A preliminary exploration of the impact of accreditation on interprofessional education using a modified Delphi analysis

AbstractSurgical site infections represent a considerable burden for healthcare systems. To obtain a consensus on the impact and future clinical and economic needs regarding SSI management in an era of multidrug resistance. A modified Delphi method was used to obtain consensus among experts from five European countries. The Delphi questionnaire was assembled by a steering committee, verified by a panel of experts and administered to 90 experts in 8 different surgical specialities (Abdominal, Cancer, Cardiac, General surgery, Orthopaedic, Thoracic, Transplant and Vascular and three other specialities (infectious disease, internal medicine microbiology). Respondents (n = 52) reached consensus on 62/73 items including that resistant pathogens are an increasing matter of concern and increase both treatment complexity and the length of hospital stay. There was strong positive consensus on the cost-effectiveness of early discharge (ED) programs, improvement of quality of life with ED and association between increased length of stay and economic burden to the hospital. However, established ED protocols were not widely available in their hospitals. Respondents expressed a positive consensus on the usefulness of antibiotics that allow ED. Surgeons are aware of their responsibility in an interdisciplinary team for the treatment of SSI, and of the impact of multidrug-resistant bacteria in the context of SSI. Reducing the length of hospital stays by applying ED protocols and implementing new treatment alternatives is crucial to reduce harm to patients and costs for the hospital.

Download Full-text

Sustainability of Biosimilars in Europe: A Delphi Panel Consensus with Systematic Literature Review

Pharmaceuticals ◽

10.3390/ph13110400 ◽

2020 ◽

Vol 13 (11) ◽

pp. 400

Author(s):

Arnold G. Vulto ◽

Jackie Vanderpuye-Orgle ◽

Martin van der Graaff ◽

Steven R. A. Simoens ◽

Lorenzo Dagna ◽

...

Keyword(s):

Health Care ◽

Literature Review ◽

Systematic Literature Review ◽

Health Care Systems ◽

Delphi Panel ◽

The European Union ◽

Modified Delphi ◽

Care Systems ◽

Supply Risks ◽

The Impact

Introduction: Biosimilars have the potential to enhance the sustainability of evolving health care systems. A sustainable biosimilars market requires all stakeholders to balance competition and supply chain security. However, there is significant variation in the policies for pricing, procurement, and use of biosimilars in the European Union. A modified Delphi process was conducted to achieve expert consensus on biosimilar market sustainability in Europe. Methods: The priorities of 11 stakeholders were explored in three stages: a brainstorming stage supported by a systematic literature review (SLR) and key materials identified by the participants; development and review of statements derived during brainstorming; and a facilitated roundtable discussion. Results: Participants argued that a sustainable biosimilar market must deliver tangible and transparent benefits to the health care system, while meeting the needs of all stakeholders. Key drivers of biosimilar market sustainability included: (i) competition is more effective than regulation; (ii) there should be incentives to ensure industry investment in biosimilar development and innovation; (iii) procurement processes must avoid monopolies and minimize market disruption; and (iv) principles for procurement should be defined by all stakeholders. However, findings from the SLR were limited, with significant gaps on the impact of different tender models on supply risks, savings, and sustainability. Conclusions: A sustainable biosimilar market means that all stakeholders benefit from appropriate and reliable access to biological therapies. Failure to care for biosimilar market sustainability may impoverish biosimilar development and offerings, eventually leading to increased cost for health care systems and patients, with fewer resources for innovation.

Download Full-text

Use of a Structured Panel Process to Define Quality Metrics for Antimicrobial Stewardship Programs

Infection Control and Hospital Epidemiology ◽

10.1086/665324 ◽

2012 ◽

Vol 33 (5) ◽

pp. 500-506 ◽

Cited By ~ 62

Author(s):

Andrew M. Morris ◽

Stacey Brener ◽

Linda Dresser ◽

Nick Daneman ◽

Timothy H. Dellit ◽

...

