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Interprofessional education: effects on professional practice and healthcare outcomes (update)

  1. Scott Reeves1,*,
  2. Laure Perrier2,
  3. Joanne Goldman2,
  4. Della Freeth3,
  5. Merrick Zwarenstein4

Editorial Group: Cochrane Effective Practice and Organisation of Care Group

Published Online: 28 MAR 2013

Assessed as up-to-date: 3 AUG 2011

DOI: 10.1002/14651858.CD002213.pub3


How to Cite

Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education: effects on professional practice and healthcare outcomes (update). Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD002213. DOI: 10.1002/14651858.CD002213.pub3.

Author Information

  1. 1

    University of California, San Francisco, Center of Innovation in Inteprofessional Education, San Francisco, California, USA

  2. 2

    Li Ka Shing Knowledge Institute of St. Michael's Hospital, Continuing Education and Professional Development, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

  3. 3

    Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Centre for Medical Education, Institute of Health Sciences Education, London, UK

  4. 4

    University of Western Ontario, Department of Family Medicine, London, ON, Canada

*Scott Reeves, Center of Innovation in Inteprofessional Education, University of California, San Francisco, 521 Parnassus Avenue, CL112, San Francisco, California, 94143, USA. scott.reeves@ucsf.edu.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 28 MAR 2013

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Characteristics of included studies [ordered by study ID]
Barcelo 2010

MethodsRCT where teams based in 10 public health centers were randomised to intervention project to improve the quality of diabetes care (n = 5) or control group (n = 5)


ParticipantsPhysicians, nurses, patients, nutritionists and psychologists


InterventionsThe intervention group received learning sessions focused on the implementation of strategies to improve quality of diabetes care


OutcomesClinical outcomes, healthcare process quality improvement goals


NotesNone


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskDescribes that health centres were "

randomly selected" (p. 146) but random component in the sequence generation process is not described

Allocation concealment (selection bias)Unclear riskNot specified

Baseline outcome measurements similar
All outcomes
Low riskReported in Table 5 (p. 150)

Baseline characteristics similarLow riskReported in Table 1 (p. 148)

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskNot reported

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskNot reported

ContaminationHigh riskQuote "…avoiding the contamination' of centers that acted as controls…was not possible" (p. 151)

Selective reporting (reporting bias)High riskQuote "…did not collect data on intermediate process variables" (p. 151)

Other biasHigh riskShort follow-up (p. 151)

Brown 1999

MethodsRCT where clinicians were randomly assigned to attend immediate (intervention) or later sessions of the programme (control group)


ParticipantsPhysicians, nurse practitioners, physician assistants, optometrists


Interventions2 physicians gave a communication skills training programme consisting of a 4-hour interactive workshop and a 4-hour follow-up workshop 1 month later. Between workshops participants were asked to audio record and review at least 2 consultations, and an instructor made an encouraging telephone call to each participant


OutcomesRoutinely collected patient satisfaction scores, self reported ratings of communication skills


NotesReported increases in patient satisfaction were not significant. However baseline scores were high in both groups, leaving little room for increase. The study authors state that longer and more intensive training, performance incentives, ongoing feedback and possibly practice restructuring may be needed to improve general patient satisfaction. They also note that the content of the routinely conducted patient satisfaction survey was not well-aligned to the particular focus of the communication skills training. The Art of Medicine survey used in this study is not a validated instrument


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskQuote "…we used a random-number table" (p. 823)

 

Allocation concealment (selection bias)Low riskQuote "we used a random-number table to assign persons to the intervention or control group" (p. 823)

Baseline outcome measurements similar
All outcomes
Low riskReported in Table 2 (p. 826)

Baseline characteristics similarLow riskQuote "Table 1 compares the characteristics of the intervention and control groups at study entry. No statistically significant differences were seen…" (p. 825)

Incomplete outcome data (attrition bias)
All outcomes
Low riskReported and intention-to-treat analysis was modified (p. 825)

Blinding of outcome assessment (detection bias)
All outcomes
Low riskOutcomes were obtained from quote "an anonymous questionnaire that was mailed to patients by a contractor to the HMO" (p. 823)

ContaminationUnclear riskNot specified if control group could have received similar training through other educational opportunities

