Intermountain Healthcare's McKay-Dee Hospital Center: Driving Down Readmissions by Caring for Patients the "Right Way"

Outlines the hospital's strategies for low readmission rates for heart failure and pneumonia, including standardization of care, interdisciplinary care coordination and discharge planning, and integration with community providers, and lessons learned

Interdisciplinary care clinics in chronic kidney disease

The burden of chronic kidney disease (CKD) is substantial, and is associated with high hospitalization rates, premature deaths, and considerable health care costs. These factors provide strong rationale for quality improvement initiatives in CKD care. The interdisciplinary care clinic (IDC) has emerged as one solution to improving CKD care. The IDC team may include other physicians, advanced practice providers, nurses, dietitians, pharmacists, and social workers--all working together to provide effective care to patients with chronic kidney disease. Studies suggest that IDCs may improve patient education and preparedness prior to kidney failure, both of which have been associated with improved health outcomes. Interdisciplinary care may also delay the progression to end-stage renal disease and reduce mortality. While most studies suggest that IDC services are likely cost-effective, financing IDCs is challenging and many insurance providers do not pay for all of the services. There are also no robust long-term studies demonstrating the cost-effectiveness of IDCs. This review discusses IDC models and its potential impact on CKD care as well as some of the challenges that may be associated with implementing these clinics

Improving interdisciplinary care on the general medical ward

General medical wards deliver the majority of inpatient care. Despite technological and therapeutic advances, these wards expose 10% of patients to preventable adverse events, and disproportionately contribute to preventable hospital deaths. Improving ward team performance is often proposed as a mechanism to improve patient outcomes. The overarching goal of this thesis is to identify effective strategies to improve interdisciplinary team care on the medical ward. Chapter 1 introduces key concepts in healthcare quality, and specific issues in the delivery and measurement of interdisciplinary ward care. The existing literature for ward improvement strategies is then described. A narrative review identifies common targets for ward interventions [chapter 2], and a systematic review evaluates interdisciplinary team care interventions, finding little evidence of significant impact on objective patient outcomes [chapter 3]. The development and evaluation of prospective clinical team surveillance (PCTS) is then reported. PCTS is a novel interdisciplinary team care intervention, engaging staff to identify barriers to care delivery, with facilitation and feedback. A programme theory and mixed methods evaluation are presented, using a stepped wedge, cluster controlled trial [chapter 4]. Mixed-effects models show a significant reduction in excess length of stay with high fidelity PCTS [chapter 5]. Surveys, focus groups and auto-ethnography identify PCTS’ mechanisms of action, and its impact on incident reporting, safety and teamwork climates [chapter 6]. Implementation outcomes, facilitators and barriers are described in chapter 7. Other perspectives on improvement are also explored. A model of organisational alignment is developed [chapter 8], and an interview study with patients and carers elicits their priorities [chapter 9]. Finally, chapter 10 summarises the findings, highlighting opportunities to develop medical ward outcome sets and construct a model of interdisciplinary team effectiveness. These can be used to support improvements in interdisciplinary care, through changes in policy and practice.Open Acces

Qualitative Survey of a Collaborative Team Approach to Treating Autism Spectrum Disorder

PURPOSE: To examine a unique interdisciplinary approach to ASD care that is utilized at KidsLink School/Neurobehavioral Center through a qualitative survey. This study determines the role of each interdisciplinary team member, the advantages and disadvantages of KidsLink’s approach, what is unique about their approach, and how a collaborative approach affects individual team members. METHODS: An online qualitative survey was distributed to KidsLink’s professional staff who are members on the interdisciplinary care teams. The survey results were read over three times in order to identify common themes and conduct a frequency analysis of codes across all participant responses. RESULTS: There were 23 participants and 11 different professional fields represented in the survey. Several common themes emerged from the data analysis including: communication and collaboration, consistency, clinician development, individualized care, efficiency, positive environment, and learning opportunities. DISCUSSION: This study is significant as no other research study on ASD interdisciplinary care was found that represents as many as 11 different professionals collaborating together. Participants stated more overall advantages than disadvantages to interdisciplinary care and explained they receive more support than other professionals in their fields. The study broadly concludes that the approach used at KidsLink offers several advantages for the professionals on the team, the parents, and the child

Addressing Cultural Considerations of African Americans in Interdisciplinary Care

