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A scoping review of interprofessional collaborative practice and education using the lens of the Triple Aim

A scoping review of interprofessional collaborative practice and education using the lens of the... Keywords The Triple Aim unequivocally connects interprofessional healthcare teams to the provision of Health system reform, interprofessional better healthcare services that would eventually lead to improved health outcomes. This review collaboration, interprofessional education, of the interprofessional education (IPE) and collaborative practice empirical literature from 2008 interprofessional research to 2013 focused on the impact of this area of inquiry on the outcomes identified in the Triple Aim. The preferred reporting items for systematic reviews and meta-analyses methodology History were employed including: a clearly formulated question, clear inclusion criteria to identify Received 14 January 2014 relevant studies based on the question, an appraisal of the studies or a subset of the studies, a Revised 14 March 2014 summary of the evidence using an explicit methodology and an interpretation of the findings Accepted 17 March 2014 of the review. The initial search yielded 1176 published manuscripts that were reduced to 496 Published online 7 April 2014 when the inclusion criteria were applied to refine the selection of published manuscripts. Despite a four-decade history of inquiry into IPE and/or collaborative practice, scholars have not yet demonstrated the impact of IPE and/or collaborative practice on simultaneously improving population health, reducing healthcare costs or improving the quality of delivered care and patients’ experiences of care received. We propose moving this area of inquiry beyond theoretical assumptions to systematic research that will strengthen the evidence base for the effectiveness of IPE and collaborative practice within the context of the evolving imperative of the Triple Aim. Introduction ones). To frame this work, we conducted an extensive scoping review of the ICP/IPE literatures from 2008 – the year that There is now a pressing need to foster high quality research Berwick, Nolan, and Whittington (2008) promulgated the Triple examining the impact of collaborative practice and interprofes- Aim focused on reforming US healthcare delivery – through 2013. sional education (IPE) around the world (Goldman, Zwarenstein, The purpose of this review was to determine the current state of Bhattacharyya, & Reeves, 2009; Thistlethwaite & the GRIN ICP/IPE inquiry, in light of the Triple Aim (Berwick et al., 2008), working group, 2012; Zwarenstein, Goldman, & Reeves, 2009). as a starting point for two of the National Center’s transformative This is one defining role of the United States (US) National goals – strengthening the evidence base for the effectiveness of Center for Interprofessional Practice and Education at the ICP/IPE and creating, implementing and assessing new models of University of Minnesota, a public–private partnership created ICP/IPE – within the context of the US healthcare delivery system from a competitive process to provide leadership, scholarship, and its global counterparts. evidence, coordination and national visibility advancing IPE and While reviewing the two literatures of ICP and IPE is often collaborative practice as a viable and efficient healthcare delivery done independently, the work of the National Center conceptually model. In this role, the National Center is developing a series of links them in a NEXUS (D’Amour & Oandasan, 2005). This articles to stimulate meaningful inquiry to ascertain the impact NEXUS entails the process of redesigning both healthcare of interprofessional collaborative practice and IPE (ICP/IPE) on education and healthcare delivery to be better integrated and health and healthcare delivery outcomes (hereafter, we use the more interprofessional. The ultimate goal of the NEXUS is to acronym ICP/IPE, while recognizing that others may use different create a unified system from currently disparate ones focusing on achieving the outcomes of the Triple Aim. The Triple Aim (Berwick et al., 2008) has become a This is an open-access article distributed under the terms of the CC-BY- NC-ND 3.0 License which permits users to download and share the article galvanizing force drawing attention to a generalized approach for non-commercial purposes, so long as the article is reproduced in the needed to fix the US healthcare system by simultaneously whole without changes, and provided the original source is credited. improving patient experiences of care (including quality and Correspondence: May Nawal Lutfiyya, PhD, Academic Health Center, satisfaction), improving the health of populations and reducing University of Minnesota, Minneapolis, MN, USA and Office of the per capita cost of healthcare. Ultimately, the Triple Aim Education, R6685 Children’s Rehab Center, 426 Church Street SE, outcomes entail the domains of quality (the delivery of safe and Minneapolis 55455, MN, USA. E-mail: [email protected] effective care by healthcare teams as well as patient outcomes); For more information about the National Center, see: http://www. cost (total cost and measures of utilization that drive costs); and ahceducation.umn.edu/national-center-for-interprofessional-practice-and- experience (not only patients’ experiences but also the education/index.htm. 394 B. Brandt et al. J Interprof Care, 2014; 28(5): 393–399 experiences of providers working in interprofessional teams as using the question to develop clear inclusion criteria to identify well) (Berwick et al., 2008). The Triple Aim has re-enforced the relevant studies, an approach to appraise the studies or a subset of possible importance of ICP/IPE in the context of multiple the studies, a summary of the evidence using an explicit organizations and systems. methodology and interpreting the findings of the review. The Since the mid-1970s, educators, health professionals, health- details of these five steps are described below. care researchers and policy makers have acknowledged that ICP/IPE have the potential to play key parts in possibly improving Step 1: formulating the question healthcare delivery and health outcomes (Reeves et al., 2008). Prior to conducting the literature search, the purpose of the study In 2010, the World Health Organization (WHO) affirmed its and a specific question were established, leading to the clarifi- commitment to ICP/IPE with its Framework for Action on cation of the inclusion criteria. The question was: since 2008, Interprofessional Education and Collaborative Practice (WHO, have the ICP/IPE literatures been focused on examining how these 2010). This framework, highlighting the importance of IPE in the (ICP/IPE) simultaneously improve population health outcomes, development of a collaboration-ready workforce armed with the delivery of quality and safe healthcare and healthcare cost skills needed to become part of collaborative practice, also reduction? outlined the possible importance of ICP/IPE in improving fragmented healthcare delivery systems globally. In this 2010 Step 2: identifying the relevant work publication, the WHO, in similar fashion to the Triple Aim, unequivocally connected interprofessional healthcare teams to the The inclusion criteria emerged directly from the question guiding provision of better healthcare services that would eventually lead this review and were specified a priori. The review began in to improved health outcomes (WHO, 2010). In addition, authors consultation with librarians who helped develop a rigorous of this report intentionally linked these outcomes to the long-held analysis of the best terms and search strategy. This initial search definition of IPE, or learning about, from and with each other to was limited to papers written in English and produced enhance collaboration and improve health outcomes (Barr & between 2008 (the year Berwick et al. published the Triple Waterton, 1996; WHO, 2010). Aim paper) and 2013. The initial search terms, narrowed from a The fields of ICP/IPE have experienced ebbs and flows of list of approximately 50 search terms that were compiled from interest since the 1970s. Concurrent with the creation of the Triple 17 IPE and collaborative practice review articles (Abu-Rish Aim and the WHO (2010) report, the US has been experiencing et al., 2012; Budgen & Gamroth, 2008; Mann et al., 2009; another resurgence of interest in the promise of IPC/IPE. In 2011, Morgan & Jones, 2009; Reeves, 2008, 2009, 2010a,b, 2011, the US IPE Collaborative defined 38 core competencies in four 2013; Rodger & Hoffman, 2010; Suter et al., 2009; domains of ICP (IPEC, 2011). Pragmatically, these competencies Thannhauser et al., 2010; Thistlethwaite, 2012; Thistlethwaite & build on the WHO’s (2010) definition of collaborative practice Moran, 2010; Xyrichis & Lowton, 2008; Zwarenstein et al., and are geared to prepare ‘‘all health professions students for 2009), were as follows: Interprofessional*, Multiprofession*, deliberatively working together with the common goal of building Teamwork*, Interprofessional Relations*, Patient Care Team* a safer and better patient-centered and community/population- and Education*. Our target was to retrieve and review a range of oriented US health care system’’ (p. 3, emphasis in original) 1200–1500 articles from Ovid. The Ovid MEDLINE database (IPEC, 2011). (US National Library of Medicine, Bethesda, MD) contains Many reviews of the ICP/IPE literatures have been conducted bibliographic citations and author abstracts for an estimated 4600 (Abu-Rish et al., 2012; Budgen & Gamroth, 2008; Mann, Gordon, biomedical journals published in the US and in approximately 70 & MacLeod, 2009; Morgan & Jones, 2009; Reeves, 2009; Reeves, other countries. The favored language for Ovid is English. Gray Goldman, Burton, & Sawatzky-Girling, 2010a; Reeves et al., literature was excluded from this review. 