Selective reporting (reporting bias)Unclear riskInsufficient information to make an assessment

Other biasHigh riskSurvey not validated (p. 824)

Campbell 2001

MethodsRCT with baseline (pre-test), immediate (9-12 months), and long-term (18-24 months) post assessments. Hospitals randomly assigned to experimental and control groups


ParticipantsEmergency department teams (physicians, nurses, social workers, administrators) and local domestic violence advocates


Interventions2-day information and team planning intervention


OutcomesRates of reported domestic violence, patient satisfaction, audit of clinical documentation


NotesOnly 1 hospital sent a complete team as requested; 2 hospitals did not send a physician; social worker sent from 5 of 6 hospitals. Limited institutional support for IPE noted as a possibility for poor outcomes in this study. The components of the culture of emergency department system-change indicator instrument used in this study is not a validated tool


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskNot specified

Allocation concealment (selection bias)Unclear riskNot specified

Baseline outcome measurements similar
All outcomes
Low riskQuote "This evaluation used an experimental design with baseline (pretest), immediate (9–12 months), and long-term (18–24 months) post-assessments…" (p. 132)

Baseline characteristics similarHigh riskNot specified

Incomplete outcome data (attrition bias)
All outcomes
Low riskResponse rates reported (p. 134)

Blinding of outcome assessment (detection bias)
All outcomes
Low riskReviewers had "no knowledge of an individual woman's responses to acute abuse" (p. 136)

ContaminationLow riskSites geographically spread across California and Pennsylvania (p. 132)

Selective reporting (reporting bias)Low riskAll relevant outcomes in the methods section are reported in results

Other biasHigh riskOnly 1 intervention hospital sent a complete team for training (p. 134); insufficient sample size (p. 136); external events may have impacted treatment of battered women at California hospitals (OJ Simpson trial) (p. 136)

Hanbury 2009

MethodsITS study to test the effectiveness of an intervention to increase adherence to a national suicide prevention guideline at a single trust hospital


ParticipantsCommunity mental health professionals (individual professions not specified)


InterventionsA didactic presentation, an interprofessional group discussion stressing positive normative beliefs, interactive group work based on 2 real-life vignettes


OutcomesAdherence rates to guideline use


NotesNeeds assessment data (interviews and questionnaires) were gathered in 2 earlier phases of the study to inform the design of the intervention. The impact of 2 extraneous events was also included – the national introduction of the guideline, and a local change in the system for monitoring service-user discharges


Risk of bias

BiasAuthors' judgementSupport for judgement

Incomplete outcome data (attrition bias)
All outcomes
High riskQuote "...discontinuity occurred between those who returned the questionnaire and those who attended the intervention" (p. 516)

Blinding of outcome assessment (detection bias)
All outcomes
Low riskRoutinely collected audit adherence data used (p. 505)

Selective reporting (reporting bias)Low riskRoutinely collected audit adherence data used (p. 505)

Other biasHigh riskHigh staff turnover at intervention site (p. 516). Discontinuities in the samples

Intervention independent of other changesLow risk2 events were identified and 6 separate analyses were done in order to accommodate the events (p. 509)

Shape of intervention effect pre-specifiedLow riskPoint of analysis is the point of intervention

Intervention unlikely to affect data collectionLow riskRoutinely collected audit adherence data used (p. 505)

Helitzer 2011

MethodsAn RCT of an IPE intervention aimed to improve patient-centred care with follow-up data gathered at 6 and 18 months. Individual professionals were randomised to receive the intervention (n = 13) or act as a control group (n = 14)


ParticipantsPhysicians, physician assistants and nurse practitioners


InterventionsA full-day interprofessional training, individualised feedback on video-taped interactions with simulated patients, and optional workshops to reinforce strategies for engaging the patient


OutcomesObservations of patient-centred communication


NotesData were also gathered on simulated professional-patient interactions to detect the efficacy of the intervention


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskNot reported

Allocation concealment (selection bias)Unclear riskNot reported

Baseline outcome measurements similar
All outcomes
Low riskPatient-centredness summary score reported for training and medical visits (Tables 4 and 5)