Keyword(s):

Quality Improvement ◽

Antimicrobial Stewardship ◽

Bloodstream Infections ◽

The United States ◽

Community Acquired Pneumonia ◽

Public Reporting ◽

Modified Delphi ◽

Number Of Patients ◽

Days Of Therapy ◽

The Impact

Introduction.Antimicrobial stewardship programs are being implemented in health care to reduce inappropriate antimicrobial use, adverse events, Clostridium difficile infection, and antimicrobial resistance. There is no standardized approach to evaluate the impact of these programs.Objective.To use a structured panel process to define quality improvement metrics for evaluating antimicrobial stewardship programs in hospital settings that also have the potential to be used as part of public reporting efforts.Design.A multiphase modified Delphi technique.Setting.Paper-based survey supplemented with a 1-day consensus meeting.Participants.A 10-member expert panel from Canada and the United States was assembled to evaluate indicators for relevance, effectiveness, and the potential to aid quality improvement efforts.Results.There were a total of 5 final metrics selected by the panel: (1) days of therapy per 1000 patient-days; (2) number of patients with specific organisms that are drug resistant; (3) mortality related to antimicrobial-resistant organisms; (4) conservable days of therapy among patients with community-acquired pneumonia (CAP), skin and soft-tissue infections (SSTI), or sepsis and bloodstream infections (BSI); and (5) unplanned hospital readmission within 30 days after discharge from the hospital in which the most responsible diagnosis was one of CAP, SSTI, sepsis or BSI. The first and second indicators were also identified as useful for accountability purposes, such as public reporting.Conclusion.We have successfully identified 2 measures for public reporting purposes and 5 measures that can be used internally in healthcare settings as quality indicators. These indicators can be implemented across diverse healthcare systems to enable ongoing evaluation of antimicrobial stewardship programs and complement efforts for improved patient safety.

Download Full-text

Training interprofessional faculty in humanism and professionalism: a qualitative analysis of what is most important

International Journal of Whole Person Care ◽

10.26443/ijwpc.v9i1.340 ◽

2022 ◽

Vol 9 (1) ◽

pp. 46-47

Author(s):

Elizabeth A Rider ◽

Deborah D. Navedo ◽

William T. Branch, Jr.

Keyword(s):

Identity Formation ◽

Learning Environments ◽

Interprofessional Education ◽

Well Being ◽

Care Quality ◽

Self Awareness ◽

Use Of Self ◽

Important Thing ◽

Relational Capacities ◽

The Impact

Introduction: The capacity of healthcare professionals to work collaboratively influences faculty and trainees’ professional identity formation, well-being, and care quality. Part of a multi-institutional project*, we created the Faculty Fellowship for Leaders in Humanistic Interprofessional Education at Boston Children’s Hospital/ Harvard Medical School. We aimed to foster trusting relationships, reflective abilities, collaboration skills, and work together to promote humanistic values within learning environments. Objective: To examine the impact of the faculty fellowship from participants’ reports of “the most important thing learned”. Methods: We studied participants’ reflections after each of 16 1½ hour fellowship sessions. Curriculum content included: highly functioning teams, advanced team formation, diversity/inclusion, values, wellbeing/renewal/burnout, appreciative inquiry, narrative reflection, and others. Responses to “What was the most important thing you learned?” were analyzed qualitatively using a positivistic deductive approach. Results: Participants completed 136 reflections over 16 sessions–77% response rate (136/176). Cohort was 91% female; mean age 52.6 (range 32-65); mean years since completion of highest degree 21.4; 64% held doctorates, 36% master’s degrees. 46% were physicians, 27% nurses, 18% social workers, 9% psychologists. 27% participated previously in a learning experience focusing on interprofessional education, collaboration or practice. Most important learning included: Relational capacities/ Use of self in relationships 96/131 (73%); Attention to values 46/131 (35%); Reflection/ Self-awareness 44/131 (34%); Fostering humanistic learning environments 21/131 (16%). Discussion: Results revealed the importance of enhancing relational capacities and use of self in relationships including handling emotions; attention to values; reflection/self-awareness and recognition of assumptions; and fostering humanistic learning environments. These topics should receive more emphasis in interprofessional faculty development programs and may help identify teaching priorities. *Supported in part by a multi-institutional grant from the Josiah Macy, Jr. Foundation (Dr. Branch as PI; Dr. Rider as site PI).

