Team-Based Care. Allied Health Professionals as Core Team Members Under Health Care Reform

Transcription

1 Team-Based Care Allied Health Professionals as Core Team Members Under Health Care Reform Joan C. Rogers, PhD, OTR/L, FAOTA Professor of Occupational Therapy, Psychiatry and Nursing Chair, Department of Occupational Therapy School of Health and Rehabilitation Sciences University of Pittsburgh, Pittsburgh, PA

2 Disclaimer I have no conflicts to declare

3 Law & Legal Definition A health professional (other than a registered nurse or physician assistant) Who has a certificate, associate s degree, bachelor s degree, master s degree, doctoral degree, or post-baccalaureate training, in a science relating to health care; Who shares in the responsibility for the delivery of health care services or related services including Services relating to the identification, evaluation, and prevention of disease and disorders; Dietary and nutrition services; Health promotion services; Rehabilitation services; or Health system management services; and Who does not have a degree in ---- medicine, osteopathy, dentistry, veterinary medicine, optometry, podiatric medicine, pharmacy, public health, chiropractic, health administration, clinical psychology, social work, or counseling 42USCS 295p

4 Interprofessional Team An interprofessional health care team is A group of individuals from different professions, who collaborate effectively with the patient and each other, to solve patient problems that are more complex than can be managed by the knowledge and skills of any one profession alone.

5 Interprofessional Team A group of individuals From different professions Collaborate effectively To solve patient problems That are more complex than can be managed by the knowledge and skills of any one profession alone Size: 2 or more members Structure: Implies different education, skills & values Process: Interdependent--- patient--team communication Purpose: We work together because patients are not just arms, legs, GI tracts, and emotions. They are biopsychosocial beings who present as whole beings to a team Outcome: Patient-centered and comprehensive at multiple levels (e.g., condition, function)

6 Interprofessional Team Team Context

7 Contributions to Team Care Historical perspective Rehabilitation team composition Model for future US health care

8 Evidence of Rehabilitation Team Positive Outcomes Strasser and colleagues Multisite studies of team functioning Veterans Administration Hospitals (VAH) Six core disciplines Physical medicine & rehabilitation (PM&R) Nursing (RN) Social work (SW)/ case management (CM) Occupational therapy (OT) Physical therapy (PT) Speech language pathology (SLP)

9 Evidence of Rehabilitation Team Positive Outcomes Strasser et al. (2005) found that 3/10 measures of team functioning were significantly associated with patient functional improvement: Task orientation Order and organization Quality of information 1 measure (effectiveness ) was associated with length of stay

10 Evidence of Rehabilitation Team Positive Outcomes Smits et al. (2003) in a study of team cohesiveness found that Expectations of discipline-specific supervisors Hands-on team leadership, and Involvement of the attending physician Were associated with the extent to which teams reported functioning in a cohesive manner The authors speculated that higher functioning on the cohesiveness scale indicated that patient services were likely delivered with greater interprofessional communication and joint effort

11 Evidence of Rehabilitation Team Positive Outcomes Strasser et al. (2008) examined whether a team training intervention improved outcomes in patients with stroke The intervention was conducted over 6 months Team dynamics, problem-solving, use of performance feedback data, action plans for process improvement, telephone and videoconference consultation Intervention and Control teams received team performance profiles FIM patient outcomes for the Intervention teams were 13.6% better than for the Control teams

12 Significance of the Studies Team functioning Rehabilitation patient outcomes

13 Physical Medicine & Rehabilitation Geriatrics Rehabilitation Team Geriatric Team

14 Evidence of Geriatric Team Positive Outcomes Mukamel et al. (2006) examined PACE programs [Program of All inclusive Care for the Elderly] Community-based and provides primary, acute, and longterm care to frail elderly Team = PCP, RN, SW, PT, OT, RT/Activity Coordinator, RD, PCA, and home care and day care coordinators Team performance was significantly associated with better functional outcomes short and long term, and with better long-term urinary incontinence outcomes PACE programs improved functional outcomes by improving the functioning of care teams