Baseline characteristics similarLow riskQuote "…no significant differences between the groups in terms of sex or practice type, either at baseline or at the final medical visit"

Incomplete outcome data (attrition bias)
All outcomes
Low riskDrop-outs indicated in Figure 1. Adjusted for in analysis

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskQuote "The simulated patients were blind to the provider group assignment", however no statement is made about whether coders were blinded

ContaminationUnclear riskSample size is small and recruited from departments of General Internal Medicine and Family Practice of 1 university medical system

Selective reporting (reporting bias)Low riskSee Tables 4 and 5

Other biasHigh riskSampling bias

Janson 2009

MethodsA CBA study that aimed to evaluate interprofessional team-based diabetes care. 120 clinical students received the intervention, while 28 medical residents acted as the control group


ParticipantsMedicine residents, nurse practitioner students, pharmacy students


InterventionsWeekly intervention consisting of didactic presentations, clinical discussions and clinic visits with patients. Quality improvement projects were also developed and implemented. Quarterly patient panel reports also received


OutcomesClinical outcomes, planned visits


NotesAs intervention team members were clinical learners enrolled in different training programmes, they had different rotational schedules, which resulted in a changing team membership


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskQuote "This study was designed as a

nonrandomized, parallel-group clinical trial" (p. 1541)

Allocation concealment (selection bias)High riskEPOC indicates: CBA studies should be scored ‘high risk’

Baseline outcome measurements similar
All outcomes
Low riskReported in Tables 3 and 4 (p. 1544-1545)

Baseline characteristics similarLow riskQuote "Table 2 shows the demographic characteristics of the two cohorts; there were no significant differences between them" (p. 1543)

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskTable 2 has data missing for 1 participant

Blinding of outcome assessment (detection bias)
All outcomes
Low riskData came in from clinical info system directly and loaded into SPSS (p. 1543). Aggregate data stripped of identifiers was analysed (p. 1541)

ContaminationHigh risk1 institution, team members from intervention group could readily interact with control group

Selective reporting (reporting bias)Low riskAll relevant outcomes in the methods section are reported in results

Other biasLow riskStudy patients were pre-assigned to the medicine residents in both groups and were not randomised (p. 1546)

Morey 2002

MethodsCBA study with data gathered 8 months after the intervention. 6 emergency departments received the intervention, while 3 emergency departments acted as the control group


ParticipantsPhysicians, nurses, technicians, and clerks based in 9 teaching and community hospital emergency departments


InterventionsAn 8-hour intervention delivered to groups of physicians, nurses, technicians and clerks involving lectures, discussion of video-taped segments of teamwork and clinical vignettes and interactive teamwork exercises


OutcomesCollaborative behaviour, clinical error rates


NotesAlso gathered survey data which indicated no change in attitudes for participants following the delivery of the IPE intervention


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskQuote "A prospective investigation using a quasi-experimental, untreated control group design" (p. 1556)

Allocation concealment (selection bias)High riskEPOC indicates: CBA studies should be scored ‘high risk’

Baseline outcome measurements similar
All outcomes
Low riskReported in Tables 3 and 4 (pp. 1569-1570)

Baseline characteristics similarLow riskQuote "The control and experimental group patients who participated in the study

were similar in both Period 1 and Period 2…"

(p. 1563)

Incomplete outcome data (attrition bias)
All outcomes
Low riskMissing data was minimal, amounting to 8.1% or less for each of the outcome measures (p. 1563)

Blinding of outcome assessment (detection bias)
All outcomes
Low riskReported use of "blinded raters…" (p. 1566)

ContaminationLow risk9 separate teaching and community hospital sites (p. 1553)

Selective reporting (reporting bias)Low riskReported in Table 2 (pp. 1555-1556)

Other biasLow riskQuote "91 percent agreement rate of observed errors that was significantly above chance,

we feel that the lack of blinding was unlikely to introduce appreciable bias into the observed error results" (p. 1575)

Nielsen 2007

MethodsA cluster RCT to evaluate the effectiveness of an interprofessional intervention aimed at reducing adverse outcomes and improving processes of care in labour and delivery units. Fifteen hospitals were randomised to either receive the intervention (n = 7) or act as the control (n = 8)