Download Full-text

Power and physician leadership

BMJ Leader ◽

10.1136/leader-2019-000139 ◽

2019 ◽

Vol 3 (3) ◽

pp. 92-98 ◽

Cited By ~ 3

Author(s):

Anurag Saxena ◽

Diane Meschino ◽

Lara Hazelton ◽

Ming-Ka Chan ◽

David A Benrimoh ◽

...

Keyword(s):

Interprofessional Education ◽

Meaning Making ◽

Well Being ◽

Power Bases ◽

Physician Leadership ◽

Abuse Of Power ◽

Inappropriate Use ◽

Physician Leaders ◽

Study Power ◽

The Impact

Power and leadership are intimately related. While physician leadership is widely discussed in healthcare, power has received less attention. Formal organisational leadership by physicians is increasingly common even though the evidence for the effectiveness of physician leadership is still evolving. There is an expectation of leadership by all physicians for resource stewardship. The impact of power on interprofessional education and practice needs further study. Power also shapes the profession’s attempts to address physician and learner well-being with its implications for patient care. Unfortunately, the profession is not exempt from inappropriate use of power. These observations led the authors to explore the concept and impact of power in physician leadership. Drawing from a range of conceptualisations including structuralist (French and Raven), feminist (Allen) and poststructuralist (Foucault) conceptualisations of power, we explore how power is acquired and exercised in healthcare systems and enacted in leadership praxis by individual physician leaders (PL). Judicious use of power will benefit from consideration and application of a range of concepts including liminality, power mediation, power distance, inter-related use of power bases, intergroup and shared leadership, inclusive leadership, empowerment, transformational leadership and discourse for meaning-making. Avoiding abuse of power requires moral courage, and those who seek to become accountable leaders may benefit from adaptive reflection. Reframing ‘followers’ as ‘constituents or citizens’ is one way to interrupt discourses and narratives that reinforce traditional power imbalances. Applying these concepts can enhance creativity, cocreation and citizenship-strengthening commitment to improved healthcare. PLs can contribute greatly in this regard to further transform healthcare.

Download Full-text

Defining colchicine resistance/intolerance in patients with familial Mediterranean fever: a modified-Delphi consensus approach

Rheumatology ◽

10.1093/rheumatology/keaa863 ◽

2020 ◽

Author(s):

Seza Özen ◽

Erdal Sag ◽

Eldad Ben-Chetrit ◽

Marco Gattorno ◽

Ahmet Gül ◽

...

Keyword(s):

