Editor’s note: Viewpoint highlights the thoughts, opinions, and expertise of well-known nurse leaders. We welcome your comments about these thought-provoking articles.
A much-anticipated and much-heralded report released by the Institute of Medicine late last year, The Future of Nursing: Leading Change, Advancing Health, included several key recommendations for improving health and health care in the U.S. The report committee’s recommendation that opportunities be expanded “for nurses to lead and diffuse collaborative improvement efforts,” highlights the need to foster interprofessional collaboration among health care providers. That is, ensuring that nurses are full partners with physicians and other health care professionals in redesigning health care. I wholeheartedly agree with the committee’s assertion that this approach will provide all patients with the care they need in the communities in which they live.
This idea is not new, nor is it untested. Interprofessional, or interdisciplinary, collaboration is one of the hallmarks of several highly successful health care innovations. Ongoing research in this area continues to produce results showing that in settings where nurses collaborate as equals with other health care providers, patient outcomes and quality of care both improve.
With the pending dramatic changes to our health care system, proven approaches for improving care and reducing costs, like interdisciplinary collaboration among providers—and among researchers— will become increasingly important. Accountable care organizations and patient-centered medical homes are two health care models in the Affordable Care Act that benefit from interprofessional collaboration. As our population ages, the need for effective, high quality models of care will only increase.
An evidence-based approach that highlights the contributions of nurse-led, team-based care is the Transitional Care Model (TCM), which fills a major gap in health care delivery – the transition from hospital to home – during which up to one third of preventable and costly re-hospitalizations occur. TCM focuses on chronically ill high-risk older adults who have been hospitalized for common medical or surgical conditions. The centerpiece is an APRN who follows patients from the hospital to home and coordinates with a health care team that includes physicians, nurses, social workers, discharge planners, pharmacists and other providers to ensure continuity of care, prevention and avoidance of complications and close clinical treatment and management. TCM also involves partnerships with patients and their caregivers, who collaborate on the discharge plan and implement that plan in the patients’ homes. Three clinical trials funded by the National Institute of Nursing Research consistently demonstrated that the TCM improves the quality of care and reduces costs, especially those associated with re-hospitalization. Preliminary outcomes from an ongoing clinical trial comparing the TCM to other evidence-based approaches among hospitalized cognitively impaired older adults reinforce the capacity of this model to improve care and outcomes and reduce costs.
Interprofessional collaboration is not, of course limited to transitional care. It has the potential to influence advances in knowledge that span health promotion, care of the chronically ill and end of life care. The Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative (INQRI) is a prime example of interprofessional collaboration among scholars from nursing and many other disciplines such as social scientists. This important initiative is uncovering the linkages between nursing and the quality of patient care. Studies supported by INQRI are exploring the importance of collaborations between health care professionals, making the case to provide nurses with an equal role in providing care, deciding on courses of care and making decisions about how health care systems operate.
Among the research funded by INQRI, are:
- an intervention study which applies a nurse-led, inter-professional program of delirium screening, prevention, and treatment to improve the care and outcomes of critically ill adults;
- an investigation to determine the effectiveness of a toolkit to prevent patient falls that involves a support intervention and an individualized evidence-based care plan accessible to all members of the health care team working with that patient;
- an evaluation of a nurse-pharmacist clinical coordination team to determine how well this approach improves medication reconciliation management on admission and discharge, as well as a cost-benefit analysis of the approach; and
- a study to identify the changes needed in nursing care processes, staffing and the practice environment that help to facilitate prevention or interception of medication errors. The team found that hospitals where nurses and physicians had good collaborative relationships and those that allowed nurses to participate in organizational decisions had better outcomes.
This is a small sample of the myriad interprofessional studies funded by INQRI. In addition to learning more about how collaboration and shared leadership in care settings improve quality of care and patient outcomes, INQRI research teams have learned more about how collaborations with other disciplines add tremendous value to research and its translation. Lessons learned will prove invaluable as our health care system continues to evolve and interprofessional collaboration becomes more widespread and more important.
There’s no question that interprofessional collaboration improves patient outcomes and quality of care. What’s more, in research, it allows for more fulsome approaches to the questions asked, the methodology used and the analysis of results. Collaboration across disciplines allows professionals to bring their particular expertise and experiences to influence the nature of the questions and proposed solutions to the priority health care issues our country is confronting. These diverse perspectives provide a fuller and more complete picture and understanding of how and where we need to improve our systems to ensure better care for all Americans.
Mary D. Naylor, PhD, FAAN, RN, is the Marian S. Ware Professor in Gerontology and Director of NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia.