Can Interprofessional Student Teams Impact Patient Outcomes? Yes They Can!

In 2000, the Institute of Medicine (IOM) reported that provider communication was a contributing factor to patient errors. A subsequent IOM report pinpointed health professions education programs as a possible solution to the problem, recommending more co-training while students were in their academic programs (2003). Academic program accrediting bodies have included interprofessional competencies in their evaluation criterial for accreditation, and increases in interprofessional activities are evident in the literature. Additionally, interprofessional competencies have been developed by a consortium of academic health program organizations (Interprofessional Education Collaborative, 2016).

The World Health Organization (WHO, 2010), advanced a framework for interprofessional education and collaborative practice. The framework asserts that by preparing health professions students in an interprofessional environment, they will emerge as “collaborative practice-ready” providers who will impact the healthcare and produce improved health outcomes. The National Center for Interprofessional Practice and Education seeks to accelerate this process through supporting incubator sites that will impact patient outcomes through collaborative education and practice partnerships (National Center for Interprofessional Practice and Education, 2017). The goals of the National Center are built on the Triple Aim, as advanced by the Institute for Healthcare Improvement (IHI, 2017), which includes quality care, improving population health, and reduce costs per capita. This presentation describes the development and outcomes from one incubator site that advances clinical education and patient outcomes concurrently.

Our pre-licensure nursing and medical programs have been engaged in interprofessional activities for nearly 10 years. These activities include team training, standardized and high fidelity patient scenarios, and direct practice. Direct practice interprofessional experiences are relatively rare across the United States, because they present unique challenges. However, our university, we have built a collaborative practice/academe partnership that leverages our joint strengths to the benefit of both patients and students.

In our program, senior Bachelor of Science in Nursing (BSN) students, and 2^nd year medical students work in teams to conduct transitional care home visits. The home visits are a part of the Transitional Care Program at our affiliated clinical agency, a regional academic health center, and focus on patients discharged from acute care who are high risk for readmission. The Transitional Care Nurse Manager makes the initial visit to patients, and then makes a referral to faculty for the student teams. Student teams review the patient electronic health record to review the discharge medication list and plan of care. Teams also receive information about any crucial areas needed for the visit. Using a standardized protocol, students work with patients and their families to conduct a focused assessment, reinforce self-monitoring and education, identify medication and dietary considerations, consider additional needs for equipment, and assess for barriers to follow up appointment adherence. All visits were supervised by a faculty/practitioner via iPad technology.

After a feasibility pilot in spring, 2015, year one of the program (AY 2015-2016) was implemented with nursing and medical student navigator teams visiting patient homes as a part of their clinical experiences. The transitional care program was expanded by 64 unique patient visits. Patient outcomes on 30-day readmissions, all readmissions, and time to readmission were evaluated for patients who were in the navigator program. Results demonstrated a significant improvement in all outcomes, with the 30-day readmission rate decreasing from 36% to 0% for patients in the navigator program. Additionally, there was a reduction from 64% to 28% in all patient readmissions, and an increased in time to readmission from 72 days to 98 days.

While this project received substantive funding from both practice and educational institutions, the goal was to construct a financial model where the academic supervision costs were transferred to the clinical agency. The FTE requirement for the faculty/practitioner was $40,000 for year one, and the return on investment (ROI) model yielded $210,170. As a result, the practice institution will be assuming the cost of the faculty/practitioner and we are expanding the model to begin a program of interprofessional student teams to make phone calls to patients discharged from the Emergency Department.

The navigator program is an innovative clinical strategy validating that academic/practice partnerships have the ability to deliver on substantive and effective patient outcomes that also reduce the cost load of the clinical facility. The program demonstrates that health professions students can impact elements on the IHI Triple Aim before they become licensed professionals, and that they learn the value of each other’s roles as they collaborate for improved patient care.