15 Significance of the Studies Team functioning Primary care patient outcomes

16 Contributions to Health Care Reform PATIENT-CENTERED TEAM-CENTERED

17 Patient-Centered Contributions to Health Care Reform ISSUE 1: Disease Prevention & Health Promotion Physical activity Diet Athletic trainer, dance/ movement therapist, exercise physiologist, kinesiotherapist, physical therapist Dietitians Healthy lifestyle/ Well-being Health educator, occupational therapist, recreational therapist

18 Patient-Centered Contributions to Health Care Reform ISSUE 2: Disease Self-Management Focus of rehabilitation Change I can t to I can Self-Management Enhancing team functioning Of daily activities despite disease Health educators Health information managers Medical librarians

19 OT, PT, SLP OT Patient-Centered Contributions to Health Care Reform ISSUE 2: Disease Self-Management Medication Management Assessing the functional implications of medications: unstable/rigid gait, shaky hands, drooling Assessing cognitive & dexterity skills for manipulating medications; developing functional aids for selfmanagement Health Educator Health Information Manager Developing medication management teaching/learning aids for staff/ patients Assessing polypharmacy and prescribing patterns

20 Dysphagia Patient-Centered Contributions to Health Care Reform ISSUE 3: Prevention Screening Dogget et al. (2001) Substantial reductions in pneumonia rates for patients with acute stroke Preventive screening = health promotion & cost savings Functional status Min et al. (2009) PCP study using Vulnerable Elders-13 (ADL/IADL) scores predicted 5 year functional decline and death in community-dwelling older adults Screening by the PCP can identify older adults at risk for functional decline & death and refer them for appropriate rehabilitation interventions

21 Patient-Centered Contributions to Health Care Reform ISSUE 4: Access to Care Populations (e.g., Mental Health) Mental Health Service Providers Art therapists Dance therapists Music therapists Occupational therapists Recreational therapists Role responsibilities for these professions may be able to be extended

22 Mental Health Patient-Centered Contributions to Health Care Reform ISSUE 4: Access to Care Populations (e.g., Mental Health) Meyer (1922) Moral and humanitarian treatment in mental health OT Focus of mental health OT on habit training, adaptation, and balance of work/play PTSD AOTA OT responsible for assessing Frontline soldiers for PTSD Readiness of soldiers to return to battle Need for soldiers to be reassigned

23 Patient-Centered Contributions to Health Care Reform ISSUE 4: Access to Care Allied Health Role Restrictions Limiting Access to Care Examples: Dietitians Dental hygienists Occupational therapists

24 Patient-Centered Contributions to Health Care Reform ISSUE 4: Access to Care Telerehabilitation: Virtual rehabilitation Projected Benefits of Telerehabilitation Accessibility Continuity of care Decreased costs Assessments and intervention in naturalistic environments

25 SPECIALTY # of SUCCESSFUL STUDIES TOTAL# OF STUDIES OUTCOMES Cardiology 10/16 Cardiacrisk factors Neurology-TBI 3/5 Depressivesymptoms Behavioraloutcomes; Return to work Telephone groups = On-site groups Speech disorders 2/2 Successful outcomes Mobility impairment 1/1 Various morbidities: At risk of readmission to hospital Patient-Centered Contributions to Health Care Reform ISSUE 4: Access to Care Telerehabilitation: Virtual rehabilitation 2/5 Telerehabilitation may be acceptable for treating patients using new mobility devices Emergency admissions Quality of life Team communication (Institute of Health Economics, 2010)

26 Patient-Centered Contributions to Health Care Reform ISSUE 4: Access to Care Telerehabilitation: Virtual rehabilitation Overall: 71% of the TR applications were successful 51% were clinically significant 18% were unsuccessful 11% had unclear outcomes (Institute of Health Economics, 2010)

27 Patient-Centered Contributions to Health Care Reform ISSUE 4: Access to Care Telerehabilitation: Virtual rehabilitation Clinical outcomes: Clinical processes: Costs: These were generally improved They tended to be similar or better than alternative interventions Attendance and adherence were high Consultation time was longer Satisfaction was high Satisfaction was higher for patients than therapists Preliminary evidence of cost savings (Kairy et al., 2009)