2011; Reeves et al., 2010b; Reeves, Perrier, Goldman, Freeth, & Zwarenstein, 2013; Rodger & Hoffman, 2010; Suter et al., 2009; Step 3: an approach to appraise the studies Thannhauser, Russell-Mayhew & Scott, 2010; Thistlethwaite, The abstracts were sorted by article type (research reports, 2012; Thistlethwaite & Moran, 2010; Xyrichis & Lowton, 2008; program descriptions, opinion/position papers, summaries of Zwarenstein et al., 2009). These have included scoping reviews previous articles and unknown/other) (Table I) and type of (Reeves et al., 2011), literature syntheses (Thistlethwaite & Moran, 2010), environmental scans (Rodger & Hoffman, 2010), professional interaction around learning and/or practice (inter- Cochrane reviews (Reeves et al., 2013; Zwarenstein et al., 2009), professional as defined earlier, multiprofessional, uniprofessional systematic reviews (Reeves et al., 2010a), syntheses of systematic and unknown/other) (Table II). reviews (Reeves et al., 2010b) and reviews focused on clarifying The criterion for inclusion for further examination was as the fields of IPE and collaborative practice (Abu-Rish et al., 2012) follows: a research article that either reported on the development and on defining the field’s research agenda (Thistlethwaite, 2012). of or evaluation of an ICP/IPE program. A research article, While prior reviews have focused on quality (e.g. effective care) regardless of methodological approach, is grounded in the and experience (e.g. experiences of healthcare providers), to date, rigorous and systematic collection and analysis of data, with no comprehensive review of the ICP/IPE literatures has focused investigators paying attention to reliability and validity as well as on the impact of this area of inquiry on the outcomes of the Triple generalizable findings and conclusions. Sometimes the descrip- Aim as articulated by Berwick et al. (2008). tors of dependability or consistency are used for reliability and trustworthiness or applicability for external validity in qualitative research studies (Guba & Lincoln, 1981; Stake, 1995; Thyer, Methods 2001). By contrast, evaluation, which is also systematic and For this scoping review, we employed the preferred reporting rigorous, is grounded in a specific program’s context where items for systematic reviews and meta-analyses (PRISMA) evaluators answer questions of interest to potential users. approach (Liberati et al., 2009; Moher, Liberati, Tetzlaff, & Although the terms are sometimes used interchangeably, research Altman, 2009a; Moher, Liberati, Tetzlaff, Altman, & The seeks to generalize while evaluation to particularize. By and large, PRISMA Group, 2009b), which is organized by five distinct articles examined for this review focused on either the creation of elements or steps: beginning with a clearly formulated question, an ICP/IPE program or a study of its effects. All articles classified DOI: 10.3109/13561820.2014.906391 ICP/PE literature review 395 Table I. Article type code. Code Classification Description P Program or research report An interprofessional education or collaborative practice program or activity is described. May include some data, analysis or research methods. Activities could include developing programs, data collection tools, planning processes, drafting competency models, conducting qualitative or quantitative research or collecting data. O Opinion/position paper Thoughts about interprofessional education and collaborative practice. No research or program development presented. S Summary or meta-analysis Review of existing literature or research. of prior articles U Unknown/other Also code as U if there is no abstract. Table II. Level of interprofessionalism code. Code Classification Description I Interprofessional Two or more professions learning or practicing interprofessional competencies: teamwork, communication, ethics and/or professional roles. Includes abstracts that claim interprofessional activities, even if it is not clear which professions or competencies. M Multiprofessional Two or more professions working side by side for any purpose. N Not interprofessional (uniprofessional) Focused on one profession or not on professions at all. Also, if the professions described are not health care practitioners U Unknown/Other Also code as U if there is no abstract or if it is unclear if multiple professions are involved. as multiprofessional were excluded as were opinion pieces, change) (Goldman et al., 2009; Reeves, Goldman, & Zwarenstein, reviews and editorials. 2009) addressed in the findings of the 133 papers classified as To answer our question, only research (and not evaluation) research into ICP. articles were germane. The review and coding of the abstracts identified 552 potential articles for additional examination. Two Step 5: interpreting the findings readers reviewed and coded each of the 552 articles using the In the discussion section, the findings of this scoping review are same coding scheme. Their inter-coder reliability was checked interpreted in light of the Triple Aim. In addition, a summary of with the goal of reaching consensus. Fifty-six articles, examined the current focus of this area of inquiry is presented along with to reconcile coder ratings, were eliminated either because they suggestions for re-orientation. were not original research or because, upon further review, they were actually opinion pieces or reviews. The 496 remaining Results articles became the corpus for this literature review. The initial search yielded 1176 published manuscripts that were Step 4: summarizing the presented evidence reduced to 496 when the inclusion criteria were used to refine the All of the 496 papers selected for final appraisal were classified selection of published manuscripts (Figure 1). Table III displays by article content, country of origin, health system type, study the frequency and percent of ICP/IPE manuscripts by analytic setting, sample size range, methodology and number of profes- descriptors. The analysis revealed that, of the 496 manuscripts sions included in the study. In addition, specific professions examined, 254 papers (51.2%) focused on an assessment/evalu- ation of a specific IPE program or intervention, whereas involved, as well as the frequency and percent of their inclusion in 133 papers (26.8%) focused on research into ICP. In addition, studies, were captured. In a sub-analysis, we examined the 42 papers (8.5%) were a combination of assessing ICP/IPE research questions and findings of the 133 papers classified as instruments and programs, 32 (6.5%) described the development research into interprofessional collaborative practice. For this of programs, 14 papers (2.8%) assessed and/or evaluated instru- additional analysis, each of these articles was coded by whether or ments, 13 papers (2.6%) of the papers reviewed presented models not any Triple Aim identified outcome was part of the data or discussed competencies and 6 papers (1.2%) were focused on collected and analysis conducted. Each paper was coded as either instruments. The largest share of the papers reviewed were 0, 1, 2 or 3. Papers coded as zero included no Triple Aim Canadian (32.5%), followed by US (23.2%) and UK (20.4%) outcome, whereas those coded as three included all of the Triple papers. The work described in 75% of the articles reviewed Aim outcomes. Had we chosen to examine these papers using the originated within universal coverage health systems. criteria of including the Triple Aim outcomes simultaneously, no Only 12.7% of the 496 papers involved a setting that combined paper would have passed muster. Two reviewers (C.C. and M.N.L.) examined and coded the 133 papers classified as research higher education and healthcare practice sites where health into ICP. During the coding process, disagreement occurred over profession students were placed. One in three of the papers 15 or 11.3% of the papers. The disagreement was resolved by reviewed employed mixed methods, whereas 41.4% of the articles re-reading the paper’s abstract and coming to agreement on all relied on quantitative methods. In the majority of the papers, 15 papers. Finally, two of the paper’s authors (C.C. and M.N.L.) 55.2% investigators reported a sample size 550 and 15.1% coded the level of analysis (practice-based process; individual included a sample size 300. Of those papers reviewed, 43.1% change in knowledge, skill or attitude; and organizational level included 2–4 professions. Table IV displays the frequency and percent of professions included in the 496 articles. Twenty different professions For a complete list of all papers included in this review, see: http:// nexusipe.org/resource-exchange/scoping-review-ipc-ipe. appeared in the literature reviewed, with nursing the most 396 B. Brandt et al. J Interprof Care, 2014; 28(5): 393–399 Figure 1. Article selection flowchart by Bibliographic Database for IPE/ICP created using OVID Medline Criteria: published during reviewer inclusion criteria. 2008-2013, and written in English. Search yielded 1176 articles The 1176 article abstracts were coded according to article type (Table I) and type of interprofessionalism (Table II). Inclusion criteria for further investigation was research articles that reported on the development of or evaluated an interprofessional program. Coding resulted in 552 articles Three researchers (JK, CC, MNL) read 552 articles. Each article was read by at least two authors for inter-coder reliability. The same coding scheme was used as earlier on abstracts. Fifty-six (56) articles were further examined for inter-coder reconciliation and were removed because they were not original IPE/ICP research or were opinion pieces or reviews. 