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Interprofessional Collaborative Teams
chsrf.ca
Commissioned Paper by Canadian Nurses Association
Canadian Health Services Research Foundation
June 2012
Tazim Virani
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation
This document is available at www.chsrf.ca.
This research report, commissioned by the Canadian Nurses Association, is a publication of the Canadian Health Services Research Foundation. Funded through an agreement with the Government of Canada, CHSRF is an independent, not-for-profit organization that is dedicated to accelerating healthcare improvement and transformation for Canadians. The views expressed herein are those of the authors and do not necessarily represent the views of CHSRF, CNA, or the Government of Canada.
ISBN 978-1-927024-53-9
Interprofessional Collaborative Teams © 2012, Canadian Health Services Research Foundation.
All rights reserved. This publication may be reproduced in whole or in part for non-commercial purposes only and on the condition that the original content of the publication or portion of the publication not be altered in any way without the express written permission of the CHSRF. To seek this permission, please contact [email protected].
To credit this publication please use the following credit line: “Reproduced with the permission of the Canadian Health Services Research Foundation, all rights reserved, (modify year according to the publication date).”
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interProFeSSional CollaBorative teaMS
Table of conTenTsKEY MEssagEs ..................................................................................................................2
ExEcutivE suMMarY ..................................................................................................3
1 INTROduCTION ............................................................................................................6
2 PARAmETERS OF THE SCOPING REvIEw ...........................................................72.1 Objectives ................................................................................................................72.2 Questions Guiding the Scoping Review ................................................................7
3 mETHOdS .........................................................................................................................83.1 Overview .................................................................................................................83.2 Identifying Information Sources to Include in the Review ..................................83.3 Search Strategy and Information Extraction .......................................................83.4 Criteria for Case Studies ........................................................................................93.5 Limitations ..............................................................................................................9
4 RESulTS OF THE REvIEw ........................................................................................104.1 Overview ...............................................................................................................104.2 Interprofessional Team Model .............................................................................114.3 Nurse-Led Model ..................................................................................................124.4 Case Management Model ....................................................................................144.5 Patient Navigation Model ....................................................................................144.6 Shared Care Model ...............................................................................................16
5 BARRIERS ANd ENABlERS FOR SuCCESSFul APPlICATION OF mOdElS ....................................................................................................................17
6 RECOmmENdATIONS ...............................................................................................18
7 CONCluSION ................................................................................................................19
8 REFERENCES ..................................................................................................................20
APPENdICES ..........................................................................................................................24Appendix A: Search Terms and Strategy ......................................................................24Appendix B: Literature Summary Table ......................................................................26Appendix C: Case Study – Interprofessional Model of Care .....................................101Appendix D: Case Study – Interprofessional Model of Care ....................................105Appendix E: Case Study – Nurse-Led Model of Care ...............................................110Appendix F: Case Study – Patient Navigation Model of Care .................................115Appendix G: Case Study – Shared Care Model .........................................................119Appendix H: Factors Influencing Application of Models of Care in Primary Care ...........................................................................................................123Appendix I: Bibliography ............................................................................................127
2 Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation
KeY MessaGes ◥ Contrary to popular belief, there is an array of interprofessional collaborative care models in
primary care with an essential role for nurses. many of these models are found in Canada and also internationally.
◥ Five types of interprofessional care models with a substantive role for nurses were found in the published and grey literature:
◥ Interprofessional team models ◥ Nurse-led models ◥ Case management models ◥ Patient navigation models ◥ Shared care models
◥ One or more models of care can be implemented within the same healthcare setting. ◥ Evidence to support the effectiveness of these models of care varies, but there are increasingly
positive patient, provider and system level outcomes. ◥ Choosing the right model is dependent on the context. The context variables include:
◥ leadership (particularly nursing leadership), advocacy and championing of specific model ◥ Political environment, biases and supports ◥ Regulatory environment ◥ Knowledge about the needs of the specific population being targeted ◥ Availability, preparation and experience of human resources ◥ willingness of providers to collaborate ◥ Capacity to train the appropriate mix of providers ◥ Supports for team development (opportunities or forums, time, funding ◥ Supports to address the challenges and gaps in the healthcare system ◥ Available assets (balance in workload, funding, expertise, space, in-kind supports).
◥ lessons learned about planning and implementing interprofessional service delivery models of care need to be disseminated broadly along with supports for implementation.
◥ more research is required to identify the essential components of each of the five models; however, since context matters, implementation of innovative models of care should be encouraged, accompanied by rigorous evaluation.
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eXecUTIVe sUMMaRYAs Canada strategizes on how best to provide equitable access to healthcare to its citizens, careful attention is being placed on how to optimize its health human resources in the most cost-effective manner. Increasingly, the response to this interest is to leverage and optimize the largest group of healthcare providers – nurses – while acknowledging that healthcare recipients require a range of knowledge and skills from a wide array of health professionals.
what examples of interprofessional collaborative models of care have been tested in primary healthcare? A scoping literature review was conducted that included published and grey literature as well as information gathered from key informants. The objectives of the review were (1) to gather examples of models of care in primary care and other non-acute care settings that included a substantive role for nurses, and (2) to understand the effectiveness of these models as well as the essential factors that influence their successful implementation.
The models of care identified from the review were loosely grouped in five broad categories:
1. Interprofessional team models2. Nurse-led models3. Case management models4. Patient navigation models5. Shared care models
Interprofessional team models are teams with different healthcare disciplines working together towards common goals to meet the needs of a patient population. Team members divide the work based on their scope of practice; they share information to support one another’s work and coordinate processes and interventions to provide a number of services and programs. In advanced or mature collaborative teams, the patient and family are included as key members of the team. Examples of interprofessional team models include family health teams, community health centre teams, and integrated health teams. Positive evidence of interprofessional team models is building, particularly for teams working with patients with chronic diseases and/or mental health needs.
Interprofessional team models of care vary based on the context, intra-group processes, nature of the tasks, and intensity of collaboration that are engineered in the structure and processes of the teams. The intensity of collaboration ranges from consultative activities to integrative work practices. The effectiveness of teams is dependent on the team members’ knowledge of one another’s roles and scopes of practice; mutual trust and respect amongst the team members; commitment in building relationships; willingness to cooperate and collaborate; and the extent to which the team has organizational supports. Incentives such as appropriate system-level policies/legislation, favourable compensation models, balance in workload, working arrangements (opportunities to communicate, discussion, conducting joint work) and team characteristics (team size, team leadership) influence how team members collaborate to achieve positive outcomes.
Nurse-led models of care are formal programs, centres, clinics or services that place primacy on the nurse’s role, and where the nurse independently and collaboratively provides nursing services. The nurse’s interventions are holistic in nature and include assessment, treatment, patient education, and health- and self-care supports, as well as outreach activities for hard-to-reach populations. Examples of nurse-led models include RN-led (led by registered nurses) or NP-led (led by nurse practitioners) clinics, nursing centres, or specific programs embedded in other broader programs or teams. Nurse-led programs can
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be generic, such as those that provide care for patients with undifferentiated problems, as in a primary care clinic, or they can be models designed for very specific patient groups or care needs (for example, cardiac patients, patients with rheumatoid arthritis, patients who require colorectal screening using flexible sigmoidoscopy or patients who need support with smoking cessation). Evidence shows that nurse-led models of care provide equal or better care when compared to physician-led models of care.
Case management models are most often embedded in multidisciplinary or interdisciplinary team models and tend to focus on complex or high-resource groups of patients such as patients with chronic conditions. The key feature is the assignment of a defined number of patients to one provider (a case manager) who takes the lead in coordinating the activities to meet patient goals, such as supporting the patients to remain in the community for as long as possible. The focus in this model tends to be on system-level factors such as preventing readmission or decreasing length of stay in hospitals. Nurses are often in the formal role of a case manager, as they bring a broad set of knowledge and skills (clinical, interpersonal and problem-solving). The evaluation of case management models has been difficult, as it is challenging to isolate the key elements that contribute to the outcomes. Research findings are mixed.
Patient navigation models are relatively new in the healthcare sector. They require a navigator who has a multifaceted role as a patient advocate, helping the patient navigate through the healthcare system by circumventing and/or removing barriers while coordinating activities to meet the patient’s needs. Navigators can be nurses, social workers or lay persons. Patient navigators tend to focus on the patient’s experience, ensuring the patient receives timely services as well as ensuring that he or she does not fall through the cracks in the healthcare system. Navigators who are nurses assess patients, address symptom management and “fast track” patients through the system, depending on clinical status. These models of care are being used with patients suspected as having, or who have been diagnosed with, cancer, as well as patients who have chronic diseases. The model has had mixed research findings.
Shared care models are primarily models in which two healthcare providers (for example, a nurse and a physician, nurse and pharmacist or nurse and community health worker) share or have joint responsibility for specific patient groups or programs. Other providers are involved, but to a significantly lesser degree. Sharing or co-management of patients or programs requires clear roles and responsibilities, high levels of communication and collaboration, and a high degree of trust and mutual respect for each other’s contribution to patient care. There are mixed findings on the impact of these models on health and system outcomes. Issues are primarily related to role ambiguity and trust between providers.
An extensive inventory of barriers and enablers was identified from the literature and from analysis of the case studies. These are grouped in five categories:
1. Policy/system factors (favourable legislation for optimizing scope of practice)2. Appropriate model of care factors (suitable to patient population needs)3. Individual/team factors (effective interprofessional collaboration)4. Organization factors (appropriate business case)5. Implementation factors (training, integrated work processes)
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These factors have not been differentiated for the five models because there are significant commonalities in barriers and enablers across the models.
Five broad recommendations are made based on the lessons learned from this scoping review:
1. Study further the models of care identified in this scoping review. 2. Be open to the plurality of primary healthcare models, at least in the short run. Supporting diverse
models of care is a good thing.3. develop a pan-Canadian strategy to integrate registered nurses and nurse practitioners in primary
care models of care. 4. Promote the use of evidence-based implementation of models of care using the PEPPA
framework (Participatory, Evidence-based, Patient-focused Process, for guiding the development, implementation, and evaluation of advanced nursing practice.
5. Support nurses in their quest to implement innovative models of care in primary care.
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1 InTRoDUcTIonNumerous calls have been made to continue to improve the healthcare system, not only in terms of access but also in terms of effectiveness, efficiency and value for money1,2,3. Optimizing utilization of health human resources has been a consistent theme over the last decade4. Increasingly, the response to this challenge is to leverage and optimize the largest provider of healthcare – nurses – and in doing so, leverage the apparent benefits of interprofessional collaborative teams5.
This paper aims to explore and explain the use of models of care delivery that optimally utilize the role of nurses in primary healthcare, community-based care and other non-acute care contexts such as chronic disease management, long-term care, continuing care, health promotion and disease prevention. Additionally, exemplar models of care, as case studies, are identified to highlight essential elements of effective service delivery models and strategies for successful application. ultimately, this paper aims to inform the Canadian Nurses Association’s efforts to address policy priorities for a renewed health accord in Canada.
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2 PaRaMeTeRs of THe scoPInG ReVIeW2.1 obJecTIVesThe objectives of this paper were shaped by the directions provided by a working group of the Canadian Nurses Association. Specifically, the objectives of the paper were to:
1. Report on the findings of a scoping review of interprofessional teams that include registered nurses and/or nurse practitioners in the context of primary healthcare, community and other non-acute care settings.
2. Provide specific examples of interprofessional teams in Canada that have demonstrated success from multiple perspectives (for example, patient, practice and system levels; chronic care models).
3. Based on evidence and expert opinion, identify the essential elements or key attributes of an efficient model for interprofessional teams.
4. Provide a brief analysis of the barriers to fully integrating interprofessional models of care into the Canadian health system.
5. Identify key success factors for implementing interprofessional models of care that involve nurses and nurse practitioners.
2.2 QUesTIons GUIDInG THe scoPInG ReVIeWThe following questions guided the scoping review, based on the stated objectives:
a) what are the types of interprofessional collaboration models that have been tested or implemented in Canada and elsewhere?
b) what is the role of the nurse in these models of care?c) what are the essential elements or key attributes of an efficient model for interprofessional teams?d) what factors pose barriers to the successful application of the models of care?e) what are the factors that have made interprofessional models successful?
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3.0 MeTHoDs3.1 oVeRVIeWThe following key methods were used to gather the information for this paper:
a) Review of the literature to explore the variety of interprofessional models of care involving nurses. b) Review of grey literature (unpublished reports and papers) describing models of care including
field evaluation studies.c) Review of CNA’s concurrent papers.d) Interviews with key informants to develop detailed case studies of models of primary healthcare
found in Canada.
3.2 IDenTIfYInG InfoRMaTIon soURces To InclUDe In THe ReVIeWA scoping review methodology was used, as this approach allows an examination of the extent, range and nature of research activity and other literature with some degree of flexibility with respect to the quality of the publications. The value of scoping reviews is that they allow a topic area to be explored with some liberty with respect to the quality of the existing literature, and serve as a foundation for more rigorous review6.
we used a modification of the five steps identified by Arksey and O’malley7 for a scoping review:
1. Identifying the research question(s).2. Identifying relevant systematic reviews, randomized controlled trials (RCTs), qualitative research
studies, evaluation papers, reports, and descriptive information on models of care found on government, professional association, research and policy institution websites.
3. Selecting papers to include in the review.4. Collating and summarizing the information in a summary table (our initial tables were detailed;
these were further summarized for this report).5. Reporting the results.
In addition, we contacted individuals who could provide greater detail on selected models of care so that we could write five case studies exemplifying the different models in Canada. we interviewed 10 key informants (KI) by phone and/or received information by e-mail on select case studies (case study 1, 2 KI; case study 2, 1 KI; case study 3, 5 KI; case study 4, 2 KI; case study 5, 1 KI). Key informants were recommended by nursing leaders in the field based on who could best articulate the development and implementation of the model of care. Additional reports and documents provided by the key informants were reviewed to validate and/or add detail and clarification for the written case studies.
3.3 seaRcH sTRaTeGY anD InfoRMaTIon eXTRacTIonThe following literature databases were used to search and access published literature: Cochrane database of Systematic Reviews, Pubmed, CINAHl, HealthSTAR and Health-Evidence.ca. In addition, web searches were conducted using Google, and hand searches were done using reference lists from key reports and articles, as well as suggestions made by key informants. Broad search terms were used, including interprofessional teams, healthcare teams, collaboration, and primary healthcare. Additionally, specific search terms were used, including family health teams, chronic management teams and nurse-led models. (See Appendix A for detailed search strategy and articles included in the review.) The following criteria were used to include articles in the review:
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a) written in English or French. b) Published or disseminated on the website from 2001 to 2012 (papers were limited to those that
were part of the recent rounds of primary care reforms and of models that were still in use). c) Involved a substantial role of a registered nurse or nurse practitioner.d) Contained detailed information on the description of the model and how the model was implemented.e) Addressed discussion of barriers, implementation challenges and success factors or solutions.
All papers meeting the above criteria were included regardless of type or quality of paper.
Three junior research assistants (two were bilingual) extracted information from each paper. A senior research lead reviewed the extracted information and where there were questions, the report/paper was reviewed by the research lead. This process allowed for the inclusion of an extensive set of information sources. This iterative process provided the opportunity to group models of care as the literature was being reviewed, and to re-group several times as further information was gathered. One type of model that emerged, which was later combined with “interprofessional team,” was the “self-management” model. Self-management models were seen as nested models within the interprofessional team model and were not viewed as independent or distinct models. (See Appendix B for the literature tables organized by type of models that emerged from the literature.)
3.4 cRITeRIa foR case sTUDIesThe following criteria were used to identify five examples of models of care in primary healthcare and to develop the detailed case studies:
a) All case studies should be examples of models of care delivery currently in use in Canada.b) Case studies should be geographically distributed, but not necessarily one per province or territory.c) Each case study should reflect one of the main categories of models of care that have been
identified in the literature/website review.d) Case studies should represent different practice settings.e) Case studies should represent different patient/client populations.
3.5 lIMITaTIonsScoping reviews are meant to assess the broad scope or “lay of the land.” As such, this review examined a range of papers with a range of study designs and reports generated by various organizations. However, the review is by no means exhaustive. The depth of examination of each model was constrained by available time and resources. Caution needs to be taken in making firm conclusions on the value of one model over another, as that was not the intent, nor were we able to identify rigorous studies comparing the models. we have also taken liberty to categorize the papers using loose definitions of the five models of care that emerged in the review and that are discussed in this paper.
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4 ResUlTs of THe ReVIeW4.1 oVeRVIeWThe world Health Organization defines a primary healthcare team as “a group of persons who share a common health goal and common objectives determined by community needs, to which the achievement of each member of the team contributes, in a co-ordinated manner, in accordance with his/her competence and skills and respecting the functions of others”8. The search for primary healthcare team models of care resulted in the identification of five broad categories of such models involving nurses. The categories are not meant to be a rigid taxonomy or classification, but rather, a loose organization of models that emerged from the review of the literature. Overview of the models are presented in Table 1 to highlight the overall distinctions of the models. discussion of each model category follows the table.
table 1: Service delivery Models of Care in Primary Care
Model Context intragroup processes Scope of Practice effectiveness*
INter-ProFeSSIoNAl teAmS
various healthcare disciplines working together towards common goals to meet the needs of a patient population
Team members co-located at centres or clinics
model design is highly context dependent (local needs target patient population, availability of human resources)
various designs of team collaboration that range from consultation to integrated practices
Physicians generally leaders of the teams
division of labour based on scopes of practice of team members
Positive FindingsSystematic Reviews: Adams et al, 2007; Barrett et al, 2007; Craven et al, 2006; Suter et al, 2010;
RCTs: Humbert et al, 2009;
Other Studies: lui et al, 2003; Schaeder et al., 2008; Russel et al, 2009;
mixed FindingsSystematic Reviews: Zwarenstein et al., 2009
No ImpactRCTs: lin et al, 2006
NurSe-led modelS
Formally structured with the focus on the nurse delivering holistic care
Often dependent on lack of access to physicians
Independent practice and collaboration with other healthcare providers
Nurse has central role in governance and leadership
Nurses working to full scope of practice
model is highly dependent on the nurse’s role *and capacity to take on expanded responsibilities
Positive FindingsSystematic Reviews: Cooper et al., 2006; Glynn et al, 2010: Horrocks et al., 2002; laurant et al., 2007, 2009; lewis et al., 2009; Schadewaldt & Schultz, 2011 (no difference compared to convention model;
RCTs: Chui et al., 2010; Given et al, 2010; Hebert et al, 2008; Raferty et al., 2005; Ryan et al., 2006; Smeulder et al, 2010; van Zuelien et al., 2011
mixed FindingsSystematic Reviews
No ImpactSystematic Reviews: Cruickshank et al, 2008;
RCTs: New et al, 2003
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CASe mANAgemeNt
An assignment of a set number of complex care patients to the nurse and to coordinate their care. Focus is on meeting organizational objectives for efficiency
Complexity of patient care, (for example, chronic diseases)
model design is highly dependent on patient care requirements
Nurse plays central role in coordinating team member requirements for the patients in the caseload
model design is highly dependent on size of team and the complexities of coordinating care activities
Potential to work to full scope of practice if there is a manageable caseload
Positive Findings:Systematic Reviews: Schroeder et al., 2008; Berra et al., 2011; Norris et al., 2002
mixed FindingsOther Studies: Taylor et al., 2005
No ImpactOther Studies: vam der Sluis et al., 2008
ShAred CAre Co-location of two primary care providers
Highly collaborative requiring high trust and respect between team members.
model is highly dependent on how providers work out their shared arrangement
working to full scope of practice
Positive Findings:Systematic Reviews: Kelly et al (2011); Research Power In., 2011
Other Studies: Griffiths et al, 2007
mixed: Other Studies: Smith et al (2007); Eley et al (2008)
No Impact
* References listed in Appendix B.
4.2 InTeRPRofessIonal TeaM MoDelDescription of interprofessional team models Interprofessional team models are teams comprising various healthcare disciplines working together towards common goals to meet the needs of a patient population. Team members divide the work based on the team members’ education and experience9; they share information to support one another’s work and coordinate processes and interventions to provide a number of different services and programs to their target population. Generally, there is an explicit or underlying value for non-hierarchical decision-making10.
Such models of care vary based on the context, the intra-group processes, the nature of the tasks, and the intensity of collaboration that is engineered in the structure and process of the teams11. The intensity of collaboration ranges from consultative activities to integrative work practices12.
The effectiveness of interprofessional teams is dependent on a number of factors, including the team members’ knowledge of one another’s roles; the scope of practice; mutual trust and respect amongst the team members; commitment in building relationships; willingness to cooperate and collaborate;13-15 and the extent to which the team has organizational supports16. Incentives such as appropriate system-level policies/legislation17, favourable compensation models18, balance in workload19, working arrangements20 (for example, opportunities to communicate, have meaningful discussion, conduct joint work, and leverage information systems) and team characteristics,21 such as team leadership and shared purpose, influence how team members collaborate to achieve positive outcomes.
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At a practical level, interprofessional teams are involved in the assessment and planning of care, making independent and joint decisions about approaches to care, and providing direct services individually or jointly with other team members to meet the needs of the patient22. The team members meet informally, formally and virtually, and use various structures and tools to meet, communicate, coordinate and monitor care23.
In advanced interprofessional teams, the patient and his or her significant others are central members of the team24, 25. Structures, processes and tools are established that empower the patient in optimal involvement (for example, the patient has access to his or her electronic health record). Patients and their caregivers are involved in regular team meetings, and patients are taught and supported to self-monitor and adjust their own treatment within given parameters.
Registered nurses, nurse practitioners, and in some instances licenced practical nurses are involved in generalist and/or specialized roles and often provide a pivotal role in a leadership, facilitative or a coordinating capacity. They also provide patient advocacy and direct service. more often than not, however, physicians play the leadership role in such models, particularly when the funding for primary care is tied with the physician reimbursement using fee-for-service or capitation models, in contrast to models where all team members are salaried26.
Examples of interprofessional team modelsThe literature has many examples of team-based collaborative models of care. The following are a few examples of these models and the context in which they are applied. (See Appendix C and d for two detailed case studies of interprofessional team model of care.)
a) Family Health Teams (FHT) in Ontario27
b) Community Health Centres (CHC) – found across all provinces in Canada, including the earliest ones in Quebec known as communauté locale de soins communautaires, or ClSCs28.
c) Integrated Health Teams – Katzie Integrated Health Team in British Columbia, led by the Katzie First Nation Health Promotion Team29; Sure Start local Programs (SSlPs in united Kingdom)30.