Communication and appreciation for culturally significant factors are essential to the helping relationship between the patient and the interdisciplinary team members in the health care setting. Historically, the relationship between African Americans and health care professionals in the American health care system has been one of mistrust based on unequal treatment, stereotypes, and other factors negatively affecting rapport. The main purpose of this study was to identify the cultural considerations within the Black and African American communities and their impact on the relationship between interdisciplinary care team members and their African American patients. This study used a qualitative grounded theory design and included 12 individuals aged 19 years and older recruited from the southeastern Pennsylvania, metro Philadelphia area. Semistructured interviews were conducted to gather information regarding cultural considerations African Americans deemed to be important in their interactions with interdisciplinary team members. Results identified 11 themes across five contexts that suggest relevant cultural factors for African Americans working with physical and mental health providers. Themes included Patient-Provider Collaboration, Personal Values and Sharing, Physical Environment, Empathy, Provider Reviews, Cultural Awareness and Competency, Racial Connections, Health Care Teams, Follow-up Referrals, Provider Mistrust, and Stereotypes and Stigma. Overlap in themes suggested the importance of the role of values and trust in rapport building during health care interactions. Future research may benefit from studies discussing and acknowledging the impact of providers eliciting the individual values relevant to African American patients during these patients\u27 health care visits on patients\u27 perceptions of trust and health outcomes

Interdisciplinary Healthcare Teams

Interdisciplinary healthcare teams have emerged in response to dilemmas that arise when healthcare professionals operate in their own silos. The benefits of interdisciplinary teams has been widely touted as the answer to patient safety and other desirable health outcomes. The 2001 Institute of Medicine report identified six dimensions for quality 21st century healthcare: safe, effective, patient-centered, timely, efficient and equitable. This paper explores the dynamics of interdisciplinary care teams in healthcare organizations in the United States. It is hypothesizes that, when an interdisciplinary care team model is used, patient outcomes and staff satisfaction will improve. Based on the review of the existing research literature, the impacts of interdisciplinary teams on the key patient outcomes is examined: inpatient length of stay (LOS), readmission rates, medical errors and team communication, rates of Adverse Drug Events (ADEs. Further the impact of interdisciplinary teams on staff attitudes and satisfaction, interdisciplinary collaboration, and overall patient satisfaction are examined for their subsequent impact on healthcare outcomes. In this review, some clear benefits of interdisciplinary care were found relative to a decline in length of stay, decrease in adverse drug events, and improvements in staff communication with other team members. There was no positive relationship with readmission rate and not all professionals experienced the same degree of satisfaction with communications within the team

Interdisciplinary care to enhance mental health and social and emotional wellbeing

This chapter discusses and defines the difference between multidisciplinary and interdisciplinary/interprofessional care with a focus on interdisciplinary care as a model of practice which supports equality and interconnectedness of responsibility amongst team members when working in Aboriginal and Torres Strait Islander contexts. The chapter describes the various professional and para professional practitioners that comprise interdisciplinary teams working in mental health and wellbeing contexts and their roles. The focus is on an interdisciplinary team approach to providing health and wellbeing care as its ethos of equal relationships and interdependent collaboration is more encompassing of social and emotional wellbeing values. Identification of the issues and limitations of interdisciplinary practice and the means to addressing them are explored within the context of how interdisciplinary care fits into mental health best practice and human rights

Exploring patient satisfaction with interdisciplinary care of complex feeding problems

Measures of patient satisfaction with health care experiences are recognized as essential in the healthcare market environment. To our knowledge, there are no specific patient experience measures that assess patient and caregiver satisfaction with a multidisciplinary approach to management of complex feeding and swallowing issues in pediatric patients. In order to explore patient experience and to identify opportunities for improvement, a pilot patient satisfaction survey was developed in an interdisciplinary feeding team clinic. Patients and families were surveyed following clinic encounters between July of 2014 and January of 2015. Likert style questions were used to assess experience with ease of scheduling, perception of the team’s ability to understand feeding concerns, and to identify agreement with the appropriateness of recommendations. Two open-ended questions were used to elicit qualitative responses regarding what was positive about the experience and what could be improved or done differently. Qualitative responses were categorized by opportunities for improvement and affirmative statements. Analysis of survey results indicated high levels of satisfaction (96%) with the team’s ability to understand feeding concerns and to provide feasible recommendations for treatment options. Satisfaction scores for scheduling were lower (92%); dissatisfaction with the next available options for appointments and with the overall length of the visit was identified. The pilot patient satisfaction project confirmed satisfaction with a multidisciplinary approach to feeding problems in pediatric patients, and identified opportunities for future quality improvement. Ongoing patient satisfaction measures will provide a mechanism to identify the effects of future improvement measures

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We thank Dr. Kalmanovich and colleagues for their comments on our randomized controlled trial on improving medication adherence and quality of life of heart failure (HF) patients by a pharmacist‐led interdisciplinary approach.1 This study showed that pharmacy care safely improved adherence to HF medications and quality of life. These data extend recent consensus statements of both the Canadian Cardiovascular Society guidelines for the management of HF2 and the German clinical practice guideline on chronic HF3 that acknowledge the available evidence of pharmacist care and interdisciplinary care.4, 5 Topics and tasks include prevention of HF, particularly by improving adherence to antihypertensives, providing medication reviews, assuring appropriate self‐medication, and improving both medication safety and adherence.4 We congratulate Kalmanovich et al. to their research plan. Their study will hopefully provide additional randomized evidence for the effects of interdisciplinary care in patients with HF