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Suggested Citation:"Front Matter." Institute of Medicine. 2015. Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes. Washington, DC: The National Academies Press. doi: 10.17226/21726.
×

MEASURING THE IMPACT OF
INTERPROFESSIONAL EDUCATION
ON COLLABORATIVE PRACTICE AND
PATIENT OUTCOMES

Committee on Measuring the Impact of Interprofessional Education on
Collaborative Practice and Patient Outcomes

Board on Global Health

INSTITUTE OF MEDICINE
                 OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes. Washington, DC: The National Academies Press. doi: 10.17226/21726.
×

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This activity was supported by contracts between the National Academy of Sciences and the Academic Consortium for Complementary and Alternative Health Care, the Academy of Nutrition and Dietetics, the Accreditation Council for Graduate Medical Education, the Aetna Foundation, the Alliance for Continuing Education in the Health Professions, the American Academy of Family Physicians, the American Academy of Nursing, the American Association of Colleges of Nursing, the American Association of Colleges of Osteopathic Medicine, the American Association of Colleges of Pharmacy, the American Association of Nurse Anesthetists, the American Association of Nurse Practitioners, the American Board of Family Medicine, the American Board of Internal Medicine, the American College of Nurse-Midwives, the American Congress of Obstetricians and Gynecologists/American Board of Obstetrics and Gynecology, the American Council of Academic Physical Therapy, the American Dental Education Association, the American Medical Association, the American Occupational Therapy Association, the American Psychological Association, the American Society for Nutrition, the American Speech–Language–Hearing Association, the Association of American Medical Colleges, the Association of American Veterinary Medical Colleges, the Association of Schools and Colleges of Optometry, the Association of Schools and Programs of Public Health, the Association of Schools of the Allied Health Professions, the Atlantic Philanthropies, the China Medical Board, the Council of Academic Programs in Communication Sciences and Disorders, the Council on Social Work Education, Ghent University, the Josiah Macy Jr. Foundation, Kaiser Permanente, the National Academies of Practice, the National Association of Social Workers, the National Board for Certified Counselors, Inc. and Affiliates, the National Board of Medical Examiners, the National League for Nursing, the Office of Academic Affiliations of the Veterans Health Administration, the Organization of Associate Degree Nursing, the Physician Assistant Education Association, the Robert Wood Johnson Foundation, the Society for Simulation in Healthcare, the Uniformed Services University of the Health Sciences, and the University of Toronto. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

International Standard Book Number-13: 978-0-309-37282-4
International Standard Book Number-10: 0-309-37282-8
DOI: 10.17226/21726

Additional copies of this workshop summary are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

For more information about the Institute of Medicine, visit the IOM home page at: http://iom.nationalacademies.org.

Copyright 2015 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Cover photo © 2015 Diane Melms, Behold. Size 76 × 32 inches. Fabric hand-dyed by artist, line patterns printed on fabric with textile paint using a mono-print technique, shapes cut freehand with rotary cutter, machine pieced, layered with batting and machine quilted. Documentation of the creation of this piece is on the SAQA website: http://www.saqa.com/media/file/SPal/MelmsBinder1.pdf.

Suggested citation: IOM (Institute of Medicine). 2015. Measuring the impact of interprofessional education on collaborative practice and patient outcomes. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes. Washington, DC: The National Academies Press. doi: 10.17226/21726.
×

Knowing is not enough; we must apply.
Willing is not enough; we must do.
”      

                                                —Goethe

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INSTITUTE OF MEDICINE
         OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes. Washington, DC: The National Academies Press. doi: 10.17226/21726.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Victor J. Dzau is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes. Washington, DC: The National Academies Press. doi: 10.17226/21726.
×

COMMITTEE ON MEASURING THE IMPACT OF INTERPROFESSIONAL EDUCATION ON COLLABORATIVE PRACTICE AND PATIENT OUTCOMES

MALCOLM COX (Chair), Adjunct Professor, Perelman School of Medicine, University of Pennsylvania

BARBARA F. BRANDT, Director, National Center for Interprofessional Practice and Education, University of Minnesota

JANICE PALAGANAS, Director of Educational Innovation and Development, Center for Medical Simulation, Massachusetts General Hospital, Harvard Medical School

SCOTT REEVES, Professor in Interprofessional Research, Centre for Health and Social Care Research, Kingston University and St George’s, University of London

ALBERT W. WU, Professor and Director, Center for Health Services and Outcomes Research, Johns Hopkins Bloomberg School of Public Health

BRENDA ZIERLER, Co-Director, Center for Health Sciences Interprofessional Education, Practice and Research, University of Washington