Effectiveness of interprofessional team modelsEvidence is building on the positive outcomes associated with interprofessional team- based primary care models. (See Table 1.) However, identifying the effectiveness of specific aspects of team structures and behaviours in the context of primary care requires more study31. Challenges that have been identified from qualitative studies include communication and relationships between members, documentation systems and practices, knowledge of team members’ scopes of practice, issues of team cohesion, referral mechanisms between team members, agreement of plans of care, and lack of a clear leader32.
4.3 nURse-leD MoDelDescription of nurse-led modelsThe emergence of nurse-led models of care is often associated with a chronic shortage of physicians and a lack of access to primary care. Nurse-led models of care are formally structured33 and the delivery of care gives primacy to the nurse’s role, where the nurse independently and collaboratively provides holistic care including assessment, planning, organizing, coordinating, care delivery/treatment, patient education and monitoring, and attention to social determinants of health. There are a number of features of nurse-led models that are different from conventional models34:
interProFeSSional CollaBorative teaMS 13
◥ They are independently managed by nurses while maintaining team-based collaboration. ◥ They are more holistic and are focused on prevention and education, in contrast to being
treatment- or medicinal-focused (although nurse-led models also do these). ◥ Beyond the conventional interventions, nurse-led models may include psychosocial support to
patients, outreach in the community, group-level activities and programs, coordination of activities, and a strong focus on health counselling, education and assisting patients with self-care management.
◥ Such models provide greater professional autonomy to nurses whereby nurses have their own patient case load. In some nurse-led models, nurses may make decisions related to patient admissions, referrals and discharge.
Examples of nurse-led models of careThere are a number of different nurse-led models of care delivery35 including RN (registered nurse)-led general models, RN-led specialist models, NP (nurse practitioner)-led general models, and NP-led specialist models. The decision on whether to have an RN or an NP is associated with the patient care needs and scope of practice of the nurse. (See Table 2 and see Appendix E for detailed case study.)
table 2: nurse-led Models of Care
Model examples
rN-led generalist models of Care delivery
Family practice clinics (Alsaffar, 2004)
Nurse-led primary healthcare walk-in centres (desborough et al, 2011). rN-led Specialist models of Care delivery
Nurse-led hepatitis C program (Butt, 2009)
Nurse-run post-acute stroke clinic (Crowe, 2009)
Nurse-led smoking cessation clinic (Thompson et al, 2007)
Nurse-led rheumatology clinic (Arvidsson et al. 2006)
Nurse-family partnership program (www.nurseamilypartnership.org)
RN-led flexible sigmoidoscopy clinics for colorectal cancer screening (dubrow et al, 2007).NP-led generalist models of Care delivery
NP-led clinics in Ontario (http://www.health.gov.on.ca/transformation/np_clinics/np_mn.html), NP-led school based primary healthcare clinic for children and families (Clendon, 2001)
NP-led multidisciplinary team to improve chronic illness (watts et al, 2009).NP-led Specialist models of Care delivery
NP-led anticoagulant clinic (Connor, 2002)
NP model of care for people with dementia (Ashcroft et al, 2010)
NP services for patients with chronic kidney disease (van Zulien et al, 2011).mixed rN, NP, generalist, and specialized
Comox valley Nursing Centre in British Columbia (www.viha.ca/comox_valley_nursing_centre).
Effectiveness of nurse-led modelsThere is good evidence to support nurse-led primary care models. (See Table 1 for details.) most research shows positive or similar outcomes to conventional care models. Having stakeholder buy-in and physician support are key factors of success.
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4.4 case ManaGeMenT MoDelDescription of case management modelsCase management models are most often embedded in multidisciplinary or interdisciplinary models and tend to focus on highly complex or high-resource groups of patients such as patients with chronic conditions36. The key feature of this model is the assignment of a defined number of patients to one provider (a case manager) who takes the lead in collaborating with team members to develop a comprehensive care plan, coordinating the activities to meet patient goals, and monitoring the achievement of patient objectives and system-level targets37. The focus of the model is often on system-level factors such as preventing readmission or decreasing wait times. Nurses are often in the formal role of a case manager, as they bring a broad set of knowledge and skills in clinical, interpersonal and problem-solving domains and help to improve interprofessional collaboration38. In doing so, case managers are often “navigating” the system, advocating for the patient and identifying and addressing gaps in the healthcare system.
Case management is differentiated from patient navigation models in that the focus is on coordination of the healthcare team and other system players, and on creating efficiencies. The key processes in case management are case-finding, assessment, planning, action and monitoring39. The monitoring of cases is often over a longer period of time compared to other models.
Examples of case management modelsSchraeder et al.40 describe a collaborative primary care nurse case management model located in Illinois, u.S. that is situated within a multi-specialty physician group practice using a multi-disciplinary team model. The focus of case management is on patients with chronic conditions. Similarly, other case management models that focus on chronic disease management and/or complex care include:
◥ disease and care management41
◥ Guided care management42
◥ Supportive care clinic for cancer patients43
◥ Primary care case management for chronic care44
Case management models are widely used in the management and care of patients who are discharged from hospital to receive care in the home45.
Effectiveness of case management modelsSystematic reviews and studies of case management show a mixture of findings – some positive, some with mixed findings and some with no impact. (See Table 1.) It has been noted that it is difficult to isolate the impact of case management models, as they are often embedded or implemented with other models such as interprofessional team, nurse-led or patient navigation models46.
4.5 PaTIenT naVIGaTIon MoDelDescription of patient navigation modelsThe patient navigation model is a relatively newer model of care in the healthcare sector, requiring a patient navigator who has a multifaceted role. Navigators can be nurses, social workers or lay persons. The navigators are patient advocates who help the patient navigate through the healthcare system by circumventing and/or removing barriers while coordinating activities to meet the patient’s
interProFeSSional CollaBorative teaMS 15
needs47. Patient navigators tend to focus on the patient’s experience, ensuring the patient receives timely services and ensuring that he or she does not fall through the cracks in the healthcare system48. Navigators who are nurses assess patients, address symptom management and “fast track” patients through the system depending on clinical status. Hence, they also play a triage function49.
Patient navigation models, unlike case management models, do not focus largely on highly complex patient groups, nor are they all situated within a broader multi-disciplinary environment. However, various patient navigator roles include functions such as assessment, symptom management, patient education, and follow-up, which makes better use of the scope of practice of nurses50.
Although the notion of supporting the patient to navigate the healthcare system is not new, the formalized role of patient navigator is a recent innovation. The term patient navigation is purported to appear in the health literature around 199551 and is sometimes referred to as “nurse navigator” or used interchangeably with “care coordinator”52. The literature has examples of patient navigators who are nurses, social workers, community health workers or lay persons, and whose role overlaps with those of case managers53. Research on patient navigation for patients with cancer, particularly in the diagnostic/work-up stage, appears to be advanced compared to navigation for patients in cancer treatment or other health conditions54, 55.
The role of patient navigator aims to not only improve patient experience in the healthcare system, but also to decrease wait times for patient services; improve diagnostic resolution, timeliness in care and treatment adherence; improve the likelihood of follow-up; and improve clinical outcomes56. The approaches used by a patient navigator include assessing needs; developing relationships within the healthcare system in order to leverage this for the benefit of the patient; coordinating care aspects between healthcare providers and between providers and the patient/family; ensuring referrals do not fall through the cracks; reviewing diagnostic results and acting upon them in a timely manner; tracking wait times and timeliness to care; and identifying gaps in the system and thereby acting as a catalyst for change.
Gilbert et al.57 built a case for nurses to take the role of patient navigator in the cancer care sector. The authors note that nurses have the knowledge and skills to support patient care and work in an integrated manner with clinicians while improving the patient’s experience of the healthcare system.
Examples of patient navigation modelsAlthough it is a relatively recent model of care, a variety of patient navigation models are found in the literature. (See Appendix F for a detailed case study of one such model.) Other examples of patient navigation models include:
a) Patient navigator to support patients with confirmed breast lesion in Nova Scotia58.b) Navigation role for chronic care in older adults59.
Effectiveness of patient navigation modelsThere is some research to show the positive impact of patient navigation; however, the evidence is limited. (See details in Table 1.)
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation16
4.6 sHaReD caRe MoDelDescription of shared care modelShared care models are primarily models in which two healthcare providers (for example, a nurse and a physician, nurse and pharmacist, or nurse and community health worker) share or have joint responsibility for specific patient groups or programs. Other providers are involved but to a significantly lesser degree. Sharing or co-management of care requires clear roles and responsibilities, high levels of communication and collaboration, and a high degree of trust and mutual respect for each other’s contribution to patient care60.
This model is differentiated from the interprofessional team model in that shared care arrangements are established through formalized agreements and/or specific delineation of roles and responsibilities for the same group of patients, and are usually between two members. The healthcare providers may have independent practices or other groups of patients using different models of care while involved in co-management or shared care model for some of their patients61.
The focus of shared care models is most often on managing a higher roster or panel of patients in an effective and timely manner while providing high-quality and consistent care62. Additionally, there is an underlying belief that the combination of skills and knowledge brought together by the providers in the shared care arrangement provides a greater value-added service to the patients, thereby improving the quality of care63.
Although there are variations in shared care models, there are common features that have been noted64:
◥ Joint provision of clinical services by health providers, often located in the same setting. ◥ Shared responsibility for patient care by shared-care team members. ◥ Clear differentiation of roles among health providers, which is typically outlined in a shared-practice
guideline or memorandum of understanding. ◥ Collaborative education that seeks to increase understanding among shared-care team members
of each other’s professional skills, knowledge and abilities. ◥ development of a shared strategy for patient care that is based on explicated defined guidelines.
Examples of shared care modelsShared care models are often treated as interprofessional team models. However, as described above, this paper notes the key characteristics of the shared care model. (See Appendix G for detailed case study of one such model.) The following are examples of diverse shared care models:
a) Family Practice Nurse Initiative in Nova Scotia65
b) Nurse Practitioner/Family Physician Primary Care model in Interior British Columbia66 c) Nurse-led weekly clinic with general physician (GP) support occurring twice a year for patients
with poor diabetic control in the united Kingdom67 d) Nurse/pharmacy-led capecitabine clinic for colorectal cancer68
Effectiveness of shared care modelsThere is limited research evidence on the effectiveness of shared care models in primary care. One systematic review that was found focused on shared care arrangements between primary and specialist shared care arrangements69. Qualitative findings identify that issues with the models were primarily related to role ambiguity and trust between providers70. (See Table 1.)
interProFeSSional CollaBorative teaMS 17
5.0 baRRIeRs anD enableRs foR sUccessfUl aPPlIcaTIon of MoDelsAn extensive inventory of barriers and enablers was identified from the literature (see Appendix H) and from analysis of the case studies. These are grouped in five categories: policies/system; appropriate model of care; individual/team; organization; and implementation. These have not been differentiated for the five models discussed in this paper, as there are significant commonalities.
Policies or system factors address the conditions that enable models of care to take root and be effectively implemented. The lack of such enablers creates challenges in the optimal use of the full scope of nurses. These factors include legislation, regulation, funding support, data availability, research, educational requirements, fair compensation including benefits, and liability protection. Policies in almost all funding models generate tensions between policy controls and practice efficiencies: for example, patients must be seen by a physician in fee-for-service models regardless of whether the patient needs the physician; and adequate throughput of patients should be ensured in salary models. Policy decision-makers’ understanding and appreciation of these challenges and the impact of policy decisions appear to be ongoing challenges.
The appropriate model of care is highly context-dependent. Successful models reflect community needs and characteristics as well as priorities identified by community stakeholders. Flexibility in models is also important due to divergent needs of the community and the changing nature of these needs, requiring mechanisms to provide a varying intensity of programs and services. models of care are dependent on the availability of appropriate health provider resources and supports to work to full scope of practice. local adaptation of models of care, therefore, produces different models, each with its own set of challenges and successes. This creates difficulties in comparing the models’ effectiveness.
Individual and team factors play an obvious and intricate role in the successful application of any of the models of care discussed in this paper. The effectiveness of teams is dependent on how well individuals embrace working in teams, perceive advantages and disadvantages, have the competencies and experience to be effective team members, and have the right supports and tools. Having mutual trust and respect and knowledge of one another’s roles, the scope of practice, and how each member can bring value to patient care are cited frequently in the literature and by key informants.
organization factors refer to organizational supports and tools that enable the successful implementation and ongoing operation of models of care and effective and efficient interprofessional collaboration. Examples of these supports include a clear business plan, a governance mechanism, work place policies, and integrated processes. Insufficient supports and tools can lead to inappropriate conclusions on whether a model is successful or not.
Implementation factors can also support or hinder the successful outcomes of any of the models of care. Inadequate attention to supporting human resources, from selection to training and mentorship, can result in failed models. The use of evidence-based practices in providing programs and services are interlinked with models of care, as is the effective support for team development. These inter-related components – model of care, evidence- based practices and team collaboration – have to work in concert to result in positive patient, provider and system-level outcomes.
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation18
6 RecoMMenDaTIonsThe overall lessons derived in this paper are summarized in five key recommendations:
recommendation 1: Study further the models of care identified in this scoping review.
As with any scoping review, the findings are a broad reflection of the subject matter. Each of the five models of care identified in this paper (interprofessional teams, nurse-led, case management, patient navigation and shared care) requires a detailed literature review, conceptual clarification and more rigorous understanding of how the models are experienced in the field. The development of case studies in this paper is a first step towards this exploration.
recommendation 2: Be open to the plurality of primary healthcare models, at least in the short run. Supporting diverse models of care is a good thing.
Primary healthcare in Canada is undergoing reform and is experimenting with different models of care, team approaches and funding schemas, often within the same jurisdiction. The plurality of models will likely prevent the premature adherence to a single path of untested primary care model for the majority of the population.
recommendation 3: develop a pan-Canadian strategy to integrate registered nurses and nurse practitioners in primary care models of care.
Although models of care are context-dependent, there are a number of challenges that require stakeholders to come together to develop common solutions such as clarity in roles/scopes of practice, educational standards, supportive legislative frameworks, and public campaigns on the contribution nurses can make to primary care.
recommendation 4: Promote the use of evidence-based implementation of models of care using the PePPA framework (Participatory, evidence-based, Patient-focused Process, for guiding the development, implementation, and evaluation of advanced nursing practice [PePPA])71.
Extensive research has been done to develop and test the framework in the context of implementing advanced nursing practice roles in the field72. The framework takes into account the barriers and enablers identified in this paper and provides a systematic process and set of tools. It is therefore important to leverage this framework as well as other tools developed by the pioneers of the various models.
recommendation 5: Support nurses in their quest to implement innovative models of care in primary care.
various forms of support are needed for nurses in the field, including strong nursing leadership; communities of practice to share and learn and avoid isolation; and educational opportunities to continue strengthening knowledge, skills and confidence to meet increasing healthcare challenges and be effective collaborators working in teams.
interProFeSSional CollaBorative teaMS 19
7 conclUsIonThis paper aims to explore and explain the use of models of care delivery that enhance the role of nurses in primary healthcare and other non-acute care settings. The scoping review provides a preliminary focus of attention on five models of care: interprofessional teams, nurse-led models, case management, patient navigation, and shared care models. The case studies provide a detailed understanding of these models and greater insight into their emergence in the Canadian primary care system. An overview of factors that support or hinder the models of care has been outlined along with five broad recommendations.
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation20
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aPPenDIces aPPenDIX a: seaRcH TeRMs anD sTRaTeGYThe search terms were used in combination.
Population intervention Comparison outcomes
◥ Registered Nurses
◥ Nurse Practitioners
◥ Health Teams
◥ Practice teams
◥ Healthcare organizations
◥ Healthcare facilities
◥ Primary care
◥ Interprofessional teams
◥ Interprofessional collaboration
◥ Collaboration
◥ Teams
◥ Team based care
◥ Primary care
◥ Primary healthcare
◥ Family health teams
◥ Healthcare teams
◥ Chronic management teams
◥ Nurse-led
◥ Traditional teams
◥ Non team based
◥ Health services outcomes
◥ Right person at the right time to provide care
◥ Improve access to care
◥ Cost effectiveness, savings
◥ Team effectiveness outcomes
◥ Communication ◥ Coordination ◥ Collaboration ◥ Team member
satisfaction
◥ Patient outcomes – functional, disability, quality of life
◥ Population health status
◥ Optimized scope of practice
limitations: English, French, 2001 onwards, optimize role of NPs, RNs, primary care (health promotion, prevention, chronic management, screening, non-acute care/hospital care but include outpatient clinics and long term care/nursing homes)
databases: ◥ CINHAl, PuBmEd, Cochrane database ◥ Hand search references in key articles
interProFeSSional CollaBorative teaMS 25
literature/information retrieved
Sources Reviewed, Information Extracted in Data Table = 173
64 articles reviewed for general knowledge and to inform the
research team
Potential Articles/Sources on Models of Care
CINHAL Abstracts = 176
Pubmed Abstracts = 690
Cochrane Abstracts = 49
Website Hits - undefined
Screened and Included = 63
Screened andIncluded = 27
Screened and Included = 12
Screened and Included = 23
Screened and Included = 48
Hand Search/Other Abstracts = 76
Health Star and Healthevidence.ca searches did not produce additional papers of value.
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation26
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44 –
451
.
Cas
e St
udy
Impa
ct o
f col
labo
rativ
e pr
actic
e on
qua
lity
and
cost
-effe
ctiv
e ca
re fo
r di
abet
ic p
atie
nts
lEBA
NO
NIn
terp
rofe
ssio
nal t
eam
dia
bete
s Car
e
◥
Nur
se is
the
teac
her a
nd c
lient
is
the
lear
ner i
n or
der t
o fo
ster
st
rong
self-
man
agem
ent m
aste
ry
in th
e cl
ient
◥
Focu
s on
defin
ing
prob
lem
s, go
al
setti
ng, p
lann
ing
and
follo
w-u
ps
◥
Incr
ease
in co
ntin
uity
of c
are,
impr
ovem
ents
in g
lyce
mic
co
ntro
ls, d
ecre
ased
cost
s
3Ba
ker,
m.w
. & H
eitk
empe
r, m
.m.
(200
5). Th
e ro
les o
f nur
ses o
n In
terp
rofe
ssio
nal t
eam
s to
com
bat
elde
r mist
reat
men
t. N
urse
Out
look
, 53
, 253
-259
.
des
crip
tive
Stud
y
Role
s of n
urse
s on
the
IP te
ams o
n el
der
mist
reat
men
t
uN
ITEd
ST
ATES
Inte
rpro
fess
iona
l tea
m
Ger
iatr
ics
◥
Nur
ses o
n El
der m
anag
emen
t Te
ams a
id w
ith a
sses
smen
ts/
scre
enin
g, re
port
ing,
dire
ct c
are,
and
com
plai
nt in
vest
igat
ion
◥
Nur
ses o
n co
llabo
rativ
e Eld
er
man
agem
ent T
eam
s can
hel
p id
entif
y m
ore c
ases
of a
buse
sin
ce m
ost g
o un
repo
rted
interProFeSSional CollaBorative teaMS 27
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
4Ba
ker,
G.R
., & d
enis,
J.l.
(201
1).
A C
ompa
rativ
e St
udy
of Th
ree
Tran
sfor
mat
ive
Hea
lthca
re S
yste
ms:
Can
ada
Hea
lth l
esso
ns fo
r Can
ada.
Cana
da H
ealth
Ser
vice
s Res
earc
h Fo
unda
tion,
Otta
wa,
ON
, 1-4
0.
Avai
labl
e at
: ww
w.ch
srf.c
a.
Com
para
tive
Rese
arch
St
udy
Ove
rvie
w o
f 3 h
ealth
care
sy
stem
s, le
sson
s Can
ada
can
lear
n
CA
NA
dA
- G
ENER
Al
Inte
rpro
fess
iona
l tea
m
Prim
ary
Car
e (m
odel
from
Ala
ska,
uta
h, a
nd S
wed
en)
◥
mod
els d
emon
stra
te v
ario
us
prin
cipl
es su
ch a
s pat
ient
driv
en
care
, tea
m-b
ased
car
e, pr
oact
ive
heal
th p
anel
s, an
d in
tegr
ated
be
havi
oura
l hea
lth
◥
mod
els h
ave
sh
own
impr
oved
pa
tient
eng
agem
ent
◥
For t
his m
odel
to w
ork,
ro
le e
xpan
sion
need
s to
occu
r; cr
eate
gre
ater
loca
l ca
paci
ty th
roug
h tr
aini
ng
and
lead
ersh
ip
◥Id
entif
y ke
y ta
rget
are
as fo
r im
prov
emen
t and
pri
oriti
ze
◥C
ontin
ue to
dev
elop
an
effec
tive
EmR
(Ele
ctro
nic
med
ical
Rec
ords
) sys
tem
5Ba
rret
t, J.,
Cur
ran,
v., G
lynn
, l., &
G
odw
in, m
. (20
07).
CH
SRF
Synt
hesis
: In
terp
rofe
ssio
nal C
olla
bora
tion
and
Qua
lity
Prim
ary
Hea
lthca
re.
Cana
dian
Hea
lth S
ervi
ces R
esea
rch
Foun
datio
n, 1
-54.
Syst
emat
ic R
evie
w
Expl
orin
g IP
mod
els
GEN
ERA
lIn
terp
rofe
ssio
nal t
eam
Prim
ary
Car
e
◥
Fam
ily p
hysic
ian
wor
king
in
vari
ous p
artn
ersh
ips w
ith n
urse
s, di
etiti
ans,
phar
mac
ists a
nd
com
mun
ity h
ealth
syst
ems
◥
3 ar
eas w
ere
revi
ewed
: IP
Col
labo
ratio
n an
d H
ealth
Sys
tem
O
utco
mes
, Pat
ient
Out
com
es,
Prov
ider
Out
com
es
Hea
lth S
yste
m O
utco
mes
: Bet
ter
coor
dina
tion
of ca
re, u
se o
f re
sour
ces,
broa
der r
ange
of s
ervi
ces
Patie
nt O
utco
mes
: Pos
itive
, bet
ter
acce
ss to
serv
ices
, im
prov
e wai
t tim
es, d
evel
oped
enha
nce s
elf-c
are
and
heal
th co
nditi
on k
now
ledg
e
Prov
ider
Out
com
es: P
ositi
ve,
heal
th w
orke
rs m
ore
satis
fied
wor
king
in a
n IP
env
ironm
ent
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation28
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
6Ba
xter
, P., &
mar
kle-
Reid
, m. (
2009
). A
n in
terp
rofe
ssio
nal t
eam
app
roac
h to
fall
prev
entio
n fo
r old
er h
ome
care
cl
ient
s ‘at
risk
’ of f
allin
g: h
ealth
car
e pr
ovid
ers s
hare
thei
r exp
erie
nces
. In
tern
atio
nal J
ourn
al o
f Int
egra
ted
Care
, 9, 1
-12.