496 articles remained frequently included (62.2%) followed by medicine (57.9%). attitudes and in 16.5% organization level change was reported. Veterinary medicine was the least frequently included in the Finally, 83 papers (62.4%) were classified as collaborative papers reviewed (1.2%). Public health was notably absent. practice, while 50 (37.6%) as IPE. In analyses to examine the questions and findings of the Discussion 133 papers classified as research into IPE and/or collaborative practice, reviewers coded each article by whether or not at least ICP/IPE have been areas of inquiry for many decades now. This one Triple Aim outcome was part of the data collected and inquiry has been carried out by scholars from multiple disciplines analysis conducted. These results are displayed in Table V. From such as education, psychology, sociology, pharmacy, nursing and this analysis, 108 (81.2%) papers were coded as 0 (no Triple Aim medicine. The professions included in the research of ICP/IPE outcome), 22 (16.5%) as 1 (at least one Triple Aim outcome, and have also been quite diverse. Healthcare reform in the US, spurred all these papers focused on patient experience of care) and on by the articulation of the Triple Aim outcomes, has provided 3 (2.3%) papers as 2 (at least two Triple Aim outcomes, and these an avenue for re-vitalizing this area of inquiry, encouraging the papers focused on patient experience of care as well as population elevation of the research foci from the level of program-specific health). None of the papers reviewed were coded as 3. Therefore, impacts to the impact of ICP/IPE on simultaneously focusing on none of the papers included the Triple Aim focusing on the patient healthcare cost, healthcare quality and improvement in reduction of healthcare costs, an important and critical element in population health. transforming the healthcare delivery system. Our review revealed that, at present, the inquiry remains The 133 manuscripts were also classified by methods used focused on examining three levels of impact – individual level in (quantitative, qualitative or mixed), study setting, sample size terms of immediate or short-term changes that ICP/IPE has on range and level of analysis for study findings reported. In over half knowledge, skills and attitudes; practice level in terms of practice- of the studies (51.1%), investigators used qualitative methods, as based processes – but not outcomes; and organizational level in compared to quantitative (30.8%) or mixed methods (18.0%). The terms of intermediate policy changes. We are not alone in making highest proportion of studies was conducted in healthcare practice this observation (Goldman et al., 2009; Reeves et al., 2009). None sites – 36.1% in multiple sites and 17.3% in a single site. The of the literature reviewed was situated directly in the context of majority (61.7%) of the studies reported sample sizes550. Only current US healthcare reform explicitly mapping the outcomes of 23 of these studies (17.3%) reported sample sizes 300. An ICP/IPE to those identified as the Triple Aim. Very little of the examination of the level of analysis for study findings indicated literature reviewed focused on population health or patient health that 59.4% of the 133 papers had a practice-based process focus, outcomes, and none on the reduction in the cost of health care. 21.0% were focused on individual level skills, knowledge and Given that population health is most often the purview of the DOI: 10.3109/13561820.2014.906391 ICP/PE literature review 397 Table III. Frequency and percent of ICP/IPE literature descriptors intersection of IPE and collaborative practice (the NEXUS). 2008–2013 (n¼ 496). Our review documents that few researchers have studied either this NEXUS or its connection with the Triple Aim. We would Variable and factors Frequency Percent argue that the time is right for such a focus. If ICP/IPE hold the promise of moving health professions education and collaborative Article content Assessment/evaluation of ICP/IPE program 254 51.2 practice together along the path of achieving the Triple Aim Research into IP practice 133 26.8 outcomes, then creating a well-documented, rigorous research Combination of assessing 42 8.5 base is essential. Crucial first steps are as follows: (1) developing ICP/IPE instruments and programs a consensus about concepts for this area of inquiry, (2) a Development or description of 32 6.5 systematic integration of the IPEC ICP core competencies ICP/IPE program framework and (3) consensus on measurement of the concepts. Assessment/evaluation of 14 2.8 ICP/IPE instrument(s) Others have noted these same concerns (Thistlethwaite & the Models or competencies 13 2.6 GRIN working group, 2013). Development or description of 6 1.2 We chose to examine the inquiry into ICP more closely to IP instrument(s) ascertain what the current research foci were because, by our Other 2 0.4 definition, investigators were attempting to answer questions Article classification for research into beyond localized programs. Moreover, we believe that continuing IP practice papers to produce reviews of this area of inquiry employing narrow Collaborative practice 83 62.4 inclusion criteria that result in only a few papers (if any) being Interprofessional education 50 37.6 examined (Reeves et al., 2008, 2013; Zwarenstein et al., 2009) Country does not maximize the potential for moving the field forward. By Canada 161 32.5 proposing a research agenda for the National Center based on a US 115 23.2 UK 101 20.4 broader examination of the current state of the field and research Australia/Asia 48 9.7 within it, we recognize what has been accomplished and set our Scandinavia 40 8.1 sights on the next stages of a critically important journey. Other 31 6.3 Moving forward requires asking questions about the impact of Health system type ICP/IPE in new ways, which call for the collection and generation Universal coverage 372 75.0 of data allowing examination of as yet untested causal pathways USA 115 23.2 between and among the domains of IPE, practice and healthcare Other 9 1.8 delivery, health outcomes and healthcare costs. This work is not Study setting for the faint of heart – it is conceptually difficult and encompasses Higher education – 1 institution 162 32.7 the potential challenge of discovering that ICP/IPE may not have Health care practice – multiple sites 132 26.6 Health care practice – 1 site 79 15.9 the impact we believe it might. For example, given the complexity Combination of higher education 63 12.7 of the healthcare world, training learners in effective team work and practice sites may not ultimately lead to improved health outcomes or reduce Higher education – multiple institutions 46 9.3 the cost of care. The NEXUS is the innovative framing of tackling Other 14 2.8 these complex issues. In the NEXUS, both clinical practice and Sample size range education join forces to ensure sustainable change. 550 274 55.2 Generalizable findings are paramount if the hope of ICP/IPE is 50–99 69 13.9 to be realized. For findings to be generalizable, they must come 100–299 78 15.7 300 75 15.1 from rigorous research and data analysis employing quantitative, qualitative and mixed methods. Among the untested associations Methodology Mixed methods 125 25.2 and/or causal pathways we foresee are those that posit and Qualitative methods 167 33.7 develop Triple Aim outcomes as dependent variables and data Quantitative methods 204 41.1 collected on multiple dimensions of IPE and collaborative Number of professions practice as independent variables, with demographic and Unclear 95 19.2 ecological variables as covariates. Of equal importance is high- 1 38 7.7 quality qualitative research that documents the context-specific 2–4 214 43.1 experience with implications for other settings. While generating 5–8 103 20.7 and collecting these data will require a serious commitment of 9 or more 46 9.3 resources, the ultimate value of understanding the extent to which Other countries included: Belgium, The Netherlands, Germany, Israel, – and in what ways – ICP/IPE may affect the achievement of the Iran, Mexico, Italy, Chile, India, Nepal, Hungary, Honduras, Triple Aim will make the commitment of time and research Switzerland, Nigeria and Spain. funding worthwhile. For 40 years, the promise of ICP/IPE has inspired a small group of researchers, health professions educators and clinical practitioners. It is time to call the question of the discipline of public health, perhaps it is not surprising that none of extent to which ICP/IPE may help catalyze a major transformation the papers reviewed in this study included public health as an of the US healthcare system. integral discipline in IPE or collaborative practice. Since everyone There are a number of limitations to this review that should be has a part in the game, this absence is unfortunate and provides explicitly noted. First, although ICP and IPE have been areas of important actionable information. inquiry for 40-some years, the review was not comprehensive, but A critical reason for the creation of the National Center in limited to the years 2008–2013. While this limit was purposive, it 2012 was the resurgence of interest in IPE and collaborative nevertheless should be acknowledged. Second, while also pur- practice in a healthcare environment energized by significant posive, the lens for analysis was the Triple Aim. This is one lens practice and health policy change. Research needs to focus on the of many that could be applied to a scoping review of these health-related outcomes, specifically the Triple Aim, at the materials. We chose it because of the connection between the 398 B. Brandt et al. J Interprof Care, 2014; 28(5): 393–399 Table IV. Frequency and percent of professions included in reviewed Triple Aim and healthcare delivery reform in the US. Third, this literature (2008–2013; n¼ 496). review was focused on examining ICP/IPE in the context of US healthcare reform. There are many other ways to examine and Variables and factors Frequency Percent understand ICP/IPE. Specifically, different issues might be pertinent in other types of healthcare systems (e.g. universal Nursing 309 62.2 Medicine 288 57.9 healthcare systems). Finally, our assessment of the quality of the Physical therapy 138 27.8 133 research into collaborative practice papers did not entail a Pharmacy 120 23.1 meta-analysis. Again, this was