The Importance of Interprofessional Practice and Education in the Era of Accountable Care.

In order to succeed in today's health care environment, interprofessional teams are essential. The terms "multidisciplinary care" and "interdisciplinary care" have been replaced by the more contemporary term "interprofessional practice and education" (IPE), which occurs when individuals "from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes." This commentary discusses new models of care, team members who contribute to IPE, and incentives and challenges.

Jump starting a quality and performance improvement initiative to meet the updated ACGME guidelines.

BACKGROUND: The Accreditation Council for Graduate Medical Education requires residents to be trained in practice-based learning and improvement as well as systems-based practice. In an effort to establish a formal curriculum for graduate medical education, a Performance Improvement (PI) Training Program was initiated at Memorial University Medical Center. Training for the chief residents across all residency programs focused on the basic Six Sigma framework. Chief residents chose faculty sponsors and were also mentored by Six Sigma-trained staff. Faculty and physicians who participated in the initiative received PI/Continuing Medical Education credit. METHODS: A total of 17 presurveys and postsurveys were completed on 7 outcome measures. Nonparametric Wilcoxon signed rank 2-tailed tests were performed to test for significant change from presurvey to postsurvey. RESULTS: Analysis of the 2-year data (2009-2011) found statistically significant improvement for all 7 outcome measures. The surgical residents' PI Project for 2011 included the development of the Venous Thromboembolism Reassessment Tool. The project included a multidisciplinary team to develop a computer prompt that continued to trigger if the physician launched the prophylaxis or treatment form without ordering anticoagulation. The new prompt resulted in a 391% increase in anticoagulant orders. CONCLUSIONS: This study demonstrated that the resident-based PI Training Program was innovative, practical, and comprehensive. Education, tools, and skill development were provided on quality and PI theory and practice for resident physicians in support of the Accreditation Council for Graduate Medical Education core competencies of professionalism, practice-based learning and improvement, and systems-based practice.

Physician attitudes regarding cardiovascular risk reduction: the gaps between clinical importance, knowledge, and effectiveness.

Reducing risk factors for patients with vascular disease can reduce the subsequent incidence of cerebro-cardiovascular disease. While physicians have had extensive training in the importance of atherosclerotic vascular disease risk factor modification, evidence suggests that they systematically miss opportunities for clinical prevention during routine practice. The aim of this study was to identify whether physicians felt confident in their knowledge and effectiveness regarding counseling patients to reduce cardiovascular risk and to determine barriers to prevention interventions in the office setting. Surveys were mailed to 509 physicians affiliated with an academic community hospital. Nonrespondents were sent reminders and a second survey. Comparisons were made using chi-square analysis. Two hundred and five surveys were returned (40.3%). Thirty-six percent of physicians felt knowledgeable about weight management techniques, compared to 3% who were confident that they succeeded in their practice (p < 0.001). Similar patterns were found for Tobacco Cessation (62% versus 14%, p = 0.001), Alcohol Reduction (46% versus 7%, p < 0.001), Stress Management (35% versus 5%, p < 0.001), Exercise (53% versus 10%, p < 0.001), Nutrition (36% versus 8%, p < 0.001), Diabetes Management (48% versus 23%, p < 0.001), Blood Pressure Management (57% versus 43%, p < 0.001) and Lipid Management (59% versus 38%, p < 0.001). We identified a significant gap between physician confidence in their knowledge about risk factors and their effectiveness at providing counseling and obtaining results in their office. Most physicians felt that the routine office follow-up visit was an ineffective method for instituting vascular risk factor reduction. Alternate settings for risk factor reduction may be needed for improving atherosclerosis prevention.