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An Interprofessional Course on Improving Older Adults’ Care Transitions for Advanced Learners

An Interprofessional Course on Improving Older Adults’ Care Transitions for Advanced Learners. Mitchell T. Heflin, MD, MHS Eleanor S. McConnell, PhD, RN, GCNS, BC Durham VA Geriatric Research, Education & Clinical Center Duke University. Objectives.

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An Interprofessional Course on Improving Older Adults’ Care Transitions for Advanced Learners

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  1. An Interprofessional Course on Improving Older Adults’ Care Transitionsfor Advanced Learners Mitchell T. Heflin, MD, MHS Eleanor S. McConnell, PhD, RN, GCNS, BC Durham VA Geriatric Research, Education & Clinical CenterDuke University

  2. Objectives • Describe a course for interprofessional students on improving transitions of care • Objectives for the experience • Educational philosophy • Design and implementation • Evaluation • Future directions

  3. Why a focus on interprofessional education & transitions ? • 1 in 4 transitions are complicated and require a return to a higher-intensity care setting • Patient perspective • Patient and caregiver frustration • Adverse health events • Health system perspective • Duplication of tests and services • Increased costs • Patient dissatisfaction Patients and Caregivers

  4. Challenges: Education “Once in practice, health professionals are asked to work in interdisciplinary teams, often to support those with chronic conditions, yet they are not educated together or trained in team-based skills.” Health Professions Education: A Bridge to Quality. IOM 2003 Pharmacists Social workers Physical therapists Patients and Caregivers Physicians PhysiciansAssistants Nurses

  5. Educational Philosophy REAL WORK!

  6. Course description

  7. Target Problem: Congestive Heart Failure • Common, important problem • Large evidence-base • Institutional interest and activity • Core issues: • Teamwork • Transitions • Quality

  8. Project work

  9. Learner Evaluation Evaluation Peer and self assessment of team work Pre- and Post Self-efficacy QI proposal rubric Observe teams, form project team Interview pts, Identify problems Design QI proposal Final Course Grade

  10. Learner Evaluation 2008-2009 • 22 students from 6 professions • Medicine, Nursing (ABSN & APN), PA, Pharmacy, PT, Nutrition • Self efficacy: • 2008: Significant gains in 3 of 4 domains • 2009: Significant gains in all domains • Teamwork • High ratings by peers • Project work

  11. Student Self-Efficacy Gains- Fall 2009 p< 0.01 for all categories.

  12. Projects Discharge Instruction for Patients with Congestive Heart Failure HEART FAILURE ACTION PLAN Each morning check for swelling Morning weight after Discharge ____ lbx My Heart Failure Passport Shortness of Breath

  13. REAL WORK! Successes Through interactive, multi-modal learning, students: • Engaged in real teamwork • Examined real transitions • Identified and proposed solutions to real problems

  14. REAL WORK! Challenges • Teaching and learning: • Finding the right balance between faculty and students • Coordinating didactics and project work • Accounting for viewpoints of all professions • Including a broader array of professions • Turning real work into real improvements

  15. Next steps • Continue IP faculty development and teaching • Reach more students in more places • Geriatric Education Resource Hub • Collaborate with faculty, learners and clinical partners on QI initiatives • Transitions in cognitively impaired patients • Mobilize expertise and resources to teach patients and caregivers

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