9/5/2014 why ipe?€¦ · what is ipe? who definitions (2010) • ipe – “when students from two...

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The National Center for Interprofessional Practice and Education is supported by a Health Resources and Services Administration

Cooperative Agreement Award No. UE5HP25067. © 2013 Regents of the University of Minnesota, All Rights Reserved.

Why IPE?

Amy Pittenger, PharmD, PhD

Associate Professor and Director of

Interprofessional Education

University of Minnesota, College of Pharmacy

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Goals

1. Review the domains of the IPEC competencies and their

application to clinical education and practice.

2. Understand the University of Minnesota's 1Health curriculum

framework.

3. Identify opportunities for clinical IPE activities at the

University of Minnesota and the Alliance for Integrated

Medication Management (AIMM).

4. Leave the session with ideas for how to engage with the

University of Minnesota, the National Center for IPE, and the

AIMM Collaborative.

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What is IPE?

WHO definitions (2010)

• IPE – “When students from two or more professions learn

about, from and with each other to enable effective

collaboration and improve health outcomes”

• IPCP – “When multiple health workers from different

professional backgrounds work together with patients,

families, carers, and communities to deliver the highest quality

of care.”

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What IPE is NOT

• IPE is not simply being in the same classroom or on rotation

on the same unit or in the same practice with other

professions

• Multiple disciplines, within a single profession, working

together

Instead - Purposeful activities framed around the IPEC

(Interprofessional Education Collaborative)

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IPEC Competencies – May 2011

American Association of Colleges of Nursing

American Association of Colleges of Osteopathic Medicine

American Association of Pharmacy

American Dental Education Association

Association of American Medical Colleges

Association of Schools of Public Health

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IPEC Competencies

Competency Domains

1: Values/Ethics for Interprofessional Practice

2: Roles/Responsibilities

3: Interprofessional Communication

4: Teams and Teamwork

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Why IPE?

Evidence to support positive patient outcomes for collaborative care

Triple Aim, Affordable Care Act

Pharmacy Specific reasons:

• ACPE accreditation

• Important opportunity for pharmacy practice

• “remarkably underutilized”

• Giberson S, Yoder S, Lee MP. Improving Patient and Health System Outcomes through Advanced Pharmacy Practice. A Report to the U.S. Surgeon General. Office of the Chief Pharmacist. U.S. Public Health Service. Dec 2011.

• Basic Science foundations of the profession

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Guiding Principles

Participatory Culture:

“…everyone knows something, nobody knows

everything, and what any one person knows

can be tapped by the group as a whole”

Jenkins, H. (2007). Confronting the challenges of participatory culture: Media

education for the 21st century [Report]. The John D and Catherine T. MacArthur

Foundation Reports on Digital Media and Learning.

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Why is IPE so difficult?

This has been a priority for a long time

• 1972 “IOM Education for the Health Team”

Challenges/Barriers

• Educational

• Logistical

• Cultural

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What does the literature say about ‘effective’

IPE? Start early

Interactions occur more than once

Embed within core courses

• with meaningful application to patient care competency

development

• Example – Diabetes Experience Elective, IPE Leadership and

Facilitation Elective, Acute Care Rotation

Many examples of student directed initiatives

• Examples – PNC and HOPE clinics, CLARION

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University of Minnesota IPE Framework

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National Center:

A New Model for Public-Private Partnership

The National Center for Interprofessional Practice and

Education is supported by a Health Resources and Services

Administration $4M, five year Cooperative Agreement

Award No. UE5HP25067.

In addition, the Josiah Macy Jr. Foundation, the Robert

Wood Johnson Foundation (RWJF), the Gordon and Betty

Moore Foundation, and the John A. Hartford Foundation

have collectively committed up to $8.1 million in grants over

five years to support and guide the center.

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About National Center

Because we believe high-functioning teams can improve the

experience, outcomes and costs of health care,

National Center for Interprofessional Practice and Education

is studying and advancing the way

health workers learn and work together.

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Our vision for health

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How we’re making a difference

• Creating a national conversation about the potential

for interprofessional education and collaborative practice

to improve health outcomes

• Growing a dynamic platform to connect people,

practical tools and relevant resources across sectors

• Establishing the evidence to support sustainable

change

• Challenging cultural and business norms that have

resisted change

• Accelerating the adoption of new models of learning

and care through the use of real-time information and

expertise

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Developing a business case for

interprofessional practice and education

• Evidence is critical for sustainability

• National Center is collecting data together with

partners across the country

• Goal: articulate the impact of interprofessional,

team-based care and learning on the patient

experience of care, population health and the cost

of care

Building a community of practitioners,

scholars, students and patients

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About our online community

NexusIPE.org is…

• a community-supported network of information and resources

for interprofessional practice and education across sectors.

