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Interprofessional team-based care has the potential to improve patient outcomes, improve access to care, decrease costs, and improve team satisfaction. In recent years, efforts to implement team-based care have grown with the adoption of the Patient-Centered Medical Home (PCMH) and an increasing focus on value-based payment models. To better prepare our learners for this future, we introduced a formal team-based care curriculum in our three family medicine residency programs and one pediatric program. In addition to curricula for residents, we developed a team-based care didactic for family medicine clerkship students, presented by an interprofessional team of faculty. This session will describe our curricular efforts, team-based didactic for students, and outcomes related to students’ experiences with and knowledge of team-based care.

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Team-based primary care is an innovative care delivery model that has the potential to improve access to comprehensive, coordinated, and high-quality patient care. It is understood that in order for primary care teams to work effectively, health care providers must work across disciplinary boundaries and develop strong relationships that enable them to coordinate their roles and expertise. This research investigated how health care providers make use of different team structures (i.e., tools) to manage their interdependent work, enabling them to deliver team-based primary care. This research also examined how team structures influence the intra-team relationships important for coordinating care. By exploring the different ways primary care teams enact team structures, this research identifies ways primary care teams use team structures differently to address the needs of patients and coordinate team-based care. In-person interviews were conducted at 7 primary care clinics participating in a population health management program in a southeastern city in the United States. Research participants from various health care disciplines (e.g., medicine, nursing, social work) were asked to describe their experiences delivering team-based primary care. Interviews were recorded, transcribed, and analyzed. Data were analyzed using a constant comparative approach in order to investigate how different team structures were used to address the needs of patients and the challenges of delivering team-based primary care. The data suggested that primary care teams enact structures in different ways. In some teams, huddles were used to anticipate the specific needs of patients and coordinating care, referrals occurred via warm handoffs with co-located providers, and protocols were used to facilitate collaborative problem-solving. In other clinics, huddles were focused on clinic operations, referrals were performed using traditional methods (e.g., phone calls), and protocols were used to guide task delegation. Participants in some clinics described how team huddles were used to leverage high-quality relationships by fostering respectful interactions between team members. More research is needed to determine whether the use of patient-focused huddles, warm handoffs, and protocols that initiate problem-solving is associated with better patient outcomes, particularly for patient populations with complex medical and non-medical needs.

BACKGROUND AND OBJECTIVES: Interprofessional education (IPE) is recommended by many as a means by which to prepare clinicians for collaborative practice and a mechanism by which to improve the overall quality of health care. The objective of this study was to determine the impact of an interprofessional medicine-pharmacy student home visit experience on students’ self-assessments of skills and abilities related to team-based care and identification of medication-related problems. METHODS: Third-year medical and fourth-year pharmacy students completed an interprofessional home visit centered on identification of medication-related problems. Students were surveyed before and after the IPE assignment to assess changes in self-assessed skills and abilities. Survey items consisted of Likert-type statements on a 5-point scale (1=strongly disagree, 5=strongly agree) and free-text responses. Students also completed reflection papers regarding their experiences. RESULTS: Twenty-two medical and 20 pharmacy students conducted medication-focused interviews of 22 patients at home as interprofessional teams. Medical and pharmacy student self-assessments of skills and abilities related to team-based care and identification of medication-related problems improved after completion of the assignment. Both groups of students perceived an improvement in confidence regarding communication skills, both with patients and with other health professions students. Changes were reported on 12 survey items. Student feedback on the IPE experience was positive. CONCLUSIONS: Students’ self-perception of skills and abilities related to interprofessional team-based care and identification of medication-related problems are improved after IPE medication-focused home visit assignment. Student feedback supports the value of interprofessional patient care clinical experiences.

Introduction: Efforts to improve health care in the US are focusing on the Quadruple Aim which targets enhanced patient experiences, population health management, control of costs and improved provider satisfaction. Traditional academic centers have fallen behind in preparing pediatricians to practice in this new milieu; pediatric residents consistently report feeling least competent in systems-based practice. To better prepare residents to enter the work force, we introduced a team based care curriculum for pediatric residents in the 2016-2017 academic year. Methods: Participants in the new curriculum included all 21 residents in our academic based residency program. An inter-professional team developed a curriculum consisting of six core modules: team care, team communication, quality improvement, health care roles, champion teams and advanced communications. Prior to participation, residents completed a pre-test of knowledge and the validated Attitudes Toward Health Care Teams scale. The same instruments were administered after completion of the modules. Results: All 21 pediatric residents completed the pre and post-tests. Resident knowledge significantly improved from a pre-test score of 63% to a post test score of 70% (p< 0.05). The Quality Improvement and Team Roles subtests showed significant improvement (p<0.05). On the Attitudes Towards Health Care Teams scale, the residents had a favorable attitude toward team value and team efficiency; these did not significantly change from pre to post-test. Pediatric residents’ attitudes toward physicians shared role in the team improved significantly (p<0.01). They reported enhanced attitudes regarding two key constructs: 1) shared team leadership and responsibility and 2) limits on physician control of team function. Conclusions: While pediatric residents in general had a favorable view of team-based care, participation in a team-based care curriculum positively affected their views of the physician’s role on a team. Understanding shared labor within a team, may help residents to achieve the fourth Quadruple Aim of satisfaction in healthcare by all providers.

