus Length of stay Readmission Service Cost per case Quality = CAUTI, CLABSI, VTE

15 Indiana University Health Methodist Hospital Length of Stay Index 1.10 Goal LOS LOS Linear (LOS) 1.06 ACU Staffing s 0.86 Length of stay index reduced from 1.04 to % reduction in variance days in ,574 saved days in 2013

16 Indiana University Health Methodist Hospital Readmission Rate Goal Readmission Rate ACU Readmission Rate 30 day all-cause readmit rate reduced from 10.85% to 9.85% 35% reduction in readmit variance cases in avoided readmissions in 2013

17 Indiana University Health Methodist Hospital Mortality Index Goal Mortality Index ACU Mortality Index Mortality Index reduced from 0.92 to % reduction in mortality variance cases in saved lives in 2013

18 Indiana University Health Methodist Hospital Quality Panel Aggregate Roll up Score Goal Quality Panel Linear (Quality Panel) ACU The IU Health Quality Panel score is a weighted average of scaled scores for 156 key quality indicators

19 NEXT STEPS Understand culture and function of unit through observation,qualitative interviews/focus groups/ quantitative survey results IUH/IUSON team selects intervention(s) IUH/IUSON team develops implementation plan

20 GRANT OBJECTIVES Objective 2: Cultivate IPCP environments in rural community-based primary care settings to improve efficiency, quality, and costeffectiveness of care among targeted patient populations

21 PRIMARY HEALTH CARE CENTERS OPENDOOR HEALTH SERVICES - MUNCIE RIGGS COMMUNITY HEALTH CENTER - LAFAYETTE VALLEY PROFESSIONALS COMMUNITY HEALTH CENTER - CLINTON HEALTHLINC COMMUNITY HEALTH CENTER - VALPARAISO AND MICHIGAN CITY NORTH CENTRAL NURSING CLINICS INC - DELPHI AND MONON

22

23 OBJECTIVE 2 SUB-OBJECTIVES IPCP Teams of practitioners will be formed at each clinic site and educated on the core competencies associated with IPCP IPCP Team members will engage in educational activities to develop collaborative care model Facilitate the development of leadership skills among emerging nurse leaders in advanced nursing practice

24 EVALUATION Will assess interprofessional communication, teams, & teamwork with surveys and qualitative data collection Chronic disease outcome data at 6 mos intervals & at project completion Provider(s) satisfaction Costs of care

25 Lessons Learned Nothing is as simple as we hope it will be ( Jim Horning) Get buy-in from leadership and staff All things are difficult before they are easy (Thomas Fuller ) Be Flexible and open Efficiency is doing things right. Effectiveness is doing the right things ( Peter Drucker) Each clinic and unit is unique

26 Reference Questions Interprofessional Education Collaborative Panel.(2011). Core Competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative