Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes

 

Abstract

Background

Poor interprofessional collaboration (IPC) can negatively affect the delivery of health services and patient care. Interventions that address IPC problems have the potential to improve professional practice and healthcare outcomes.     

Objectives

To assess the impact of practice-based interventions designed to change IPC, compared to no intervention or to an alternate intervention, on one or more of the following primary outcomes: patient satisfaction and/or the effectiveness and efficiency of the health care provided. Secondary outcomes include the degree of IPC achieved.

Search methods

We searched the Cochrane Effective Practice and Organisation of Care Group Specialised Register (2000-2007), MEDLINE (1950-2007) and CINAHL (1982-2007). We also handsearched the Journal of Interprofessional Care (1999 to 2007) and reference lists of the five included studies.

Selection criteria

Randomised controlled trials of practice-based IPC interventions that reported changes in objectively-measured or self-reported (by use of a validated instrument) patient/client outcomes and/or health status outcomes and/or healthcare process outcomes and/or measures of IPC.

Data collection and analysis

At least two of the three reviewers independently assessed the eligibility of each potentially relevant study. One author extracted data from and assessed risk of bias of included studies, consulting with the other authors when necessary. A meta-analysis of study outcomes was not possible given the small number of included studies and their heterogeneity in relation to clinical settings, interventions and outcome measures. Consequently, we summarised the study data and presented the results in a narrative format.

Main results

Five studies met the inclusion criteria; two studies examined interprofessional rounds, two studies examined interprofessional meetings, and one study examined externally facilitated interprofessional audit. One study on daily interdisciplinary rounds in inpatient medical wards at an acute care hospital showed a positive impact on length of stay and total charges, but another study on daily interdisciplinary rounds in a community hospital telemetry ward found no impact on length of stay. Monthly multidisciplinary team meetings improved prescribing of psychotropic drugs in nursing homes. Videoconferencing compared to audioconferencing multidisciplinary case conferences showed mixed results; there was a decreased number of case conferences per patient and shorter length of treatment, but no differences in occasions of service or the length of the conference. There was also no difference between the groups in the number of communications between health professionals recorded in the notes. Multidisciplinary meetings with an external facilitator, who used strategies to encourage collaborative working, was associated with increased audit activity and reported improvements to care.

Authors' conclusions

In this updated review, we found five studies (four new studies) that met the inclusion criteria. The review suggests that practice-based IPC interventions can improve healthcare processes and outcomes, but due to the limitations in terms of the small number of studies, sample sizes, problems with conceptualising and measuring collaboration, and heterogeneity of interventions and settings, it is difficult to draw generalisable inferences about the key elements of IPC and its effectiveness. More rigorous, cluster randomised studies with an explicit focus on IPC and its measurement, are needed to provide better evidence of the impact of practice-based IPC interventions on professional practice and healthcare outcomes. These studies should include qualitative methods to provide insight into how the interventions affect collaboration and how improved collaboration contributes to changes in outcomes.

 

Plain language summary

Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes

The extent to which different healthcare professionals work well together can affect the quality of the health care that they provide. If there are problems in how healthcare professionals communicate and interact with each other, then problems in patient care can occur. Interprofessional collaboration (IPC) practice-based interventions are strategies put into place in healthcare settings to improve work interactions and processes between two or more types of healthcare professionals.

In this review, we found five studies that evaluated the effects of practice-based IPC interventions, categorised as interprofessional rounds, interprofessional meetings, and externally facilitated interprofessional audit. Three of these studies found that these interventions led to improvements in patient care, such as drug use, length of hospital stay and total hospital charges. One study showed no impact, and one study showed mixed outcomes.

The studies indicate that practice-based IPC interventions can lead to positive changes in health care, but further studies are needed to have a better understanding of the range of possible interventions and their effectiveness, how they affect interprofessional collaboration and lead to changes in health care, and in what circumstances these interventions may be most useful.