purposive since we wanted to Occupational therapy 116 23.3 include quantitative, qualitative and mixed methods papers it was Social work 111 22.3 not possible to combine the data for additional analysis. These Other professions 87 17.5 limitations are not detrimental to the work presented in this study Mental and behavioral health 53 10.7 Healthcare assistants 52 10.5 but do suggest the boundaries for interpreting the findings. Nutrition/dietetics 50 10.1 Audiology 40 8.0 Concluding comments Dentistry 32 6.4 Midwifery 29 5.8 Even though research into ICP/IPE efforts has been an area of Health administration 26 5.2 inquiry for almost four decades, it has not as yet demonstrated the Diagnostic radiography 20 4.0 impact of these on improving population health, reducing Paramedic 16 3.2 healthcare costs, improving the quality of delivered care and/or Medical laboratory science 15 3.0 patients’ experiences of care received. This is not to say that much Dental hygiene 10 2.0 Complementary and alternative medicine (CAM) 8 1.6 of the published literature does not situate the importance of ICP/ Veterinary medicine 6 1.2 IPE in the context of health services and health-related outcomes. It is to say that when the studies are designed, analysis plans Other professions included: pastoral/spiritual care, engineering, business, developed and data generated and collected, these impacts have respiratory therapy, and ‘‘Volunteers’’ with no other professional not to date been identified. We hope that this review of literature identified. and the research agenda we have proposed will begin to move this area of inquiry beyond theoretical statements to hypothesis testing aimed at strengthening the evidence base for the effectiveness of Table V. Characteristics of papers classified as research into ICP/IPE within the context of healthcare delivery. interprofessional education/collaborative practice (n¼ 133). Variables and factors Frequency Percent Declaration of interest Papers with an identifiable Triple Aim-related outcome The authors report no declaration of interest. The authors are responsible No Triple Aim health-related outcome 108 81.2 for the writing and content of this article. At least one Triple Aim health-related 22 16.5 This work was produced at the National Center for Interprofessional outcome Practice and Education, which is supported by a Health Resources At least two Triple Aim health-related 3 2.3 and Services Administration Cooperative Agreement Award outcomes No. UE5HP25067. In addition, the Josiah Macy Jr. Foundation, the At least three Triple Aim health-related 00 Robert Wood Johnson Foundation (RWJF), the Gordon and Betty Moore outcomes Foundation and the John A Hartford Foundation have collectively committed up to $8.1 million in grants over five years to support and Methods guide the Center, which will work to accelerate team work and Qualitative 68 51.1 collaboration among doctors, nurses and other health professionals – as Quantitative 41 30.8 well as patients – and break down the traditional silo-approach to health Mixed 24 18.0 professions education. Study setting Higher education – 1 institution 22 16.5 References Health care practice – multiple sites 48 36.1 Health care practice – 1 site 23 17.3 Abu-Rish, E., Kim, S., Choe, L., Varpio, L., Malik, E., White, A.A., Combination of higher education 14 10.5 Craddick, K., et al. (2012). Current trends in interprofessional and practice sites education of health sciences students: A literature review. Journal of Higher education – multiple institutions 20 15.0 Interprofessional Care, 26, 444–451. Other 6 4.5 Barr, H., & Waterton, S. (1996). Interprofessional education in health and Sample size social care in the United Kingdom: Report of a CAIPE survey. 550 82 61.7 Fareham, UK: Centre for the Advancement of Interprofessional 50–99 17 12.8 Education in Primary Health and Community Care. 100–299 11 8.3 Berwick, D.M., Nolan, T.W., & Whittington, J. (2008). The triple aim: 300 23 17.3 Care, health, and cost. Health Affairs, 27, 759–769. Budgen, C., & Gamroth, L. (2008). An overview of practice education Leval of analysis for study findings Practice-based process 79 59.4 models. Nurse Education Today, 28, 273–283. D’Amour, D., & Oandasan, I. (2005). Interprofessionality as the field of Individual level skills, knowledge 28 21.0 and attitudes interprofessional practice and interprofessional education: An emer- ging concept. Journal of Interprofessional Care, 19, 8–20. Organization level change 22 16.5 Unclear 4 3.0 Goldman, J., Zwarenstein, M., Bhattacharyya, O., & Reeves, S. (2009). Improving the clarity of the interprofessional field: Implications for Article classification research and continuing interprofessional education. Journal of Collaborative practice 83 62.4 Continuing Education in the Health Professions, 29, 151–156. Interprofessional education 50 37.6 Guba, E.G., & Lincoln, Y.S. (1981). Effective evaluation: Improving the usefulness of evaluation results through responsive and naturalistic approaches. San Francisco: Jossey-Bass. Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an DOI: 10.3109/13561820.2014.906391 ICP/PE literature review 399 expert panel. Washington, DC: Interprofessional Education education: Key findings from a new systematic review. Journal of Interprofessional Care, 24, 230–241. Collaborative Expert Panel. Liberati, A., Altman, D.G., Tetzlaff, J., Mulrow, C., Gøtzsche, P.C., Reeves, S. (2009). An overview of continuing interprofessional education. Journal of Continuing Education in the Health Professions, 29, Ioannidis, J.P.A., Clarke, M., et al. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate 142–146. Rodger, S., & J. Hoffman, S. (2010). Where in the world is healthcare interventions: Explanation and elaboration. BMJ, 339, interprofessional education? A global environmental scan. Journal of b2700. Interprofessional Care, 24, 479–491. Mann, K., Gordon, J., & MacLeod, A. (2009). Reflection and reflective Suter, E., Arndt, J., Arthur, N., Parboosingh, J., Taylor, E., & practice in health professions education: A systematic review. Deutschlander, S. (2009). Role understanding and effective communi- Advances in Health Sciences Education, 14, 595–621. cation as core competencies for collaborative practice. Journal of Moher, D., Liberati, A., Tetzlaff, J., & Altman, D.G. (2009a). Preferred Interprofessional Care, 23, 41–51. reporting items for systematic reviews and meta-analyses: The Stake, R.E. (1995). The art of case study research. Thousand Oaks, CA: PRISMA statement. Annals of Internal Medicine, 151, 264–269. Sage Publications. Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., & The PRISMA Thannhauser, J., Russell-Mayhew, S., & Scott, C. (2010). Measures of Group. (2009b). Preferred reporting items for systematic reviews and interprofessional education and collaboration. Journal of meta-analyses: The PRISMA statement. PLoS Medicine, 6, e1000097. Interprofessional Care, 24, 336–349. Morgan, A., & Jones, D. (2009). Perceptions of service user and carer Thistlethwaite, J. (2012). Interprofessional education: A review of involvement in healthcare education and impact on students’ know- context, learning and the research agenda. Medical Education, 46, ledge and practice: A literature review. Medical Teacher, 31, 82–95. 58–70. Reeves, S., Goldman, J., Burton, A., & Sawatzky-Girling, B. (2010a). Thistlethwaite, J., & the GRIN Working Group. (2013). Introducing the Synthesis of systematic review evidence of interprofessional education. Global Research Interprofessional Network (GRIN). Journal of Journal of Allied Health, 39, 198–203. Interprofessional Care, 27, 107–109. Reeves, S., Goldman, J., Gilbert, J., Tepper, J., Silver, I., Suter, E., & Thistlethwaite, J., & Moran, M. (2010). Learning outcomes for Zwarenstein, M. (2011). A scoping review to improve conceptual interprofessional education (IPE): Literature review and synthesis. clarity of interprofessional interventions. Journal of Interprofessional Journal of Interprofessional Care, 24, 503–513. Care, 25, 167–174. Thyer, B.A. (Ed.). (2001). Reliability and validity in qualitative research. Reeves, S., Goldman, J., & Zwarenstein, M. (2009). An emerging The handbook of social work research methods. In The handbook of framework for understanding the nature of interprofessional interven- social work research methods (pp. 273–293). Thousand Oaks, CA: tions. Journal of Interprofessional Care, 23, 539–542. SAGE Publications. Reeves, S., Perrier, L., Goldman, J., Freeth, D., & Zwarenstein, M. World Health Organization Department of Human Resources for Health. (2013). Interprofessional education: Effects on professional practice (2010). Framework for action on interprofessional education and and health care outcomes.(update). Cochrane Database of Systematic collaborative practice. Geneva: WHO. Reviews, 3, CD002213. Xyrichis, A., & Lowton, K. (2008). What fosters or prevents interprofes- Reeves, S., Zwarenstein, M., Goldman, J., Barr, H., Freeth, D., Hammick, sional team working in primary and community care? A literature M., & Koppel, I. (2008). Interprofessional education: Effects on review. International Journal of Nursing Studies, 45, 140–153. professional practice and health care outcomes. Cochrane Database of Zwarenstein, M., Goldman, J., & Reeves, S. (2009). Interprofessional Systematic Reviews, 1, CD002213. collaboration: Effects of practice-based interventions on professional Reeves, S., Zwarenstein, M., Goldman, J., Barr, H., Freeth, D., Koppel, I., practice and healthcare outcomes. Cochrane Database of Systematic & Hammick, M. (2010b). The effectiveness of interprofessional Reviews, 3, CD000072. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Interprofessional Care Taylor & Francis

A scoping review of interprofessional collaborative practice and education using the lens of the Triple Aim

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Taylor & Francis
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© 2014 The Author(s). Published by Taylor & Francis.