Where community members can…

• share information about their experiences;

• ask questions and start conversations;

• showcase their contributions to the field, such as articles,

reports, curricula and tools;

• learn from experts and from each other;

• and connect with others with similar interests and issues.

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How to get involved?

At the University of Minnesota

• FIPCC facilitator

• IPE debrief facilitator

• Develop an IPE activity within your clinical setting

• CLARION mentor

• Patient Care Simulator rater

• Contact me to get involved or to find out more

• [email protected]

Nationally

• NexusIPE.org

Improving Quality of Care through Integration of Medication Management Services into Interprofessional Primary

Care Teams

Todd D. Sorensen, Pharm.D. Professor, University of Minnesota

Executive Director, Alliance for Integrated Medication Management

mailto:[email protected]

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Creating Team-Based Care Across a Community

Number of readmissions and 30 day readmission rates were recorded and calculated for high risk patients managed in new vs. old pathway

Population Total # seen Number readmitted 30 day readmission

rate

High Risk Patients

Seen 156

27 hospital

readmissions by 22

high risk patients

High Risk Patients

Not Seen 104

38 hospital

readmissions by 31

high risk patients

October 7th 2013 – January 6th 2014

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0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

Iowa Percent Readmission by Payer 10/2008 - 9/2013

Collaborative Clinical

Pharmacy Services

Standard Care

Community

Standard Care Statewide

Medicare Dual Eligible

Iowa Potential Cost Savings

Iowa Potential Cost Savings

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Objectives Learning

Outline key themes that have led to success in integrating medication management services with primary care.

Recognize the roll of the Alliance for Integrated Medication Management Collaborative in supporting community-based care delivery transformation focused on medication use.

What are the key elements in achieving team-based care around medication use?

Discussion

Strategies for Safe Medication Use in Ambulatory Care Settings in the United States

Case studies across 34 organizations

186 key informants (leadership, pharmacists, physicians, nurses)

3 interim debriefings

Technical expert panel

Sorensen AV, Bernard SL. J Pt Safety. 2009:5(3)

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Leadership Commitment Develop organizational

relationships that promote safe medication-use systems and optimal health outcomes.

Measurable Improvement Achieving change using the

value and power of data-driven improvements

Integrated Care Delivery Build an integrated health care

system across providers and settings that produces safety and optimal health outcomes.

Safe Medication Use Systems

Develop and then operate safety medication-use practices.

Patient-Centered Care Build a patient-centered medication-use system

Change Package for Performance Improvement in Medication Use

Themes Driving Implementation and Adoption of Medication Management Services in Six Minnesota Health Systems

Six Minnesota Health Systems- Medication Management Program Profile

# Clinics w/

MTM Rx FTEs

Years Program in

Place

Essentia Health 12 5.5 10

Fairview Health

Services 28 20 15

Hennepin County

Medical Center 14 15 6

HealthPartners 16 6.5 7

Mayo Clinic 8 17.15 17

Park Nicollet Health

Services 11 6.7 7

Nearly 50,000 MTM encounters per year across 6 health systems.

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Themes Driving Implementation and Adoption of Medication Management Services

Team-Base Care: Working in a team environment in which pharmacists are recognized as valued members of the team. Making pharmacists accessible to the rest of the team. Hiring the right people for the job who are passionate about providing services at the highest extent of their clinical abilities.

Pharmacists as an Untapped Resource: Recognizing the untapped experience and expertise of pharmacists. Recognizing problems that existed in care delivery that could be most effectively addressed by pharmacists.

Organizational culture: An organizational environment that is supportive of innovation, piloting new ideas and strives to improve patient quality and safety while reducing cost.

Themes Driving Implementation and Adoption of Medication Management Services (continued)

Momentum Champions: Individuals that were key in establishing and moving medication management services forward; leadership support and enthusiasm; gathering key players.

Supportive Care Model Process: Administrative tools used to establish a process that fosters success of medication management services (creating service consistency; documentation standards; referral processes; resource sharing; collaborative practice agreements).

Measuring and Reporting Results: Having data to support the services of MTM; creating transparency of data; patient satisfaction.

A Tool to Support Care Delivery Transformation Focused on Medication Use

The AIMM Collaborative

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The AIMM Collaborative

Health care organizations committed improving medication use through integrated, comprehensive medication management, linked and supported through a national community of learning.