Familial Mediterranean Fever ◽

Nominal Group ◽

Evidence Based ◽

Delphi Consensus ◽

Modified Delphi ◽

Health Authorities ◽

Colchicine Resistance ◽

Mediterranean Fever ◽

Definition Of ◽

The Impact

Abstract Objectives Colchicine is the main treatment for familial Mediterranean fever (FMF). Although a number of individuals with FMF are intolerant/resistant to colchicine, there is no standard definition of colchicine resistance/intolerance. We developed a set of evidence-based core statements defining colchicine resistance/intolerance in patients with FMF that may serve as a guide for clinicians and health authorities. Methods A set of statements was identified using a modified-Delphi consensus-based approach. The process involved development of an initial colchicine resistance/intolerance-related questionnaire derived from a systematic literature review. The questionnaire, which was completed by an international panel of 11 adult and pediatric rheumatologists with expertise in FMF, was analysed anonymously. The results informed draft consensus statements that were discussed by a round-table expert panel, using a nominal group technique to agree on the selection and wording of the final statements. Results Consensus among the panel was achieved on 8 core statements defining colchicine resistance/intolerance in patients with FMF. A definition of resistance was agreed upon that included recurrent clinical attacks (average one or more attacks per month over a 3-month period), or persistent laboratory inflammation in between attacks. Other core statements recognize the importance of assessing treatment adherence, and the impact of active disease and intolerance to colchicine on quality of life. Conclusion Based on expert opinion, a set of evidence-based core statements defining colchicine resistance/intolerance in patients with FMF were identified to help guide clinicians and health authorities in the management of patients with FMF.

Download Full-text

Health Humanities in Post-Graduate Medical Education

10.1093/med/9780190849900.001.0001 ◽

2018 ◽

Cited By ~ 4

Author(s):

Allan D. Peterkin ◽

Anna Skorzewska

Keyword(s):

Medical Education ◽

Interprofessional Education ◽

Medical Humanities ◽

Visual Art ◽

Postgraduate Medical Education ◽

Health Humanities ◽

Arts And Humanities ◽

Wide Range ◽

The Subject ◽

The Impact

Arts and humanities education is widespread in undergraduate but almost nonexistent in postgraduate medical education where it is arguably more helpful. This book fills that gap. It covers a wide range of arts and humanities subjects including film, theatre, narrative, visual art, history, ethics, and social sciences. Each chapter provides not only 1) a literature review of the relevant subject in postgraduate medical education and, where helpful, undergraduate medical education but 2) a theoretical discussion of the subject as it relates to medicine and medical education 3) challenges to implementing arts and humanities programming and 4) appendices with a number of different and relevant resources as well as sample lesson plans. There is a chapter on the use of humanities in interprofessional education, a domain whose importance has recently gained prominence. Finally there are also chapters guiding the medical humanities educator on evaluating the impact of their programs, an ever-present challenge, and on the thorny issue of how to fund programs in medical humanities.

Download Full-text

The Impact of an Interprofessional Pediatric Oral Health Clerkship on Advancing Interprofessional Education Outcomes

Journal of Dental Education ◽

10.21815/jde.019.088 ◽

2019 ◽

Vol 83 (8) ◽

pp. 878-886 ◽

Cited By ~ 4

Author(s):

Erin Hartnett ◽

Judith Haber ◽

Peter Catapano ◽

Nancy Dougherty ◽

Amr M. Moursi ◽

...

Keyword(s):

Oral Health ◽

Interprofessional Education ◽

Education Outcomes ◽

Pediatric Oral Health ◽

The Impact

Download Full-text

Seminar in Public Health Law and Policy in an Interprofessional Setting: Preparing Practitioners for Collaborative Practice at the Macro Level

The Journal of Law Medicine & Ethics ◽

10.1177/1073110516644229 ◽

2016 ◽

Vol 44 (S1) ◽

pp. 56-61 ◽

Cited By ~ 2

Author(s):

Heather A. McCabe

Keyword(s):

Public Health ◽

Interprofessional Education ◽

Collaborative Practice ◽

Health Law ◽

Important Work ◽

Public Health Law ◽

Reciprocal Relationships ◽

Professional Students ◽

Law And Policy ◽

The Impact

The author created a new course, called “Seminar in Public Health Law and Policy in an Interprofessional Setting” to address the need for interprofessional education (IPE) to equip graduate and professional students for collaborative practice at the systemic and policy (i.e., macro”) levels in the health care and public health fields. Despite important work being done at the clinical practice level, limited existing IPE models examine larger systemic issues. The course is designed specifically to enable students in social work, law, and public health to recognize the reciprocal relationships between policy and interprofessional collaborative practice, including the need for understanding of the impact of team-practice work at the system and policy levels.

Download Full-text