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10.3109/13561820.2014.906391
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Abstract

Keywords The Triple Aim unequivocally connects interprofessional healthcare teams to the provision of Health system reform, interprofessional better healthcare services that would eventually lead to improved health outcomes. This review collaboration, interprofessional education, of the interprofessional education (IPE) and collaborative practice empirical literature from 2008 interprofessional research to 2013 focused on the impact of this area of inquiry on the outcomes identified in the Triple Aim. The preferred reporting items for systematic reviews and meta-analyses methodology History were employed including: a clearly formulated question, clear inclusion criteria to identify Received 14 January 2014 relevant studies based on the question, an appraisal of the studies or a subset of the studies, a Revised 14 March 2014 summary of the evidence using an explicit methodology and an interpretation of the findings Accepted 17 March 2014 of the review. The initial search yielded 1176 published manuscripts that were reduced to 496 Published online 7 April 2014 when the inclusion criteria were applied to refine the selection of published manuscripts. Despite a four-decade history of inquiry into IPE and/or collaborative practice, scholars have not yet demonstrated the impact of IPE and/or collaborative practice on simultaneously improving population health, reducing healthcare costs or improving the quality of delivered care and patients’ experiences of care received. We propose moving this area of inquiry beyond theoretical assumptions to systematic research that will strengthen the evidence base for the effectiveness of IPE and collaborative practice within the context of the evolving imperative of the Triple Aim. Introduction ones). To frame this work, we conducted an extensive scoping review of the ICP/IPE literatures from 2008 – the year that There is now a pressing need to foster high quality research Berwick, Nolan, and Whittington (2008) promulgated the Triple examining the impact of collaborative practice and interprofes- Aim focused on reforming US healthcare delivery – through 2013. sional education (IPE) around the world (Goldman, Zwarenstein, The purpose of this review was to determine the current state of Bhattacharyya, & Reeves, 2009; Thistlethwaite & the GRIN ICP/IPE inquiry, in light of the Triple Aim (Berwick et al., 2008), working group, 2012; Zwarenstein, Goldman, & Reeves, 2009). as a starting point for two of the National Center’s transformative This is one defining role of the United States (US) National goals – strengthening the evidence base for the effectiveness of Center for Interprofessional Practice and Education at the ICP/IPE and creating, implementing and assessing new models of University of Minnesota, a public–private partnership created ICP/IPE – within the context of the US healthcare delivery system from a competitive process to provide leadership, scholarship, and its global counterparts. evidence, coordination and national visibility advancing IPE and While reviewing the two literatures of ICP and IPE is often collaborative practice as a viable and efficient healthcare delivery done independently, the work of the National Center conceptually model. In this role, the National Center is developing a series of links them in a NEXUS (D’Amour & Oandasan, 2005). This articles to stimulate meaningful inquiry to ascertain the impact NEXUS entails the process of redesigning both healthcare of interprofessional collaborative practice and IPE (ICP/IPE) on education and healthcare delivery to be better integrated and health and healthcare delivery outcomes (hereafter, we use the more interprofessional. The ultimate goal of the NEXUS is to acronym ICP/IPE, while recognizing that others may use different create a unified system from currently disparate ones focusing on achieving the outcomes of the Triple Aim. The Triple Aim (Berwick et al., 2008) has become a This is an open-access article distributed under the terms of the CC-BY- NC-ND 3.0 License which permits users to download and share the article galvanizing force drawing attention to a generalized approach for non-commercial purposes, so long as the article is reproduced in the needed to fix the US healthcare system by simultaneously whole without changes, and provided the original source is credited. improving patient experiences of care (including quality and Correspondence: May Nawal Lutfiyya, PhD, Academic Health Center, satisfaction), improving the health of populations and reducing University of Minnesota, Minneapolis, MN, USA and Office of the per capita cost of healthcare. Ultimately, the Triple Aim Education, R6685 Children’s Rehab Center, 426 Church Street SE, outcomes entail the domains of quality (the delivery of safe and Minneapolis 55455, MN, USA. E-mail: [email protected] effective care by healthcare teams as well as patient outcomes); For more information about the National Center, see: http://www. cost (total cost and measures of utilization that drive costs); and ahceducation.umn.edu/national-center-for-interprofessional-practice-and- experience (not only patients’ experiences but also the education/index.htm. 394 B. Brandt et al. J Interprof Care, 2014; 28(5): 393–399 experiences of providers working in interprofessional teams as using the question to develop clear inclusion criteria to identify well) (Berwick et al., 2008). The Triple Aim has re-enforced the relevant studies, an approach to appraise the studies or a subset of possible importance of ICP/IPE in the context of multiple the studies, a summary of the evidence using an explicit organizations and systems. methodology and interpreting the findings of the review. The Since the mid-1970s, educators, health professionals, health- details of these five steps are described below. care researchers and policy makers have acknowledged that ICP/IPE have the potential to play key parts in possibly improving Step 1: formulating the question healthcare delivery and health outcomes (Reeves et al., 2008). Prior to conducting the literature search, the purpose of the study In 2010, the World Health Organization (WHO) affirmed its and a specific question were established, leading to the clarifi- commitment to ICP/IPE with its Framework for Action on cation of the inclusion criteria. The question was: since 2008, Interprofessional Education and Collaborative Practice (WHO, have the ICP/IPE literatures been focused on examining how these 2010). This framework, highlighting the importance of IPE in the (ICP/IPE) simultaneously improve population health outcomes, development of a collaboration-ready workforce armed with the delivery of quality and safe healthcare and healthcare cost skills needed to become part of collaborative practice, also reduction? outlined the possible importance of ICP/IPE in improving fragmented healthcare delivery systems globally. In this 2010 Step 2: identifying the relevant work publication, the WHO, in similar fashion to the Triple Aim, unequivocally connected interprofessional healthcare teams to the The inclusion criteria emerged directly from the question guiding provision of better healthcare services that would eventually lead this review and were specified a priori. The review began in to improved health outcomes (WHO, 2010). In addition, authors consultation with librarians who helped develop a rigorous of this report intentionally linked these outcomes to the long-held analysis of the best terms and search strategy. This initial search definition of IPE, or learning about, from and with each other to was limited to papers written in English and produced enhance collaboration and improve health outcomes (Barr & between 2008 (the year Berwick et al. published the Triple Waterton, 1996; WHO, 2010). Aim paper) and 2013. The initial search terms, narrowed from a The fields of ICP/IPE have experienced ebbs and flows of list of approximately 50 search terms that were compiled from interest since the 1970s. Concurrent with the creation of the Triple 17 IPE and collaborative practice review articles (Abu-Rish Aim and the WHO (2010) report, the US has been experiencing et al., 2012; Budgen & Gamroth, 2008; Mann et al., 2009; another resurgence of interest in the promise of IPC/IPE. In 2011, Morgan & Jones, 2009; Reeves, 2008, 2009, 2010a,b, 2011, the US IPE Collaborative defined 38 core competencies in four 2013; Rodger & Hoffman, 2010; Suter et al., 2009; domains of ICP (IPEC, 2011). Pragmatically, these competencies Thannhauser et al., 2010; Thistlethwaite, 2012; Thistlethwaite & build on the WHO’s (2010) definition of collaborative practice Moran, 2010; Xyrichis & Lowton, 2008; Zwarenstein et al., and are geared to prepare ‘‘all health professions students for 2009), were as follows: Interprofessional*, Multiprofession*, deliberatively working together with the common goal of building Teamwork*, Interprofessional Relations*, Patient Care Team* a safer and better patient-centered and community/population- and Education*. Our target was to retrieve and review a range of oriented US health care system’’ (p. 3, emphasis in original) 1200–1500 articles from Ovid. The Ovid MEDLINE database (IPEC, 2011). (US National Library of Medicine, Bethesda, MD) contains Many reviews of the ICP/IPE literatures have been conducted bibliographic citations and author abstracts for an estimated 4600 (Abu-Rish et al., 2012; Budgen & Gamroth, 2008; Mann, Gordon, biomedical journals published in the US and in approximately 70 & MacLeod, 2009; Morgan & Jones, 2009; Reeves, 2009; Reeves, other countries. The favored language for Ovid is English. Gray Goldman, Burton, & Sawatzky-Girling, 2010a; Reeves et al., literature was excluded from this review. 