Based on IHI’s Breakthrough Model for Improvement

Supported via tools, coaching, calls/webinars/live meetings and an “All Teach, All Learn” mantra.

Harnessing community-based action and leadership can lead to systems-level change and service sustainability

www.medsmatter.org

AIMM’s Offer To Teams

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AIMMc focuses on integrating comprehensive medication

management (CMM) into your delivery system to….

• Number of potential and

Adverse Drug Events per patient;

• Community care transitions

• Readmissions rates;

• Overall health care spending;

Decrease Increase

• Patients with controlled chronic

conditions

• Patient satisfaction and

engagement

• Alignment with national measures

National Learning Community

Change

Package

Webinars,

Learning

Sessions

Local Health

Care Organization

QI

Coaches

PDSA

Cycles

Pop. of

Focus

State QIO

Alliance for Integrated Medication Management Collaborative

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Improvement

Cycles

The Breakthrough Model for Improvement A Series of Activities to Precipitate Action and Results

www.medsmatter.org

Value

Status Quo Drift

Time Today

Our Aim

Getting

Started

Change

Package in

Action

Producing

Results

Scale Up

& Spread

State

Forum

Leader

5 Stage Accountability Pathway Model

Team

Assessment

Team

Assessment

AIMMc

Validated

Assessment

Team

Graduation

Structure

• Series of defined processes

• Teams complete AIMM administered assessments for validated

progression of team’s rapid-cycle improvements

• Highlight, recognize and celebrate successes

Learning

Coach

Feedback

Learning

Coach

Feedback

Learning

Coach

Feedback

Learning

Coach

Feedback

Learning

Coach

Feedback

Advancement Celebrated Publicly Both in and Outside the Collaborative

AIMMc

Validated

Assessment

AIMMc

Validated

Assessment

A Defined Pathway for Integrating Comprehensive Medication Management

Initial teams adopting, refining, and measuring

impact of comprehensive, integrated medication

management practices

Advanced Teams converting best practices shared consortium-wide

performance improvement activities into value statements

Foundation

and Structure

Innovation

and

Testing

Phase I Spread

and Value

Definition

Proven Med Mgmt Innovations,

Metrics and Practices Aligned with

Quality and Payment Systems

Systems Level

Adoption and

Sustainability

AIMM External

Stakeholder Engagement

Partners and Sponsors

AIMM Leadership Team

http://www.medsmatter.org/

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Outcomes Data Reporting, Method for Monitoring & Tracking Results

APhA Foundation IMPACT Healthcare Innovation Hub • Core components:

Allows organizations to produce a set of self-service reports using their data

Interfaces with EMR’s for ease of use

Enter data directly into the system if EMR is not in place

Provides data aggregation and reporting tool for teams

Produces team, regional and national reporting summaries

Copyright © 2013-2014, APhA Foundation

AIMMc Positively Impacts Patients

Reported Number of Patients in Populations of Focus Through January 2014 = 10,467.

Number of Patients in Populations of Focus that are at goal on their marker = 6,724.

Percent of Patients in Populations of Focus that are at goal on their marker = 64%.

www.medsmatter.org

Putting High-Risk Patients into PoF’s Enables Teams to Bring Diverse Populations to Goal

Condition # of Pts in PoF

# of Pts at Goal

% of PoF at Goal

# of PoF Improve

% of PoFs Improve

Anticoagulation 3,853 2,623 68.1% 32 52.5%

Antipsychotic 678 483 71.2% 9 45.0%

Asthma 97 54 55.7% 1 50.0%

Diabetes 4,102 2,580 62.9% 26 44.8%

Dyslipidemia 687 374 54.4% 8 72.7%

HIV/AIDS 137 68 49.6% 1 50.0%

Hypertension 913 542 59.4% 3 21.4%

TOTAL 10,467 6,724 64.2% 80 47.6%

Results as of Jan 2014

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Contact Information - Todd D. Sorensen, Pharm.D.

Professor and Peters Chair for

Pharmacy Practice Innovation

[email protected]

Executive Director

[email protected]

[email protected]

www.medsmatter.org

On the web at www.medsmatter.org,

On Facebook at www.facebook.com/pharmacyservicesalliance

Follow @medsmatter on Twitter at

https://twitter.com/#!/medsmatter






http://www.facebook.com/pharmacyservicesalliance

https://twitter.com/#!/medsmatter

9/5/2014 why ipe?€¦ · what is ipe? who definitions (2010) • ipe – “when students from two...

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