 

摘要

背景

專業間的合作：以實務為基礎的介入措施在專業實踐及健康照護結果的效果

缺乏專業間的合作(interprofessional collaboration, IPC)會負向的影響健康服務的傳遞及病人照護。解決專業間合作問題的介入措施，有可能改善專業的實踐及健康照護的結果。

目標

評估以實務為基礎的介入措施，對改變專業間合作的影響，比較於沒有介入措施或其他選擇的介入措施，在一個或更多個追蹤的主要結果指標：病人滿意度及/或提供的健康照護的效果或效率。次要的結果指標包括專業間合作達成的程度。

搜尋策略

我們搜尋登錄於Cochrane有效的實踐和照護組織(Effective Practice and Organisation of Care, EPOC)的專業化團體的資料庫(2000 – 2007)、MEDLINE (1950 – 2007)及CINAHL (1982 – 2007)。我們也手動搜尋the Journal of Interprofessional Care (1999 to 2007)及五篇被包括的研究的參考文獻的目錄。

選擇標準

專業間合作介入措施的隨機控制試驗(Randomised controlled trials)，其報告客觀測量或自我報告(使用有效的工具)病人/顧客結果及/或健康狀態結果及/或測量專業間合作(IPC)的改變。

資料收集與分析

三位評論者中至少有兩位評論者獨立的評估每一篇可能相關的研究是否合乎資格。一位作者從納入的研究中摘取資料及評估偏差的風險，當需要時諮詢其他的作者。由於納入小量的研究及其在臨床情境間的異質性，研究結果的統合分析不可能執行。因此，我們摘要研究資料及以敘述性的方式呈現結果。

主要結論

五篇研究符合納入的標準；兩篇研究檢察專業間的巡視、兩篇研究檢察專業間的會議、一篇研究檢察外在促進專業間的監督。一篇研究在一個急性照謢醫院的內科住院病房，每天跨學門間的巡視，顯示在住院天數及總計費用上有正向的影響，但是另一篇研究在社區醫院telemetry病房，每天跨學門間的巡視，發現在住院天數上沒有影響。在護理之家，每月多學門間的小組會議，改善治療精神異常的藥物處方開立。遠距的與聲音傳送的多領域個案會議比較，顯示?雜的結果；降低每位個案討論次數及縮短治療天數，但是在服務的時間或會議的長度沒有不同。在團隊間所記錄的健康專業人員間的溝通次數也沒有不同。多學門會議是一個額外的促進者，它是使用於鼓勵合作工作的策略，與增加監察活動有關及被報告可改善照護。

作者結論

在這更新的評論中，我們發現五篇研究(四篇新的研究)符合納入的標準。此篇評論建議，以實務為基礎的專業間的合作(IPC)介入措施能改善健康照護過程及結果，但是由於少量的研究、樣本數、概念的問題、合作的測量、及介入措施和情境的異質性的限制，因此對於專業間的合作(IPC)的關鍵要素及它的效益，很困難有一個概括的推論。更嚴格的，一個明確焦點在專業間的合作(IPC)及其測量的群集隨機研究，在其以實務為基礎的專業間合作的介入措施對專業實務及健康照護的結果的影響，需要提供更好的證據。這些研究應該包括用質性的方法，以洞察措施如何影響合作及如何改善合作而有助結果的改變上。

翻譯人

本摘要由高雄榮民總醫院林麗英翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

不同健康照護專業間良好的在一起工作，會影響他們所提供的健康照護的品質。假如在健康照護專業間的溝通及彼此的互動有問題，則接著病人的照護也會發生問題。 以實務為基礎的專業間的合作(IPC)的介入措施，是一個策略用於健康照護情境，以改善在兩種或更多類型的健康照護專業人員間的工作互動與過程。在這篇評論中，我們發現五篇研究評值以實務為基礎的專業間合作(IPC)的介入措施的效果，類型有專業間的巡房、專業間的會議，及外部促進專業間的監察。這些研究中有三篇發現這些介入措施引導改善病人的照護，像是藥物的使用、住院天數及合計住院的費用。一篇研究顯示沒有影響，一篇研究顯示?雜的結果。 此研究顯示以實務為基礎的專業間的合作(IPC)的介入措施，在健康照護中能引導正向的改變，但是更進一步的研究仍然是需要的，以更瞭解可能介入的範圍及其效益，包括它們是如何影響專業間的合作及引導健康照護的改變，以及在什麼環境下這些介入措施是最有效的。