Collaborative practice among interprofessional groups of health care providers is essential to the provision of safe and effective medical care. However, health professions training programs have not traditionally prepared students for interprofessional practice. One challenge in transforming health professions education programs has been a limited number of faculty prepared to teach students in an interprofessional learning environment. Thus, faculty development programs aimed at preparing faculty to provide interprofessional learning experiences across disciplines are increasingly important. Unfortunately, best practice in training faculty for interprofessional education programs is not well-defined. Interprofessional education faculty development programs should aim to train faculty to model and teach interprofessional education competencies, including collaboration; however, a faculty member’s culture orientation may impact their collaborative skills. Of the four subscales of the Individualism-Collectivism Scale, horizontal collectivism is the subscale most aligned with collaborative team-based competencies. Few, if any, studies have examined culture orientation in academic health science faculty. The current study explored culture orientation in academic health science faculty across five colleges at a southern university. Comparisons were made on each of the four Individualism-Collectivism subscales between academic health science faculty who had attended and had not attended an interprofessional education faculty development program. Also, comparisons were made by faculty members’ status as a first-generation student, type of courses taught, and gender. Correlations between scores on each subscale and years of teaching in higher education were also examined. Results indicated that the faculty members who had attended the interprofessional education faculty development program were significantly higher in horizontal collectivism than faculty who had not attended this program. Also, faculty who taught clinical courses were higher in vertical individualism than faculty who taught nonclinical courses. Implications for interprofessional practice, education, and faculty development are discussed, and recommendations for future research and practice are made.

INTRODUCTION: Motivational Interviewing (MI) is an evidenced based counseling style to elicit health behavior change. Team-based student clinics are an ideal climate for students to learn and practice team-based care, yet little is understood as to how client-centered communication styles such as MI are implemented in a team setting. PURPOSE: The purpose of this dissertation was to conduct an exploratory study using mixed methods to better understand how an MI training translates to team-based communication with clients, the factors impacting team-based implementation of MI, and how team-based MI impacts clients’ perceived autonomy at a student-led, interprofessional, team-based wellness clinic for low-income seniors. METHODS: Fifty-five clinic sessions were audio recorded and participants completed the Health Care Climate Questionnaire to measure perceived autonomy support, 16 clinic participants were interviewed, and 15 health care students participated in four focus groups. The recordings were coded with the Motivational Interviewing Treatment Integrity code (MITI 4.2.1). Independent t-tests, and multiple regression models were used to assess differences in MITI scores, association between MITI scores and team/patient characteristics, and associations between MITI scores and perceived autonomy support. Interviews and focus groups were qualitatively analyzed to identify themes. RESULTS: A short training in MI was not associated with MI proficiency as measured by the MITI, and student teams were found to overstate their use of MI on team-report measures. Less education, older age, and a larger team size were associated with lower MITI scores. High levels of perceived autonomy support were found across all clients, but MITI scores were not associated with perceived autonomy support. Clinic participant interviews identified benefits to engaging with the student teams including opportunities to socialize, as well as support in managing their health. The students found the MI training to be beneficial but noted that team dynamics ultimately effected MI use. CONCLUSION: It is possible to implement MI in team-based settings, but sufficient training and ongoing coaching is needed to ensure translation to practice. As health care programs continue to promote team-based care, further research is needed to fully understand how teams can effectively communicate with clients, and how they can provide the autonomy supportive environment needed to elicit internal motivation to engage clients in their own health management.

Objective: Project ECHO (Extension for Community Healthcare Outcomes), a telementoring program, utilizes lectures, case-based learning, and an “all teach–all learn” approach to increase primary care provider (PCP) knowledge/confidence in managing chronic health conditions. The American Academy of Pediatrics (AAP) Epilepsy and Comorbidities ECHO incorporated quality improvement (QI) methodology to create meaningful practice change, while increasing PCP knowledge/self-efficacy in epilepsy management using the ECHO model. Methods: Monthly ECHO sessions (May 2018 to December 2018) included lectures, case presentations/discussion, and QI review. Pediatric practices were recruited through the AAP. Practices engaged in ECHO sessions and improvement activities including monthly Plan-Do-Study-Act cycles, team huddles, chart reviews, and QI coaching calls to facilitate practice change. They were provided resource toolkits with documentation templates, safety handouts, and medication side effects sheets. QI measures were selected from the American Academy of Neurology Measurement Set for Epilepsy. The AAP Quality Improvement Data Aggregator was used for data entry, run chart development, and tracking outcomes. Participants completed retrospective surveys to assess changes in knowledge and self-efficacy. Results: Seven practices participated across five states. Average session attendance was 14 health professionals (range = 13-17). A total of 479 chart reviews demonstrated improvement in six of seven measures: health care transition (45.3%, P =.005), safety education (41.6%, P =.036), mental/behavioral health screening (32.2% P =.027), tertiary center referral (26.7%, not significant [n.s.]), antiseizure therapy side effects (23%, n.s.), and documenting seizure frequency (7.1%, n.s.); counseling for women of childbearing age decreased by 7.8%. Significance: This project demonstrated that integrating QI into an ECHO model results in practice change and increases PCP knowledge/confidence/self-efficacy in managing epilepsy.

Whether it is offering services, delivering solutions or driving innovations, team work has been a hallmark of efficiency and effectiveness in various industries. The healthcare industry is not left out as its service delivery process involves numerous interfaces, information flows and patient hand-offs among professionals with different educational training, differing knowledge levels and possibly working from different locations as well. As healthcare delivery evolves to being more patient-centered, so does the team settings as well, becoming more collaborative. Such changes also translate into a need for support systems to evolve to be able to provide support for the extent of collaboration that would be needed. A framework is needed to guide in the development of such systems. However, due to the varying needs of patients, team types and make-up would generally differ, so we explored the different types of team settings studying what they entail based on their various degrees of collaboration. We therefore present in this thesis a model of team based concepts, an ontology formalizing the model, team based scenarios designed using the ontology and then application of the scenarios to test the ability of BPMN (Business Process Modeling Notation) to model healthcare teams.