ParticipantsObstetricians, anaesthesiologists and nurses


InterventionsA 3-day intervention consisting of 4 hours of didactic lessons, video scenarios, and interactive training covering team structure and processes, planning and problem solving, communication, workload management and team skills, assistance with creation of interprofessional teams by use of onsite training sessions, and an on-call contingency team to respond to obstetric emergencies


OutcomesAdverse maternal/neonatal outcomes, clinical process outcomes


NotesExplanations for lack of significant impact include training not effective, teamwork that results in a detectable impact may require more than a 4-hour training session and more than 4 months to practice behaviours regularly


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskQuote "…a table of random numbers

was used to simulate the toss of a coin" (p. 49)

Allocation concealment (selection bias)Low riskQuote "A balanced, masked randomization scheme at the hospital (cluster) level was implemented by the project biostatistician" (p. 49)

Baseline outcome measurements similar
All outcomes
Low riskReported in Table 3 (p. 52)

Baseline characteristics similarLow riskReported in Table 3 (p. 52)

Incomplete outcome data (attrition bias)
All outcomes
Low riskQuote "All analyses were by intention to treat" (p. 51)

Blinding of outcome assessment (detection bias)
All outcomes
High riskQuote "The trial was not blinded, with personnel at each site aware of their assignment to either the intervention or control arm" (p. 49)

ContaminationUnclear riskHospitals are in different US states but unclear if some personnel may be in contact (e.g. if they are in the military)

Selective reporting (reporting bias)Low riskSee Table 4 (p. 53)

Other biasUnclear riskUnclear if data were collected independently by co-ordinators that were not hospital personnel

Rask 2007

MethodsA CBA study aimed to evaluate an interprofessional fall management quality improvement project in nursing homes

19 nursing homes received the intervention while 23 acted as the control


ParticipantsNurses, physiotherapists, occupational therapists, nursing assistants, maintenance staff


InterventionsA full-day interprofessional workshop and a second follow-up workshop approximately 1 month later to address arising challenges, organisational leadership buy-in and support , a facility-based falls coordinator, ongoing consultation by advanced practice nurses with expertise in falls management


OutcomesCare documentation, fall rates, restraint use


NotesNone


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskConvenience sample of 19 nursing homes (p. 342)

Allocation concealment (selection bias)High riskEPOC indicates: CBA studies should be scored ‘high risk’

Baseline outcome measurements similar
All outcomes
Low riskReported in Table 2 (p. 347)

Baseline characteristics similarLow riskTable 1 indicates no statistically significant differences (p. 346)

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskTable 2 reports results of care processes for 14 of 19 nursing homes – no explanation of missing data on 5 nursing homes

Blinding of outcome assessment (detection bias)
All outcomes
High riskChart audits done by individuals who quote "were not blind to the intervention status of the facilities" (p. 345)

ContaminationHigh riskNursing homes owned and operated by a single non-profit organisation (p. 342)

Selective reporting (reporting bias)High riskChart audits only done on 14 out of 19 intervention nursing homes

Other biasHigh riskNot randomised, chart audit incomplete

Strasser 2008

MethodsCluster RCT involving 31 stroke rehabilitation clinics that were randomised to either receive an IPE intervention designed to improve the care of people who had had a stroke (n = 15) or act as a control group (n = 16)


ParticipantsPhysicians, nurses, occupational therapists, speech-language pathologists, physiotherapists and social workers


InterventionsA 6-month intervention consisting of an interactive workshop emphasising team dynamics, problem solving, and the use of performance feedback data and action plans for process improvement. Follow-up telephone and video-conference consultations were also offered


OutcomesFunctional gains, length of stay, rates of community discharge


NotesNone


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskQuote "…randomized sites to either intervention or control group using a computer…" (pp. 11-12)

Allocation concealment (selection bias)Low riskQuote "…randomized sites to either intervention or control group using a computer…" (pp. 11-12)

Baseline outcome measurements similar
All outcomes
Low riskReported in Table 2

Baseline characteristics similarLow riskReported in Table 1. Description of adjustments in analyses (pp. 12-13)

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskAcknowledge sites dropped out but do not discuss if necessary to adjust analyses (p. 12)

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskNot reported if data collectors and assessors were blinded

