Fall 2012 to Fall of 2015
Awarded in fall of 2012, the School of Nursing at the University of Tennessee at Chattanooga hosted the IPCP-AGES Grant. IPCP-AGES or Inter-Professional Collaborative Practice Approach for Geriatric Education Strategies was a two part encompassing grant. The first part provided educational services and care to geriatric patients with heart failure. Care manifested in two ways: a heart failure clinic hosted with Memorial Health and as house calls in which interprofessional teams visited patients in their home. The second aspect of the IPCP-AGES grant included interprofessional education of students from a variety of care professions.
Community and Team Partners
Partnerships Supporting the IPCP-AGES Project
UTC’s responsiveness to regional workforce development priorities enabled us to leverage significant linkages with internal collaborators, major health care entities, and community partners. The IPCP-AGES project was designed in collaboration with internal and community partners.
- UTC Department of Physical Therapy: The UTC Department of Physical Therapy has more than 105 students enrolled in its Doctor of Physical Therapy program which is fully accredited by the Commission on Accreditation of Physical Therapy Education. The Department operates the H. Carey Hanlin Motion Analysis Laboratory, a state-of-the-art computer imaging laboratory that facilitates research on a wide spectrum of topics including: spine and footwear biomechanics; clinical gait analysis; orthopedic surgery techniques; and orthotics, prosthetics, and orthopedic bracing.
- UTC Social Work: The UTC Social Work Department has more than 80 students enrolled in its Bachelor of Social Work (BSW) program and is fully accredited by the Council on Social Work Education. The BSW program offers an innovative, learner-centered/ability-based curriculum with enhanced cultural competence training.
- UTC Nutrition: The UTC Food and Nutrition Program is housed within the Department of Health and Human Performance. With over 135 undergraduate students enrolled, the Program features a comprehensive curriculum accredited by the Commission on Accreditation for Dietetics Education American Dietetic Association.
- UTC Medical Anthropology program: UTC’s offers both a bachelor of arts degree and a bachelor of science degree in Anthropology. The comprehensive curricular offerings of the Anthropology Department at UTC prepare students to think critically and analytically and to function effectively in our increasingly diverse and interrelated world. Anthropology students and faculty will contribute key perspectives in bridging interprofessional cultures and in offering culturally competent care for the geriatric population.
- University of TN College of Medicine – Chattanooga (UTCOMC) Unit: The UTCOMC’s programs are accredited by the Accrediting Council on Graduate Medical Education (ACGME). IPCP-AGES will work with Internal Medicine Residents and medical students in rotations at the UTCOMC, located adjacent to the UTC campus. The UTCOMC’s primary clinical training site is the Erlanger Health System.
- Erlanger and Memorial Health Care Systems: Erlanger Health System is one of the Southeast's premier teaching hospitals and a recognized leader in healthcare and technology. The main Baroness Erlanger Campus is a critical access hospital, and Erlanger North includes a Gero-Psych unit which is a model program for interprofessional learning & practice. Memorial Health Care System operates 2 acute care hospitals, a satellite outpatient imaging center and 38 affiliated clinics. This advanced medical facility employs more than 4,000 associates, 500 volunteers, and 700 physicians across 10 campuses and clinics. Both health care systems serve large numbers of seniors and operate community-based clinics serving low-income, mostly-minority seniors. UTC will partner with both Erlanger and Memorial Health Care Systems to help identify and implement interprofessional healthpromotion and outreach to the geriatric population.
- Chattanooga Housing Authority: The Chattanooga Housing Authority (CHA) oversees numerous public housing developments, including the Mary Walker Towers complex. This community includes 153 housing units and is home to 150 low-income, mostly-minority seniors and individuals with disabilities. CHA has a rich history of promoting safety and wellness among residents and will partner with project staff to host community-based experiential learning activities that will serve residents.
Project Innovations in Interprofessional Collaborative Practice
The IPCP-AGES project sought to shift current educational and clinical practice paradigms in our region and through the dissemination of interprofessional learning and practice. The following program hallmarks were developed and implemented:
- Establishing IPCP environments across a range of health settings including hospital, home, and community by acquainting interprofessional student teams with the continuum of care.
- Creating virtual IPCP environments with a focus on effective communication
between interprofessional care providers and geriatric patients & their families that
enabled interprofessional students to practice difficult conversations and emotional
situations within a safe, simulated environment to prepare for clinical practice.
- Implementing the House Calls initiative thereby creating an IPCP environment focused
on the critical transitions between hospital and home and/or less intensive care settings.
The program supported patients & their families, ensuring that discharged patients
had adequate follow-up and resources including at-home medication reconciliation,
environmental & health assessments, case management and resource referrals, etc.
- Creating and maintaining a robust roster of IPCP environments showcased the
accessibility of this model for universities of all sizes and those without a full
complement of health professions degree programs.
- Implementing the Fall Prevention & Safety initiative represented a unique partnership
between the School of Nursing and Physical Therapy program to implement and
enhance fall prevention services to older adults across a range of health settings.
As noted in the introduction, from December of 2012 to December of 2015 the IPCP AGES was a HRSA Award funded program which addressed these goals in the older adult population. IPCP-AGES acted as a change agent within the greater Chattanooga area. Connecting with a variety of health and service organizations, our award team was able to maximize impact. Below is a tour of some of the health partners.
IPCP-AGES provided health educational services to the older population within two domains.
Health Heart Service
As part of our initiative IPCP-AGES is partnering with Memorial Health to provide a Healthy Heart Service for the economically underserved in the greater Chattanooga and North Georgia Area. The program has been a huge success with potential clients signing up each day. The Healthy Heart Service is also tied to the House Calls Program to refer potential clients to an in-home evaluation.