Consultants

VALENTINA L. BRASHERS, Founding Co-Director of the Center for ASPIRE, University of Virginia

MAY NAWAL LUTFIYYA, Senior Research Scientist, National Center for Interprofessional Practice and Education

NELSON SEWANKAMBO, Principal and Professor, Makerere University College of Health Sciences

RONA BRIERE, Consultant Editor

IOM Staff

PATRICIA A. CUFF, Senior Program Officer

MEGAN M. PEREZ, Research Associate

BRIDGET CALLAGHAN, Research Assistant (from January 2015)

AEYSHA CHAUDRY, Intern

CHRISTIE BELL, Financial Officer (from January 2015)

ROSALIND GOMES, Financial Associate (until December 2014)

PATRICK W. KELLEY, Senior Board Director, Board on Global Health

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes. Washington, DC: The National Academies Press. doi: 10.17226/21726.
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Suggested Citation:"Front Matter." Institute of Medicine. 2015. Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes. Washington, DC: The National Academies Press. doi: 10.17226/21726.
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Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

HUGH BARR, University of Westminster, UK

MOLLY COOKE, University of California, San Francisco

SUSAN HASSMILLER, Robert Wood Johnson Foundation

LANA SUE KA’OPUA, University of Hawai‘i-Mānoa

EDUARDO SALAS, University of Central Florida

JILL THISTLETHWAITE, University of Technology Sydney, Australia

MERRICK ZWARENSTEIN, Western University, London, Ontario

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the report’s conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by CAROL PEARL HERBERT, University of British Columbia, Vancouver, BC, and Western University, London, Ontario, and SUSAN J. CURRY, University of Iowa.

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2015. Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes. Washington, DC: The National Academies Press. doi: 10.17226/21726.
×

Appointed by the Institute of Medicine and the National Research Council, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes. Washington, DC: The National Academies Press. doi: 10.17226/21726.
×
Suggested Citation:"Front Matter." Institute of Medicine. 2015. Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes. Washington, DC: The National Academies Press. doi: 10.17226/21726.
×

Glossary1

Collaboration is an active and ongoing partnership, often involving people from diverse backgrounds who work together to solve problems, provide services, and enhance outcomes.

Collaborative patient-centered practice is a type of arrangement designed to promote the participation of patients and their families within a context of collaborative practice.

Continuing education encompasses all learning (e.g., formal, informal, workplace, serendipitous) that enhances understanding and improves patient care.

Continuing professional development is self-directed learning that ensures continuing professional competence throughout one’s health professional career.

Entrustable professional activities is a “concept that allows faculty to make competency-based decisions on the level of supervision required by trainees.” (ten Cate, 2013).

____________

1 Unless otherwise noted, these definitions are based on the work of Barr et al. (2005) and Reeves et al. (2010). Note that this glossary includes only terms that appear in the report. The committee recognizes that many definitions for these terms exist and that some definitions evolve over time.

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes. Washington, DC: The National Academies Press. doi: 10.17226/21726.
×

Evaluation refers to the systematic gathering and interpretation of evidence enabling judgment of effectiveness and value and promoting improvement. Evaluations can have either formative or summative elements or both.

Interprofessional collaboration is a type of interprofessional work involving various health and social care professionals who come together regularly to solve problems, provide services, and enhance health outcomes.

Interprofessional education “occurs when two or more professions learn with, about, and from each other to enable effective collaboration and improve health outcomes.” (WHO, 2010)

Interprofessional learning is learning arising from interaction involving members or students of two or more professions. It may be a product of interprofessional education, or it may occur spontaneously in the workplace or in education settings and therefore be serendipitous.

Interprofessional teamwork is a type of work involving different health or social care professionals who share a team identity and work together closely in an integrated and interdependent manner to solve problems, deliver services, and enhance health outcomes.

One Health recognizes that the health of humans, animals, and ecosystems is interconnected.

Profession refers to an occupation or career that requires considerable training and specialized study.

Quality improvement is defined by Batalden and Davidoff (2007, p. 2) as “the combined and unceasing efforts of everyone—healthcare professionals, patients and their families, researchers, payers, planners and educators—to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development.”

Realist evaluation is a method developed by Pawson and Tilley (1997) for analyzing the social context in which an intervention does or does not achieve its intended outcome.

Team-based care is an approach to health care whereby a group of people work together to accomplish a common goal, solve a problem, or achieve a specified result.

Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2015. Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes. Washington, DC: The National Academies Press. doi: 10.17226/21726.
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Workplace learning is different from formal educational activities, and can be viewed as untapped opportunities for learning and change that are part of everyday practice and often go unrecognized as “learning.”