Qua
litat
ive
Stud
y
des
crib
e th
e ex
peri
ence
of
5 d
iffer
ent h
ealth
care
pr
ofes
sion
als i
n a
ho
spic
e ce
ntre
CA
NA
dA
- G
ENER
Al
Inte
rpro
fess
iona
l tea
m
Ger
iatr
ic C
are
◥
Hig
h-le
vel c
olla
bora
tion,
co
ordi
natio
n, c
omm
unic
atio
n
◥Te
am m
embe
rs sh
are
a co
mm
on
goal
of fi
ndin
g so
lutio
ns to
co
mpl
ex p
atie
nt is
sues
◥
Expo
se p
rofe
ssio
nal b
ound
arie
s an
d st
ereo
type
s to
deve
lop
mut
ual
resp
ect a
nd tr
ust
◥
Hav
e a fl
exib
le en
viro
nmen
t, sh
arin
g in
form
atio
n an
d de
cisio
n-m
akin
g
No
spec
ific
clin
ical
out
com
es
Fact
ors t
o ac
hiev
e an
effe
ctiv
e IP
m
odel
for i
n-ho
me
care
: Effe
ctiv
e co
mm
unic
atio
n; R
ole
Cla
rity,
Incr
ease
d Tr
ust;
Avoi
d w
orki
ng
in si
los;
Tim
e m
anag
emen
t
7By
rnes
, v., O
’Rio
rdan
, A., S
chro
der,
C., C
hapm
an, C
., med
ves,
J.,
Pate
rson
, m., &
Gri
gg, R
. (20
12).
Sout
h Ea
ster
n In
terp
rofe
ssio
nal
Col
labo
rativ
e le
arni
ng E
nviro
nmen
t (S
EIPC
lE):
Nur
turi
ng C
olla
bora
tive
Prac
tice.
Jour
nal o
f Res
earc
h in
In
terp
rofe
ssio
nal P
ract
ice a
nd
Educ
atio
n, 2
(2),
168-
186.
Qua
si-C
ontr
olle
d Ex
plor
ator
y St
udy
CA
NA
dA
- O
NTA
RIO
Inte
rpro
fess
iona
l tea
m
Prim
ary
Car
e
◥
Col
labo
ratio
n of
3 e
xist
ing
team
s; ac
ute,
reha
b, a
nd m
enta
l hea
lth
from
3 d
iffer
ent s
ites t
o pe
rfor
m
cont
rols
in a
sing
le si
te
◥In
terv
entio
n in
clud
ed o
nlin
e
◥an
d w
orks
hop
educ
atio
n, st
uden
t pl
acem
ent a
nd p
rece
ptor
ship
w
hich
was
inte
grat
ed in
to p
ract
ice
◥
Each
team
mem
ber r
ecor
ded
the
amou
nt o
f tim
e the
y sp
ent w
ith ea
ch
patie
nt in
each
stag
e of a
dmiss
ion
and
shar
ed d
ata t
o un
ders
tand
m
embe
r pro
gres
s and
roles
◥
Ove
rall
quan
titat
ive
data
di
d no
t sho
w st
atist
ical
ly
signi
fican
t res
ults
but
w
as p
ositi
ve tr
endi
ng –
in
terv
entio
n sit
es sh
owed
st
atist
ical
sign
ifica
nce
in
com
pari
son
to c
ontr
ol si
tes
◥
The
proj
ect p
rodu
ced
thre
e ed
ucat
iona
l mod
ules
, a g
uide
fo
r int
erpr
ofes
siona
l stu
dent
pl
acem
ents
and
thre
e w
orks
hops
◥
Prov
ided
val
idat
ion
of
the
CPA
T (C
olla
bora
tive
Prac
tice A
sses
smen
t Too
l)
8C
ioffi
, J., w
ilkes
, l., C
umm
ings
, J.,
war
ne, B
., & H
arri
son,
K. (
2010
). m
ultid
isci
plin
ary
team
s car
ing
for
clie
nts w
ith c
hron
ic c
ondi
tions
: Ex
peri
ence
s of c
omm
unity
nur
ses
and
allie
d he
alth
pro
fess
iona
ls.
Cont
empo
rary
Nur
se, 3
6(1-
2), 6
1-70
.
Qua
litat
ive
des
crip
tive
Stud
y
Ass
essin
g ex
peri
ence
s of
mul
tidis
cipl
inar
y te
am
mem
bers
in c
omm
unity
ch
roni
c ca
re te
ams
AuST
RAlI
AIn
terp
rofe
ssio
nal t
eam
Chr
onic
Tea
m
◥
At h
ome
appr
oach
,; A
llied
he
alth
pro
fess
iona
ls w
orki
ng
toge
ther
; nur
ses e
nsur
ing
that
pa
tient
s rec
eive
d th
e ca
re th
ey
need
ed in
ord
er to
pro
long
or
prev
ent h
ospi
taliz
atio
n
◥
Col
labo
ratio
n iss
ues i
n co
mm
unic
atio
n, co
hesiv
enes
s an
d ro
le cl
arity
caus
ing
tens
ion,
del
ays i
n re
ferr
als
interProFeSSional CollaBorative teaMS 29
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
9C
ôté,
G., l
auzo
n, C
., & K
yd-
Stri
ckla
nd, B
. (20
08).
Envi
ronm
enta
l sc
an o
f Int
erpr
ofes
siona
l co
llabo
ratio
n pr
actic
e in
itiat
ives
. Jo
urna
l of I
nter
prof
essio
nal C
are,
25(5
), 44
9-46
0.
Envi
ronm
enta
l Sca
n
Ott
awa
Hos
pita
l mod
el
CA
NA
dA
- O
NTA
RIO
Inte
rpro
fess
iona
l tea
m
Prim
ary
Car
e
◥
In 2
008,
the
Otta
wa
Hos
pita
l la
unch
ed it
s pla
n to
inte
grat
e 80
team
s ove
r tw
o ye
ars a
cros
s 3
sites
to fu
lfill
the
Ont
ario
visi
on
for i
nteg
ratin
g in
terp
rofe
ssio
nal
care
in a
ll as
pect
s of h
ealth
care
◥
The O
ttaw
a H
ospi
tal
Inte
rpro
fess
iona
l mod
el o
f Prim
ary
care
(IPm
PC) w
as d
esig
ned
to
orga
nize
pat
ient
care
bet
wee
n he
alth
pro
fess
iona
ls fr
om d
iffer
ent
disc
iplin
es fa
ctor
ing
in th
eir
vario
us co
mpe
tenc
ies t
o cr
eate
the
mos
t effe
ctiv
e col
labo
rativ
e pat
ient
ce
ntre
d pr
actic
es
◥
Cre
ate
a na
tiona
l tre
nd o
f in
form
atio
n sh
arin
g in
ord
er
to im
prov
e an
d ex
pand
pa
tient
-cen
tred
car
e; m
ore
impo
rtan
ce b
eing
pla
ced
on
the
valu
e of
com
mun
icat
ion
◥
Tool
kits
hav
e be
en
deve
lope
d to
gui
de
othe
rs th
roug
h th
e in
terp
rofe
ssio
nal
colla
bora
tion
proc
ess
10Cr
aven
, m., &
Blan
d, R.
(200
6). B
ette
r Pr
actic
es in
Col
labor
ativ
e men
tal
Hea
lth C
are:
An
Ana
lysis
of t
he
Evid
ence
Bas
e. Ca
nadi
an Jo
urna
l of
Psy
chol
ogy,
51(1
), 1-
74.
Syst
emat
ic R
evie
w
Iden
tify B
ette
r Pra
ctice
s in
Col
labor
ative
men
tal H
ealth
GEN
ERA
lI n
terp
rofe
ssio
nal t
e am
(G
P &
Nur
se, C
linic
iens
, Pha
rmac
ists,
Psyc
hoth
erap
ists,
etc.
)
Prim
ary
Car
e –
men
tal H
ealth
Role
s of t
he N
urse
◥
Atte
nd e
duca
tiona
l int
erve
ntio
ns
◥
Stru
ctur
e as
sess
men
ts a
t var
ious
in
terv
als
◥
Follo
w-u
p ca
lls, e
mot
iona
l sup
port
◥
Form
ulat
e a
trea
tmen
t pla
n an
d dr
ug c
ouns
ellin
g
Fact
ors f
or su
cces
s: bu
ild o
n pr
e-ex
istin
g re
latio
nshi
ps, u
se o
f evi
denc
e bas
ed
guid
elin
es, s
uppo
rtiv
e ser
vice
stru
ctur
e
◥
Enha
nced
pat
ient
edu
catio
n
◥IP
wor
k ha
d a
posit
ive
effec
t on
dep
ress
ion
care
◥
mor
e co
nsum
er c
hoic
e ab
out
trea
tmen
t mod
ality
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation30
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
11d
avis,
P., C
lack
son,
J., H
enry
, C.,
Boby
n, J.
, & S
uveg
es, l
. (20
08).
Inte
rpro
fess
iona
l con
tinui
ng h
ealth
ed
ucat
ion
for d
iabe
tic p
atie
nts i
n an
urb
an u
nder
serv
ed c
omm
unity
. Jo
urna
l of I
nter
prof
essio
nal C
are,
22(1
), 51
-60.
Pilo
t Stu
dy
Eval
uatio
n Fi
ndin
gs
lear
ning
nee
ds o
f hea
lth
prof
essi
onal
s wor
king
w
ith u
nder
serv
ed
com
mun
ities
CA
NA
dA
- SA
SKAT
CHE w
ANIn
terp
rofe
ssio
nal t
eam
IC
EC ^
4
dia
bete
s Car
e
◥
This
IP te
am in
clud
es e
duca
tors
, nu
rses
, doc
tors
, phy
sical
ther
apist
s, ph
arm
acist
s, nu
triti
onist
s, ki
nesio
logi
sts,
and
dent
ists
◥
Serv
es 2
targ
et a
udie
nces
; urb
an
unde
rser
ved
com
mun
ity, a
nd
heal
th p
rofe
ssio
nals
◥
No
clin
ical
out
com
es
◥Fo
r thi
s mod
el to
wor
k, te
am
sizes
mus
t be
real
istic
, and
al
thou
gh te
am le
ader
s are
es
sent
ial n
o on
e pe
rson
is in
ch
arge
of t
akin
g al
l the
lead
s
◥Se
vera
l edu
catio
ns m
odel
s w
ere
deve
lope
d; In
tera
ctio
n w
ith th
e Pa
tient
and
his/
her
care
give
r; In
tera
ctio
n w
ith
com
mun
ity a
nd it
s res
ourc
es;
fam
ily c
onfe
renc
e 12
dem
iris,
G., w
ashi
ngto
n, K
., Oliv
er,
d.P
., & w
i tten
berg
-ly l
es, E
. (20
08).
A
stud
y of
info
rmat
ion
flow
in h
ospi
ce
inte
rdis
cipl
inar
y te
am m
eetin
gs.
Jour
nal o
f Int
erpr
ofes
siona
l Car
e, 22
(6),
621-
629.
Expl
orat
ory
Stud
y
det
erm
ine
the
flow
of
info
rmat
ion
in
hosp
ice
care
uN
ITEd
ST
ATES
Inte
rpro
fess
iona
l tea
m
Hos
pice
Car
e
◥
Inte
rdis
cipl
inar
y te
am in
clud
es
phys
icia
n, n
urse
, soc
ial w
orke
r, co
unse
llor
◥
Team
wor
ks o
n ca
re p
lan,
shar
es
goal
s and
resp
onsib
ilitie
s
◥
def
ined
lead
er n
eeds
to
be id
entif
ied
to a
ddre
ss/
reso
lve
issu
es
◥To
impr
ove
patie
nt/c
areg
iver
sa
tisfa
ctio
n, p
atie
nts/
fam
ilies
sh
ould
be
incl
uded
in
prog
ress
mee
tings
interProFeSSional CollaBorative teaMS 31
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
13d
iCen
so, A
., Bou
rgea
ult,
I., A
belso
n,
J., m
artin
-mis
ener
, R., K
aasa
lain
en,
S., C
arte
r, N
., & H
arbm
an, P
. (20
10).
util
izat
ion
of N
urse
Pra
ctiti
oner
s to
Incr
ease
pat
ient
Acc
ess t
o Pr
imar
y H
ealth
care
in C
anad
a: Th
inki
ng
Out
side
the
Box.
Nur
sing
Lead
ersh
ip,
23, 2
39-2
58.
Scop
ing
Rev
iew
Inte
grat
ion
of N
P
GEN
ERA
lIn
terp
rofe
ssio
nal t
eam
s
◥Tw
o m
odels
: B.C
. – in
tegr
atio
n of
N
Ps in
fee-
for-
serv
ice fa
mily
pra
ctice
cli
nics
; Ont
ario
– N
P-led
clin
ics
◥d
iscu
ssio
n of
fact
ors t
hat
supp
orte
d su
cces
s
◥B.
C. –
cle
ar p
roce
ss la
id o
ut b
y Re
gion
al H
ealth
Aut
horit
y fo
r ro
le in
trod
uctio
n, e
valu
atio
n an
d fo
llow
- thr
ough
; sup
port
ive
polic
ies,
infr
astr
uctu
re, p
ract
ice
envi
ronm
ent;
prom
ote
team
fu
nctio
ning
; mut
ual r
espe
ct; o
pen
and
regu
lar c
omm
unic
atio
n;
ongo
ing
clar
ifica
tion
of ro
les
◥
Cha
lleng
es fo
r sus
tain
abili
ty –
hi
erar
chy
– ph
ysic
ian
on to
p;
phys
icia
ns w
orrie
d ab
out w
orkl
oad
and
gaps
in th
eir o
wn
know
ledg
e; co
ncer
ns o
f NP
educ
atio
n;
conc
erns
for t
heir
own
stat
us
◥In
volv
e al
l phy
sicia
ns a
t clin
ic
in sh
ared
lead
ersh
ip in
stea
d of
just
one
as a
lead
phy
sicia
n;
invo
lve
othe
r pro
vide
rs/s
taff
to
unde
rsta
nd N
P ro
le
◥O
ntar
io –
faci
litat
ors –
larg
e nu
mbe
r of u
natta
ched
pat
ient
s; sh
orta
ge o
f phy
sicia
ns, a
vaila
bilit
y of
NPs
, loc
al m
edia
cov
erag
e, go
od w
orki
ng re
latio
nshi
ps w
ith
cons
ultin
g ph
ysic
ians
, hig
h pa
tient
sa
tisfa
ctio
n, N
P-le
d go
vern
ance
st
ruct
ure
(NP
as c
linic
dire
ctor
–
unde
rsta
nd th
e sc
ope)
◥
Cha
lleng
es –
hig
hly
com
plex
nee
ds
of p
atie
nts;
leng
thy
visit
s with
pa
tient
s; fr
eque
nt co
nsul
tatio
ns
with
phy
sicia
ns; c
ould
not
mee
t fir
st y
ear t
arge
ts d
ue to
leng
thy
visit
s; op
posit
ion
by o
rgan
ized
m
edic
ine –
conc
erns
that
NPs
are
inde
pend
ently
pra
ctic
ing
(issu
e m
ay b
e rel
ated
to ti
tle N
P-le
d)
◥
Hig
h pr
ovid
er a
nd
patie
nt sa
tisfa
ctio
n
◥C
reat
ed g
reat
er a
cces
s to
pri
mar
y ca
re
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation32
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
14d
ufou
r, S.
P., &
deb
orah
-luc
y, S.
(201
0). S
ituat
ing
Prim
ary
Hea
lthca
re w
ithin
the
Inte
rnat
iona
l C
lass
ifica
tion
of F
unct
ioni
ng,
disa
bilit
y, an
d H
ealth
: Ena
blin
g th
e C
anad
ian
Hea
lth T
eam
Initi
ativ
e. Jo
urna
l of I
nter
prof
essio
nal C
are,
24(6
), 66
6-67
7.
lite
ratu
re R
evie
w
Com
pari
son
of F
amily
H
ealth
Tea
ms (
FHT)
in
Ont
ario
to th
e
wH
O c
lass
ifica
tion
GEN
ERA
lIn
terp
rofe
ssio
nal t
eam
Prim
ary
Car
e
◥
The
FHT
is su
ppos
ed to
ad
dres
s loc
al n
eeds
and
pro
vide
co
mpr
ehen
sive
care
◥
This
incl
udes
a te
leph
one
heal
th
advi
sory
serv
ice,
an e
xpan
ded
hour
s pra
ctic
e, sp
ecia
lized
ou
tpat
ient
serv
ices
, hea
lth
prom
otio
n, c
hron
ic d
isea
se
man
agem
ent,
patie
nt-c
entr
ed c
are
◥
Gui
ding
pri
ncip
les o
f the
mod
el
incl
ude
flexi
bilit
y, ch
oice
, loc
al
inte
grat
ion,
tran
spar
ency
, co
nsul
tatio
n, a
nd fo
ster
ing
com
mun
ity p
artn
ersh
ips
◥
dis
cuss
ion
does
not
indi
cate
w
heth
er th
e m
odel
has
bee
n im
plem
ente
d or
not
◥
In o
rder
to a
chie
ve
optim
al o
utco
mes
the
follo
win
g fa
ctor
s nee
d to
be
cons
ider
ed: (
1) A
sses
smen
t of
com
mun
ity; (
2) S
elec
ting
the
mos
t app
ropr
iate
he
alth
care
pro
fess
iona
ls;
(3) Th
e tr
ansf
orm
atio
n pr
oces
s fro
m g
roup
to
colla
bora
tive
team
pra
ctic
e ne
eds t
o ta
ke p
lace
; (4
) leg
islat
ion
need
s to
be
mod
ified
and
app
ropr
iate
fu
ndin
g ne
eds t
o be
put
in
pla
ce
15G
abou
ry, I
., lap
ierr
e, l.
m., B
oon,
H.
& m
oher
, d. (
2011
). In
terp
rofe
ssio
nal
colla
bora
tion
with
in in
tegr
ativ
e he
alth
care
clin
ics t
hrou
gh th
e le
ns
of th
e re
latio
nshi
p –c
ente
red
care
m
odel
. Jou
rnal
of I
nter
prof
essio
nal
Care
, 25,
124
-130
.
Expl
orat
ory
Stud
y
Surv
eys w
ith p
ract
ition
ers
at th
e cl
inic
s
CA
NA
dA
- A
lBER
TAIn
terp
rofe
ssio
nal t
eam
Inte
grat
ed H
ealth
care
Clin
ics
Prim
ary
Car
e
◥
Prac
titio
ners
wor
king
toge
ther
in
clin
ic se
tting
s in
vary
ing
com
posit
ions
and
size
s. A
utho
rs
conc
lude
the
need
for t
eam
m
embe
rs to
und
erst
and
the
bene
fits o
f col
labo
ratio
n sk
ills.
◥
Prac
titio
ner b
ehav
iour
s an
d sk
ills a
ssoc
iate
d w
ith
job
satis
fact
ion
interProFeSSional CollaBorative teaMS 33
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
16G
aglia
rdi, A
.R., d
obro
w, m
. J., &
w
righ
t, F.
C. (
2011
). H
ow c
an w
e im
prov
e ca
ncer
car
e? A
revi
ew o
f In
terp
rofe
ssio
nal c
olla
bora
tion
mod
els a
nd th
eir u
se in
clin
ical
m
anag
emen
t. Jo
urna
l of S
urgi
cal
Onc
olog
y, 20
(3),
146-
154.
lite
ratu
re R
evie
w
Con
cept
ual m
odel
s of
colla
bora
tion
amon
g di
ffere
nt p
rofe
ssio
ns in
di
ffere
nt s
ettin
gs; f
ocus
on
clin
ical
man
agem
ent
of c
ance
r pat
ient
s
GEN
ERA
lIn
terp
rofe
ssio
nal t
eam
Can
cer C
are
– O
ncol
ogy
◥
All
mod
els o
f tea
mw
ork
and
colla
bora
tion
that
wer
e de
scrib
ed
invo
lved
two
or m
ore p
rofe
ssio
nals
that
shar
e pa
tient
goa
ls, fo
ster
ing
cont
inuo
us in
tera
ctio
n
◥Si
nce
canc
er p
atie
nts r
equi
re
mul
tiple
hea
lth p
rofe
ssio
nals,
co
llabo
rativ
e m
anag
emen
t and
sy
stem
atic
pla
nnin
g w
ill im
prov
e pa
tient
car
e
◥
Patie
nts w
ill b
enefi
t fro
m
bette
r pla
nned
and
enh
ance
d co
llabo
rativ
e ca
re a
nd
unde
rsta
ndin
g be
twee
n he
alth
pro
fess
iona
ls
17G
oldm
an, J
., meu
ser,
J., R
oger
s, J,
law
rie,
l., &
Ree
ves,
S. (2
010)
. In
terp
rofe
ssio
nal c
olla
bora
tion
in
fam
ily h
ealth
team
s. Ca
nadi
an F
amily
Ph
ysic
ian,
56,
368
-374
.
Qua
litat
ive
Cas
e St
udy
Exam
inin
g IP
C a
nd
its b
enef
its
CA
NA
dA
- O
NTA
RIO
Inte
rpro
fess
iona
l tea
m
Fam
ily H
ealth
Tea
ms
Prim
ary
Car
e
◥
Gai
ning
insig
ht o
f FH
T m
embe
rs
and
thei
r exp
erie
nces
in th
eir r
oles
◥
Fam
ily h
ealth
team
s gen
eral
ly
cons
isted
of a
doc
tor,
nurs
e or
nu
rse
prac
titio
ner,
diet
itian
, soc
ial
wor
ker,
phar
mac
ist, a
nd o
ther
s
◥
Patie
nts a
re re
ceiv
ing
bette
r qu
ality
of c
are
but t
here
is
still
con
fusio
n ab
out
role
s, ne
ed fo
r mor
e te
am
lead
ers,
and
barr
iers
due
to
geo
grap
hy a
nd la
ck
of fo
llow
-ups
bet
wee
n pr
ofes
siona
ls in
volv
ed,
not p
atie
nts
◥
Sugg
estio
ns to
impr
ove
FHTs
incl
ude
mor
e in
terp
rofe
ssio
nal m
eetin
gs,
incr
ease
in E
mR
use,
mor
e tr
aini
ng a
nd re
thin
king
tr
aditi
onal
scop
e of
role
s
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation34
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
18H
aire
, B. (
2010
). In
terp
rofe
ssio
nal C
are:
A m
odel
of co
llabo
rativ
e pra
ctic
e. C
AN
Ad
A, P
rince
Edw
ard
Isla
nd.