2011; Reeves et al., 2010b; Reeves, Perrier, Goldman, Freeth, & Zwarenstein, 2013; Rodger & Hoffman, 2010; Suter et al., 2009; Step 3: an approach to appraise the studies Thannhauser, Russell-Mayhew & Scott, 2010; Thistlethwaite, The abstracts were sorted by article type (research reports, 2012; Thistlethwaite & Moran, 2010; Xyrichis & Lowton, 2008; program descriptions, opinion/position papers, summaries of Zwarenstein et al., 2009). These have included scoping reviews previous articles and unknown/other) (Table I) and type of (Reeves et al., 2011), literature syntheses (Thistlethwaite & Moran, 2010), environmental scans (Rodger & Hoffman, 2010), professional interaction around learning and/or practice (inter- Cochrane reviews (Reeves et al., 2013; Zwarenstein et al., 2009), professional as defined earlier, multiprofessional, uniprofessional systematic reviews (Reeves et al., 2010a), syntheses of systematic and unknown/other) (Table II). reviews (Reeves et al., 2010b) and reviews focused on clarifying The criterion for inclusion for further examination was as the fields of IPE and collaborative practice (Abu-Rish et al., 2012) follows: a research article that either reported on the development and on defining the field’s research agenda (Thistlethwaite, 2012). of or evaluation of an ICP/IPE program. A research article, While prior reviews have focused on quality (e.g. effective care) regardless of methodological approach, is grounded in the and experience (e.g. experiences of healthcare providers), to date, rigorous and systematic collection and analysis of data, with no comprehensive review of the ICP/IPE literatures has focused investigators paying attention to reliability and validity as well as on the impact of this area of inquiry on the outcomes of the Triple generalizable findings and conclusions. Sometimes the descrip- Aim as articulated by Berwick et al. (2008). tors of dependability or consistency are used for reliability and trustworthiness or applicability for external validity in qualitative research studies (Guba & Lincoln, 1981; Stake, 1995; Thyer, Methods 2001). By contrast, evaluation, which is also systematic and For this scoping review, we employed the preferred reporting rigorous, is grounded in a specific program’s context where items for systematic reviews and meta-analyses (PRISMA) evaluators answer questions of interest to potential users. approach (Liberati et al., 2009; Moher, Liberati, Tetzlaff, & Although the terms are sometimes used interchangeably, research Altman, 2009a; Moher, Liberati, Tetzlaff, Altman, & The seeks to generalize while evaluation to particularize. By and large, PRISMA Group, 2009b), which is organized by five distinct articles examined for this review focused on either the creation of elements or steps: beginning with a clearly formulated question, an ICP/IPE program or a study of its effects. All articles classified DOI: 10.3109/13561820.2014.906391 ICP/PE literature review 395 Table I. Article type code. Code Classification Description P Program or research report An interprofessional education or collaborative practice program or activity is described. May include some data, analysis or research methods. Activities could include developing programs, data collection tools, planning processes, drafting competency models, conducting qualitative or quantitative research or collecting data. O Opinion/position paper Thoughts about interprofessional education and collaborative practice. No research or program development presented. S Summary or meta-analysis Review of existing literature or research. of prior articles U Unknown/other Also code as U if there is no abstract. Table II. Level of interprofessionalism code. Code Classification Description I Interprofessional Two or more professions learning or practicing interprofessional competencies: teamwork, communication, ethics and/or professional roles. Includes abstracts that claim interprofessional activities, even if it is not clear which professions or competencies. M Multiprofessional Two or more professions working side by side for any purpose. N Not interprofessional (uniprofessional) Focused on one profession or not on professions at all. Also, if the professions described are not health care practitioners U Unknown/Other Also code as U if there is no abstract or if it is unclear if multiple professions are involved. as multiprofessional were excluded as were opinion pieces, change) (Goldman et al., 2009; Reeves, Goldman, & Zwarenstein, reviews and editorials. 2009) addressed in the findings of the 133 papers classified as To answer our question, only research (and not evaluation) research into ICP. articles were germane. The review and coding of the abstracts identified 552 potential articles for additional examination. Two Step 5: interpreting the findings readers reviewed and coded each of the 552 articles using the In the discussion section, the findings of this scoping review are same coding scheme. Their inter-coder reliability was checked interpreted in light of the Triple Aim. In addition, a summary of with the goal of reaching consensus. Fifty-six articles, examined the current focus of this area of inquiry is presented along with to reconcile coder ratings, were eliminated either because they suggestions for re-orientation. were not original research or because, upon further review, they were actually opinion pieces or reviews. The 496 remaining Results articles became the corpus for this literature review. The initial search yielded 1176 published manuscripts that were Step 4: summarizing the presented evidence reduced to 496 when the inclusion criteria were used to refine the All of the 496 papers selected for final appraisal were classified selection of published manuscripts (Figure 1). Table III displays by article content, country of origin, health system type, study the frequency and percent of ICP/IPE manuscripts by analytic setting, sample size range, methodology and number of profes- descriptors. The analysis revealed that, of the 496 manuscripts sions included in the study. In addition, specific professions examined, 254 papers (51.2%) focused on an assessment/evalu- ation of a specific IPE program or intervention, whereas involved, as well as the frequency and percent of their inclusion in 133 papers (26.8%) focused on research into ICP. In addition, studies, were captured. In a sub-analysis, we examined the 42 papers (8.5%) were a combination of assessing ICP/IPE research questions and findings of the 133 papers classified as instruments and programs, 32 (6.5%) described the development research into interprofessional collaborative practice. For this of programs, 14 papers (2.8%) assessed and/or evaluated instru- additional analysis, each of these articles was coded by whether or ments, 13 papers (2.6%) of the papers reviewed presented models not any Triple Aim identified outcome was part of the data or discussed competencies and 6 papers (1.2%) were focused on collected and analysis conducted. Each paper was coded as either instruments. The largest share of the papers reviewed were 0, 1, 2 or 3. Papers coded as zero included no Triple Aim Canadian (32.5%), followed by US (23.2%) and UK (20.4%) outcome, whereas those coded as three included all of the Triple papers. The work described in 75% of the articles reviewed Aim outcomes. Had we chosen to examine these papers using the originated within universal coverage health systems. criteria of including the Triple Aim outcomes simultaneously, no Only 12.7% of the 496 papers involved a setting that combined paper would have passed muster. Two reviewers (C.C. and M.N.L.) examined and coded the 133 papers classified as research higher education and healthcare practice sites where health into ICP. During the coding process, disagreement occurred over profession students were placed. One in three of the papers 15 or 11.3% of the papers. The disagreement was resolved by reviewed employed mixed methods, whereas 41.4% of the articles re-reading the paper’s abstract and coming to agreement on all relied on quantitative methods. In the majority of the papers, 15 papers. Finally, two of the paper’s authors (C.C. and M.N.L.) 55.2% investigators reported a sample size 550 and 15.1% coded the level of analysis (practice-based process; individual included a sample size 300. Of those papers reviewed, 43.1% change in knowledge, skill or attitude; and organizational level included 2–4 professions. Table IV displays the frequency and percent of professions included in the 496 articles. Twenty different professions For a complete list of all papers included in this review, see: http:// nexusipe.org/resource-exchange/scoping-review-ipc-ipe. appeared in the literature reviewed, with nursing the most 396 B. Brandt et al. J Interprof Care, 2014; 28(5): 393–399 Figure 1. Article selection flowchart by Bibliographic Database for IPE/ICP created using OVID Medline Criteria: published during reviewer inclusion criteria. 2008-2013, and written in English. Search yielded 1176 articles The 1176 article abstracts were coded according to article type (Table I) and type of interprofessionalism (Table II). Inclusion criteria for further investigation was research articles that reported on the development of or evaluated an interprofessional program. Coding resulted in 552 articles Three researchers (JK, CC, MNL) read 552 articles. Each article was read by at least two authors for inter-coder reliability. The same coding scheme was used as earlier on abstracts. Fifty-six (56) articles were further examined for inter-coder reconciliation and were removed because they were not original IPE/ICP research or were opinion pieces or reviews. 