ContaminationLow riskSites randomised across US

Selective reporting (reporting bias)Unclear riskLack of reporting on sites that dropped out of study

Other biasUnclear riskLack of reporting on sites that dropped out of study

Taylor 2007

MethodsAn ITS study to assess the effects of an IPE intervention on the delivery of standard diabetes services and clinical outcomes for patients based at 1 site


ParticipantsHealthcare professionals based in a single primary care clinic


InterventionsAn education intervention that aimed to improve communication, teamwork, workflow to improve diabetes care and patient outcomes. The intervention included task redistribution, standardised communication and decision-support tool development


OutcomesRates of diabetes testing, clinical outcomes


NotesParticipants are reported as a "team" but different professional groups are not described. Clinicians and staff revised existing diabetes care protocols and processes using the American Diabetes Association clinical guidelines. The new process and diabetes checklist were implemented


Risk of bias

BiasAuthors' judgementSupport for judgement

Incomplete outcome data (attrition bias)
All outcomes
Low riskPre-intervention visit and post-intervention visit reported for 277 individuals (p. 246)

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskNot reported

Selective reporting (reporting bias)High riskTable 2 analyses reported inconsistently for 3 months or 12 months (p. 246)

Other biasHigh riskLack of a control group (p. 247)

Intervention independent of other changesUnclear riskLack of a comparator as no control group in the study

Shape of intervention effect pre-specifiedLow riskPoint of analysis is the point of intervention

Intervention unlikely to affect data collectionUnclear riskNot reported

Thompson 2000a

MethodsRCT involving 59 primary care practices which were randomly assigned to an intervention group (29 practices) or a control group (30 practices)


ParticipantsPhysician and nursing teams from the participating primary care practices


Interventions4-hour seminar delivered to the primary healthcare teams. The seminars included video-tapes, small group discussion of cases, and role play


OutcomesRecognition and treatment of patient depression


NotesWhile actual number of physicians is reported (n = 152), actual number of nurses is not recorded. Qualitative data relating to participants' views of the intervention were also gathered


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskQuote "Practices were randomly assigned by computer" (p. 186)

Allocation concealment (selection bias)Low riskQuote "Practices were randomly assigned by computer" (p. 186)

Baseline outcome measurements similar
All outcomes
Low riskQuote "Analyses controlled for ... baseline differences in outcome measures between groups" (p. 187)

Baseline characteristics similarLow riskQuote "Randomisation produced adequate matching between the intervention and control groups" (p. 188).  Also reported in Table 2

Incomplete outcome data (attrition bias)
All outcomes
High riskAn intention-to-treat analysis was reported (p. 187)

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskNot reported

ContaminationLow riskSites were geographically spread across county of Hampshire

Selective reporting (reporting bias)Low riskReported in Tables 4 and 5

Other biasHigh riskLarge drop-out rates reported in the control group

Thompson 2000b

MethodsRCT involving 5 clinics which were randomly assigned to 2 intervention groups and 3 control groups. Follow-up data were gathered at 9-10 months and 21-23 months


ParticipantsPrimary care practice teams of physicians, nurse practitioners, physician assistants, registered nurses, licensed practical nurses, medical assistants


Interventions2 half-day training sessions based on Precede/Proceed model for behaviour change; 3 extra training sessions for opinion leaders, newsletter, 4 additional educational sessions to teams, system support (e.g. posters in waiting areas, cue cards for providers)


OutcomesProvider knowledge, attitudes and beliefs, rates of asking, case finding, quality of assistance


NotesUnvalidated survey and qualitative data on provider views of the intervention were gathered


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskNot specified

Allocation concealment (selection bias)Unclear riskNot specified

Baseline outcome measurements similar
All outcomes
Low riskReported in Table 2 (p. 258)

Baseline characteristics similarLow risk"Intervention and control groups at baseline did not differ…" (p. 256)

Incomplete outcome data (attrition bias)
All outcomes
Low riskAdjustments in analysis made for this (p. 256)

Blinding of outcome assessment (detection bias)
All outcomes
Low riskQuote "Chart abstractors, blinded to intervention status, ascertained any mention of possible DV in the records" (p. 256)