Rep
ort
Eval
uatio
n Fr
amew
ork
to e
valu
ate
IPC
CA
NA
dA
- PR
INC
E Ed
wA
Rd
ISlA
Nd
Inte
rpro
fess
iona
l tea
m
Prim
ary
Car
e
◥
Focu
s on
educ
atio
n an
d tr
aini
ng
to p
repa
re fu
ture
hea
lthca
re
wor
kers
to w
ork
in IP
setti
ngs
◥
Shar
e re
spon
sibili
ties,
acco
unta
bilit
y an
d de
velo
p
a fr
amew
ork
to b
road
en
the
scop
e of
wor
k
◥Pr
omot
e cul
tura
l cha
nge t
o aid
w
orke
rs in
adap
ting n
ew p
roce
dure
s, pr
actic
es an
d ex
pect
atio
ns
◥
For t
his I
P sy
stem
to w
ork,
pa
tient
s mus
t be
will
ing
to
adju
st th
eir e
xpec
tatio
ns o
f th
e he
alth
care
syst
em a
nd
resp
onsib
ility
of t
heir
own
heal
th a
nd w
elln
ess
19H
asse
lbac
k, P
., Sau
nder
s, d
., d
astm
alch
ian,
A., A
libha
i, A.,
Boud
reau
, R., C
hrei
m, S
., &
d`A
gnon
e, K
. (20
03).
The
Tabe
r In
tegr
ated
Pri
mar
y C
are
Proj
ect:
Turn
ing
visi
on in
to R
ealit
y. Ca
nadi
an H
ealth
Ser
vice
s res
earc
h Fo
unda
tion,
1-2
9, R
etri
eved
from
: w
ww.
chrs
f.ca.
Pilo
t Eva
luat
ion
CA
NA
dA
RuRA
l A
lBER
TA
Inte
rpro
fess
iona
l tea
m
Rura
l, sm
all t
own
◥
Co-
loca
tion
of p
rovi
ders
◥
Alte
rnat
e pa
ymen
t sys
tem
–
ensu
re n
o fin
anci
al d
isinc
entiv
e
◥
Impr
oved
serv
ices
◥
Impr
oved
satis
fact
ion
of
reci
pien
ts
interProFeSSional CollaBorative teaMS 35
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
20H
illie
r, S.
l. (2
010)
. A S
yste
mat
ic
Revi
ew o
f Col
labo
rativ
e m
odel
s for
H
ealth
and
Edu
catio
n Pr
ofes
siona
ls w
orki
ng in
Sch
ool S
ettin
gs a
nd
Impl
icat
ions
for T
rain
ing.
Edu
catio
n fo
r Hea
lth, 2
3(3)
.
Syst
emat
ic R
evie
w
wha
t are
the
best
mod
els
to su
ppor
t col
labo
ratio
n be
twee
n ed
ucat
ion
and
heal
th st
aff
GEN
ERA
lIn
terp
rofe
ssio
nal t
eam
s
Hea
lthca
re S
choo
l Set
tings
◥
mul
tidis
cipl
inar
y: T
eam
mem
bers
w
ork
in is
olat
ion
but c
ontr
ibut
e
to m
ultid
isci
plin
ary
mee
tings
an
d pl
anni
ng
◥C
ase
man
agem
ent:
Cen
tral
per
son
taki
ng th
e le
ad o
n m
anag
ing
a sp
ecifi
c ca
se
◥C
onsu
ltatio
n: C
onsu
ltant
bri
ngs
expe
rtis
e an
d w
orks
with
the
clie
nt
thro
ugh
a m
edia
tor (
prof
essio
nal
wor
king
dire
ctly
with
the
clie
nt)
◥
Col
labo
ratio
n: A
t lea
st
2 in
divi
dual
s wor
king
toge
ther
to
war
ds a
com
mon
goa
l
◥Te
amin
g: O
rgan
ized
gro
up
of p
erso
nnel
, eac
h tr
aine
d in
a
diffe
rent
pro
fess
iona
l dis
cipl
ine;
coop
erat
ive
prob
lem
-sol
ving
◥
Inte
ract
ive
team
ing:
A fu
sion
of
con
sulta
tion
and
colla
bora
tion
◥
mod
el o
f ser
vice
shift
ed
from
‘’fixi
ng’’ t
he p
robl
em to
gr
eate
r und
erst
andi
ng; f
ocus
on
join
t dec
ision
- mak
ing
and
shar
ing
of re
spon
sibili
ty
◥Fo
r sch
ool c
hild
ren,
a
colla
bora
tive
appr
oach
from
he
alth
care
pro
fess
iona
ls an
d ed
ucat
ors f
oste
rs a
m
ore
holis
tic e
nviro
nmen
t, w
hich
is m
ore
bene
ficia
l and
po
sitiv
e fo
r the
m
◥H
ealth
care
pro
vide
rs
and
educ
ator
s nee
d tr
aini
ng a
nd su
ppor
ts
in in
terp
rofe
ssio
nal
colla
bora
tion
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation36
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
21H
owar
d, m
. (20
11).
Self-
repo
rted
te
amw
ork
in fa
mily
hea
lth te
am
prac
tices
in O
ntar
io. C
anad
ian
Fam
ily P
hysic
ian,
57,
185
-91.
Cro
ss S
ectio
nal S
tudy
Surv
ey d
one
on te
am
clim
ate
mea
sure
s to
det
erm
ine
the
func
tioni
ng o
f a F
HT
CA
NA
dA
- O
NTA
RIO
Inte
rpro
fess
iona
l tea
m
Prim
ary
Car
e
◥
Fam
ily H
ealth
Tea
ms c
onsis
t of
allie
d he
alth
care
pro
fess
iona
ls in
pr
imar
y ca
re p
ract
ices
with
the
aim
to a
chie
ve h
ighe
r qua
lity
of
care
, pra
ctic
es, a
nd a
cces
sibili
ty
◥C
an b
e co
mpo
sed
of a
gro
up o
f pr
ofes
siona
ls at
a si
ngle
clin
ic o
r be
twee
n m
ultip
le o
ffice
s tha
t sha
re
prog
ram
s and
Em
Rs
◥u
sual
ly in
itiat
ed a
nd g
over
ned
by p
hysic
ians
◥
FHTs
show
pos
itive
tren
ds
whe
re th
ere
is st
rong
le
ader
ship
, the
shar
ing
of
EmRs
and
dev
elop
men
t of
cultu
re a
mon
g st
aff
22H
umbe
rt, J.
, leg
ault,
F., d
ahro
uge,
S., H
alabi
sky,
B., B
oyce
, G., &
Hog
g, w
. (20
09).
Inte
grat
ion
of n
urse
pr
actit
ione
rs in
to a
fam
ily h
ealth
ne
twor
k. Ca
nadi
an N
urse
, 103
(9),
30-3
4.
Ran
dom
ized
Con
trol
led
Tria
ls
Bene
fits o
f NPs
in F
HTs
to
man
age
at-r
isk
, at
-hom
e pa
tient
s with
ch
roni
c di
sabi
litie
s
CA
NA
dA
- O
NTA
RIO
Inte
rpro
fess
iona
l tea
m
Ant
icip
ator
y an
d Pr
even
tive
Chr
onic
Car
e
◥
Eigh
teen
-mon
th st
udy
inte
grat
ing
thre
e N
Ps in
FH
Ts to
man
age
at-h
ome
and
at-r
isk p
atie
nts w
ith
chro
nic
disa
bilit
ies
◥
NP
wou
ld v
isit t
he p
atie
nt a
nd
crea
te a
car
e pl
an, v
erify
car
e pl
an
with
the
phys
icia
n, a
nd d
iscu
ss
med
icat
ions
with
the
phar
mac
ist
◥N
P al
so p
rovi
ded
exte
rnal
lin
ks fo
r the
pat
ient
to a
cces
s co
mm
unity
reso
urce
s
◥N
P so
lely
resp
onsib
le fo
r chr
onic
ill
ness
es; a
cute
illn
esse
s wer
e the
re
spon
sibili
ty o
f the
phy
sicia
n or
ER
◥
NP
used
a c
ompr
ehen
sive
heal
th
asse
ssm
ent t
o gu
ide
the
care
pla
n,
whi
ch w
as a
cces
sible
for o
ther
te
am m
embe
rs v
ia E
mR
◥
Patie
nts w
ere
very
satis
fied
with
the
leve
l of c
are
they
w
ere
prov
ided
from
the
NPs
◥
Phys
icia
ns d
ispla
yed
confi
denc
e an
d tr
ust i
n
the
leve
l of c
are
the
NPs
w
ere
prov
idin
g
interProFeSSional CollaBorative teaMS 37
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
23H
uron
Per
th H
ealth
care
Alli
ance
. (2
010)
. Inte
rpro
fess
iona
l Pra
ctice
mod
el.
Insti
tute
of m
edici
ne. (
2010
). Th
e fut
ure
of n
ursin
g: le
adin
g cha
nge,
adva
ncin
g he
alth.
was
hing
ton,
dC:
The N
atio
nal
Acad
emies
Pre
ss (p
repu
blica
tion
copy
). Re
triev
ed fr
om: h
ttp://
ww
w.na
p.ed
u/ca
talo
g/12
956.
htm
l.
Ove
rvie
w o
f the
H
uron
Per
th
Hea
lthca
re A
llian
ce
Inte
rpro
fess
iona
l Pr
actic
e m
odel
CA
NA
dA
- O
NTA
RIO
Inte
rpro
fess
iona
l tea
m
Fam
ily-P
atie
nt F
ocus
ed C
are
◥
Prov
ide
inte
grat
ed a
sses
smen
ts
and
care
pla
ns fo
r the
pat
ient
ba
sed
on e
vide
nce-
info
rmed
pr
actic
e; RN
s and
RPN
s wor
king
in
col
labo
ratio
n
◥m
utua
l und
erst
andi
ng fo
r eac
h te
am m
embe
r’s ro
le; R
N d
eals
with
co
mpl
ex c
lient
s, RP
N h
andl
es le
ss-
risk
clie
nts
◥
Supp
ort p
rofe
ssio
nal d
evelo
pmen
t of
each
team
mem
ber;
plan
ning
and
impl
emen
ting c
ollab
orat
ive s
trate
gies
su
ch as
par
ticip
ator
y lea
ders
hip
◥
Impr
ove
patie
nt sa
fety
, qu
ality
of c
are,
satis
fact
ion
of p
atie
nts a
nd c
areg
iver
s th
roug
h ac
coun
tabi
lity,
part
ners
hip,
and
equ
ity
of te
am m
embe
rs
24la
copi
no, A
.m. (
2010
). m
odel
s for
In
terp
rofe
ssio
nal P
ract
ice:
Inno
vativ
e C
olla
bora
tion
Betw
een
Nur
sing
and
de n
tistr
y. Jo
urna
l of t
he C
anad
ian
Den
tal A
ssoc
iatio
n, 7
6(16
).
Prog
ram
Ove
rvie
w
dis
cuss
ion
on
colla
bora
tion
betw
een
NPs
and
de n
tal T
eam
s to
impr
ove
and
prom
ote
oral
aw
aren
ess
CA
NA
dA
- m
AN
ITO
BAIn
terp
rofe
ssio
nal t
eam
Nur
sing
and
den
tistr
y
◥
Col
labo
rativ
e edu
catio
nal e
xcha
nge;
Scho
ol o
f Nur
sing
mer
ging
with
the
Col
lege o
f den
tistr
y
◥N
urse
s tea
chin
g ab
out t
heir
prac
tice,
the
need
for r
efer
rals
and
awar
enes
s of p
atie
nt h
ealth
ri
sk p
rofil
es; d
entis
ts p
rovi
ding
te
achi
ng o
n or
al h
ealth
scre
enin
g an
d im
port
ance
◥
Exam
inin
g ho
w c
erta
in d
isea
ses
can
be c
o-m
anag
ed v
ia n
urse
and
de
ntist
scre
enin
g
◥
Patie
nts u
nder
stand
ing
the
impo
rtan
ce o
f see
king
den
tal
serv
ices
as w
ell as
prim
ary
care
serv
ices
impr
oved
; pa
tient
s wer
e ver
y op
en an
d ac
cept
ing
of o
ral h
ealth
chec
k-up
s and
den
tal r
efer
rals
◥
dem
onst
rate
d th
at n
urse
s can
im
prov
e acc
ess t
o or
al h
ealth
an
d al
so p
rom
ote d
iseas
e pr
even
tion
by w
orki
ng
alon
gsid
e den
tal t
eam
s and
be
ing
a pa
rt o
f the
firs
t-po
int
of co
ntac
t with
clie
nts
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation38
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
25le
gare
, F., P
oulio
tt, S
., Sta
cey,
d.,
des
roch
ers,
S., K
ryw
oruc
hko,
J.,
dun
n, S
., & E
lwyn
, G. (
2011
).In
terp
rofe
ssin
alism
and
shar
ed
deci
sion-
mak
ing
in p
rim
ary
care
: a
step
wis
e ap
proa
ch to
war
ds a
new
m
odel
. Jou
rnal
of I
nter
prof
essio
nal
Care
, 25,
18-
25.
Con
cept
ual P
aper
Ach
ievi
ng a
con
sens
us
on a
n IP
Sha
red
dec
isio
n m
akin
g m
odel
CA
NA
dA
- G
ENER
Al
Inte
rpro
fess
iona
l tea
m
Prim
ary
Car
e
◥
Indi
vidu
al l
evel
: The
pat
ient
ca
n m
ake
a va
lue-
base
d in
form
ed d
ecis
ion
with
a te
am
of h
ealth
care
pro
fess
iona
ls
◥H
ealth
care
mes
o le
vel:
des
igni
ng
orga
niza
tiona
l rou
tines
and
hav
ing
a de
cisio
n co
ach
◥
Hea
lthca
re m
acro
lev
el:
und
erst
andi
ng th
e in
fluen
ce
of sy
stem
-leve
l fac
tors
; he
alth
pol
icie
s; pr
ofes
siona
l or
gani
zatio
ns; s
ocia
l con
text
◥
No
spec
ific
clin
ical
out
com
es
◥va
lidat
e the
mod
el am
ongs
t va
rious
stak
ehol
ders
; pat
ient
s, m
anag
ers,
polic
y m
aker
s; off
er IP
educ
atio
n; id
entif
y fa
ctor
s tha
t cou
ld aff
ect t
he
mod
el’s i
mpl
emen
tatio
n
26li
n, E
.H.B
., Kat
on, w
., Rut
ter,
C.,
Sim
on, G
.E., l
undm
an, E
.J., v
on-
Kor
ff, m
., & Y
oung
, B. (
2006
). Eff
ects
of
Enh
ance
d d
epre
ssio
n on
dia
bete
s Se
lf-C
are.
Anna
ls of
Fam
ily M
edic
ine,
4(1)
, 46-
53.
Ran
dom
ized
Con
trol
led
Tria
l (RC
T)
Exam
inin
g eff
ects
of
depr
essio
n in
terv
entio
ns
on se
lf-m
anag
ed
depr
esse
d di
abet
ic p
atie
nts
uN
ITEd
ST
ATES
Inte
rpro
fess
iona
l tea
m
dia
bete
s
◥
Ran
dom
ize
Con
trol
led
Tria
l (R
CT)
incl
uded
329
pat
ient
s ac
ross
9 P
rim
ary
Car
e C
linic
s
◥Pa
tient
s in
the i
nter
vent
ion
grou
p w
ere r
ecei
ving
pha
rmac
othe
rapy
an
d pr
oble
m-s
olvi
ng su
ppor
t; ev
ery
few
mon
ths (
3,6,
12) p
atie
nts’
sum
mar
ies o
f dia
bete
s sel
f-car
e ac
tiviti
es w
ere l
ooke
d at
, alo
ng w
ith
pres
crip
tion
adhe
renc
e and
inta
ke
◥
Enha
nced
dep
ress
ion
care
an
d ou
tcom
es w
ere n
ot
asso
ciat
ed w
ith im
prov
ed
diab
etes
self-
care
beh
avio
rs;
no si
gnifi
cant
chan
ges i
n nu
triti
on, i
ncre
ased
phy
sical
ac
tivity
, or s
mok
ing
cess
atio
n;
min
or ch
ange
s in
BmI f
or
som
e pat
ient
s; no
diff
eren
ces
in m
edic
al a
dher
ence
interProFeSSional CollaBorative teaMS 39
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
27li
u, C
.F., H
edri
ck, S
.C., C
hane
y, E.
F.,
Hea
gert
y, P.
, Fel
ker,
B., &
Has
enbe
rg,
N. (
2003
). C
ost-
Effec
tiven
ess o
f C
olla
bora
tive
Car
e fo
r dep
ress
ion
in
a Pr
imar
y C
are v
e ter
an P
opul
atio
n.
Psyc
hiat
ric s
ervi
ces.
54(5
), 69
8-70
4.
Ran
dom
ized
Con
trol
led
Tria
l
Cos
t-effe
ctiv
enes
s of
a col
labo
rativ
e car
e in
terv
entio
n fo
r dep
ress
ion
uN
ITEd
ST
ATES
Inte
rpro
fess
iona
l te a
m
Prim
ary
Car
e –
men
tal H
ealth
◥
men
tal H
ealth
Tea
m (m
HT)
pr
ovid
es tr
eatm
ent p
lans
, te
leph
one
follo
w-u
ps, t
reat
men
t ad
here
nce,
resu
lts, m
odifi
catio
ns
to c
are
plan
◥Fo
cus o
n de
liver
ing
evid
ence
-bas
ed
trea
tmen
ts, b
ette
r com
mun
icat
ion
and
coor
dina
tion
of ca
re
◥
mH
Ts in
pri
mar
y ca
re
enab
le m
ore
patie
nts w
ith
men
tal i
llnes
s and
dep
ress
ion
to g
et sc
reen
ed a
nd c
are
◥
Incr
ease
d co
st a
nd
effec
tiven
ess o
f car
e
◥Pa
tient
s in
the
colla
bora
tive
care
mod
el w
ith th
e m
HT
rece
ived
pre
scrip
tions
for
anti-
depr
essa
nts a
nd w
ere
trea
ted
for d
epre
ssio
n
◥Pa
tient
s exp
erie
nced
14
.6 ad
ditio
nal d
epre
ssio
n-fre
e day
s ove
r the
nin
e-m
onth
stu
dy, r
esul
ting
in co
st sa
ving
s28
ludw
ig, K
. (20
07).
Patie
nts
Firs
t Pro
ject
: Fin
al R
epor
t. In
terp
rofe
ssio
nal N
etw
ork
of B
C.
Briti
sh C
olum
bia,
Can
ada.
Fina
l Rep
ort
How
to im
prov
e th
e qu
ality
of c
are
for F
irst
Nat
ion
com
mun
ities
in
nort
hern
BC
CA
NA
dA
- BR
ITIS
H
CO
lum
BIA
Inte
rpro
fess
iona
l tea
m
Abo
rigi
nal H
ealth
Car
e
◥
Eval
uatio
n of
cur
rent
in
terp
rofe
ssio
nal t
eam
s an
d ex
peri
ence
with
Fi
rst N
atio
n co
mm
uniti
es
◥Ed
ucat
ion
and
trai
ning
on
inte
rpro
fess
iona
l kno
wle
dge
and
skill
s for
hea
lthca
re p
ract
ition
ers
◥
Pres
enta
tions
, edu
catio
nal s
essio
ns,
and
conf
eren
ces w
ere o
rgan
ized
to
disc
uss fi
ndin
gs o
f the
pro
ject
◥
Firs
t Nat
ions
gro
ups s
till
appr
ehen
sive
of o
utsid
ers
◥
mor
e int
egra
tion
of ed
ucat
ion,
pr
actic
e, an
d po
licy;
susta
ined
by
the c
omm
unity
◥Es
tabl
ish st
rong
er co
nnec
tions
be
twee
n he
althc
are p
rovi
ders
in
the c
omm
unity
and
thos
e in
tend
ing t
o w
ork
with
the
com
mun
ity, i.
e. “u
nity
lear
ning
.’’
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation40
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
29m
acA
dam
, m. (
2008
). Fr
amew
orks
of
Inte
grat
ed C
are
for t
he E
lder
ly: A
Sy
stem
atic
Rev
iew.
Can
adia
n Po
licy
Rese
arch
Net
wor
ks, 1
-35.
Syst
emat
ic R
evie
w
How
to re
dire
ct c
are
from
inst
itutio
naliz
ed
serv
ices
and
focu
s on
case
man
agem
ent
GEN
ERA
lIn
terp
rofe
ssio
nal t
eam
s
Revi
ew o
f Int
egra
ted
Car
e m
odel
s; w
agne
r’s C
Cm
(Chr
onic
Car
e m
odel
); C
ase
man
agem
ent m
odel
s: PA
CE
mod
el, S
IPA
, PRI
S mA
)
PAC
E (P
rogr
am, A
ll-In
clusiv
e Car
e fo
r the
Eld
erly
): Jo
int r
even
ues,
case
m
anag
emen
t, m
ultid
iscip
linar
y te
am,
serv
ice d
eliv
ery
focu
s; pr
even
tion
focu
s, re
habi
litat
ion
and
supp
ortiv
e car
e
SIPA
(Sys
tem
of I
nteg
rate
d C
are f
or
Old
er P
erso
ns):
Con
trol o
f joi
nt fu
ndin
g, ca
se m
anag
emen
t with
mul
tidisc
iplin
ary
team
, use
of c
linic
al p
roto
cols,
inte
nsiv
e ho
me c
are,
24-h
our o
n-ca
ll av
aila
bilit
y, ra
pid
team
mob
iliza
tion)
PISm
A (I
nter
- and
intr
a-or
gani
zatio
nal
coor
dina
tion,
sing
le p
oint
of e
ntry
, cl
inic
al m
anag
emen
t, se
rvic
e co
ordi
natio
n vi
a ca
se te
am m
anag
ers
who
wor
k w
ith p
rovi
ders
, com
mon
as
sess
men
t ins
trum
ent,
clin
ical
cha
rt,
serv
ice
plan
, bud
getin
g of
serv
ices
in
tegr
ated
info
rmat
ion
syst
em
Succ
ess f
acto
rs: s
tron
g ph
ysic
ian
invo
lvem
ent,
com
mon
ass
essm
ent
and
care
pla
nnin
g to
ols,
inte
grat
ed
data
syst
ems;
umbr
ella
org
aniz
atio
nal
stru
ctur
e, m
ultid
isci
plin
ary
case
m
anag
emen
t, or
gani
zed
netw
ork
of
pro
vide
rs, fi
nanc
ial i
ncen
tives
vario
us: d
epen
ding
on
whi
ch ty
pe
of in
tegr
ated
syst
em w
as u
sed
◥
PAC
E: R
educ
ed h
ospi
tal
visit
s, lo
wer
mor
talit
y, im
prov
ed q
ualit
y of
life
an
d he
alth
stat
us, n
o st
rong
ev
iden
ce o
f cos
t sav
ings
◥
SIPA
: Inc
reas
e in
clie
nt
satis
fact
ion,
no
incr
ease
in
care
give
r bur
den,
no
over
all
cost
savi
ngs b
ut co
st- e
ffect
ive
◥
PRIS
mA
: Pro
misi
ng re
sults
, la
ck o
f out
com
e m
easu
res
interProFeSSional CollaBorative teaMS 41
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
30m
alin
, N., &
mor
row,
G. (
2007
). m
odel
s of i
nter
prof
essio
nal
wor
king
with
in a
Sur
e St
art
‘‘Tra
ilbla
zer’’
Pro
gram
me.
