Weppner William G, Davis Kyle, Sordahl Jeffrey, Willis Janet, Fisher Amber, Brotman Adam, Tivis Rick, Gordon Tim, Smith C Scott
W.G. Weppner is codirector and physician associate director, Boise VA Center of Excellence for Primary Care Education, Boise, Idaho, and assistant professor, Division of General Internal Medicine, University of Washington, Seattle, Washington. K. Davis is clinical psychologist, Saint Luke's Mountain States Tumor Institute, Boise, Idaho. J. Sordahl is neuropsychology postdoctoral fellow, South Texas Veterans Health Care System, San Antonio, Texas. J. Willis is nursing associate director, Boise VA Center of Excellence for Primary Care Education, Boise, Idaho. A. Fisher is codirector and pharmacy associate director, Boise VA Center of Excellence for Primary Care Education, Boise, Idaho. A. Brotman is psychology associate director, Boise VA Center of Excellence for Primary Care Education, Boise, Idaho. R. Tivis is statistician, Boise VA Center of Excellence for Primary Care Education, Boise, Idaho. T. Gordon is data manager, Boise VA Center of Excellence for Primary Care Education, Boise, Idaho. C.S. Smith is national physician consultant, VA Centers of Excellence for Primary Care Education, and professor, Division of General Internal Medicine and Medical Education, University of Washington, Seattle, Washington.
Acad Med. 2016 Jun;91(6):798-802. doi: 10.1097/ACM.0000000000001151.
As health care systems convert to team-based care, the need to improve interprofessional education is tremendous. In addition to formal instruction, trainees need authentic team-based workplace learning experiences.
The authors designed the PACT-ICU (Patient-Aligned Care Team Interprofessional Care Update) conference to provide team-based care to high-risk patients while teaching trainees principles of interprofessionalism and modeling relevant behaviors. Trainees, supervisors, and affiliated support staff from the fields of internal medicine, nurse practitioner, pharmacy, psychology, and nursing all participate in this conference. During the conference, each participant focuses on the narrative of the patient's illness from his/her own professional perspective. A multifaceted care plan with specific action items is the product of the conference. To evaluate this workplace learning opportunity, the authors recorded patient characteristics, plus trainees' participation and satisfaction.
Over the first 16 months (2013-2014) of the PACT-ICU, 33 trainees presented 79 patients. Each trainee presented two or three times each academic year. Patients were 90% male; their mean age was 64.5 years (SD 9.3, range 28-92), and their mean calculated 90-day risk of death or hospitalization was 22% (SD 14%, range 1%-45%).Overall, all surveyed trainees (n = 32; 97% response rate) expressed satisfaction, reporting that the conference was "helpful" or "very helpful" in developing treatment plans.
Further assessment of change in trainee behavior related to interprofessional team care, patient-level outcomes (e.g., quality of care and utilization), and factors facilitating dissemination of the model to other academic clinic settings is necessary.
随着医疗保健系统向基于团队的护理模式转变，改善跨专业教育的需求极为迫切。除了正规教学外，学员还需要基于团队的真实工作场所学习体验。
作者设计了PACT-ICU（患者协作护理团队跨专业护理更新）会议，在为高危患者提供基于团队的护理的同时，向学员传授跨专业原则并展示相关行为。来自内科、执业护士、药学、心理学和护理领域的学员、主管及附属支持人员均参与了此次会议。会议期间，每位参与者从自身专业角度关注患者的病情叙述。会议成果是一份包含具体行动项目的多方面护理计划。为评估这一工作场所学习机会，作者记录了患者特征以及学员的参与情况和满意度。
在PACT-ICU的头16个月（2013 - 2014年），33名学员展示了79例患者。每位学员每学年展示两到三次。患者中90%为男性；他们的平均年龄为64.5岁（标准差9.3，范围28 - 92岁），其计算得出的90天死亡或住院风险平均为22%（标准差14%，范围1% - 45%）。总体而言，所有接受调查的学员（n = 32；回复率97%）均表示满意，称该会议在制定治疗计划方面“有帮助”或“非常有帮助”。
有必要进一步评估学员与跨专业团队护理相关行为的变化、患者层面的结果（如护理质量和利用率），以及促进该模式向其他学术诊所环境推广的因素。