ContaminationLow riskClinics spread across large metropolitan area (p 254)

Selective reporting (reporting bias)Low riskReported in Table 2 (p. 258)

Other biasHigh riskSmall number of clinics (p. 260)

Weaver 2010

MethodsA CBA study to evaluate an interprofessional intervention designed to improve team-based collaboration for operating room clinicians. Staff at 1 hospital site received the intervention, while staff based at 1 other site acted as a control


ParticipantsSurgeons, nurses, surgical technicians, anaesthesiologists, physician assistants


InterventionsThe intervention consisted of a 4-hour session which included interactive role-playing activities between participants


OutcomesObserved collaborative behaviour between participants


NotesOther outcomes reported included changes in perceptions and attitudes from the use of the Hospital Survey on Patient Safety Culture and Operating Room Management Attitudes Questionnaire


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskQuote "teams...volunteered to participate in the training and evaluation efforts" (p. 135)

Allocation concealment (selection bias)High riskEPOC indicates: CBA studies should be scored ‘high risk’

Baseline outcome measurements similar
All outcomes
High riskReported in Tables 3 and 4 (p. 136-137)

Baseline characteristics similarUnclear riskNot reported (p. 135)

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskFor example, analyses not conducted for initial observations with regards to debriefing (p. 139)

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskNot reported if observers were blinded (p. 137)

ContaminationLow riskGroups located at separate campuses (p. 133)

Selective reporting (reporting bias)Unclear riskFor example, analyses not conducted for initial observations with regards to debriefing (p. 139)

Other biasUnclear riskObservation tool not validated (p. 137). Small sample size of volunteers used in the study. Attrition of control group (p. 139)

Young 2005

MethodsCBA study involving 2 mental health provider organisations which received the intervention, while 3 acted as the control group


ParticipantsPsychiatrists, mental health nurses, therapists, case managers


Interventions6 educational components delivered over 1 year involving presentations, small group discussions, role play and 3- to 4-day detailing visits

16 hours of follow-up discussions to monitor progress


OutcomesPractitioner professional competencies


NotesSemi-structured interviews were gathered to qualitatively explore the effects of the intervention in more detail


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskQuote "This study used a quasi-experimental

design" (p. 968)

Allocation concealment (selection bias)High riskEPOC describes that CBAs should be scored high for first 2 items

Baseline outcome measurements similar
All outcomes
Low riskReported in Tables 4 and 5

Baseline characteristics similarHigh riskSite selection based on clinics which "served a large population with severe and persistent mental illness, and provided similar types of services" (p. 986)

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskAnalyses undertaken "using multiple imputation to replace missing data" (p. 970)

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskNot reported

ContaminationLow riskSites based in 2 US states – Quote "each state included both intervention and control organizations, ensuring that external events would not be confounded with the intervention" (p. 986)

Selective reporting (reporting bias)Low riskSee Tables 4 and 5

Other biasHigh riskSmall sample size, authors did not measure change in the appropriateness of care or client outcomes (p. 974)

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Ammentorp 2007Not an IPE intervention

Anderson 2009Not an RCT, CBA or ITS

Antunez 2003Post-intervention study design

Armitage 2009Not an RCT, CBA or ITS

Barrett 2001Description of IPE intervention that reports no outcomes

Barton 2006Not an IPE intervention. 1 group pre-/post-test study design

Bashir 2000Not an IPE intervention

Bauer 2009Not an IPE intervention

Beal 2006Not an IPE intervention

Belardi 2004Not an IPE intervention

Bell 2000Not an IPE intervention

Bellamy 20061 group pre-/post-test study design

Benjamin 1999Not an IPE intervention

Berg 2009Not an RCT, CBA or ITS

Berggren 2008Not an IPE intervention

Birch 2007Not an RCT, CBA or ITS

Bluespruce 20011 group pre-/post-test study design

Boyle 20041 group pre-/post-test study design

Bradshaw 2011Not an IPE intervention

Buck 1999Post-intervention study design

Burns 2003Not an IPE intervention

Buxton 2004Not an IPE intervention

Cameron 2009Not an IPE intervention

Carew 2001Post-intervention study design

Cobia 1995Before and after study with no controls

Coggrave 2001Not an IPE intervention

Connolly 1995Post-intervention study with no controls

Cooper 2005A CBA study that gathered self report data related to attitudes and knowledge change