Jour
nal o
f In
terp
rofe
ssio
nal C
are,
21(4
), 44
5-45
7.
Qua
litat
ive
Stud
y (S
ingl
e C
ase
Stud
y d
esig
n)
des
crib
ing
IP w
ork
in
the “
trai
lbla
zer’’
pro
gram
uN
ITEd
K
ING
dO
mIn
terp
rofe
ssio
nal t
eam
Chi
ld C
are
Early
Sup
port
Clo
se g
ap in
out
com
es b
etw
een
child
ren
livin
g in
pov
erty
and
wid
er
child
pop
ulat
ion
◥
Sure
Sta
rt lo
cal p
rogr
ams p
rovi
de
outr
each
, hom
e vi
sitin
g, fa
mily
su
ppor
t, su
ppor
t for
goo
d qu
ality
pla
y, le
arni
ng, c
hild
care
ex
peri
ence
s, pr
imar
y an
d co
mm
unity
hea
lthca
re, a
dvic
e ab
out c
hild
and
fam
ily h
ealth
an
d de
velo
pmen
t and
supp
ort
for p
eopl
e w
ith sp
ecia
l nee
ds
(incl
udin
g he
lp in
acc
essin
g sp
ecia
lized
serv
ices
)
◥
Prog
ram
impr
oves
soci
al
and
emot
iona
l dev
elop
men
t, he
alth
, chi
ldre
n’s a
bilit
y to
le
arn,
stre
ngth
ens f
amili
es/
com
mun
ities
31m
anns
, B.J.
, Ton
elli,
m., Z
hang
, J.,
Cam
pbel
l, d
.J.T.
, Joh
nson
, J.,
& S
argi
ous,
P. (2
011)
. The
impa
ct
of p
rim
ary
care
net
wor
ks o
n th
e ca
re a
nd o
utco
mes
of p
atie
nts
with
dia
bete
s. Re
port
to A
lber
ta
Hea
lth a
nd w
elln
ess a
nd A
lber
ta
Hea
lth S
ervi
ces.
Retr
ieve
d fr
om:
Inte
rdis
cipl
inar
y C
hron
ic d
isea
se
Col
labo
ratio
n (w
ww.
ICd
C.c
a ).
Coh
ort S
tudy
Ana
lysi
s of s
tate
of
prim
ary
care
net
wor
ks
in A
lber
ta u
sing
a
coho
rt st
udy
of d
iabe
tic
patie
nts (
prev
alen
t vs.
inci
dent
dia
bete
s)
CA
NA
dA
- A
lBER
TAIn
terp
rofe
ssio
nal t
eam
Prim
ary
Car
e
◥
Prim
ary
Car
e N
etw
orks
(PC
N) –
38
as o
f Oct
ober
201
0. F
undi
ng
coul
d be
use
d to
hir
e nu
rses
. So
me
PCN
s offe
red
chro
nic
dise
ase
man
agem
ent t
o so
me
of
thei
r pat
ient
s whi
le o
ther
s offe
red
to a
ll. S
trat
egie
s use
d by
PC
Ns
incl
uded
: use
of E
mR
, pat
ient
re
min
ders
, clin
ical
rem
inde
rs,
audi
t and
feed
back
, fac
ilita
ted
rela
y of
pat
ient
dat
a, cl
inic
ian
educ
atio
n, p
atie
nt e
duca
tion,
pr
omot
ion
of se
lf-m
anag
emen
t, te
am c
hang
es, c
ase
man
agem
ent.
mo s
t com
mon
stra
tegi
es w
ere
team
cha
nges
and
pat
ient
ed
ucat
ion.
Non
-phy
sici
ans
pres
crib
ing
med
icat
ions
in h
alf
of P
CN
s.
◥
Bette
r gly
cem
ic c
ontr
ol, l
ess
ER v
isits
and
hos
pita
lizat
ion
amon
g di
abet
ic p
atie
nts
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation42
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
32m
artin
-mis
ener
, R., w
ambo
ldt,
B.d
., C
ain,
E., &
Giro
uard
, m. (
2009
). C
ost e
ffect
iven
ess a
nd o
utco
mes
of
a n
urse
pra
ctiti
oner
-par
amed
ic-
fam
ily p
hysic
ian
mod
el o
f car
e: Th
e lo
ng a
nd B
rier
Isla
nds s
tudy
. Pr
imar
y H
ealth
care
Res
earc
h an
d D
evelo
pmen
t, 10
, 14-
25.
long
itudi
nal S
tudy
CA
NA
dA
- N
OvA
SC
OTI
AIn
terp
rofe
ssio
nal t
eam
Rura
l Em
erge
ncy
Car
e
◥
Ons
ite N
P an
d pa
ram
edic
; off-
site
, phy
sici
an m
odel
◥
dec
reas
ed c
osts
(mos
tly
from
dec
reas
ed tr
avel
)
◥In
crea
sed
satis
fact
ion
◥
Incr
ease
d ac
cess
◥
Incr
ease
d eff
ectiv
e co
llabo
ratio
n
33m
a rtin
-mi s
ener
, R., m
cNab
, J.,
Sket
ris,
I.S., &
Edw
ards
, l. (
2004
). C
olla
bora
tive
prac
tice
in h
ealth
sy
stem
s cha
nge:
the
Nov
a Sc
otia
ex
peri
ence
with
the
stre
ngth
enin
g pr
imar
y ca
re in
itiat
ive.
Nur
sing
Lead
ersh
ip, 1
7(2)
, 33-
46.
Pers
pect
ive
Pape
r
Aut
hors
pro
vide
thei
r pe
rspe
ctiv
es o
n ho
w to
im
prov
e hea
lthca
re u
sing
the S
tren
gthe
ning
Prim
ary
Car
e Ini
tiativ
e (SP
CI)
CA
NA
dA
- N
OvA
SC
OTI
AIn
terp
rofe
ssio
nal t
eam
Prim
ary
Car
e
◥
Focu
s of t
he te
am w
as o
n ho
w to
in
trod
uce c
olla
bora
tive p
ract
ice
betw
een
prim
ary
heal
thca
re n
urse
pr
actit
ione
rs an
d fa
mily
phy
sicia
ns
◥A
im is
for t
he N
P to
wor
k al
ongs
ide
the
FP u
sing
met
hods
ot
her t
han
FSS,
and
inco
rpor
atin
g on
line
med
ical
pat
ient
reco
rds
◥
Goa
ls w
ere
to im
prov
e th
e re
spon
se to
the
com
mun
ity;
impr
ove
acce
ss to
car
e by
pr
omot
ing
illne
ss p
reve
ntio
n,
acco
unta
bilit
y an
d co
llabo
ratio
n
◥
Prov
ide
clea
r gui
delin
es
of re
spon
sibi
lity;
ens
urin
g th
at p
harm
acis
ts a
re
awar
e of
the
new
nur
se
pres
crip
tive
auth
ority
◥
Ensu
re th
e di
ssol
utio
n
of h
iera
rchi
es to
pro
mot
e co
llabo
ratio
n be
twee
n
FPs a
nd N
Ps
◥
Add
ress
issu
es o
f mal
prac
tice
and
liabi
lity
◥
Trea
ting
ambu
lato
ry c
are-
sens
itive
con
ditio
ns in
a
mor
e co
hesiv
e w
ay
34m
cNea
l, G
. (20
08).
um
dN
J Sch
ool
of N
ursin
g m
obile
Hea
lthca
re
Proj
ect:
A C
ompo
nent
of t
he N
ew
Jers
ey C
hild
ren’s
Hea
lth P
roje
ct.
ABN
F Jo
urna
l, 19
(4),
121-
128.
Cas
e St
udy
Exam
ples
of n
urse
-m
anag
ed h
ealth
cen
tres
uN
ITEd
ST
ATES
Inte
rpro
fess
iona
l tea
m
Am
bula
tory
Car
e
◥
Staff
inclu
ded
med
ical
dire
ctor
, pa
edia
tric
ian,
and
nurs
ing
assis
tant
◥
Nur
sing
ass
ista
nt w
ould
hel
p w
ith
scre
enin
gs, n
utri
tion
asse
ssm
ents
an
d im
mun
izat
ions
◥
Trea
ting
ambu
lato
ry c
are-
sens
itive
con
ditio
ns in
a
mor
e co
hesiv
e w
ay
interProFeSSional CollaBorative teaMS 43
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
35m
ills,
J.E., F
ranc
is, K
., Birk
s, m
., C
oyle
, m., H
ende
rson
, S. &
Jone
s, J.
(201
0). R
egist
ered
nur
ses a
s mem
bers
of
inte
rpro
fess
iona
l pri
mar
y he
alth
ca
re te
ams i
n re
mot
e or
isol
ated
ar
eas o
f Que
ensla
nd: C
olla
bora
tion,
co
mm
unic
atio
n an
d pa
rtne
rshi
ps in
pr
actic
e. Jo
urna
l of I
nter
prof
essio
nal
Care
, 24(
5), 5
87–5
96.
Com
mis
sion
ed m
ulti-
Cas
e R
esea
rch
Proj
ect
und
erst
andi
ng th
e ro
le o
f nu
rses
in re
mot
e se
tting
s
AuST
RAlI
AIn
terp
rofe
ssio
nal t
eam
Prim
ary
Car
e –
Rem
ote A
reas
◥
Col
labo
rativ
e de
cisi
on-m
akin
g in
clud
ing
case
con
fere
ncin
g
◥En
hanc
ing
exch
ange
of
info
rmat
ion
◥
Fost
erin
g st
rong
er re
latio
nshi
ps
◥
No
clin
ical
out
com
es
◥Re
sear
ch sh
owed
that
nur
ses
and
indi
geno
us w
orke
rs
frequ
ently
misu
nder
stand
on
e ano
ther
, so
colla
bora
tion
is es
sent
ial; e
stabl
ishin
g pa
rtne
rshi
ps an
d hi
gh le
vels
of
com
mun
icat
ion
will
impr
ove
heal
th se
rvic
es an
d ca
re36
min
ore,
B. &
Bon
e, m
. (20
02).
Real
izin
g po
tent
ial:
impr
ovin
g in
terd
isci
plin
ary
prof
essio
nal-
para
prof
essio
nal h
ealth
car
e te
ams
in C
anad
a’s n
orth
ern
abor
igin
al
com
mun
ities
thro
ugh
educ
atio
n.
Jour
nal o
f Int
erpr
ofes
siona
l Car
e, 16
(2),
139-
147.
Opi
nion
Pap
er
Enha
ncin
g he
alth
hum
an
reso
urce
s in
rura
l are
as
with
the
Hea
lth H
uman
Re
sour
ce m
odel
CA
NA
dA
- O
NTA
RIO
Inte
rpro
fess
iona
l tea
m
Hea
lth H
uman
Res
ourc
e m
odel
◥
This
mod
el co
nsist
s of m
enta
l he
alth
wor
kers
, com
mun
ity h
ealth
w
orke
rs, a
nd a
lcoh
ol an
d ad
dict
ion
prog
ram
wor
kers
wor
king
al
ongs
ide p
rimar
y ca
re n
urse
s
◥Th
is m
odel
was
des
igne
d to
hel
p fil
l in
gaps
in ru
ral a
nd re
mot
e ar
eas w
here
recr
uitm
ent o
f hea
lth
prof
essi
onal
s is d
ifficu
lt
◥
No
clin
ical
out
com
es
◥m
odel
will
wor
k eff
ectiv
ely
if in
divi
dual
s inv
olve
d re
ceiv
e ad
ditio
nal i
nstr
uctio
n,
(clin
ical
, int
erpr
ofes
siona
l, cu
ltura
l, co
mm
unic
atio
nal)
to o
ptim
ize
the
heal
th
hum
an re
sour
ces m
odel
in
orde
r to
mee
t the
nee
ds o
f un
ders
erve
d cl
ient
s
37N
icho
las,
d.B
. (20
10).
Exam
inin
g or
gani
zatio
nal c
onte
xt a
nd a
de
velo
pmen
tal f
ram
ewor
k in
ad
vanc
ing
inte
rpro
fess
iona
l co
llabo
ratio
n: A
cas
e st
udy.
Jour
nal
of In
terp
rofe
ssio
nal C
are,
24(3
), 31
9–32
2.
Cas
e St
udy
Exam
inin
g in
terp
rofe
ssio
nal
colla
bora
tion
at
Toro
nto’s
Hos
pita
l for
Si
ck K
ids
CA
NA
dA
- O
NTA
RIO
Inte
rpro
fess
iona
l tea
m
Sick
Kid
s mod
el
◥
The
core
of t
his m
odel
is c
entr
ed
arou
nd fa
mily
-cen
tred
car
e an
d th
e in
clus
ion
of a
bro
ad sp
ectr
um
of st
akeh
olde
rs
◥
No
clin
ical
out
com
e
◥m
odel
can
be
adva
nced
th
roug
h a
mul
ti-la
yer
appr
oach
, and
fam
ily
incl
usio
n ha
s bee
n a
t op
app
roac
h
◥Th
e ‘’fa
mily
-cen
tred
care
ad
viso
ry co
unci
l’’ ha
s bee
n
an im
port
ant c
ompo
nent
of
IP a
dvan
cem
ent i
nclu
ding
pl
anni
ng, o
pera
tions
, an
d ev
alua
tion
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation44
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
38N
orth
wes
t Ter
ritor
ies H
ealth
and
So
cial
Ser
vice
s. (2
004)
. Int
egra
ted
Serv
ice
del
iver
y m
odel
for t
he N
wT
Hea
lth a
nd S
ocia
l Ser
vice
s Sys
tem
: A
det
aile
d d
escr
iptio
n. P
rimar
y H
ealth
care
Tra
nsiti
on F
und:
Hea
lth
Cana
da, 1
-168
.
des
crip
tive A
naly
sis
Ove
rvie
w o
f the
In
tegr
ated
Ser
vice
d
eliv
ery
mod
el S
trat
egy
for N
orth
wes
t Ter
ritor
ies
CA
NA
dA
- N
wT
Inte
rpro
fess
iona
l tea
m
Prim
ary
Car
e
◥
A h
ealth
and
soci
al se
rvic
es
orga
niza
tion
with
a v
ertic
al
and
hori
zont
al a
ppro
ach
that
is
seam
less
and
com
preh
ensi
ve, w
ith
a st
rong
clie
nt-c
entr
ed fo
cus
◥
Aim
is to
pro
vide
tran
spar
ent,
com
pete
nt, a
nd su
stai
nabl
e ca
re w
ith q
ualit
y as
sura
nce
and
cont
inui
ty, w
ith ro
om fo
r on-
goin
g ev
alua
tions
◥
The
succ
ess o
f thi
s mod
el
depe
nds l
arge
ly o
n th
e ab
ility
to
recr
uit,
reta
in, a
nd re
trai
n st
aff w
hen
nece
ssar
y
◥En
suri
ng th
at c
olla
bora
tion
is ta
king
pla
ce a
t a re
gion
al
and
terr
itori
al le
vel
◥
Cre
atin
g a
para
digm
shift
th
at p
rom
otes
a w
elln
ess
mod
el o
ver a
n ill
ness
mod
el,
easin
g th
e bu
rden
on
the
heal
thca
re sy
stem
39O
’Bri
en, J
.l. (
2009
). A
ph
enom
enol
ogic
al p
ersp
ectiv
e on
adv
ance
d pr
actic
e nu
rse–
phys
icia
n co
llabo
ratio
n w
ithin
an
inte
rdis
cipl
inar
y he
alth
care
team
. Jo
urna
l of t
he A
mer
ican
Aca
dem
y of
N
urse
Pra
ctiti
oner
s, 21
, 444
–453
.
Phen
omen
olog
ical
Pe
rspe
ctiv
e
Expe
rien
ces o
f A
dvan
ced
Prac
tice
Nur
ses a
nd P
hysi
cian
s in
a n
ursi
ng h
ome
uN
ITEd
ST
ATES
Inte
rpro
fess
iona
l tea
m
Focu
s on
APN
and
phy
sicia
n co
llabo
ratio
n in
mul
tisite
nur
sing
hom
e pr
actic
e
◥
Impr
ovin
g th
e co
mm
unic
atio
n,
acco
mm
odat
ion,
und
erst
andi
ng
info
rmat
ion
and
know
ledg
e-ex
chan
ge b
etw
een
phys
icia
ns a
nd
adva
nced
pra
ctic
e nu
rses
◥
Nur
se-p
hysic
ian
rela
tions
hips
impr
oved
in
setti
ngs w
here
team
wor
k is
vita
l: op
erat
ing
room
s, in
tens
ive
care
uni
ts
◥Fo
cus o
n im
prov
ing
phys
icia
n’s u
nder
stan
ding
of
the
NP
role
, sco
pe o
f pra
ctic
e to
enh
ance
trus
t/res
pect
40O
dega
rd, A
., Hag
tvet
,K.A
., & B
jork
ly,
S. (2
008)
. App
lyin
g as
pect
s of
gene
raliz
abili
ty th
eory
in p
relim
inar
y va
lidat
ion
of th
e m
ultif
acet
In
terp
rofe
ssio
nal C
olla
bora
tion
mod
el (P
INC
Om
). In
tern
atio
nal
Jour
nal o
f Int
erpr
ofes
siona
l Car
e, 8(
17),
1568
-415
6.
Empi
rica
l Ass
essm
ent
Ass
essm
ent o
f the
IP
C m
odel
with
the
Gen
eral
izab
ility
Theo
ry
(GT)
NO
RwAY
Inte
rpro
fess
iona
l tea
m
Chi
ldre
n an
d yo
uth
in m
enta
l hea
lth
doe
s not
pro
vide
muc
h on
the
mod
els
◥
Stud
y ill
ustr
ates
that
in c
ontr
ast
to te
st c
onst
ruct
ion
with
in th
e cl
assi
cal t
est t
heor
y fr
amew
ork,
G
T gi
ves n
ew p
ossi
bilit
ies f
or
eval
uatin
g te
st sc
ores
◥
GT
high
light
s bot
h va
lidity
and
re
liabi
lity
issu
es, i
mpo
rtan
t in
mea
suri
ng o
f IPC
◥
IPC
mea
sure
men
t stil
l in
early
pha
ses o
f dev
elop
men
t
◥N
eed
for c
lear
er d
efini
tions
interProFeSSional CollaBorative teaMS 45
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
41Pa
uzé E
., Gag
né, m
.A., &
Pau
tler,
K.
(200
5). C
olla
bora
tive m
enta
l hea
lth
care
in p
rimar
y he
alth
care
: A re
view
of
Can
adia
n in
itiat
ives
. Vol
ume I
: An
alys
is of
Initi
ativ
es –
Can
adia
n Co
llabo
rativ
e Men
tal H
ealth
Initi
ativ
e; 1-
102.
Retr
ieve
d fr
om: w
ww.
ccm
hi.ca
.
Revi
ew
Key
them
es/tr
ends
in
colla
bora
tive m
enta
l hea
lth
CA
NA
dA
- G
ENER
Al
Inte
rpro
fess
iona
l tea
m
Prim
ary
Car
e –
men
tal H
ealth
Thre
e ap
proa
ches
with
phy
sicia
ns,
nurs
es, p
sych
iatr
ists
1.
dir
ect:
men
tal h
ealth
spec
ialis
ts
offer
thei
r ser
vice
s 2.
In
dire
ct a
ppro
ach:
pri
mar
y he
alth
care
pro
vide
r del
iver
ing
men
tal h
ealth
serv
ices
with
the
cons
ulta
tive
supp
ort o
f a m
enta
l he
alth
spec
ialis
t3.
C
ombi
natio
n of
dir
ect/
indi
rect
◥
No
spec
ific
clin
ical
out
com
es
◥A
com
bine
d ap
proa
ch to
m
enta
l hea
lth is
pre
ferr
ed;
cons
umer
s sho
uld
be
invo
lved
in al
l asp
ects
of
thei
r car
e, th
eir k
now
ledg
e an
d ex
pert
ise sh
ould
not
be
unde
rval
ued
whe
n de
velo
ping
, im
plem
entin
g, an
d ev
alua
ting
colla
bora
tive a
ctiv
ities
42Pe
tri,
l. (2
010)
. Con
cept
Ana
lysis
of
Inte
rdis
cipl
inar
y C
olla
bora
tion.
N
ursin
g Fo
rum
, 45(
2), 7
2-81
.
Con
cept
Ana
lysis
wha
t is t
he m
eani
ng
of in
terp
rofe
ssio
nal
colla
bora
tion
with
in th
e he
alth
care
cont
ext
uN
ITEd
ST
ATES
Inte
rpro
fess
iona
l tea
m
*No
spec
ific
mod
el is
exa
min
ed in
th
is st
udy
◥
Trad
ition
ally
, IPC
is d
escr
ibed
as a
pr
oble
m-f
ocus
ed p
roce
ss, s
hari
ng,
and
wor
king
toge
ther
◥In
terp
rofe
ssio
nal e
duca
tion,
ro
le a
war
enes
s, in
terp
erso
nal
rela
tions
hip
skill
s, de
liber
ate
actio
n, a
nd su
ppor
t sho
uld
be
pres
ent f
or IP
C to
be
bene
ficia
l fo
r the
pat
ient
, org
aniz
atio
n,
heal
thca
re p
rovi
der
mor
e com
preh
ensiv
e defi
nitio
n of
IPC
: pro
cess
by
heal
thca
re
prof
essio
nals
with
shar
ed
obje
ctiv
es, d
ecisi
on-m
akin
g, re
spon
sibili
ty, a
nd p
ower
wor
king
to
geth
er to
solv
e pat
ient
care
pr
oblem
s; be
st at
tain
ed th
roug
h an
inte
rpro
fess
iona
l edu
catio
n th
at p
rom
otes
an at
mos
pher
e of
mut
ual t
rust
and
resp
ect,
open
co
mm
unic
atio
n, aw
aren
ess,
acce
ptan
ce o
f rol
es, s
kills
, and
re
spon
sibili
ties o
f the
par
ticip
atin
g di
scip
lines
(pg.