28 Patient-Centered Contributions to Health Care Reform ISSUE 4: Access to Care Telerehabilitation: Virtual rehabilitation Schein et al. (2010) For patients needing a wheeled mobility and seating assessment, Results of in-person and remote assessment via videoconferencing were not significantly different

29 Contributions to Health Care Reform PATIENT-CENTERED TEAM-CENTERED

30 Team-Centered Contributions to Health Care Reform ISSUE 1: Accountability Health Information Manager Outcomes Chart patient progress Link treatment costs with patient s response

31 Team-Centered Contributions to Health Care Reform ISSUE 2: Evidence-Based Practice Medical Librarian Locate Evaluate Summarize

32 Team-Centered Contributions to Health Care Reform ISSUE 3: Communication CORE TEAM RT VIRTUAL HEALTH CARE TEAM

33 Team-Centered Contributions to Health Care Reform ISSUE 4: Role Extension and Blending DIETITIAN ON-THE-JOB TRAINING [experience] CONTINUING EDUCATION [extend/blend] OT ON-THE-JOB TRAINING [experience] CONTINUING EDUCATION [extend/blend] DIET FEEDING SWALLOWING SLP ON-THE-JOB TRAINING [experience] CONTINUING EDUCATION [extend/blend]

34 Contributions to Health Care Reform Disease prevention & health promotion Disease self-management Prevention: Screening Access to care PATIENT-CENTERED

35 Contributions to Health Care Reform Accountability Evidence-based practice Communication Role extension & blending TEAM-CENTERED

36 Contributions to Health Care Reform Under Health Care Reform It may not be the profession: It may be the professional!

37 Interprofessional Team under Health Care Reform

38 References American Occupational Therapy Association. (undated). AOTA s statement on mental health practice. Doggett, D.L., Tappe, K.A., Mitchell, M.D., Chapell, R., Coates, V., & Turkelson, C.M. (2001). Prevention of pneumonia in elderly stroke patients by systematic diagnosis and treatment of dysphagia: An evidencebased comprehensive analysis of the literature. Dysphagia, 16, Hailey, D., Roine, R., Ohinmaa, A., & Dennett, L. (2010). Evidence on the effectiveness of telerehabilitation applications. Institute of Health Economics and Finnish Office for Health Technology Assessment. Retrieved from Kairy, D., Lehoux, P., Vincent, C., & Visintin, M. (2009). A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation. Disability and Rehabilitation, 31, Meyer, A. (1922). The philosophy of occupation therapy. Archives of Occupational Therapy, 1, Min, L., Yoon, W., Mariano, J., Wenger, N.S., Elliott, M.N., Kamberg, C., & Saliba, D. (2009). The vulnerable elders-13 survey predicts 5-year functional decline and mortality outcomes in older ambulatory care patients. Journal of the American Geriatrics Society, 57, Mukamel, D.B., Temkin-Greener, H., Delavan, R., Peterson, D.R., Gross, D., Kunitz, S., & Williams, T.F. (2006). Team performance and risk-adjusted health outcomes in the program of all-inclusive care for the elderly (PACE). The Gerontologist, 46, Schein, R.M., Schmeler, M.R., Holm, M.B., Saptono, A., & Brienza, D.M. (2010). Telerehabilitation wheeled mobility and seating assessments compared with in person. Archives of Physical Medicine and Rehabilitation, 91, Smits, S.J., Falconer, J.A., Herrin, J., Bowen, S.E., & Strasser, D.C. (2003). Patient-focused rehabilitation team cohesiveness in veterans administration hospitals. Archives of Physical Medicine and Rehabilitation, 84, Strasser, D.C., Falconer, J.A., Herrin, J., Bowen, S.E., Stevens, A.B., & Uomoto, J. (2005). Team functioning and patient outcomes in stroke rehabilitation. Archives of Physical Medicine and Rehabilitation, 86, Strasser, D.C., Falconer, J.A., Stevens, A.B., Uomoto, J.M., Herrin, J., Bowen, S.E., & Burridge, A.B. (2008). Team training and stroke rehabilitation outcomes: A cluster randomized trial. Archives of Physical Medicine and Rehabilitation, 89,