A novel longitudinal interprofessional ambulatory training practice: the improving patient access care and cost through training (IMPACcT) clinic

ABSTRACT

Few graduating health professionals choose primary care. Trainees satisfied with continuity ambulatory experiences are more likely to pursue primary care. The authors developed a longitudinal interprofessional ambulatory training program to improve team-based care and encourage primary care careers. The Improving Patient Access Care and cost through Training (IMPACcT) clinic, launched in 2016, includes physician, physician assistant, pharmacy, and psychology trainees. Residents, faculty, and interprofessional trainees complete “on-service” weeks together. Co-located administrative team members coordinate care and lead team “huddles.” Interprofessional signout facilitates patient follow-up. The initial evaluation included process and quality indicators compared to the traditional resident practice. Learners reported increased perceived competence in interprofessional communication and teamwork after completing their training. Clinical quality outcomes suggested improved provider continuity and arrival rate compared to traditional resident practice (56.5% vs. 32.9%; 66.3% vs. 62.2%, p < .01). Patient satisfaction was higher in the IMPACcT clinic in the areas of coordinated care and team functioning. Ten of eighteen physician graduates in the program chose further training in primary care compared to 20 of 150 graduates not in the program (55.6% vs. 13.3%, p < .01). Implementing a longitudinal team-based ambulatory interprofessional training practice was associated with improved continuity of care and improved patient satisfaction indicators.

KEYWORDS:

• Interprofessional education
• ambulatory training
• primary care
• quality of care
• patient satisfaction
• learner attitudes

Acknowledgments

The authors would like to acknowledge IMPACcT faculty members including Jennifer Verbsky MD, Jason Ehrlich MD, Ankita Sagar MD, Nissa Mazzola, PharmD, Christine Chim, PharmD, Danielle Ezzo PharmD, Susan Hirsch, MD, Crystal McGeown, PA, Mariecel Pilapil, MD, MPH and Lyndonna Marrast, MD, MPH for their contributions to the development and implementation of this project. Special thanks to Nicole Donohue, MPH, Julie DiGregorio CCRP, and Pamela D’Elia for coordinating project management and evaluation, to Danielle Miller, Christine Cummings, and Yoowon Lim for help with data collection, and to Ilda Flanagan and Norma Roberts-Zahra for their essential contributions towards making IMPACcT a success.

Ethical approval

The Northwell Institutional Review Board deemed this project as exempt from IRB review on 7/12/17.

Previous presentations

Data was presented, in part, at the 37^th, Annual Meeting of the Society of General Internal Medicine, in Washington, DC, April 2017.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Additional information

Funding

This project was supported by a Primary Care Training Enhancement Grant from the Health Resources and Services Administration (Award #TOBHP28558).

Notes on contributors

Lauren Block

Lauren Block is associate professor, Department of Medicine and Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead NY.

Nancy A. LaVine

Nancy A. LaVine is assistant professor, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead NY.

Johanna Martinez

Johanna Martinez is assistant professor, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead NY.

Josiah Strawser

Josiah Strawser is resident, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh PA.

Celia Lu

Celia Lu is assistant professor, Department of Clinical Health Professions, St. Johns College of Pharmacy and Health Sciences, Queens NY.

Frank Cacace

Frank Cacace is associate professor, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead NY.

Alice Fornari

Alice Fornari is professor, Department of Science Education and Family Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead NY.

Joseph Conigliaro

Joseph Conigliaro is professor, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead NY.

Daniel J. Coletti

Daniel J. Coletti is assistant professor, Department of Psychiatry and Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead NY.