80)
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation46
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
43Pi
ttam
, G., S
ecke
r, J.,
& F
ord,
F. (2
010)
. Th
e rol
e of i
nter
prof
essio
nal w
orki
ng
in th
e Pat
hway
s to
wor
k C
ondi
tion
man
agem
ent P
rogr
amm
es. J
ourn
al o
f In
terp
rofes
siona
l Car
e, 24
(6),
699–
709.
Pilo
t Stu
dy in
cludi
ng
qual
itativ
e eva
luat
ions
Con
trib
utin
g to
a
real
istic
eval
uatio
n of
the
Con
ditio
n m
anag
emen
t Pr
ogra
m (C
mP)
im
plem
ente
d in
7 u
.K.
pilo
t site
s
uN
ITEd
K
ING
dO
mIn
terp
rofe
ssio
nal t
eam
Hea
lth a
nd E
mpl
oym
ent C
are
◥
Con
ditio
n m
anag
emen
t Pr
ogra
ms:
focu
s on
pain
m
anag
emen
t, pr
omot
ion
of
exer
cise
, hea
lthy
lifes
tyle
s, st
ress
man
agem
ent,
confi
denc
e-bu
ildin
g, a
nxie
ty, d
epre
ssio
n
◥Fo
cus o
n de
velo
ping
per
sona
l w
orki
ng re
latio
nshi
ps, d
evel
opin
g le
vels
of tr
ust w
ith p
atie
nts
◥
Team
s mem
bers
reco
gniz
ed
that
thei
r con
trib
utio
n w
as
part
of a
larg
er p
roce
ss
◥A
llow
ed p
atie
nts t
o ta
ke th
e le
ad in
thei
r car
e
44Po
mey
, m.P
., mar
tin, E
., & F
ores
t, P.
G.
(200
9). Q
uebe
c`s F
amily
med
icin
e G
roup
s: In
nova
tion
and
Com
prom
ise
in th
e Re
form
of F
ront
-lin
e C
are.
Cana
dian
Pol
itica
l Sci
ence
Rev
iew,
3(
4), 3
1-46
.
disc
ussio
n Pa
per
CA
NA
dA
- Q
uEB
ECIn
terp
rofe
ssio
nal t
eam
Fam
ily m
edic
ine
Gro
up
◥
Gro
ups o
f 6-1
2 do
ctor
s who
w
ork
with
oth
er p
rovi
ders
; hav
e re
gist
ered
pat
ient
s; pr
ovid
e co
mpr
ehen
sive p
rimar
y ca
re
serv
ices
– co
ntin
uity
of c
are –
co
ordi
natio
n of
serv
ices
with
oth
er
syst
em p
rovi
ders
; acc
essib
le fo
r aft
er-h
ours
nee
ds; a
lso re
ason
able
tim
e to
get a
ppoi
ntm
ent
◥
Serv
ice
agre
emen
ts w
ith C
SlC
◥
Agr
ee to
rem
uner
atio
n sc
hem
a
◥
Not
appl
icab
le
interProFeSSional CollaBorative teaMS 47
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
45R
agaz
, N., B
erk,
A., F
ord,
d., &
m
orga
n, m
. (20
10).
Stra
tegi
es fo
r fa
mily
hea
lth te
am le
ader
ship
: le
sson
s lea
rned
by
succ
essf
ul te
ams.
Hea
lthca
re Q
uart
erly,
13(
3), 3
9-43
.
des
crip
tive C
ase S
tudi
es
of fi
ve F
HTs
(Fam
ily
Hea
lth T
eam
s)
CA
NA
dA
- O
NTA
RIO
Inte
rpro
fess
iona
l tea
m
Hos
pice
Car
e
◥
This
artic
le re
view
ed 5
FH
Ts in
5
diffe
rent
loca
tions
; inc
lude
d a c
olla
bora
tion
of n
urse
s, nu
rse
clini
cian
s, do
ctor
s, di
etiti
ans,
soci
al w
orke
rs, h
ealth
pro
mot
ers,
phar
mac
ists,
and
CC
AC
case
m
anag
ers d
epen
ding
on
the l
ocat
ion
◥
This
mod
el fo
cuse
d on
the
educ
atio
n of
team
mem
bers
with
ro
le c
lari
ficat
ion,
und
erst
andi
ng
the
valu
e of
the
RN, a
nd a
ligni
ng
the
FHT
with
the
min
istr
y of
H
ealth
lon
g-Te
rm C
are
Plan
◥
Patie
nts w
ill b
enefi
t fro
m
havi
ng th
e app
ropr
iate
re
ferr
als t
ake p
lace
in
one l
ocat
ion;
hav
ing
spec
ialis
ts co
nduc
t ong
oing
ev
alua
tions
, sha
ring
acco
mpl
ishm
ents,
adap
ting
to n
ew an
d un
expe
cted
iss
ues,
data
-sha
ring,
and
open
co
mm
unic
atio
n
◥Th
e use
of E
mRs
was
ev
alua
ted
and
deem
ed cr
itica
l to
faci
litat
e and
pro
vide
bet
ter
care
to p
atie
nts
46Re
eves
, S., Z
war
enste
in, m
., Gol
dman
, J.,
Barr,
H., F
reet
h, d
., Ham
mick
, m.,
& K
oppe
l, I. (2
009)
. Inte
rpro
fessio
nal
educ
atio
n: eff
ects
on p
rofes
siona
l pr
actic
e and
hea
lth ca
re o
utco
mes
. Co
chra
ne D
atab
ase o
f Sys
temat
ic Re
view
s, 1(
Cd00
2213
), dO
I:10.1
002/
1465
1858
.Cd
00 22
13.p
ub2.
Syst
emat
ic R
evie
w
Impr
ovin
g in
terp
rofe
ssio
nal
colla
bora
tion
and
patie
nt c
are
thro
ugh
inte
rpro
fess
iona
l ed
ucat
ion
GEN
ERA
lIn
terp
rofe
ssio
nal t
eam
*Ass
essm
ent,
no sp
ecifi
c m
odel
(s)
outli
ned
◥
Ass
essi
ng d
iffer
ent r
ando
miz
ed
cont
rol t
rial
s and
the
valu
e of
in
terp
rofe
ssio
nal e
duca
tion
(IPE
)
◥Is
IPE
mor
e eff
ectiv
e fo
r IPC
te
ams i
n co
ntra
st to
edu
catio
n in
terv
entio
ns in
whi
ch th
e sa
me
heal
th a
nd so
cial
car
e pr
ofes
sion
als l
earn
sepa
rate
ly
from
one
ano
ther
◥
Onl
y 6
studi
es ex
amin
ed; a
fe
w d
emon
strat
ed p
ositi
ve
chan
ges w
hen
usin
g IP
E
◥m
ore
rese
arch
nee
ds to
be
done
on
how
IPE
affec
ts
the
heal
thca
re p
roce
ss a
nd
patie
nt o
utco
mes
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation48
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
47Ro
blin
, d.w
. (20
03).
Prim
ary
Hea
lth
Car
e Te
ams O
ppor
tuni
ties a
nd
Cha
lleng
es in
Eva
luat
ion
of S
ervi
ce
del
iver
y In
nova
tions
. J A
mbu
lato
ry
Care
Man
age,
26(1
), 22
–35.
des
crip
tive A
rtic
le
des
crib
ing
thre
e m
odel
s of
pri
mar
y he
alth
care
te
ams;
impl
emen
ting
chan
ges,
plan
ning
, and
ev
alua
tion
oppo
rtun
ities
uN
ITEd
ST
ATES
Inte
rpro
fess
iona
l tea
m
Prim
ary
Hea
lthca
re T
eam
s
◥
Stro
ng fo
cus o
n
orga
nizi
ng/im
plem
entin
g
fam
ily h
ealth
care
team
s
◥Te
ams c
onsi
sted
of
vari
ous m
embe
rs: p
hysi
cian
s, re
gist
ered
nur
ses,
nurs
e pr
actit
ione
rs, b
ehav
iour
al
spec
ialis
ts, h
ealth
edu
cato
rs
◥Fo
cus o
n ch
angi
ng o
bser
vatio
n an
d ex
pert
ise
in p
atie
nt c
are,
mor
e co
ncen
trat
ion
on c
ontin
uity
of
car
e se
rvic
e or
ient
atio
n
◥
Pote
ntia
l to
impr
ove
syst
em p
rodu
ctiv
ity, p
atie
nt
satis
fact
ion,
clin
ical
qua
lity,
empl
oyee
mor
ale
◥
Pote
ntia
l to
low
er c
are
deliv
ery
cost
s
48Ro
sser
, w.w
., Col
will
, J.m
., Kas
pers
ki,
J., &
wils
on, l
. (20
11).
Prog
ress
of
Ont
ario
’s fa
mily
hea
lth te
am m
odel
: A
patie
nt-c
entr
ed m
edic
al h
ome.
Anna
ls of
Fam
ily M
edici
ne, 9
(2),
165-
171.
des
crip
tive A
rtic
le
des
crib
ing
the
deve
lopm
ent,
impl
emen
tatio
n,
reim
burs
emen
t and
cu
rren
t sta
tus o
f the
FH
T
CA
NA
dA
- O
NTA
RIO
Inte
rpro
fess
iona
l tea
m
Fam
ily H
ealth
Tea
m
Prim
ary
Car
e
◥
This
mod
el w
as c
alle
d th
e Pa
tient
-Cen
tred
Pri
mar
y C
are
Col
labo
rativ
e m
odel
◥
The
focu
s of t
he m
odel
is o
n ad
voca
cy fo
r the
pat
ient
, ens
urin
g th
at p
rope
r ref
erra
ls an
d he
alth
as
sess
men
ts ta
ke p
lace
; edu
catio
n an
d on
-goi
ng c
ouns
ellin
g an
d fo
llow
-ups
for t
he p
atie
nt, a
nd
24 h
ours
a d
ay/7
day
s a w
eek
resp
onse
for t
he p
atie
nt
◥
Incr
ease
the n
umbe
r of
resid
ents
bein
g tr
aine
d in
fa
mily
med
icin
e will
faci
litat
e th
e wor
k of
the p
hysic
ians
w
ho w
ere b
eing
ove
rload
ed
with
pat
ient
s
interProFeSSional CollaBorative teaMS 49
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
49Ru
ssel
, G.m
., dab
roug
e, S.
, Hog
g, w
., G
enea
u, R
., mul
doon
, l., &
mel
tem
, T.
(200
9). m
anag
ing
chro
nic
dise
ase
in O
ntar
io p
rim
ary
care
: The
impa
ct
of o
rgan
izat
iona
l fac
tors
. Ann
als o
f Fa
mily
Med
icin
e, 7(
4), 3
09-3
17.
Cro
ss-S
ectio
nal S
tudy
(Q
ualit
ativ
e C
ase
Stud
ies)
Ass
essin
g fo
ur ty
pes o
f m
odel
s add
ress
ing
chro
nic
dise
ase m
anag
emen
t
CA
NA
dA
- O
NTA
RIO
Inte
rpro
fess
iona
l tea
m
Chr
onic
dis
ease
Car
e
4 m
odel
s
◥
Com
mun
ity H
ealth
Cen
tre
(CH
C) –
foun
d to
be
supe
rior
in
man
agem
ent o
f chr
onic
di
seas
e –
long
er c
onsu
ltatio
n tim
e fo
r pat
ient
s and
gre
ater
in
terp
rofe
ssio
nal c
olla
bora
tion;
pr
esen
ce o
f NP
◥
Fee
for s
ervi
ce (F
FS)
◥
Fam
ily h
ealth
net
wor
k (F
HN
)
◥H
ealth
serv
ice
orga
niza
tion
(HSO
)
◥
In a
ll fo
ur c
ases
, offi
ces
with
few
er th
an 4
fam
ily
phys
icia
ns w
ere
foun
d to
be
mor
e eff
ectiv
e in
chr
onic
di
seas
e m
anag
emen
t
◥Q
ualit
y of
care
incr
ease
d w
hen
a nu
rse p
ract
ition
er
was
invo
lved
, as t
he n
urse
pr
actit
ione
r hel
ps to
de
crea
se th
e wor
kloa
d of
th
e phy
sicia
n; th
e nur
se
prac
titio
ner h
as th
e flex
ibili
ty
to o
rgan
ize c
are m
anag
emen
t ac
tiviti
es, i
mpr
ovin
g th
e st
anda
rd o
f car
e for
pat
ient
s50
Schr
aede
r, C
., Fra
ser,
C.w
., Cla
rk, I
., lo
ng, B
., She
lton,
P., w
alds
chm
idt,
v.,
& K
ucer
a, C
.l. (
2008
). Ev
alua
tion
of a
pr
imar
y ca
re n
urse
cas
e m
anag
emen
t in
terv
entio
n fo
r chr
onic
ally
ill
com
mun
ity d
wel
ling
olde
r peo
ple.
Jour
nal o
f Nur
sing
and
Hea
lthca
re o
f Ch
roni
c Illn
ess,
17, 4
07-4
17.
Non
-Ran
dom
ized
Stu
dy
Effec
tiven
ess o
f a
colla
bora
tive
prim
ary
are
nurs
e ca
se m
anag
emen
t in
terv
entio
n em
phas
izin
g co
llabo
ratio
n be
twee
n ph
ysic
ians
, nur
ses
and
patie
nts
uN
ITEd
ST
ATES
Inte
rpro
fess
iona
l tea
m
Nur
se C
ase
man
agem
ent I
nter
vent
ion
◥
PHC
T (P
rim
ary
Hea
lthca
re
Team
) nur
ses a
nd p
rim
ary
care
ph
ysic
ians
wor
king
toge
ther
to
impr
ove
risk
iden
tifica
tion,
co
mpr
ehen
sive
asse
ssm
ents
, sh
ared
pla
nnin
g, b
ette
r pat
ient
ed
ucat
ion
and
mon
itori
ng, s
moo
th
tran
sitio
n of
car
e, m
ore
effec
tive
use
of h
ealth
care
reso
urce
s for
ch
roni
cally
ill o
lder
pat
ient
s
◥St
udy
look
ed a
t the
diff
eren
ces
betw
een
a tr
eatm
ent g
roup
and
co
mpa
riso
n gr
oup
◥
Trea
tmen
t gro
up re
sulte
d in
less
re-h
ospi
taliz
atio
n,
whi
ch sa
ved
on h
ospi
tal
cost
s, (n
o ot
her s
tatis
tical
ly
sign
ifica
nt re
sults
)
◥C
hron
ic c
are
inte
rven
tion
that
incl
udes
col
labo
ratio
n be
twee
n ph
ysic
ians
, nur
ses
and
patie
nts,
may
be
mor
e eff
ectiv
e if
appl
ied
in
inte
grat
ed p
rovi
der n
etw
orks
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation50
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
51Sc
hrae
der,
C., v
olla
nd, P
., & G
olde
n,
R. (2
011)
. Pro
misi
ng m
odel
s of C
are
Coo
rdin
atio
n fo
r Ben
efici
arie
s with
C
hron
ic Il
lnes
ses.
Agin
g in
Am
eric
a,
Pow
erPo
int S
lides
1-3
1.
Pres
enta
tion
Slid
esu
NIT
Ed
STAT
ESIn
terp
rofe
ssio
nal t
eam
Chr
onic
dis
ease
man
agem
ent
Tran
sitio
nal c
are
inte
rven
tions
◥
Car
e Tr
ansit
ions
Inte
rven
tion
(Col
eman
)
◥Tr
ansit
iona
l Car
e m
odel
(Nay
lor)
◥
Enha
nced
dis
char
ge P
lann
ing
Prog
ram
– R
uSH
(Per
ry)
Com
preh
ensiv
e C
are
man
agem
ent -
m
e dic
are/
du a
ls
◥
Gui
ded
Car
e (B
oult)
◥
GRA
CE
(Cou
nsel
l)
◥C
are
man
agem
ent P
lus (
dor
r)
◥m
CC
d: B
est P
ract
ice S
ites (
Brow
n)
Com
preh
ensiv
e C
are
man
agem
ent –
m
e dic
aid/
du a
ls
◥
Inte
grat
ed C
are
man
agem
ent
(do u
glas
)
◥C
omm
unity
Bas
ed C
hron
ic C
are
man
agem
ent (
less
ler)
◥
Hos
pita
l to
Hom
e (R
aven
)
◥H
ealth
Car
e m
anag
emen
t Pr
ogra
m (R
econ
nu &
Her
ndon
)
◥
Not
appl
icab
le
interProFeSSional CollaBorative teaMS 51
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
52Si
cotte
, C., d
’Am
our, d
., & m
orea
ult,
m.P.
(200
2). In
terd
iscip
linar
y C
ollab
orat
ion
with
in Q
uébe
c C
omm
unity
Hea
lth C
are C
entre
s. So
cial
Scien
ce a
nd M
edici
ne, 5
5, 99
1-20
03.
Empi
rica
l Stu
dy P
aper
Stud
ying
inte
rpro
fess
iona
l co
llabo
ratio
n in
Que
bec,
surv
ey o
f CH
CC
’s (C
omm
unity
Hea
lth
Car
e C
entr
es)
CA
NA
dA
- Q
uEB
ECIn
terp
rofe
ssio
nal t
eam
Com
mun
ity H
ealth
Car
e C
entr
es
◥
Serv
ices
pro
vide
d in
a sin
gle l
ocat
ion
◥
vari
ous h
ealth
care
pro
vide
rs
are
pres
ent (
heal
thca
re/s
ocia
l se
rvic
es c
ombi
natio
n)
◥Pr
ofes
siona
ls sh
are
goal
s/re
spon
sibili
ties,
mak
e co
llect
ive
deci
sions
, atte
mpt
to d
istrib
ute
task
s eve
nly
◥
Com
mun
ity-s
pons
ored
gov
erni
ng
stru
ctur
e (u
sual
ly le
d by
a
com
mun
ity b
oard
of d
irect
ors)
◥
CH
CC
s in
Que
bec
wer
e on
ly a
ble
to a
chie
ve m
odes
t re
sults
with
thei
r wid
ely
used
IP
C m
odel
– m
odel
is v
ery
depe
nden
t on
inte
rnal
wok
gr
oup
dyna
mic
s
◥d
espi
te IP
C, p
rofe
ssio
nals
crea
te m
onop
olie
s to
prot
ect
thei
r are
a of
exp
ertis
e
◥Re
-alig
n tr
aini
ng p
rogr
ams t
o fo
ster
stro
nger
colla
bora
tion
betw
een
diffe
rent
gro
ups
in h
ealth
care
53Su
ter,
P., H
enne
ssey
, B., H
arris
on, G
., Fa
gan,
m., N
orm
an, B
., & S
uter
, N.w
. (2
008)
. Hom
e Bas
ed C
hron
ic C
are:
An
Expa
nded
Inte
grat
ive m
odel
for H
ome
Hea
lth P
rofe
ssio
nals.
Hom
e Hea
lth
Care
Nur
se O
nlin
e, 26
(4),
222-
228.
Kno
wle
dge
Synt
hesis
Re
view
The
bene
fits o
f util
izin
g th
e ‘’d
ivisi
on o
f la
bour
’’ in
heal
thca
re
and
the
expa
nsio
n of
th
e tr
aditi
onal
CC
m
(Chr
onic
Car
e m
o del
)
GEN
ERA
lIn
terp
rofe
ssio
nal t
eam
Hom
e Ba
sed
Chr
onic
Car
e m
odel
(H
BCC
m)
4 K
ey P
illar
s:
1.
Hig
h To
uch
del
iver
y Sy
stem
(c
ompr
ehen
sive
asse
ssm
ent,
face
-to
-fac
e vi
sits)
2.
Th
eory
-bas
ed se
lf-m
anag
emen
t su
ppor
t (se
lf-effi
cacy
im
prov
emen
t, he
alth
lite
racy
)3.
Spec
ialis
t ove
rsig
ht (c
oach
, gui
de
staff;
liai
se w
ith p
hysic
ian
spec
ialis
ts)4.
T e
chno
logy
(Tel
ehea
lth, E
lect
roni
c Re
gist
ry, d
ata
Exch
ange
)
◥
Posi
tive
– co
st- e
ffect
ive,
bette
r adh
eren
ce
mon
itori
ng, i
mpr
oved
pa
tient
edu
catio
n, e
arlie
r de
tect
ion
and
trea
tmen
t for
de
pres
sion
, pat
ient
s ben
efit
from
hea
lth c
oach
ing
and
self-
mas
tery
tech
niqu
es
54vy
t, A
. (20
08) I
nter
prof
essio
nal
and
tran
sdis
cipl
inar
y te
amw
ork
in
heal
th c
are.
Dia
bete
s Met
ab R
es R
ev,
24(1
), S1
06 –
S10
9. R
etri
eved
from
: w
ww.
inte
rsci
ence
.wile
y.com
(dO
I: 10
.100
2/dm
rr.8
35).