496 articles remained frequently included (62.2%) followed by medicine (57.9%). attitudes and in 16.5% organization level change was reported. Veterinary medicine was the least frequently included in the Finally, 83 papers (62.4%) were classified as collaborative papers reviewed (1.2%). Public health was notably absent. practice, while 50 (37.6%) as IPE. In analyses to examine the questions and findings of the Discussion 133 papers classified as research into IPE and/or collaborative practice, reviewers coded each article by whether or not at least ICP/IPE have been areas of inquiry for many decades now. This one Triple Aim outcome was part of the data collected and inquiry has been carried out by scholars from multiple disciplines analysis conducted. These results are displayed in Table V. From such as education, psychology, sociology, pharmacy, nursing and this analysis, 108 (81.2%) papers were coded as 0 (no Triple Aim medicine. The professions included in the research of ICP/IPE outcome), 22 (16.5%) as 1 (at least one Triple Aim outcome, and have also been quite diverse. Healthcare reform in the US, spurred all these papers focused on patient experience of care) and on by the articulation of the Triple Aim outcomes, has provided 3 (2.3%) papers as 2 (at least two Triple Aim outcomes, and these an avenue for re-vitalizing this area of inquiry, encouraging the papers focused on patient experience of care as well as population elevation of the research foci from the level of program-specific health). None of the papers reviewed were coded as 3. Therefore, impacts to the impact of ICP/IPE on simultaneously focusing on none of the papers included the Triple Aim focusing on the patient healthcare cost, healthcare quality and improvement in reduction of healthcare costs, an important and critical element in population health. transforming the healthcare delivery system. Our review revealed that, at present, the inquiry remains The 133 manuscripts were also classified by methods used focused on examining three levels of impact – individual level in (quantitative, qualitative or mixed), study setting, sample size terms of immediate or short-term changes that ICP/IPE has on range and level of analysis for study findings reported. In over half knowledge, skills and attitudes; practice level in terms of practice- of the studies (51.1%), investigators used qualitative methods, as based processes – but not outcomes; and organizational level in compared to quantitative (30.8%) or mixed methods (18.0%). The terms of intermediate policy changes. We are not alone in making highest proportion of studies was conducted in healthcare practice this observation (Goldman et al., 2009; Reeves et al., 2009). None sites – 36.1% in multiple sites and 17.3% in a single site. The of the literature reviewed was situated directly in the context of majority (61.7%) of the studies reported sample sizes550. Only current US healthcare reform explicitly mapping the outcomes of 23 of these studies (17.3%) reported sample sizes 300. An ICP/IPE to those identified as the Triple Aim. Very little of the examination of the level of analysis for study findings indicated literature reviewed focused on population health or patient health that 59.4% of the 133 papers had a practice-based process focus, outcomes, and none on the reduction in the cost of health care. 21.0% were focused on individual level skills, knowledge and Given that population health is most often the purview of the DOI: 10.3109/13561820.2014.906391 ICP/PE literature review 397 Table III. Frequency and percent of ICP/IPE literature descriptors intersection of IPE and collaborative practice (the NEXUS). 2008–2013 (n¼ 496). Our review documents that few researchers have studied either this NEXUS or its connection with the Triple Aim. We would Variable and factors Frequency Percent argue that the time is right for such a focus. If ICP/IPE hold the promise of moving health professions education and collaborative Article content Assessment/evaluation of ICP/IPE program 254 51.2 practice together along the path of achieving the Triple Aim Research into IP practice 133 26.8 outcomes, then creating a well-documented, rigorous research Combination of assessing 42 8.5 base is essential. Crucial first steps are as follows: (1) developing ICP/IPE instruments and programs a consensus about concepts for this area of inquiry, (2) a Development or description of 32 6.5 systematic integration of the IPEC ICP core competencies ICP/IPE program framework and (3) consensus on measurement of the concepts. Assessment/evaluation of 14 2.8 ICP/IPE instrument(s) Others have noted these same concerns (Thistlethwaite & the Models or competencies 13 2.6 GRIN working group, 2013). Development or description of 6 1.2 We chose to examine the inquiry into ICP more closely to IP instrument(s) ascertain what the current research foci were because, by our Other 2 0.4 definition, investigators were attempting to answer questions Article classification for research into beyond localized programs. Moreover, we believe that continuing IP practice papers to produce reviews of this area of inquiry employing narrow Collaborative practice 83 62.4 inclusion criteria that result in only a few papers (if any) being Interprofessional education 50 37.6 examined (Reeves et al., 2008, 2013; Zwarenstein et al., 2009) Country does not maximize the potential for moving the field forward. By Canada 161 32.5 proposing a research agenda for the National Center based on a US 115 23.2 UK 101 20.4 broader examination of the current state of the field and research Australia/Asia 48 9.7 within it, we recognize what has been accomplished and set our Scandinavia 40 8.1 sights on the next stages of a critically important journey. Other 31 6.3 Moving forward requires asking questions about the impact of Health system type ICP/IPE in new ways, which call for the collection and generation Universal coverage 372 75.0 of data allowing examination of as yet untested causal pathways USA 115 23.2 between and among the domains of IPE, practice and healthcare Other 9 1.8 delivery, health outcomes and healthcare costs. This work is not Study setting for the faint of heart – it is conceptually difficult and encompasses Higher education – 1 institution 162 32.7 the potential challenge of discovering that ICP/IPE may not have Health care practice – multiple sites 132 26.6 Health care practice – 1 site 79 15.9 the impact we believe it might. For example, given the complexity Combination of higher education 63 12.7 of the healthcare world, training learners in effective team work and practice sites may not ultimately lead to improved health outcomes or reduce Higher education – multiple institutions 46 9.3 the cost of care. The NEXUS is the innovative framing of tackling Other 14 2.8 these complex issues. In the NEXUS, both clinical practice and Sample size range education join forces to ensure sustainable change. 550 274 55.2 Generalizable findings are paramount if the hope of ICP/IPE is 50–99 69 13.9 to be realized. For findings to be generalizable, they must come 100–299 78 15.7 300 75 15.1 from rigorous research and data analysis employing quantitative, qualitative and mixed methods. Among the untested associations Methodology Mixed methods 125 25.2 and/or causal pathways we foresee are those that posit and Qualitative methods 167 33.7 develop Triple Aim outcomes as dependent variables and data Quantitative methods 204 41.1 collected on multiple dimensions of IPE and collaborative Number of professions practice as independent variables, with demographic and Unclear 95 19.2 ecological variables as covariates. Of equal importance is high- 1 38 7.7 quality qualitative research that documents the context-specific 2–4 214 43.1 experience with implications for other settings. While generating 5–8 103 20.7 and collecting these data will require a serious commitment of 9 or more 46 9.3 resources, the ultimate value of understanding the extent to which Other countries included: Belgium, The Netherlands, Germany, Israel, – and in what ways – ICP/IPE may affect the achievement of the Iran, Mexico, Italy, Chile, India, Nepal, Hungary, Honduras, Triple Aim will make the commitment of time and research Switzerland, Nigeria and Spain. funding worthwhile. For 40 years, the promise of ICP/IPE has inspired a small group of researchers, health professions educators and clinical practitioners. It is time to call the question of the discipline of public health, perhaps it is not surprising that none of extent to which ICP/IPE may help catalyze a major transformation the papers reviewed in this study included public health as an of the US healthcare system. integral discipline in IPE or collaborative practice. Since everyone There are a number of limitations to this review that should be has a part in the game, this absence is unfortunate and provides explicitly noted. First, although ICP and IPE have been areas of important actionable information. inquiry for 40-some years, the review was not comprehensive, but A critical reason for the creation of the National Center in limited to the years 2008–2013. While this limit was purposive, it 2012 was the resurgence of interest in IPE and collaborative nevertheless should be acknowledged. Second, while also pur- practice in a healthcare environment energized by significant posive, the lens for analysis was the Triple Aim. This is one lens practice and health policy change. Research needs to focus on the of many that could be applied to a scoping review of these health-related outcomes, specifically the Triple Aim, at the materials. We chose it because of the connection between the 398 B. Brandt et al. J Interprof Care, 2014; 28(5): 393–399 Table IV. Frequency and percent of professions included in reviewed Triple Aim and healthcare delivery reform in the US. Third, this literature (2008–2013; n¼ 496). review was focused on examining ICP/IPE in the context of US healthcare reform. There are many other ways to examine and Variables and factors Frequency Percent understand ICP/IPE. Specifically, different issues might be pertinent in other types of healthcare systems (e.g. universal Nursing 309 62.2 Medicine 288 57.9 healthcare systems). Finally, our assessment of the quality of the Physical therapy 138 27.8 133 research into collaborative practice papers did not entail