Corso 20061 group post-intervention study design

Crutcher 2004A clinical controlled trial of an IPE intervention. Reports outcomes related to self reported knowledge change

Dacey 2010Not an RCT, CBA or ITS

Dalton 1999Not an IPE intervention

DeVita 20051 group post-intervention study design

Dienst 1981CBA study. Failed to meet comparison group criteria

Dobson 20021 group pre-/post-test study design

Falconer 1993Post-intervention study with control group. Failed to meet comparison group criteria

Fields 2005Not an IPE intervention

Gandara 2010Not an IPE intervention

Hanson 2005Not an IPE intervention

Harmon 19985-year longitudinal study with no controls

Hayward 1996Before and after study with no controls

Hien 2008Not an IPE intervention

Hook 20031 group post-intervention study design

Hope 20051 group pre-/post-intervention study design

Horbar 2001Not an IPE intervention

Hughes 2000Descriptive study

James 20051 group pre-/post-intervention study design

Jones 2006Not an IPE intervention

Jordan-Marsh 20041 group pre-/post-test study with follow-up data collection points

Kenward 2009Not an RCT, CBA or ITS

Ketola 2000Not an IPE intervention

Kwan 2006Outcomes did not meet inclusion criteria

Landon 2004Not an IPE intervention

Lawrence 2002Not an IPE intervention

Lia-Hoagberg 1997Before and after study with no controls

Llewellyn-Jones 1999Not an IPE intervention

McBride 2000Not an IPE intervention

Monette 2008Not an IPE intervention

Nash 1993Before and after study with no controls

O'Boyle 1995Before and after study with no controls

Olivecrona 2010Not an RCT, CBA or ITS

Ouslander 2001Not an IPE intervention

Phillips 2002Not an IPE intervention

Price 2005Not an IPE intervention

Rogowski 2001Not an IPE intervention

Rubenstein 1999Not an IPE intervention

Ryan 2002Not an IPE intervention

Sauer 2010Not an IPE intervention

Smarr 2003Not an IPE intervention

Smith 20051 group pre-/post-intervention study design

Stewart 2010Not an IPE intervention

Taylor 2002Not an IPE intervention

Thomas 2007Not an IPE intervention

Trummer 2006No control group

Tschopp 20051 group pre-/post-intervention study design

Umble 2003Not an IPE intervention

Unutzer 2001Not an IPE intervention

Ward 2004Not an IPE intervention

Wells 2000Not an IPE intervention

Westfelt 2010Not an RCT, CBA or ITS

Wisborg 2009Not an RCT, CBA or ITS

 
Summary of findings for the main comparison.

Interprofessional education to improve professional practices

Patient or population: professionals or patients involved in interprofessional education intervention

Settings: primarily USA and the UK

Intervention: use of interprofessional education to improve collaboration and patient care

Comparison: separate, profession-specific education interventions; or no education intervention

OutcomesImpactsNo of studiesQuality of the evidence
(GRADE)*

Patient outcomesThe care provided by use of interprofessional education may lead to improved outcomes for patients6⊕⊕⊖⊖

Low

Adherence ratesThe use of interprofessional education may lead to changes in the use of guidelines or standards (e.g. adherence to clinical guidelines) among different professions3⊕⊕⊖⊖

Low

Patient satisfactionPatients may be more satisfied with care provided by professionals who have participated in an interprofessional education intervention2⊕⊕⊖⊖

Low

Clinical process outcomesChanges in clinical processes (e.g. shared decisions on surgical incisions) may be linked to the use of interprofessional education1⊕⊕⊖⊖

Low

Collaborative behaviourWe are unable to assess adequately the extent to which different professions behave collaboratively in the delivery of care to patients3⊕⊖⊖⊖

Very low

Error ratesWe are unable to assess adequately the reduction of error due to improved interprofessional education1⊕⊖⊖⊖

Very low

Practitioner competenciesWe are unable to assess adequately the competencies (e.g. skills, knowledge) of professionals to work together in the delivery of care1⊕⊖⊖⊖

Very low


*GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.