House Calls Program
Some members of our interprofessional teams are visiting clients in their home to evaluate medicine, nutrition, medicine reconciliation, and fall risks. Our team schedules the visits through our partner Memorial health and the list of clients is growing. The House Calls program is to provide a higher quality of evaluative care and suggest services to help clients.
This included press regarding IPCP-AGES impact on the area.
Data as of October 2014
The current study looks at the impact of an interprofessional care team. A total of 36 patients completed the baseline questionnaire. Twenty-six reaction questionnaires were completed after care team visit 1 and 9 follow-up questionnaires were completed after care team visit 2. The following subsections reflect the results that have been gathered thus far.
Demographics: The current patient population is primarily over 65 years old, Non-Hispanic, and Caucasian. The majority of the patients have some high school or are high school graduates. The average yearly income reported is less than the 2012 national average wage index reported by the Social Security Administration.
Baseline Results: The average number of hospitalizations and primary care physician visits reported in the last 6 months was converted to a 30 day average to allow for multiple time report comparisons. The baseline average of primary care physician visits was .49 and the baseline average of hospitalizations was .16. A medical form was completed and discussed with each patient.
Care team visit 1: During the initial interprofessional care team visit, patients were educated on medication usage and were asked about the difficulty of traveling to the doctor for check-ups. Ninety-two percent of patients understood how to use their medications and the same percentage stated they were able to travel to their primary care physician when needed. After exposure to an interdisciplinary care team, the number of hospitalizations slightly decreased and the number of primary care doctor visits remained the same.
View of care team: The quality of care and interaction questions were asked after the care team visit 1. The overall view of the interprofessional healthcare team was positive. For instance, patients reported high levels of agreement to all positively worded questions regarding their interactions with the care team. Conversely, patients reported high levels of disagreement to all negatively worded care team interaction statements.
As of the fall of 2014, 36 patients have at least partially completed the baseline survey. The baseline survey includes demographic information. A summary of that information is below.
53 % - Male
47% - Female
100 % - Non-Hispanic
71% - Caucasian
29% - African American / Black
18.2 % - Some High School
39.4 % - High School
30.3 % - Some College
6.1 % - Bachelor’s Degree
3.0 % - Some Graduate School
3.0 % - Doctorate
Education and Dissemination
The IPCP-AGES team developed over 10 learning modules and training videos for inter-disciplinary dissemination. Those videos address care in the older adult from the inter-professional collaborative approach to care. The following is a list of those videos and their descriptions.
Module One - Introduction to Interprofessional Collaborative Practice (Video converted to Youtube 12-28-2014)
To introduce students and professionals from various medical service industries to the concept of interprofessional education.
To create awareness for the need for interprofessional collaboration in a variety of medical settings.
To compare interprofessional collaboration and compartmentalized care from the perspective of the geriatric patient.
Module Two - Core Competencies of Interprofessional Collaborative Practice (Video converted to Youtube 12-28-2014)
- To familiarize the learner with the core competencies of interprofessional collaborative practice
- To give examples of care both from following the competencies and from poor collaboration
- To provide a template for treatment behavior for those who wish to adopt the intercollaborative model of care
Module Three - Safety and Falls Training
- Describe the impact that falls have on the elderly, their families, and society.
- Identify the top five risk factors associated with falls.
- Identify intrinsic and extrinsic fall risk factors in the elderly.
Module Four - Advanced Safety and Falls Training
- Apply the Centers for Disease Control and Prevention’s STEADI program for preventing falls in older adults.
- Identify interprofessional resources to support decreasing elderly person’s fall risk.
Module Five - No One Gets Out Alive
- Define Palliative Care health care discipline
- Define Hospice Care health care discipline
- Understand the relationship between palliative care and hospice care
- Be familiar with documents important at end-of-life
Module Six - Special Concerns in the Older Adult
- Students will have a better understanding of age-related changes in the older adult
- Students will be able to apply environmental interventions to promote function in older adults
- Students will be familiar with screening recommendations for older adults
Module Seven - Pharmacology Video
- The students will gain a better understanding of causes of medication issues in the older adult
- The students will recognize evidence-based tools available to reduce occurrences of inappropriate medication use in older adults
- Recognize the importance of an interprofessional approach to pharmacology in the older adult population
Module Eight - Care of the Older Adult
- The student will gain understanding of informal caregivers and their unique needs
- The student will appreciate the importance of assessing caregivers for role stress and strain
- The student will be able to identify potential abuse and neglect in an older adult
Module Nine - An Interprofessional Guide to Supporting Mental Health Issues in Older Adults
- Enhance understanding of cognitive impairment and depression in the older adult.
- Increase awareness regarding appropriate expectations of clients these mental health concerns.
- Better appreciate the roles and responsibilities of various healthcare professionals in the detection, assessment, and treatment of dementia and depression.
- Become familiar with how to best select screening tools for cognitive impairment and dementia and when to refer your client for additional testing.
Module Ten - Malnutrition in the Older Adult
- Describe the significance of malnutrition in the older adult.
- Recognize how aging changes impact nutritional status.
- Discuss how nutrition screening impacts malnutrition.
- Module A1 – Dr Guo Presentation on Cultural Competency and Interprofessionality
- Presentation to the School of Nursing
- Module A2 – Interprofessional Panel Presentation to the School of Nursing
- Module A3 – Interprofessional Panel Presentation to Physical Therapy
- Simulation – Interprofessional Collaboration with Nutrition and Dietetics
- Simulation – Interprofessional Collaboration with a Heart Failure Patient
In all 6 health fairs were hosted at public housing facilities in Chattanooga. Additionally three safety and falls fairs were held as well including one safety and falls conference at UTC.