Sustainable and replicable clinical and financial outcomes in an interprofessional education and collaborative practice nexus

ABSTRACT

Our Interprofessional Education and Collaborative Practice (IPECP) Nexus previously reported significant reductions in Emergency Department (ED) visits, hospitalizations, hemoglobin A1c levels, and patient charges. This study examines sustainability of these results over two additional years and replication in two subsequent independent patient cohorts. Participants in the sustainability cohort (N = 276) met ≥1 of the following criteria: (a) ≥3 ED visits in first or second half of the year, (b) hemoglobin A1c level ≥ 9, or (c) Length of Stay, Acuity, Comorbidities, and ER (Emergency Room) Visits (LACE) score ≥ 10. Participants in two replicability cohorts (N = 255) and (N = 160) met the same criteria, but the LACE criterion was changed to ≥3 hospitalizations in baseline years. The Nexus, housed in a family medicine (FM) residency clinic, included professionals and students from multiple disciplines. IPECP skills and interventions included communication, team building, and conflict engagement skills training, daily huddles and pre-visit planning, immediate consultations, small teamlet IPECP interactions, and weekly IPECP case conferences for complex patients. Original health improvements and charge reductions were sustained for two additional years for ED visits, hospitalizations, A1c, and patient charges, and replicated in two additional patient cohorts. The IPECP Nexus interventions were associated with Quadruple Aim outcomes while training the next generation of health care professionals.

KEYWORDS:

• Interprofessional collaborative practice
• clinical and cost outcomes
• nexus
• primary care
• family medicine residency

Acknowledgements

The authors express our heartfelt gratitude for the dedicated, engaged, and highly professional IPECP team at ACC. Special thanks to Todd DeFreece for outstanding leadership and Elle Cooper and Tracy Newby for data management assistance.

Disclosure statemnt

No potential conflict of interest was reported by the author(s).

Ethical approval

This study was approved by the Institutional Review Board of Creighton University, Reference Number 104695-2, Date: 6/20/2017.

Previous presentations

A portion of this work was presented at Nexus Summit: July 29 - 31, 2018 Minneapolis, MN. Creating Results: Interprofessional Vision to Action.

Previous publication

Guck, T. P., Potthoff, M. R., Walters, R. W., Doll, J., Greene, M. A., & DeFreece, T. (2019). Improved outcomes associated with interprofessional collaborative practice. Annals of Family Medicine, 17(sup1), 82. https://doi.org/10.1370/afm.2428.

Additional information

Funding

Partially funded by the National Center for Interprofessional Practice and Education in partnership with the Robert Wood Johnson Foundation, the John A. Hartford Foundation, the Josiah Macy Jr. Foundation and the Gordon and Betty Moore Foundation. Potthoff, M. (PI); Co Investigators: Doll, J., McCafferty, K., Jensen, G., Lappe, J., DeFreece, T., & Walters, R. Cultivating Collaboration: Building a Successful Collaborative Care Model in an Academic Health Partnership. Accelerating Interprofessional Community-Based Education and Practice.

Notes on contributors

Thomas P. Guck

Thomas Guck is a Professor, Vice-Chair, and Director of Behavior Health in the Department of Family & Community Medicine at Creighton University School of Medicine. His clinical interests are in behavioral health with an emphasis on chronic pain management. His research focuses on processes and outcomes related to integrated interprofessional team-based care and medical and residency education in primary care.

Ryan W. Walters

Ryan Walters in an Associate Professor in the Department of Clinical Research and Department of Medicine at Creighton University School of Medicine. His research focuses on best methodological practices for modeling longitudinal data with a special interest in quantifying and predicting individual differences in outcome variability.

Christie Abdul-Greene

Christie Abdul-Greene is the Market Manager for Practice Transformation and Value Based Care with CHI Health. She led 47 primary care clinics to NCQA recognition as Patient Centered Medical Homes. She has presented nationally at the PCMH Congress and American Public Health Association conference. She has served as President of the National Association of Social Workers-Nebraska Chapter and on the Advisory Board for Mid-America Addiction Technology Transfer Center and  with local coalitions to reduce binge drinking.

Joy Doll

Joy Doll is the Vice President of Academic Programs with the Nebraska Healthcare Collaborative powered by CyncHealth. She supports the translation of health data from a health information exchange, community data exchange and prescription drug monitoring program to improve population health. She is the former Director of the Creighton Center for Interprofessional Practice, Education and Research.

Michael A Greene

Michael Greene is an Associate Professor and Medical Residency Director in the Department of Family & Community Medicine at Creighton University School of Medicine. His clinical interests are team-based care in pediatrics, maternal care, inpatient hospital care, and hospice medicine. He has authored peer-reviewed articles on aseptic meningitis and urolithiasis.

Amy L. McGaha

Amy McGaha is Roland L. Kleeberger, MD Professor and Endowed Chair in the Department of Family & Community Medicine at Creighton University School of Medicine. She is the Director of the Inteprofessional Clinical Learning Environment within the Creighton Center for Interprofessional Practice, Education and Research. She has served on the CHI Health Board of Directors.  She is the past president of the Society of Teachers of Family Medicine Foundation. Her clinical and academic work focuses on achieving the Quadruple Aim in healthcare.