REFERENCES

Barr, H., I. Koppel, S. Reeves, M. Hammick, and D. Freeth. 2005. Effective interprofessional education: Argument, assumption, and evidence. Oxford and Malden: Blackwell Publishing.

Batalden, P. B., and F. Davidoff. 2007. What is “quality improvement” and how can it transform healthcare? Quality & Safety in Health Care 16(1):2-3.

Pawson, R., and N. Tilley. 1997. Realistic evaluation. London: Sage Publications.

Reeves, S., S. Lewin, S. Espin, and M. Zwarenstein. 2010. Interprofessional teamwork for health and social care. London: Wiley-Blackwell.

ten Cate, O. 2013. Nuts and bolts of entrustable professional activities. Journal of Graduate Medical Education 5(1):157-158.

WHO (World Health Organization). 2010. Framework for action on interprofessional education and collaborative practice. Geneva: WHO.

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes. Washington, DC: The National Academies Press. doi: 10.17226/21726.
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Preface

In 2002, the Institute of Medicine (IOM) convened a summit of diverse stakeholders who made the case for reforming health professions education to improve the quality and safety of health care. While many of their recommendations remain relevant today, much has changed over the past decade, necessitating new thinking. Innovators at that time stressed the importance of “patient-centered care,” while today they think of patients as partners in health promotion and health care delivery. Patients are integral members of the care team, not solely patients to be treated, and the team is recognized as comprising a variety of health professionals. This changed thinking is the culmination of many social, economic, and technological factors that are transforming the world and forcing the fields of both health care and education to rethink long-established organizational models.

This report examines the evidence linking interprofessional education to patient and health system outcomes and provides general guidance on approaches to strengthening this evidence base in the future. Although this was the study committee’s primary focus, however, it became clear early in the committee’s deliberations that there are two essential prerequisites for the successful completion of this important task. First, efforts to reform education of the health care workforce and redesign practice in the health care system need to be better aligned. Because change in one of these interacting systems inevitably influences the other, efforts to improve interprofessional education or collaborative practice independently have fallen short. Second, widespread adoption of a model of interprofessional education across the learning continuum is urgently needed. An ideal model would retain the tenets of professional identity formation while provid-

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes. Washington, DC: The National Academies Press. doi: 10.17226/21726.
×

ing robust opportunities for interprofessional education and collaborative care. Such a model also would differentiate between learning outcomes per se and the individual, population, and system outcomes that provide the ultimate rationale for ongoing investment in health professions education. And it would take into account the many enabling or interfering influences on learning and these more distal outcomes.

The committee hopes its appraisal of the evidence linking interprofessional education to enhanced health and system outcomes will catalyze additional studies that provide a stronger rationale for interprofessional education and collaborative care than is presently available. The committee likewise hopes that the presentation of an outcomes-based model of interprofessional education will stimulate the model’s further refinement and thereby promote improvements in study design and execution.

Once tested, such a model could be adapted to fit the particular needs of higher- and lower-resource settings around the globe. It is no longer acceptable to think of either health or education in isolation. The final model must accommodate the reality of today’s globalized community. It is through this lens that this report is intended to be read. In essence, the committee asks readers of this report to consider how all health professionals and all countries might learn and work together to maximize the health and well-being of individuals and populations around the world.

Malcolm Cox, Chair
Committee on Measuring the Impact of Interprofessional Education on Collaborative
Practice and Patient Outcomes

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Interprofessional teamwork and collaborative practice are emerging as key elements of efficient and productive work in promoting health and treating patients. The vision for these collaborations is one where different health and/or social professionals share a team identity and work closely together to solve problems and improve delivery of care. Although the value of interprofessional education (IPE) has been embraced around the world - particularly for its impact on learning - many in leadership positions have questioned how IPE affects patent, population, and health system outcomes. This question cannot be fully answered without well-designed studies, and these studies cannot be conducted without an understanding of the methods and measurements needed to conduct such an analysis.

This Institute of Medicine report examines ways to measure the impacts of IPE on collaborative practice and health and system outcomes. According to this report, it is possible to link the learning process with downstream person or population directed outcomes through thoughtful, well-designed studies of the association between IPE and collaborative behavior. Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes describes the research needed to strengthen the evidence base for IPE outcomes. Additionally, this report presents a conceptual model for evaluating IPE that could be adapted to particular settings in which it is applied. Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes addresses the current lack of broadly applicable measures of collaborative behavior and makes recommendations for resource commitments from interprofessional stakeholders, funders, and policy makers to advance the study of IPE.

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