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Patient-centered interprofessional collaborative care: factors associated with bedside interprofessional rounds.

ABSTRACT: BACKGROUND: Medical care delivered in hospital-based medicine units requires interprofessional collaborative care (IPCC) to improve quality. However, models such as bedside interprofessional rounds, or encounters that include the team of physician and nurse providers discussing medical care at the patient's bedside, are not well studied. OBJECTIVE: To examine the incidence of and time spent in bedside interprofessional rounds on internal medicine teaching services in one academic medical center. DESIGN AND PARTICIPANTS: Observational descriptive study of internal medicine faculty serving as inpatient medicine attending physicians. Participants completed a daily electronic survey following team rounding sessions to assess rounding characteristics (November 2012-June 2013); variables such as resident level-of-training, attending physician years' of experience, house staff call day and clinic schedule were obtained from administrative data. Descriptive, Kruskal-Wallis, and multivariable logistic regression statistics were used to evaluate the study objectives. MAIN MEASURES: Primary outcomes were: (1) incidence of bedside interprofessional rounds, (2) time spent with patients during bedside interprofessional rounding encounters, and, (3) factors associated with increased occurrence of and time spent with patients during bedside interprofessional rounds. Covariates included resident level-of-training, attending physician years' of experience, census size, and call day. KEY RESULTS: Of 549 rounding sessions, 412 surveys were collected (75 % response) from 25 attending physicians. Bedside interprofessional rounds occurred with 64 % of patients (median 8.0 min/encounter), differing by unit (intermediate care 81 %, general medicine 63 %, non-medicine 57 %, p < 0.001). Factors independently associated with increased occurrence of bedside interprofessional rounds were senior resident (OR 2.67, CI 1.75-4.06, PGY-3/PGY-4 vs. PGY-2), weekdays (OR 1.74, CI 1.13-2.69), team census size ≤ 11 (OR 2.36, CI 1.37-4.06), and attending physicians with ≤ 4 years' experience (OR 2.15, CI 1.31-3.55). Factors independently associated with increased time spent during encounters were attending physicians with ≤ 4 years (OR 2.38, CI 1.44-3.95), 5-15 years of experience (OR 1.82, CI 1.10-3.02), and weekdays (OR 1.71, CI 1.10-2.65). CONCLUSIONS: These findings highlight factors associated with increasing or decreasing occurrence and time spent in bedside interprofessional collaborative care delivery. Systematic changes to census size caps, resident scheduling, and attending physician education and staffing may be required to increase the occurrence of interprofessional collaborative care.

SUBMITTER: Gonzalo JD

PROVIDER: S-EPMC4061365 | biostudies-other | 2014 Jul

REPOSITORIES: biostudies-other

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Project description:Interprofessional collaborative practice has been shown to be an appropriate model of care for chronic disease management in primary care. However, how patients play a role in this model is relatively unknown. The aim of this constructivist grounded theory focus group study was to explore the perceptions of patient advocates regarding the role of patients in interprofessional collaborative practice for chronic conditions in primary care. Primary data were collected from patient advocates, from public and private Australian organisations and who represent patients with chronic disease in primary care, through focus groups in July-August 2020. Videoconference focus groups were recorded, transcribed verbatim and inductively, thematically analysed using the five-step approach by Charmaz: (1) initial line-by-line coding, (2) focused coding, (3) memo writing, (4) categorisation and (5) theme and sub-theme development. Three focus groups comprising 17 patient advocates with diverse cultural and professional backgrounds participated. Two themes and five sub-themes relating to interprofessional collaborative practice teams were constructed from the data. In theme 1, patients 'shifted across the spectrum of roles' from 'relinquishing control to the team', 'joining the team' to 'disengaging from the team'. The second theme was the need for 'juggling roles' by 'integrating patient role with life roles', and 'learning about the patient role'. The diversity and variability of patient roles as described by patient advocates highlight the challenges of working with people with chronic conditions. The diverse patient roles described by advocates are an important finding that may better inform communication between patients and health professionals when managing chronic conditions. From the health professional perspective, identification of the role of a patient may be challenging. Therefore, future research should explore the development of a tool to assist both patients and health professionals to identify patient roles as they move across the spectrum, with the support of policy makers. This tool should aim to identify and promote patient engagement in interprofessional collaborative practice in primary care settings.

Project description:ObjectivesPatients speaking a primary language other than English face barriers to equitable care, particularly patient-provider communications. There is no gold standard for providing inpatient medical interpretation on family-centered rounds (FCR). We aimed to implement simultaneous, in-person interpretation of FCR for Spanish-speaking families and hypothesized improved satisfaction in care.MethodsIn-person, Spanish Equipment-Assisted Simultaneous Medical Interpretation (EASMI) was implemented in March 2018 on FCR. Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) experience scores on communication domains were analyzed for Spanish and English-speaking families pre- (n = 118) and postimplementation (n = 552). Postimplementation, we conducted medical team surveys (n = 104) and semistructured interviews with Spanish-speaking families (n = 25) to determine satisfaction with interpretation modalities (phone, video, and EASMI).ResultsSpanish-speaking families exhibited statistically significant improvements in Child HCAHPS top box scores compared to English-speaking families in multiple communication and informed care-related domains. For example, "How often did your child's doctors explain things to you in a way that was easy to understand?" top box scores improved from 58% to 95% for Spanish-speaking families, compared to 85% to 83% for English speakers, with the differential effect of the intervention showing statistical significance (P = .001). Medical team surveys demonstrated high satisfaction with EASMI. Qualitative themes from interviews and open-ended survey responses emphasized multiple care benefits with EASMI, including a perceived reduction of communication errors and increased family participation.ConclusionsEASMI was associated with significant improvements in Child HCAHPS scores in communication domains and increased medical team and family members' satisfaction with interpretation. EASMI presents a novel method for equitable FCR for Spanish-speaking families.

Project description:OBJECTIVES:The Scleroderma Patient-centered Intervention Network (SPIN) Cohort uses the cohort multiple randomised controlled trial design to embed trials of online self-care interventions for people living with systemic sclerosis (SSc; scleroderma). To offer interventions to patients interested in using them, participants complete signalling items that query about the likelihood that patients would agree to participate in nine different hypothetical online programmes addressing common SSc-related problems. It is not known what factors influence patient-reported interest in participating in a particular online intervention and if intervention-specific signalling questions provide unique information or replicate broader characteristics, such as overall willingness to participate or self-efficacy. This study assessed factors that explain responses to intervention-specific signalling items. DESIGN:Cross-sectional survey. SETTING:SPIN Cohort participants enrolled at 42 centres from Canada, the USA, the UK, France, Spain and Mexico who completed study questionnaires from March 2014 to January 2018 were included. MEASURES:Demographic and disease characteristics, self-efficacy and symptoms related to each specific intervention were completed in addition to signalling items. General likelihood of using interventions was calculating by taking the mean score of the remaining signalling questions. PARTICIPANTS:1060 participants with complete baseline data were included in the analyses. RESULTS:For all individual signalling questions, controlling for other variables, the mean of the remaining signalling questions was the strongest predictor (standardised regression coefficient ? from 0.61 (sleep) to 0.80 (self-management)). Smaller, but statistically significant, associations were found with the symptom associated with the respective signalling question and with general self-efficacy for 7 of 9 signalling questions. CONCLUSIONS:The main factor associated with patients' interest in participating in a disease-specific online self-care intervention is their general interest in participating in online interventions. Factors that may influence this general interest should be explored and taken into consideration when inviting patients to try online interventions.

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Patient-centered interprofessional collaborative care: factors associated with bedside interprofessional rounds.

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