Revi
ew
do
nurs
e-le
d w
alk-
in
cent
res i
mpr
ove
acce
ss
to p
rim
ary
care
GEN
ERA
lIn
terp
rofe
ssio
nal t
eam
dia
bete
s Car
e
◥
Shar
ed C
are
Plan
: Pro
mot
es IP
te
amw
ork,
eac
h te
am m
embe
r is
activ
ely
cont
ribut
ing;
eac
h on
e re
spon
sible
for o
ne g
oal w
hile
co
ordi
natin
g sh
ared
car
e of
ca
rryi
ng o
ut re
spon
sibili
ties
◥
Ensu
re th
at th
ere
is an
as
sess
men
t of c
ompe
tenc
ies
◥
use
tech
nolo
gy to
hel
p
with
com
mun
icat
ion
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation52
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
55w
exle
r, m
.m., &
Sie
gler
, E.l
. mod
els
of C
are
and
Inte
rpro
fess
iona
l Car
e Re
late
d to
Com
plex
Car
e of
Old
er
Adu
lts. H
artfo
rd In
stitu
te fo
r Ger
iatr
ic
Nur
sing,
1-17
.
des
crip
tive
Pape
r
des
crip
tion
of d
iffer
ent
type
s of g
eria
tric
mod
els
uN
ITEd
ST
ATES
Inte
rpro
fess
iona
l tea
m
Num
erou
s mod
els
Com
plex
Car
e of
Old
er A
dults
com
preh
ensi
ve D
isch
arge
◥
Team
incl
uded
adv
ance
d pr
actic
e nu
rses
, phy
sici
ans,
soci
al w
orke
rs, o
ther
hea
lthca
re
prof
essi
onal
s as n
eede
d;
spec
ializ
ed g
eria
tric
dis
char
ge
coor
dina
ted
by n
urse
spec
ialis
ts
Pac
E M
odel
◥
Com
mun
ity n
urse
s, ph
ysic
ians
, so
cial
wor
kers
pro
vidi
ng so
cial
/m
edic
al se
rvic
es in
an
adul
t day
-ca
re se
tting
; sup
plem
ente
d by
in
-hom
e se
rvic
es
Nur
sing
Hom
e
◥
IP te
am (s
ocia
l wor
kers
, nur
ses,
phys
icia
ns, r
ecre
atio
nal t
hera
pist
s, nu
triti
onist
s) c
reat
e a
co-jo
ined
ca
re p
lan
for c
lient
s
Out
patie
nt g
eria
tric
◥
IP T
eam
(ger
iatr
icia
n, n
urse
s, so
cial
wor
ker,
phys
ical
ther
apist
) st
udyi
ng th
e ph
ysic
al, e
mot
iona
l, ps
ycho
logi
cal a
nd fu
nctio
nal
stat
us o
f the
pat
ient
◥
No
clin
ical
out
com
es
◥Q
uest
ions
nur
ses
shou
ld c
onsid
er b
efor
e cr
eatin
g a
team
: 1.
w
hat a
re th
e iss
ues t
hat
the
team
will
nee
d to
di
scus
s?
2.
who
shou
ld b
e a
mem
ber o
f the
team
an
d w
hy?
3.
How
ofte
n sh
ould
the
team
mee
t?
4.
How
can
you
es
tabl
ish e
ffect
ive
com
mun
icat
ion
and
coop
erat
ion?
5.
w
ho sh
ould
lead
the
com
mitt
ee?
6.
How
shou
ld th
e co
mm
ittee
be
man
aged
?
interProFeSSional CollaBorative teaMS 53
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
IN
ter
Pro
FeSS
IoN
Al
teA
m m
od
elS
56w
itten
berg
, E., O
liver
, d.P
., d
emir
is, G
., & R
egeh
r, K
. (20
10).
Inte
rdis
cipl
inar
y co
llabo
ratio
n in
ho
spic
e te
am m
eetin
gs. J
ourn
al o
f In
terp
rofe
ssio
nal C
are,
24(3
), 26
4-27
3.
Expl
orat
ory
Stud
y
IP m
embe
rs p
artic
ipat
ed
in a
mod
ified
Inde
x of
Inte
rdis
cipl
inar
y C
olla
bora
tion
(mIC
C) m
easu
ring
th
eir p
erce
ptio
ns o
f co
llabo
ratio
n in
thei
r ho
spic
e te
am
uN
ITEd
ST
ATES
Inte
rpro
fess
iona
l tea
m
(Exp
lora
tory
)
Hos
pice
Car
e
◥
Palli
ativ
e te
am c
are
incl
udes
vo
lunt
eers
, cha
plai
ns, n
urse
s, do
ctor
s, di
etiti
ans,
soci
al w
orke
rs
◥
No
clin
ical
out
com
es
◥R
ole
ambi
guity
in
this
mod
el re
sulte
d in
la
ck o
f col
labo
ratio
n
57Zw
aren
stei
n, m
. , Gol
dman
J., &
Re
eves
, S. (
2009
) Int
erpr
ofes
siona
l co
llabo
ratio
n: eff
ects
of p
ract
ice-
base
d in
terv
entio
ns o
n pr
ofes
siona
l pra
ctic
e an
d he
alth
care
out
com
es. C
ochr
ane
Dat
abas
e of S
yste
mat
ic Re
view
s, 3,
(C
d00
0072
), d
OI:1
0.10
02/1
4651
858.
Cd
0000
72.p
ub2.
Syst
emat
ic R
evie
w
Impa
ct o
f pra
ctic
e ba
sed
inte
rven
tions
that
will
ch
ange
Inte
rpro
fess
iona
l C
olla
bora
tion;
eith
er
by in
crea
sing
patie
nt
satis
fact
ion
or e
ffici
ency
of
hea
lthca
re
GEN
ERA
lIn
terp
rofe
ssio
nal t
eam
*S
tudy
focu
sed
on p
ract
ice
base
d in
terv
entio
ns
◥
Two
stud
ies e
xam
ined
in
terp
rofe
ssio
nal r
ound
s,
◥Tw
o st
udie
s exa
min
ed
inte
rpro
fess
iona
l mee
tings
◥
One
stud
y ex
amin
ed e
xter
nally
fa
cilit
ated
inte
rpro
fess
iona
l aud
it
◥
Revi
ew su
gges
ts th
at p
ract
ice-
base
d IP
C in
terv
entio
ns ca
n im
prov
e hea
lthca
re p
roce
sses
an
d ou
tcom
es
◥va
riou
s: O
ne st
udy
on d
aily
in
terd
isci
plin
ary
roun
ds in
in
patie
nt m
edic
al w
ards
at a
n ac
ute
care
hos
pita
l sho
wed
po
sitiv
e im
pact
on
leng
th
of st
ay a
nd to
tal c
harg
es;
anot
her s
tudy
had
mon
thly
m
ultid
isci
plin
ary
team
m
eetin
gs, w
hich
impr
oved
pr
escr
ibin
g of
psy
chot
ropi
c dr
ugs i
n nu
rsin
g ho
mes
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation54
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
Nu
rSe
-led
mo
del
S1
Alli
nson
, v. (
2003
). Br
east
can
cer:
eval
uatio
n of
a n
urse
-led
fam
ily
hist
ory
clin
ic. J
ourn
al o
f Clin
ical
N
ursin
g, 13
, 765
-766
.
Eval
uativ
e C
ase
Stud
y
Iden
tifyi
ng k
ey c
once
pts
that
mak
e nu
rse-
led
clin
ics a
ccep
tabl
e
uN
ITEd
K
ING
dO
mN
urse
-led
Brea
st C
ance
r
◥
Nur
ses d
iscu
ssin
g fa
mily
hist
ory
of b
reas
t can
cer w
ith p
atie
nts;
brea
st se
lf-ex
ams,
addr
esse
d an
y ot
her f
ears
, que
stio
ns, c
once
rns
◥
Patie
nts e
xpre
ssed
that
they
fe
lt ru
shed
, did
not
hav
e tim
e to
hav
e al
l the
ir qu
estio
ns/
conc
erns
add
ress
ed
◥
mor
e fo
llow
-ups
re
com
men
ded
to b
ridg
e in
form
atio
n ga
p2
Alsa
ffar,
A. (
2005
). Fa
mily
pra
ctic
e:
A n
ursin
g pe
rspe
ctiv
e. O
ntar
io
Fam
ily P
ract
ice,
1-5.
Expl
orat
ory
Stud
y
How
to ra
ise
the
stat
us o
f Fa
mily
Pra
ctic
e N
ursin
g
CA
NA
dA
- O
NTA
RIO
Nur
se-le
d
Fam
ily P
ract
ice
◥
Nur
se a
cts a
s the
firs
t poi
nt o
f co
ntac
t in
the
fam
ily c
are
prac
tice
◥
Nur
se p
rovi
des m
ento
rshi
p to
fa
mily
and
trie
s to
prev
ent f
eelin
gs
of is
olat
ion
of th
e pa
tient
◥
Prov
ides
mor
e cl
inic
al re
sear
ch
to a
ddre
ss th
e kn
owle
dge
gap
◥
In o
rder
to in
crea
se th
e st
atus
of t
he fa
mily
hea
lth
nurs
e, ph
ysic
ians
and
the
publ
ic n
eed
to b
e fu
rthe
r ed
ucat
ed o
n th
e ro
le o
f the
fa
mily
hea
lth n
urse
◥
dev
elop
a se
t cur
ricul
um
in u
nder
grad
uate
pro
gram
s ab
out t
he fa
mily
hea
lth n
urse
3A
rvid
sson
, S.B
., Pet
erss
on, A
., N
ilsso
n, I.
, And
erss
on, B
., Arv
idss
on,
B.S.
, Pet
erss
on, I
.F., &
Fri
dlun
d, B
. (2
006)
. A n
urse
-led
rheu
mat
olog
y cl
inic
’s im
pact
on
empo
wer
ing
patie
nts w
ith rh
eum
atoi
d ar
thrit
is: A
qu
alita
tive s
tudy
. Nur
sing
and
Hea
lth
Scie
nces
, 8, 1
33-1
39.
Qua
litat
ive
Stud
y
Nur
se-le
d rh
eum
atol
ogy
clin
ic e
mpo
wer
ing
patie
nts w
ith th
eir
func
tiona
lity
SwEd
ENN
urse
-led
Rheu
mat
olog
y C
linic
◥
Nur
se fo
cuse
s on
patie
nt
educ
atio
n, c
ouns
ellin
g; d
iscu
sses
tr
eatm
ent o
ptio
ns a
nd h
elps
to
desig
n a
care
pla
n w
ith p
atie
nt
◥
Patie
nts s
atis
fied
with
le
vel o
f car
e pr
ovid
ed in
nu
rse-
led
clin
ic
◥
App
reci
ated
follo
w-u
ps
by n
urse
s
interProFeSSional CollaBorative teaMS 55
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
Nu
rSe
-led
mo
del
S4
Ash
croft
, J., F
arre
lly, B
., Em
man
uel,
E., &
Bor
basi,
S. (
2010
). A
nur
se
prac
titio
ner i
nitia
ted
mod
el o
f se
rvic
e de
liver
y in
car
ing
for p
eopl
e w
ith d
emen
tia. C
onte
mpo
rary
Nur
se,
36(1
-2),
49-6
0.
dis
cuss
ion
Pape
r
Impo
rtan
ce o
f NP
role
in
dem
entia
trea
tmen
t
AuST
RAlI
AN
urse
-led
dem
entia
dem
entia
Out
reac
h Se
rvic
e m
odel
(d
EmO
S)
◥
Team
incl
uded
NP
(lead
), cl
inic
al
nurs
e, cl
inic
al fa
cilit
ator
, end
orse
nu
rse,
assis
tant
in n
ursin
g,
soci
al w
orke
r, re
sear
ch a
ssist
ant,
adm
inist
rativ
e as
sista
nt
◥A
ims:
Impr
ove
qual
ity o
f car
e, re
duce
agg
ress
ion
tow
ards
nur
sing
staff
, bui
ld c
apac
ity, r
educ
e in
appr
opri
ate
refe
rral
s, im
prov
e co
ntin
uity
of c
are
◥
Staff
abl
e to
see
bene
fits
of o
utre
ach
staff
; cap
acity
st
rong
ly im
prov
ed
◥A
ll fa
cilit
ies t
hat t
este
d th
e d
E mO
S m
odel
said
that
th
ey w
ould
use
it a
gain
and
reco
mm
end
dEm
OS
serv
ices
5Ba
rret
t, B.J.
, Gar
g, A
.X., G
oere
e, R.
, le
vin,
A., m
olza
hn, A
. & R
igat
to, C
. (2
011)
. A N
urse
-coo
rdin
ated
mod
el
of C
are v
ersu
s us u
al C
are f
or St
age
3/4
Chr
onic
Kidn
ey d
iseas
e in
the
Com
mun
ity: A
Ran
dom
ized
Con
trolle
d Tr
ial. C
linica
l Jou
rnal
of th
e Am
erica
n So
ciety
of N
ephr
olog
y, 6,
1241
-124
7.
Ran
dom
ized
Con
trol
led
Tria
l
How
to o
ptim
ally
car
e fo
r C
hron
ic K
idne
y d
isea
se
CA
NA
dA
- G
ENER
Al
Nur
se-le
d
Chr
onic
Kid
ney
dis
ease
◥
In th
e in
terv
entio
n gr
oup,
th
e pa
tient
s rec
eive
d ad
ditio
nal
care
, asi
de fr
om th
eir p
hysi
cian
fr
om a
nur
se a
nd n
ephr
olog
ist,
focu
sing
on
lipi
d an
d BP
(blo
od
pres
sure
) man
agem
ent
◥
Patie
nts d
isplay
ed h
igh
satis
fact
ion
with
the l
evel
of
care
in th
e int
erve
ntio
n gr
oup
◥
Bloo
d pr
essu
re le
vels
wer
e lo
wer
ed a
nd m
anag
ed b
ette
r in
the
inte
rven
tion
grou
p
6Be
rra,
K., m
iller
, N.H
., & Je
nnin
gs,
C. (
2011
). N
urse
-bas
ed m
odel
s for
ca
rdio
vasc
ular
dis
ease
pre
vent
ion
from
rese
arch
to c
linic
al p
ract
ice.
Jour
nal o
f Car
diov
ascu
lar N
ursin
g, 26
(45)
, 46-
55.
lite
ratu
re R
evie
w
Exam
inin
g th
e be
nefit
s of
a n
urse
dire
cted
te
am w
ith p
atie
nts w
ith
card
iova
scul
ar d
isea
se
CA
NA
dA
Nur
se-le
d
Car
diov
ascu
lar d
isea
se
◥
Nur
se w
orks
alo
ngsid
e nu
triti
onist
s, ph
ysic
ians
, ph
arm
acist
s, ps
ycho
logi
sts,
soci
al
wor
kers
, alli
ed h
ealth
pro
fess
iona
ls
◥N
urse
focu
ses o
n pa
tient
goa
l-se
tting
and
life
styl
e ch
ange
s
◥
Posit
ive
for p
atie
nts:
Redu
ctio
n in
smok
ing,
bl
ood
pres
sure
leve
ls, b
ette
r di
et c
hoic
es, l
oss o
f wei
ght,
incr
ease
d ph
ysic
al a
ctiv
ity
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation56
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
Nu
rSe
-led
mo
del
S7
Butt,
G. (
2009
). Pa
rtne
rshi
p an
d po
pula
tion
outc
ome
rela
tions
hips
in
four
nur
se-le
d he
patit
is C
inte
grat
ed
prev
entio
n an
d ca
re p
roje
cts.
Thes
is:
mcm
aste
r uni
vers
ity.
Com
para
tive
Stud
y
Exam
inin
g N
urse
-led
proj
ects
in u
rban
and
ru
ral a
reas
in H
epat
itis C
pr
even
tion
and
care
CA
NA
dA
- O
NTA
RIO
Nur
se-le
d
Hep
atiti
s C
◥
This
mod
el fo
cuse
s on
the
syne
rgy
betw
een
nurs
e le
ader
ship
an
d in
terp
rofe
ssio
nal p
ract
ice
and
its o
utco
mes
on
patie
nts i
n nu
rse-
led
Hep
atiti
s C p
reve
ntio
n an
d ca
re p
roje
cts
◥
Two
tool
s wer
e id
entifi
ed
that
pro
ved
to e
ffect
ivel
y m
easu
re g
roup
syne
rgy:
(1
) Par
tner
ship
Sel
f-A
sses
smen
t Too
l par
tner
ship
(P
SAT)
, whi
ch m
easu
res
part
ners
hip
syne
rgy
and
part
ners
hip
func
tioni
ng;
(2) T
eam
Clim
ate
Inve
ntor
y, (T
CI)
whi
ch m
easu
res t
he
inno
vativ
enes
s of t
he te
am8
Car
lucc
i, m.A
., Arg
uello
, l.E
., &
men
on, u
. (20
10).
Eval
uatio
n of
an
adva
nced
pra
ctic
e nur
se- m
anag
ed
diab
etes
clin
ic fo
r vet
eran
s. Th
e Jou
rnal
of
Nur
se P
ract
ition
ers,
6(7)
, 524
-531
.
des
crip
tive
Pilo
t Stu
dy
Psyc
holo
gica
l and
be
havi
oura
l ben
efits
for
vete
rans
in a
n A
dvan
ced
Prac
tice
Nur
ses c
linic
fo
r typ
e 2
diab
etes
uN
ITEd
ST
ATES
Nur
se-le
d
Adv
ance
Pra
ctic
e N
urse
– m
anag
ed
dia
bete
s Clin
ic fo
r vet
eran
s
Adv
ance
d pr
actic
e nu
rse
wor
ks
inde
pend
ently
◥
Patie
nts r
ecei
ve a
que
stio
nnai
re
to a
sses
s phy
siolo
gica
l dat
a;
follo
w-u
p do
ne 6
wee
ks la
ter
◥
Focu
s on
self-
care
and
kn
owle
dge
empo
wer
men
t
◥
Phys
iolo
gica
l cha
nges
w
ere
min
iscu
le
◥
Beha
viou
ral c
hang
es su
ch a
s di
abet
es/in
sulin
adh
eren
ce
incr
ease
d du
e to
APN
ed
ucat
ion
sess
ions
9C
harlt
on, J.
, mac
kay,
l., &
mcK
nigh
t, J.A
. (20
04).
A p
ilot s
tudy
com
parin
g a
type
1 n
urse
-led
diab
etes
clin
ic w
ith a
co
nven
tiona
l doc
tor-
led
diab
etes
clin
ic.
Euro
pean
Dia
bete
s Nur
sing,
1(1)
, 18-
21.
Pilo
t Stu
dy
Eval
uatio
n of
pat
ient
s w
ith d
iabe
tes a
nd th
eir
expe
rien
ce w
ith a
nur
se-
led
clin
ic a
s opp
osed
to
a do
ctor
-led
one
SCO
TlA
Nd
Nur
se-le
d
dia
bete
s
◥
Focu
s on
patie
nt e
duca
tion
and
awar
enes
s; be
havi
oura
l cha
nges
su
ch a
s die
t and
exe
rcisi
ng, g
oal-
setti
ng w
ere
disc
usse
d; ro
utin
es
test
s per
form
ed
◥
95%
of p
atie
nts w
ante
d to
co
ntin
ue w
ith n
urse
-led
care
◥
Shor
ter w
ait t
imes
; bet
ter
cont
inui
ty o
f car
e
◥So
me
issue
s with
ap
poin
tmen
t boo
king
s
interProFeSSional CollaBorative teaMS 57
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
Nu
rSe
-led
mo
del
S10
Chi
u, C
.w., &
won
g, F
.K.Y
. (20
10).
Effec
ts o
f 8 w
eeks
sust
aine
d fo
llow
-up
afte
r a n
urse
con
sulta
tion
on
hype
rten
sion:
a ra
ndom
ised
tria
l. In
tern
atio
nal J
ourn
al o
f Nur
sing
Stud
ies,
47, 1
375-
1382
.
Ran
dom
ized
Con
trol
led
Tria
l
do
patie
nts w
ith H
BP
(Hig
h Bl
ood
Pres
sure
) be
nefit
from
nur
se-le
d cli
nic
telep
hone
follo
w-u
ps?
HO
NG
KO
NG
Nur
se-le
d
Bloo
d pr
essu
re/h
yper
tens
ion
◥
Focu
s on
patie
nts t
o de
crea
se
bloo
d pr
essu
res l
evel
s; nu
rses
pr
ovid
ed e
duca
tion
on d
iet,
exer
cise
, man
agin
g sy
mpt
oms,
and
pres
crip
tion
adhe
renc
e
◥
Follo
w-u
p pa
tient
s inc
reas
ed
heal
thy
lifes
tyle
hab
its
◥Sa
tisfie
d w
ith te
leph
one
follo
w-u
ps
11C
lend
on, J
. (20
01).
The
feas
ibili
ty
of a
nur
se p
ract
ition
er-le
d pr
imar
y he
alth
car
e cl
inic
in a
scho
ol se
tting
: a
com
mun
ity n
eeds
ana
lysis
. Jou
rnal
of
Adv
ance
d N
ursin
g, 34
(2),
171-
178.
Feas
ibili
ty S
tudy
Can
a N
P or
a P
rim
ary
Hea
lth N
urse
take
the
lead
in a
fam
ily c
linic
in
a pr
imar
y sc
hool
?
NEw
ZE
AlA
Nd
Nur
se-le
d
Prim
ary
Car
e
◥
Nur
se p
ract
ition
er w
ould
run
a sc
hool
pri
mar
y ca
re c
linic
; the
nu
rse
wou
ld c
are
for t
he fa
mily
an
d th
e ch
ildre
n
◥
dec
reas
es in
the
num
ber o
f ch
ildre
n ho
spita
lizat
ions
12C
oddi
ngto
n, J.
A., &
San
ds, l
.P.
(200
8). C
ost o
f hea
lth c
are
and
qual
ity o
utco
mes
of p
atie
nts a
t nu
rse-
man
aged
clin
ics.
Nur
sing
Econ
omic
s, 26
(2),
75-8
3.
lite
ratu
re R
evie
w
Cos
t and
qua
lity
of n
urse
m
anag
ed c
linic
s
GEN
ERA
lN
urse
-led
Nur
se w
orks
inde
pend
ently
in c
linic
◥
Focu
s on
beha
viou
ral c
hang
es,
heal
th p
rom
otio
n, im
prov
ing
the
heal
th o
f non
-insu
red
patie
nts
◥
dec
reas
ed h
ospi
taliz
atio
n an
d em
erge
ncy
room
use
◥
Patie
nts e
xtre
mel
y sa
tisfie
d w
ith th
e nu
rse-
man
aged
cl
inic
13C
ollin
s, J.
(201
0). A
udit
of a
nur
se-le
d bo
ne m
arro
w b
iops
y cl
inic
. Can
cer
Nur
sing
Prac
tice,
9(4)
, 14-
19.
Aud
it
Expe
rien
ces o
f pat
ient
s un
derg
oing
bon
e m
arro
w
proc
edur
es b
y a
clin
ic
nurs
e sp
ecia
list
uN
ITEd
K
ING
dO
mN
urse
-led
Trep
hine
Bio
psy,
lym
phom
a
◥
Clin
ical n
urse
spec
ialis
t per
form
s bo
ne m
arro
w as
pira
tion
and
treph
ine
biop
sy in
pat
ients
with
lym
phom
a
◥Th
is is
a ne
w ro
le fo
r C
NS’s
pre
viou
sly d
one
by
seni
or m
edic
al st
aff
◥
Patie
nts e
xper
ienc
ed
min
imum
leve
ls of
pai
n
◥N
urse
was
abl
e to
retr
ieve
hi
gh-q
ualit
y sa
mpl
es
14C
onno
r, C
.C., w
righ
t, C
.C., &
Fe
ga, C
.d. (
2002
). Th
e sa
fety
an
d eff
ectiv
enes
s of n
urse
-led
antic
oagu
lant
serv
ice.