a Pharmacy 120 23.1 meta-analysis. Again, this was purposive since we wanted to Occupational therapy 116 23.3 include quantitative, qualitative and mixed methods papers it was Social work 111 22.3 not possible to combine the data for additional analysis. These Other professions 87 17.5 limitations are not detrimental to the work presented in this study Mental and behavioral health 53 10.7 Healthcare assistants 52 10.5 but do suggest the boundaries for interpreting the findings. Nutrition/dietetics 50 10.1 Audiology 40 8.0 Concluding comments Dentistry 32 6.4 Midwifery 29 5.8 Even though research into ICP/IPE efforts has been an area of Health administration 26 5.2 inquiry for almost four decades, it has not as yet demonstrated the Diagnostic radiography 20 4.0 impact of these on improving population health, reducing Paramedic 16 3.2 healthcare costs, improving the quality of delivered care and/or Medical laboratory science 15 3.0 patients’ experiences of care received. This is not to say that much Dental hygiene 10 2.0 Complementary and alternative medicine (CAM) 8 1.6 of the published literature does not situate the importance of ICP/ Veterinary medicine 6 1.2 IPE in the context of health services and health-related outcomes. It is to say that when the studies are designed, analysis plans Other professions included: pastoral/spiritual care, engineering, business, developed and data generated and collected, these impacts have respiratory therapy, and ‘‘Volunteers’’ with no other professional not to date been identified. We hope that this review of literature identified. and the research agenda we have proposed will begin to move this area of inquiry beyond theoretical statements to hypothesis testing aimed at strengthening the evidence base for the effectiveness of Table V. Characteristics of papers classified as research into ICP/IPE within the context of healthcare delivery. interprofessional education/collaborative practice (n¼ 133). Variables and factors Frequency Percent Declaration of interest Papers with an identifiable Triple Aim-related outcome The authors report no declaration of interest. The authors are responsible No Triple Aim health-related outcome 108 81.2 for the writing and content of this article. At least one Triple Aim health-related 22 16.5 This work was produced at the National Center for Interprofessional outcome Practice and Education, which is supported by a Health Resources At least two Triple Aim health-related 3 2.3 and Services Administration Cooperative Agreement Award outcomes No. UE5HP25067. In addition, the Josiah Macy Jr. Foundation, the At least three Triple Aim health-related 00 Robert Wood Johnson Foundation (RWJF), the Gordon and Betty Moore outcomes Foundation and the John A Hartford Foundation have collectively committed up to $8.1 million in grants over five years to support and Methods guide the Center, which will work to accelerate team work and Qualitative 68 51.1 collaboration among doctors, nurses and other health professionals – as Quantitative 41 30.8 well as patients – and break down the traditional silo-approach to health Mixed 24 18.0 professions education. Study setting Higher education – 1 institution 22 16.5 References Health care practice – multiple sites 48 36.1 Health care practice – 1 site 23 17.3 Abu-Rish, E., Kim, S., Choe, L., Varpio, L., Malik, E., White, A.A., Combination of higher education 14 10.5 Craddick, K., et al. (2012). Current trends in interprofessional and practice sites education of health sciences students: A literature review. Journal of Higher education – multiple institutions 20 15.0 Interprofessional Care, 26, 444–451. Other 6 4.5 Barr, H., & Waterton, S. (1996). Interprofessional education in health and Sample size social care in the United Kingdom: Report of a CAIPE survey. 550 82 61.7 Fareham, UK: Centre for the Advancement of Interprofessional 50–99 17 12.8 Education in Primary Health and Community Care. 100–299 11 8.3 Berwick, D.M., Nolan, T.W., & Whittington, J. (2008). The triple aim: 300 23 17.3 Care, health, and cost. Health Affairs, 27, 759–769. Budgen, C., & Gamroth, L. (2008). An overview of practice education Leval of analysis for study findings Practice-based process 79 59.4 models. Nurse Education Today, 28, 273–283. D’Amour, D., & Oandasan, I. (2005). Interprofessionality as the field of Individual level skills, knowledge 28 21.0 and attitudes interprofessional practice and interprofessional education: An emer- ging concept. Journal of Interprofessional Care, 19, 8–20. Organization level change 22 16.5 Unclear 4 3.0 Goldman, J., Zwarenstein, M., Bhattacharyya, O., & Reeves, S. (2009). Improving the clarity of the interprofessional field: Implications for Article classification research and continuing interprofessional education. Journal of Collaborative practice 83 62.4 Continuing Education in the Health Professions, 29, 151–156. Interprofessional education 50 37.6 Guba, E.G., & Lincoln, Y.S. (1981). Effective evaluation: Improving the usefulness of evaluation results through responsive and naturalistic approaches. San Francisco: Jossey-Bass. Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an DOI: 10.3109/13561820.2014.906391 ICP/PE literature review 399 expert panel. Washington, DC: Interprofessional Education education: Key findings from a new systematic review. Journal of Interprofessional Care, 24, 230–241. Collaborative Expert Panel. Liberati, A., Altman, D.G., Tetzlaff, J., Mulrow, C., Gøtzsche, P.C., Reeves, S. (2009). An overview of continuing interprofessional education. Journal of Continuing Education in the Health Professions, 29, Ioannidis, J.P.A., Clarke, M., et al. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate 142–146. Rodger, S., & J. Hoffman, S. (2010). Where in the world is healthcare interventions: Explanation and elaboration. BMJ, 339, interprofessional education? A global environmental scan. Journal of b2700. Interprofessional Care, 24, 479–491. Mann, K., Gordon, J., & MacLeod, A. (2009). Reflection and reflective Suter, E., Arndt, J., Arthur, N., Parboosingh, J., Taylor, E., & practice in health professions education: A systematic review. Deutschlander, S. (2009). Role understanding and effective communi- Advances in Health Sciences Education, 14, 595–621. cation as core competencies for collaborative practice. Journal of Moher, D., Liberati, A., Tetzlaff, J., & Altman, D.G. (2009a). Preferred Interprofessional Care, 23, 41–51. reporting items for systematic reviews and meta-analyses: The Stake, R.E. (1995). The art of case study research. Thousand Oaks, CA: PRISMA statement. Annals of Internal Medicine, 151, 264–269. Sage Publications. Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., & The PRISMA Thannhauser, J., Russell-Mayhew, S., & Scott, C. (2010). Measures of Group. (2009b). Preferred reporting items for systematic reviews and interprofessional education and collaboration. Journal of meta-analyses: The PRISMA statement. PLoS Medicine, 6, e1000097. Interprofessional Care, 24, 336–349. Morgan, A., & Jones, D. (2009). Perceptions of service user and carer Thistlethwaite, J. (2012). Interprofessional education: A review of involvement in healthcare education and impact on students’ know- context, learning and the research agenda. Medical Education, 46, ledge and practice: A literature review. Medical Teacher, 31, 82–95. 58–70. Reeves, S., Goldman, J., Burton, A., & Sawatzky-Girling, B. (2010a). Thistlethwaite, J., & the GRIN Working Group. (2013). Introducing the Synthesis of systematic review evidence of interprofessional education. Global Research Interprofessional Network (GRIN). Journal of Journal of Allied Health, 39, 198–203. Interprofessional Care, 27, 107–109. Reeves, S., Goldman, J., Gilbert, J., Tepper, J., Silver, I., Suter, E., & Thistlethwaite, J., & Moran, M. (2010). Learning outcomes for Zwarenstein, M. (2011). A scoping review to improve conceptual interprofessional education (IPE): Literature review and synthesis. clarity of interprofessional interventions. Journal of Interprofessional Journal of Interprofessional Care, 24, 503–513. Care, 25, 167–174. Thyer, B.A. (Ed.). (2001). Reliability and validity in qualitative research. Reeves, S., Goldman, J., & Zwarenstein, M. (2009). An emerging The handbook of social work research methods. In The handbook of framework for understanding the nature of interprofessional interven- social work research methods (pp. 273–293). Thousand Oaks, CA: tions. Journal of Interprofessional Care, 23, 539–542. SAGE Publications. Reeves, S., Perrier, L., Goldman, J., Freeth, D., & Zwarenstein, M. World Health Organization Department of Human Resources for Health. (2013). Interprofessional education: Effects on professional practice (2010). Framework for action on interprofessional education and and health care outcomes.(update). Cochrane Database of Systematic collaborative practice. Geneva: WHO. Reviews, 3, CD002213. Xyrichis, A., & Lowton, K. (2008). What fosters or prevents interprofes- Reeves, S., Zwarenstein, M., Goldman, J., Barr, H., Freeth, D., Hammick, sional team working in primary and community care? A literature M., & Koppel, I. (2008). Interprofessional education: Effects on review. International Journal of Nursing Studies, 45, 140–153. professional practice and health care outcomes. Cochrane Database of Zwarenstein, M., Goldman, J., & Reeves, S. (2009). Interprofessional Systematic Reviews, 1, CD002213. collaboration: Effects of practice-based interventions on professional Reeves, S., Zwarenstein, M., Goldman, J., Barr, H., Freeth, D., Koppel, I., practice and healthcare outcomes. Cochrane Database of Systematic & Hammick, M. (2010b). The effectiveness of interprofessional Reviews, 3, CD000072.

Journal

Journal of Interprofessional Care – Taylor & Francis

Published: Sep 1, 2014

Keywords: Health system reform; interprofessional collaboration; interprofessional education; interprofessional research

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