Transcript An Introduction to IMPACT

An Introduction to IMPACT
Sunnybrook Health Sciences Centre
GiiC
Knowledge-to-Practice Workshop
Presenters: Susan Riddle & Jasmine Arellano
What it is
• Interprofessional Model of Practice for
Aging and Complex Treatment
• A comprehensive model of:
– Assessment
– Care
– Mentorship and training
– Planning
What it is
• An interdisciplinary team works with
patient, caregiver(s), and referring
practitioner
– Typical appointment covers a diverse range of
medical, functional and psycho-social issues
– Goal: ‘unpack’ the patient’s condition
– Takes 2-3 hours
– Complements family practitioners’ care
What it is
• Room to personalize process according to
context
– Builds on unique characteristics of the patient
being assessed
– Builds on unique characteristics of the team in
place
IMPACT HCPs
• The team comprises:
– Family physician
– Family physician resident
– Pharmacist
– Occupational therapist
– Physiotherapist
– Community nurse
– Social worker
– Dietician
Patient on
Screen
Doctor
Resident 1
HCP learner
Resident 2
Physio
OT
Researchers
Dietician
Pharmacist
Community
Nurse
Social Worker
The IMPACT patient
• Inclusion criteria
– aged 65+
– 5 or more long term medications
– 3 or more chronic disease requiring monitoring and
treatment OR 2 chronic diseases when one is
frequently unstable
– minimum of 1 functional ADL limitation
– not home-bound or institutionalized
– patient and/or caregiver is willing and able to
deliberate with a team
– patient and/or caregiver are motivated to take action
to improve patient’s health status and patient is
emotionally/cognitively/socially equipped to do so
The IMPACT protocol
Documentation
& Debrief
Patient Selection
& Invitation
Team
Deliberation
Group
Discussion 1
Patient
Welcome &
Initial Patient
Interview
HCP
Assessments
Group
Discussion 2
Patient Selection & Invitation
• Selection based on
inclusion criteria
• Invitation extended to
patient/caregiver
Documentation &
Debrief
Patient Selection
& Invitation
Team
Deliberation
Group Discussion
1
Patient Welcome
& Initial Patient
Interview
HCP Assessments
Group Discussion
2
Group Discussion 1
• Referring practitioner
provides background info:
– Brief history
– Recent events
– Current issues/concerns
– Patient’s support systems
– Rationale for bringing
patient to IMPACT
Documentation &
Debrief
Patient Selection
& Invitation
Team
Deliberation
Group Discussion
1
Patient Welcome
& Initial Patient
Interview
HCP Assessments
Group Discussion
2
Patient Welcome &
Initial Patient Interview
• Patient and caregiver
greeted
• Patient and caregiver
interviewed, team observes
and gathers data on:
– Current concerns, current
function; patient and family
goals and perspectives
– Interviewer summarizes
patient and family concerns
Documentation &
Debrief
Patient Selection
& Invitation
Team
Deliberation
Group Discussion
1
Patient Welcome
& Initial Patient
Interview
HCP Assessments
Group Discussion
2
Group Discussion 2
• Interviewer debriefs team
and priorities for visit are
identified
– Issues and concerns
– Which HCPs will see
patient and caregiver
– Additional information
needed?
Documentation &
Debrief
Patient Selection
& Invitation
Team
Deliberation
Group Discussion
1
Patient Welcome
& Initial Patient
Interview
HCP Assessments
Group Discussion
2
HCP assessments
• Relevant HCPs perform assessments of
patient, caregiver
– Social worker
– Occupational therapist
– Physical therapist
– Nurse
– Dietitian
– Pharmacist
Documentation &
Debrief
Patient Selection
& Invitation
Team
Deliberation
Group Discussion
1
Patient Welcome
& Initial Patient
Interview
HCP Assessments
Group Discussion
2
Team Deliberation
• HCPs discuss situation in
light of findings of team
members’ assessments
• Investigation/treatment
options discussed
• Care plan begins to take
shape
Documentation &
Debrief
Patient Selection
& Invitation
Team
Deliberation
Group Discussion
1
Patient Welcome
& Initial Patient
Interview
HCP Assessments
– What does the
patient/caregiver want?
– What can the patient achieve?
Group Discussion
2
Documentation and Debrief
• Dialogue with patient/ caregiver
to ensure their needs and
expectations have been met
• Patient plan of care negotiated
with input from patient and
caregiver/family
• Resources and patient to-do
list provided
• Patient medical records
completed
Documentation &
Debrief
Patient Selection
& Invitation
Team
Deliberation
Group Discussion
1
Patient Welcome
& Initial Patient
Interview
HCP Assessments
Group Discussion
2
Patient Follow-up
• Follow-up visit with FP and care plan
review
• Community visits from IMPACT team
members
• Ongoing team communication
Highlights of the
IMPACT experience
• Very different from patients’ typical encounters
with their family physician
• Group discussion, shared observation
• Final recommendations arrived at through a
collaborative and interprofessional process
• Effectiveness
– Real-time problem solving
– Addressing patient and caregiver priorities
– Avoids multiple referrals
Highlights of the
IMPACT experience
• Shared knowledge and perspectives
–
–
–
–
Sharing of expertise, knowledge
Different professional and personal approaches
Opportunity to draw on expertise of entire team
“Interprofessional collaborative knowledge
construction”
• Observation
– Can see interactions
– Referring FP sees patient in a “new light”
IMPACT Successes
Appeal to patients and caregivers
• Patients feel better able to express themselves
with longer appointments
– “...so within the first 10-15 minutes, mom has a
comfort level that she never had before and is more
forthcoming than ever.” –Family member
• Patients feel that they are being listened to
– “IMPACT is a huge improvement. They’re hearing the
patient, finally they are, they have the time.” –Family
member
Appeal to patients and caregivers
• Patients felt important and supported by
the care team
– “ Well, it was just wonderful. I felt taken care
of… I felt um, I hate to say this, special” –
Patient
Thank you!
• Questions?
• "Frail older patients – unlike younger persons in the
health care system or even well elders – require complex
care. Most frail older patients have multiple chronic
illnesses. Optimum care cannot be achieved by following
the paradigm of ongoing traditional health care, which
emphasizes disease and cure. Because no one health
care professional can possibly have all of the specialized
skills required to implement such a model of health care
delivery, interdisciplinary team care has evolved.”
– Dyer et al. Frail Older Patient Care by Interdisciplinary Teams.
Gerontology & Geriatrics Education 2004;24(2): 51-62.