Interpersonal collaboration: Effects of practice-based interventions on professional practice and healthcare outcomes

Continuing Education, University of Toronto, Senior Scientist, Institute for Clinical Evaluative Sciences, Room G1 06, 1075 Bayview Ave, Toronto, ON, Canada, M4N 3M5.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2009; 3(3):CD000072. DOI: 10.1002/14651858.CD000072.pub2
Source: PubMed

ABSTRACT Poor interprofessional collaboration (IPC) can negatively affect the delivery of health services and patient care. Interventions that address IPC problems have the potential to improve professional practice and healthcare outcomes.
To assess the impact of practice-based interventions designed to change IPC, compared to no intervention or to an alternate intervention, on one or more of the following primary outcomes: patient satisfaction and/or the effectiveness and efficiency of the health care provided. Secondary outcomes include the degree of IPC achieved.
We searched the Cochrane Effective Practice and Organisation of Care Group Specialised Register (2000-2007), MEDLINE (1950-2007) and CINAHL (1982-2007). We also handsearched the Journal of Interprofessional Care (1999 to 2007) and reference lists of the five included studies.
Randomised controlled trials of practice-based IPC interventions that reported changes in objectively-measured or self-reported (by use of a validated instrument) patient/client outcomes and/or health status outcomes and/or healthcare process outcomes and/or measures of IPC.
At least two of the three reviewers independently assessed the eligibility of each potentially relevant study. One author extracted data from and assessed risk of bias of included studies, consulting with the other authors when necessary. A meta-analysis of study outcomes was not possible given the small number of included studies and their heterogeneity in relation to clinical settings, interventions and outcome measures. Consequently, we summarised the study data and presented the results in a narrative format.
Five studies met the inclusion criteria; two studies examined interprofessional rounds, two studies examined interprofessional meetings, and one study examined externally facilitated interprofessional audit. One study on daily interdisciplinary rounds in inpatient medical wards at an acute care hospital showed a positive impact on length of stay and total charges, but another study on daily interdisciplinary rounds in a community hospital telemetry ward found no impact on length of stay. Monthly multidisciplinary team meetings improved prescribing of psychotropic drugs in nursing homes. Videoconferencing compared to audioconferencing multidisciplinary case conferences showed mixed results; there was a decreased number of case conferences per patient and shorter length of treatment, but no differences in occasions of service or the length of the conference. There was also no difference between the groups in the number of communications between health professionals recorded in the notes. Multidisciplinary meetings with an external facilitator, who used strategies to encourage collaborative working, was associated with increased audit activity and reported improvements to care.
In this updated review, we found five studies (four new studies) that met the inclusion criteria. The review suggests that practice-based IPC interventions can improve healthcare processes and outcomes, but due to the limitations in terms of the small number of studies, sample sizes, problems with conceptualising and measuring collaboration, and heterogeneity of interventions and settings, it is difficult to draw generalisable inferences about the key elements of IPC and its effectiveness. More rigorous, cluster randomised studies with an explicit focus on IPC and its measurement, are needed to provide better evidence of the impact of practice-based IPC interventions on professional practice and healthcare outcomes. These studies should include qualitative methods to provide insight into how the interventions affect collaboration and how improved collaboration contributes to changes in outcomes.

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Available from: Merrick Zwarenstein, Sep 28, 2015
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    • "– Multi-step pathway involving behavioral and systemic change! • IPE and IPP empirically demonstrated to change: – IPCP outcomes (student and healthcare professional perceptions, attitudes, beliefs and knowledge about IPCP) (Lapkin 2011) – Healthcare outcomes (such as reduced length of stay and better patient care management infrastructures) (Reeves 2013, Zwarenstein 2009) • Major gap in the evidence – Lack of empirical evidence on the association between IPCP and health outcomes "
    Doctor of Nursing Practice National Conference, Seattle, WA; 09/2015
    • "Both groups appreciated the focus on goals of care rather than levels of medical intervention and agreed heartily with the recognition of various professionals' contribution in the decision-making process. This is consistent with prior research demonstrating that interprofessional collaboration has a positive or neutral effect on patient satisfaction or clinical outcomes (Sidhom & Poulsen, 2006; Yan, Gilbert, & Hoffman, 2007; Zwarenstein, Goldman, & Reeves, 2009). These results must be considered in light of certain limitations. "
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    ABSTRACT: Much improvement is needed to facilitate patient involvement in medical decision-making related to life-prolonging care. Prior research focuses mainly on the communication in the physician-patient dyad; few studies have identified how other professionals are involved. Using a Research Action design, two rounds of interviews with four interprofessional groups from various clinical settings of a health center in Quebec, Canada were conducted between 2009 and 2010. The 37 participants represented nine professions (nurse, dietitian, occupational therapist, orderly, pastoral worker, physician, physiotherapist, respiratory therapist and social worker). The first round of interviews confirmed that all of these professionals are involved, in various ways, in communicating with patients regarding their goals of care. Based on these results, the research group developed two communications tools (paper forms) to facilitate the documentation of patient care goals. The first form includes a designated area where all professionals can note patients’ comments regarding decisions related to life-prolonging care. The second is a prescription form to document in the medical file the patient’s goals of care. Both tools were submitted to, and fine-tuned by, the professionals in the second round of interviews. These results confirm that interprofessional collaboration to facilitate patient participation in goals-of-care decisions is both possible and valued.
    Journal of Interprofessional Care 06/2015; DOI:10.3109/13561820.2015.1027335 · 1.40 Impact Factor
    • "Interprofessional collaboration (IPC) among health and human services practitioners allows team members to draw upon the expertise of others in approaching and resolving clinical problems. IPC has been shown to enhance patient and provider satisfaction, improve the quality of care, and reduce medical errors and length of hospital stay (Chakraborti, Boonyasai, Wright, & Kern, 2008; Reeves, Tassone, Parker, Wagner, & Simmons, 2012; Zwarenstein, Goldman, & Reeves, 2009). Numerous health care workforce and policy statements from the WHO, Institute of Medicine (IOM), and the Health Council of Canada highlight the significant role that interprofessional education (IPE) plays in preparing collaborative practice-ready health care practitioners (Health Council of Canada, 2005; Institute of Medicine, 2001; Knebel & Greiner, 2003; WHO, 2010). "
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    ABSTRACT: Interprofessional education (IPE) in health and human services educational and clinical settings has proliferated internationally. The use of information and communication technologies (ICTs) in the facilitation of interprofessional learning is also growing, yet reviews of the effectiveness of ICTs in the delivery of pre- and/or post-licensure IPE have been limited. The current study's purpose was to review the evaluation outcomes of IPE initiatives delivered using ICTs. Relevant electronic databases and journals from 1996 to 2013 were searched. Studies which evaluated the effectiveness of an IPE intervention using ICTs were included and analyzed using the Barr et al. modified Kirkpatrick educational outcomes typology. Fifty-five studies were identified and a majority reported evaluation findings at the level 1 (reaction/satisfaction). Analysis revealed that learners react favorably to the use of ICTs in the delivery of IPE, and ICT-mediated IPE can lead to positive attitudinal and knowledge change. A majority of the studies reported positive evaluation outcomes at the learner satisfaction level, with the use of web-based learning modalities. The limited number of studies at other levels of the outcomes typology and deficiencies in study designs indicate the need for more rigorous evaluation of outcomes in ICT-mediated IPE.
    Journal of Interprofessional Care 05/2015; DOI:10.3109/13561820.2015.1021002 · 1.40 Impact Factor
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