Original Article

Implementation of Case Conferences to Improve Interprofessional Collaboration in Resident Continuity Clinic

Authors: Tanya Nikiforova, MD, MS, Carla L. Spagnoletti, MD, MS, Scott D. Rothenberger, PhD, Kwonho Jeong, MS, Peggy B. Hasley, MD, MHSc

Abstract

Objectives: Residents must be trained in skills for interprofessional collaboration and team-based care in the outpatient setting, and successful models are needed to achieve this aim. A longitudinal curriculum was developed to enhance residents’ knowledge of interprofessional team members’ roles, residents’ attitudes toward team-based care, and patient referrals to team members.

Methods: Postgraduate year 1 through postgraduate year 3 internal medicine residents with continuity clinic at a large hospital-based practice received the curriculum. Residents with continuity clinic at another site did not receive the curriculum and served as controls. Intervention residents attended five small-group conferences during the course of 1 year, each dedicated to a specific interprofessional discipline: pharmacy, psychology, diabetes/nurse education, social work, and case management. Conferences involved interactive, case-based discussions of patients who benefit from an interprofessional approach. Control and intervention residents were surveyed with pre- and posttests. The rates of patient referrals to interprofessional team members were assessed.

Results: Seventy-one residents received the curriculum. Intervention residents’ knowledge of team members’ names and roles, indications for patient referral, and communication methods improved after curriculum implementation. Attitudes toward team-based care did not change but were positive at baseline. Following curriculum implementation, new patient referrals increased for the pharmacist (0.1–1/100 patient visits, P = 0.015) and psychologist (1.1–2.2/100 patient visits, P = 0.032).

Conclusions: Case-based interprofessional conferences improved residents’ knowledge regarding interprofessional care and increased referrals to team members. This curriculum addresses barriers to team-based care experienced by residents in continuity clinic and is adaptable to other clinic settings.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Carter BL, Rogers M, Daly J, et al. The potency of team-based care interventions for hypertension: a meta-analysis. Arch Intern Med 2009;169:1748-1755.
2. Welch G, Garb J, Zagarins S, et al. Nurse diabetes case management interventions and blood glucose control: results of a meta-analysis. Diabetes Res Clin Pract 2010;88:1-6.
3. Kennelty KA, Polgreen LA, Carter BL. Team-based care with pharmacists to improve blood pressure: a review of recent literature. Curr Hypertens Rep 2018;20:1.
4. Helfrich CD, Simonetti JA, Clinton WL, et al. The association of team-specific workload and staffing with odds of burnout among VA primary care team members. J Gen Intern Med 2017;32:760-766.
5. Morey JC, Simon R, Jay GD, et al. Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. Health Serv Res 2002;37:1553-1581.
6. Wen J, Schulman KA. Can team-based care improve patient satisfaction? A systematic review of randomized controlled trials. PLoS One 2014;9:e100603.
7. Bodenheimer T, Gupta R, Dubé K, et al. High-functioning primary care residency clinics: building blocks for providing excellent care and training. https://store.aamc.org/downloadable/download/sample/sample_id/126. Published 2016. Accessed February 2, 2019.
8. Sheu L, Laponis R, Julian K. Educating the next generation of physicians in interprofessional collaboration. J Gen Intern Med 2016;31:823-825.
9. Weinberger SE, Smith LG, Collier VU, et al. Redesigning training for internal medicine. Ann Intern Med 2006;144:927-932.
10. Accreditation Council for Graduate Medical Education, American Board of Internal Medicine. The Internal Medicine Milestone Project. http://www.acgme.org/Portals/0/PDFs/Milestones/InternalMedicineMilestones.pdf. Published July 2015. Accessed May 7, 2018.
11. Soones TN, O'Brien BC, Julian KA. Internal medicine residents’ perceptions of team-based care and its educational value in the continuity clinic: a qualitative study. J Gen Intern Med 2015;30:1279-1285.
12. Shunk R, Dulay M, Chou CL, et al. Huddle-coaching: a dynamic intervention for trainees and staff to support team-based care. Acad Med 2014;89:244-250.
13. Weppner WG, Davis K, Sordahl J, et al. Interprofessional care conferences for high-risk primary care patients. Acad Med 2016;91:798-802.
14. Schmitt M, Blue A, Aschenbrener CA, et al. Core competencies for interprofessional collaborative practice: reforming health care by transforming health professionals’ education. Acad Med 2011;86:1351.
15. Leipzig RM, Hyer K, Ek K, et al. Attitudes toward working on interdisciplinary healthcare teams: a comparison by discipline. J Am Geriatr Soc 2002;50:1141-1148.
16. Edwards ST, Rubenstein LV, Meredith LS, et al. Who is responsible for what tasks within primary care: perceived task allocation among primary care providers and interdisciplinary team members. Healthc (Amst) 2015;3:142-149.