Jour
nal o
f Ad
vanc
ed N
ursin
g, 38
(4),
407-
415.
Com
para
tive
Stud
y
Are
nur
se-le
d an
ticoa
gula
nt c
linic
s as
effe
ctiv
e an
d sa
fe a
s ha
emat
olog
ist le
d cl
inic
s
uN
ITEd
K
ING
dO
mN
urse
-led
Ant
icoa
gula
nt C
linic
s
◥
Nur
se m
anag
es o
ral a
ntic
oagu
lant
th
erap
y an
d m
onito
rs a
nd
man
ages
thei
r IN
R; p
atie
nts a
ttend
cl
inic
from
1-1
0 w
eeks
◥
Ther
e w
ere
no st
atist
ical
ly
signi
fican
t diff
eren
ces
in a
ntic
oagu
lant
con
trol
be
twee
n th
e ha
emat
olog
ist;
nurs
e w
as a
s effe
ctiv
e as
m
anag
ing
the
patie
nts.
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation58
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
Nu
rSe
-led
mo
del
S15
Coo
per C
, whe
eler
, d.m
., w
oolfe
nden
, S., B
oss,
T., &
Pip
er,
S. (2
006)
. Spe
cial
ist h
ome-
base
d nu
rsin
g se
rvic
es fo
r chi
ldre
n w
ith
acut
e an
d ch
roni
c ill
ness
es. C
ochr
ane
Dat
abas
e of S
yste
mat
ic R
evie
w,
4(C
d00
4383
), 1-
22.
Syst
emat
ic R
evie
w
Eval
uatin
g sp
ecia
list
hom
e-ba
sed
nurs
ing
serv
ices
for c
hild
ren
with
ac
ute/
chro
nic
illne
sses
GEN
ERA
lN
urse
-led
Acu
te C
hron
ic Il
lnes
s
◥
Nur
se p
rovi
ding
in-h
ome
visit
s an
d fo
llow
-ups
afte
r dia
gnos
is an
d co
ntin
ued
to p
rovi
de se
rvic
es b
y te
leph
one
for t
he n
ext 2
4 m
onth
s
◥
Impr
oved
satis
fact
ion
w
ith h
ome
care
◥
No
adve
rse
outc
omes
◥
No
evid
ence
of r
educ
ed
acce
ss to
car
e
16C
orse
r, w
., & X
u, Y
. (20
09).
Faci
litat
ing
Patie
nts’
dia
bete
s Se
lf-m
anag
emen
t: A
Pri
mar
y ca
re
Inte
rven
tion
Fram
ewor
k. Jo
urna
l of
Nur
sing
Care
Qua
lity,
24(2
), 17
2-17
8.
Inte
rven
tion
Fram
ewor
k
to su
ppor
t a c
onsis
tent
de
liver
y of
dia
bete
s sel
f-m
anag
emen
t ser
vice
s
GEN
ERA
lN
urse
-led
Self-
man
agem
ent
dia
bete
s Sel
f-m
anag
emen
t (d
S m)
◥
Nur
se c
linic
ians
pla
y a
very
im
port
ant r
ole
in d
Sm;
inte
rven
tion
activ
ities
such
as
tele
phon
e fo
llow
-ups
, dist
ribut
ion
and
expl
anat
ion
of d
Sm w
ritte
n m
ater
ials;
cre
atin
g a
care
pla
n w
ith
the
patie
nt (a
sses
sing
dSm
nee
ds,
reso
urce
s, su
ppor
ts, b
arri
ers)
; pr
ovid
e m
ore
holis
tic c
are
◥
Posit
ive
resu
lts fo
r pat
ient
s:
◥Im
prov
ed d
Sm
beha
viou
rs (n
utrit
ion,
ex
erci
se, s
mok
ing
cess
atio
n)
◥G
reat
er a
cces
sibili
ty to
d
Sm re
sour
ces
◥
Impr
oved
dSm
he
alth
out
com
es
(bet
ter u
nder
stan
ding
of
hea
lth c
ondi
tion,
m
edic
inal
adh
eren
ce)
17C
ox, K
., &
wils
on, E
. (20
03).
Follo
w-u
p fo
r peo
ple
with
can
cer:
nurs
e-le
d se
rvic
es a
nd te
leph
one
inte
rven
tions
. Jou
rnal
of A
dvan
ced
Nur
sing,
43(1
), 51
-61.
lite
ratu
re R
evie
w
The
effec
tiven
ess o
f nu
rse-
led
follo
w-u
ps fo
r ca
ncer
pat
ient
s
GEN
ERA
lN
urse
-led
Can
cer C
are
Follo
w-u
p ca
re, t
elep
hone
inte
rven
tion
◥
Nur
ses p
erfo
rm fo
llow
-ups
with
pa
tient
s via
the p
hone
after
canc
er
trea
tmen
ts, o
r in
pers
on, t
o su
ppor
t th
e pat
ient
’s ps
ycho
logi
cal n
eeds
◥
Satis
fact
ion
of p
atie
nts
with
nur
se-le
d fo
llow
-up
was
hig
h; d
id n
ot im
prov
e qu
ality
of l
ife b
ut m
anag
ing
of sy
mpt
oms
◥
Cos
t-eff
ectiv
e; a
dditi
onal
su
ppor
t pat
ient
s cou
ld
not g
et fr
om th
eir G
Ps
(gen
eral
pra
ctiti
oner
s)
interProFeSSional CollaBorative teaMS 59
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
Nu
rSe
-led
mo
del
S18
Cro
we,
C. (
2009
). d
evel
opm
ent
and
impl
emen
tatio
n of
a ‘n
urse
run’
post
-acu
te st
roke
clin
ic. A
ustr
alia
n N
ursin
g Jo
urna
l, 16
(8),
28-3
1.
Cas
e St
udy
ba
sed
on fi
ndin
g
of sy
stem
atic
revi
ew
AuST
RAlI
AN
urse
-led
Stro
ke C
linic
◥
Stro
ke l
iais
on N
urse
(SlN
) co
nnec
t with
the
patie
nt’s
stro
ke
care
pro
vide
r and
gat
hers
all
the
data
bef
ore
the
patie
nt c
omes
to
the
clin
ic; 5
0-m
inut
e ap
poin
tmen
t
◥Sl
N w
orks
alo
ngsid
e st
roke
cl
inic
al n
urse
in th
e sa
me
office
, sh
are
simila
r rol
es
◥N
urse
pro
vide
s edu
catio
n, li
fest
yle/
heal
th p
rom
otio
n, st
ress
test
s, fo
llow
-ups
◥
dec
reas
e in
hos
pita
lizat
ions
◥
dec
reas
e in
ca
re fr
agm
enta
tion
19C
ruic
ksha
nk, S
., Ken
nedy
C.,
lock
hart
, K., d
osse
r, I.,
& d
alla
s, l.
(2
008)
. Spe
cial
ist b
reas
t car
e nur
ses
for s
uppo
rtiv
e car
e of w
omen
with
br
east
canc
er. C
ochr
ane D
atab
ase o
f Sy
stem
atic
Revi
ews,
1(C
d00
5634
), 1-
40.
Syst
emat
ic R
evie
w
Esta
blish
ing
chan
ges i
n ou
tcom
e fo
r pat
ient
s with
br
east
can
cer t
hrou
gh
Brea
st C
ance
r Nur
ses
GEN
ERA
lN
urse
-led
Brea
st C
ance
r
◥
Nur
se sp
ecia
list s
ees p
atie
nts 3
m
onth
s pos
t-su
rger
y; p
rovi
des
info
rmat
ion
on re
curr
ence
, ad
vice
, con
tact
det
ails,
add
ress
ing
sym
ptom
con
cern
s
◥C
oord
inat
ed y
early
mam
mog
ram
◥
Bres
t can
cer n
urse
s pro
vide
so
me
bene
fit to
pat
ient
s ar
eas s
uch
as a
nxie
ty, e
arly
re
cogn
ition
dep
ress
ive
sym
ptom
s
◥N
o sig
nific
ant fi
ndin
gs
20d
esbo
roug
h, J.
, For
rest
, l., &
Par
ker,
R. (2
011)
. Nur
se-le
d pr
imar
y he
alth
care
wal
k-in
cen
tres
: an
inte
grat
ive
liter
atur
e re
view
. Jou
rnal
of
Adv
ance
d N
ursin
g, 68
(2),
248-
263.
Inte
grat
ive
lite
ratu
re
Revi
ew
Are
wal
k-in
cen
tres
by
nurs
es a
nd e
ffect
ive
way
to
impr
ove
acce
ss to
pr
imar
y ca
re
GEN
ERA
lN
urse
-led
Prim
ary
Hea
lthca
re w
alk-
in C
entr
es
◥
Nur
ses p
rovi
ding
care
for a
var
iety
of
illn
esse
s, sh
orte
r wai
t tim
es, m
ore
focu
s on
sym
ptom
man
agem
ent
◥
Incr
ease
d de
man
d fo
r w
alk-
in c
linic
s; nu
rsin
g ed
ucat
ion
need
s to
mat
ch
the
dem
and
for t
his
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation60
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
Nu
rSe
-led
mo
del
S21
Edw
ards
, J.B
., Opp
ewal
, S., &
log
an,
C. l
. (20
03).
Nur
se-m
anag
ed
Prim
ary
Car
e: O
utco
mes
of a
Fa
culty
Pra
ctic
e N
etw
ork.
Jour
nal
of th
e Am
eric
an A
cade
my
of N
urse
Pr
actit
ione
rs, 1
5(12
), 56
3-56
9.
Prog
ram
Eva
luat
ion
Eval
uatin
g N
urse
m
anag
ed C
are
at a
Fa
culty
Pra
ctic
e N
etw
ork
uN
ITEd
ST
ATES
Nur
se-le
d
Acu
te C
hron
ic Il
lnes
s
◥
Staffi
ng v
arie
s: re
gist
ered
nur
se,
prac
tice
nurs
es, c
ase
man
ager
s, he
alth
edu
cato
rs, o
vers
een
by
a ph
ysic
ian
men
tor
◥
Focu
s on
prev
entiv
e an
d he
alth
pr
omot
ion
serv
ices
for c
lient
s
◥
Patie
nt sa
tisfa
ctio
n ra
te is
ve
ry h
igh,
(91%
) and
94%
sa
id th
at th
ey w
ould
retu
rn
for f
urth
er c
are;
exte
rnal
and
in
tern
al a
udits
find
qua
lity
of c
are
to b
e ex
celle
nt;
stud
ents
stud
y at
the
cent
res
and
facu
lty m
embe
rs p
rese
nt
rese
arch
bas
ed o
n th
eir
wor
k w
ith th
e FP
N (F
amily
Pr
actic
e N
etw
ork)
22Fa
rrel
l, C
., mol
assio
tis, A
., Bea
ver,
K.,
& H
eave
n, C
. (20
11).
Expl
orin
g th
e sc
ope
of o
ncol
ogy
spec
ialis
t nur
ses’
prac
tice
in th
e u
K. E
urop
ean
Jour
nal
of O
ncol
ogy
Nur
sing,
15, 1
60-1
66.
Surv
ey
Expl
orin
g th
e
scop
e of
pra
ctic
e of
nu
rses
in o
ncol
ogy
by
surv
eyin
g nu
rses
uN
ITEd
K
ING
dO
mN
urse
-led
Onc
olog
y
◥
Nur
se-le
d cli
nics
that
pro
vide
pa
tient
s with
scre
enin
g, as
sess
men
ts,
follo
w-u
ps, e
duca
tion,
coun
selli
ng
◥Ro
le e
xpan
sion
nece
ssar
y du
e to
ga
ps in
the
heal
thca
re sy
stem
◥
Nur
ses e
xper
ienc
ing
barr
iers
such
as
lack
of s
uppo
rt fo
r aut
onom
ous
nurs
e-le
d cl
inic
s; ca
nnot
pre
scrib
e ch
emot
hera
py d
rugs
on
thei
r ow
n
◥
Nur
se-le
d cl
inic
s tre
at
patie
nts h
olist
ical
ly a
nd
redu
ce w
ait t
imes
and
ho
spita
l visi
ts
◥Ro
le cla
rity
and
scop
e of n
urse
du
ties s
houl
d be
clar
ified
to
enha
nce c
olla
bora
tion
◥
mor
e su
ppor
t pro
vide
d
by p
hysic
ians
23Fe
lber
, d., m
aham
a, N
., moh
ar, d
.R.H
., &
Kin
ion,
E. (
2003
). N
ursin
g ca
re
deliv
ered
at ac
adem
ic co
mm
unity
-ba
sed
nurs
e-m
anag
ed ce
nter
. Out
com
es
man
agem
ent,
7(2)
, 84-
89.
Retr
ospe
ctiv
e d
escr
iptiv
e St
udy
Serv
ices
del
iver
ed b
y C
omm
unity
-bas
ed N
urse
m
anag
ed C
entr
es
uN
ITEd
ST
ATES
Nur
se-le
d
Hea
lth P
rom
otio
n/d
isea
se P
reve
ntio
n
◥
Nur
se w
orks
alo
ngsi
de n
ursi
ng
stud
ents
, med
ical
stud
ents
, vo
lunt
eers
phy
sici
ans,
3r
d ye
ar re
side
nts
◥
Com
mun
ity N
urse
-man
aged
C
ente
r (C
Nm
C) w
orks
with
the
unde
rser
ved;
stro
ng fo
cus o
n he
alth
pr
omot
ion,
dise
ase p
reve
ntio
n
◥
No
clin
ical
out
com
es
◥C
Nm
C m
ain
goal
is to
im
prov
e ac
cess
to c
are;
colla
bora
tion
with
oth
er
soci
al a
genc
ies b
ring
s mor
e at
tent
ion
to th
is iss
ue fo
r po
licy
chan
ge
interProFeSSional CollaBorative teaMS 61
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
Nu
rSe
-led
mo
del
S24
Fitz
simm
ons,
d., H
awke
r, S.
E.,
Geo
rge,
S.l.
, Joh
nson
, C.d
., &
Cor
ner,
J.l. (
2005
). N
urse
-led
mod
els o
f che
mot
hera
py c
are:
mix
ed e
cono
my
or n
urse
-doc
tor
subs
titut
ion?
Jour
nal o
f Adv
ance
d N
ursin
g, 50
(3) 2
44-2
52.
Expl
orat
ory
Stud
y
How
do
canc
er se
rvic
e us
ers f
eel a
bout
nur
se-le
d ch
emot
hera
py c
linic
s
uN
ITEd
K
ING
dO
mN
urse
-led
Che
mot
hera
py C
are
◥
Nur
se w
ould
be r
espo
nsib
le fo
r tot
al
patie
nt m
anag
emen
t (as
sess
men
t, pr
escr
ibin
g ch
emo
dose
s, pr
escr
ibin
g sy
mpt
om re
late
d dr
ugs,
adm
inist
erin
g th
e che
mot
hera
py,
orde
ring
bloo
d w
ork)
◥
Pote
ntia
l to
redu
ce w
ait
times
; les
s str
ess o
n m
edic
al
staff
; cos
t- sa
ving
mea
sure
25Fo
rem
an, d
.m., &
mor
ton,
S.
(201
1). N
urse
-del
iver
ed a
nd d
octo
r-de
liver
ed c
are
in a
n at
tent
ion
defic
it hy
pera
ctiv
ity d
isor
der f
ollo
w-u
p cl
inic
: a c
ompa
rativ
e st
udy
usin
g pr
open
sity
scor
e m
atch
ing.
Jour
nal o
f Ad
vanc
ed N
ursin
g, 67
(6),
1341
-134
8.
Com
para
tive
Stud
y
Are
nur
se p
resc
riber
s as
effe
ctiv
e as
doc
tors
in
Atte
ntio
n d
efici
t H
yper
activ
e d
isor
der
uN
ITEd
K
ING
dO
mN
urse
-led
Atte
ntio
n d
e fici
t Hyp
erac
tivity
d
isor
der (
Ad
Hd
)
◥
Nur
se-le
d A
dH
d c
linic
; the
nu
rse
wou
ld in
depe
nden
tly
diag
nose
rout
ine
case
s of A
dH
d,
man
age
thes
e pa
tient
s and
di
spen
se th
eir m
edic
atio
n.
◥Th
e nu
rse
was
to b
e qu
alifi
ed
as a
gen
eral
and
men
tal h
ealth
nu
rse,
and
obta
ined
a n
urse
pr
escr
ibin
g qu
alifi
catio
n
◥
Pote
ntia
lly c
ost-
savi
ng
◥Re
duce
s stig
mas
abo
ut
nurs
e’s sc
ope
of w
ork
26G
iven
, C. w
., Giv
en, B
.A., S
ikor
skii,
A
., You
, m., S
angc
hoon
, J., C
ham
pion
, v.
, & m
cCor
kle,
R. (2
010)
. d
econ
stru
ctio
n of
Nur
se-d
eliv
ered
Pa
tient
Sel
f-m
anag
emen
t: Fa
ctor
s Re
late
d to
del
iver
y En
actm
ent a
nd
Resp
onse
. Ann
Beh
avio
ral M
ed,
40(1
), 99
-113
.
Ran
dom
ized
Clin
ical
Tr
ial S
tudy
Self-
man
agem
ent
inte
rven
tions
rela
ted
to sy
mpt
om re
spon
ses
amon
gst c
ance
r pat
ient
s
uN
ITEd
ST
ATES
Nur
se-le
d
Prim
ary
Car
e - d
epre
ssio
n
◥
Nur
ses g
uide
d pa
tient
s thr
ough
fo
ur st
ages
; sel
f-ca
re b
ehav
iour
s, in
form
atio
n an
d de
cisio
n-m
akin
g,
com
mun
icat
ion
with
fam
ily/
prov
ider
s
◥N
urse
s use
softw
are
to a
sses
s an
d ra
te sy
mpt
oms,
reco
rd
inte
rven
tions
that
the
patie
nts h
ad
trie
d/w
ere
curr
ently
usin
g
◥
Allo
wed
pat
ient
s to
be m
ore
enga
ged
in se
lf-ca
re
◥Pa
tient
s pri
oriti
ze p
robl
ems
usin
g m
etho
ds th
at fi
t int
o th
eir r
outin
es
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation62
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
Nu
rSe
-led
mo
del
S27
Glyn
n, lG
., mur
phy, A
.w., S
mith
, S.m
., Sch
roed
er, K
., Fah
ey, T
. (201
0).
Inter
vent
ions
use
d to
impr
ove c
ontro
l of
bloo
d pr
essu
re in
pati
ents
with
hy
perte
nsio
n. Co
chra
ne D
atab
ase o
f Sy
stem
atic
Revie
ws, 3
(Cd
0051
82),
dO
I:10.1
002/
1465
1858
. Cd
0051
82.p
ub4.
Syst
emat
ic R
evie
w
Effec
tiven
ess o
f in
terv
entio
ns to
impr
ove
bloo
d pr
essu
re co
ntro
l in
patie
nts w
ith h
yper
tens
ion
GEN
ERA
lN
urse
or P
harm
acy
led
Car
e
◥
Nur
se-le
d in
terv
entio
ns in
clude
d ph
one c
all s
uppo
rts,
appo
intm
ent
follo
w-u
p re
min
ders
, tea
chin
g pa
tient
self-
mon
itorin
g te
chni
ques
, m
onito
ring
and
trac
king
of
hype
rten
sion
patie
nts`
pro
gres
s
◥
Posit
ive:
dem
onst
rate
d bl
ood
pres
sure
con
trol
, st
abili
zatio
n of
mea
n sy
stol
ic
bloo
d pr
essu
re, a
dher
ence
to
follo
w-u
ps b
y pa
tient
s
◥Ed
ucat
ion
alon
e is
no
t effe
ctiv
e
28G
raha
m, l
., Nea
l, C.P.
, Gar
cea,
G.,
lloy
d, d
. m., R
ober
tson
, G.S
. & S
utto
n,
C.d
. (20
10).
Eval
uatio
n of
nur
se-le
d di
scha
rge f
ollo
win
g la
paro
scop
ic
surg
ery.
Jour
nal o
f Eva
luat
ion
in
Clin
ical P
ract
ice, 1
8, 1
9-24
.
Retr
ospe
ctiv
e C
ompa
riso
n
Ass
essi
ng th
e eff
ectiv
enes
s of a
nur
se-
led
disc
harg
e fo
llow
ing
lapa
rosc
opic
surg
ery
uN
ITEd
K
ING
dO
mN
urse
-led
lapa
rosc
opic
Sur
gery
◥
Nur
ses h
ave
a ve
ry c
lear
out
line
on d
isch
arge
that
they
mus
t fo
llow
resu
lting
in m
ore
nurs
e-le
d di
scha
rges
◥
Nur
se-le
d di
scha
rges
shou
ld
be e
ncou
rage
d; re
duce
w
orkl
oad
of th
e ph
ysic
ians
◥
Re-a
rran
ge sc
hedu
ling
of
patie
nts s
o di
scha
rges
can
oc
cur a
t opt
imal
tim
es,
incr
easin
g be
d av
aila
bilit
y29
Hab
er, J
., Str
asse
r, S.
, llo
yd, m
., d
orse
n, C
., Kna
pp, R
., & A
uerh
ahn,
C
. (20
09).
The
oral
-sys
tem
ic
conn
ectio
n in
pri
mar
y ca
re. N
urse
Pr
actit
ione
r, 34
(3),
43-4
8.
Ove
rvie
w
Exam
ples
of n
urse
-m
anag
ed h
ealth
cen
tres
uN
ITEd
ST
ATES
Nur
se-le
d
Can
cer,
Chr
onic
dis
ease
man
agem
ent
◥
Nur
ses p
rovi
ded
com
preh
ensiv
e he
alth
and
risk
ass
essm
ents
; ca
ncer
scre
enin
g, h
ealth
ed
ucat
ion/
coun
selli
ng,
man
agem
ent o
f chr
onic
co
nditi
ons;
diag
nosis
/tre
atm
ent
of a
cute
illn
esse
s
◥
Hig
h ra
tes o
f pat
ient
sa
tisfa
ctio
n; 9
5% a
gree
d to
re
com
men
d ca
re se
rvic
es
they
rece
ived
interProFeSSional CollaBorative teaMS 63
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
Nu
rSe
-led
mo
del
S30
Har
ris,
d.l
., &
Cra
ckne
ll, P
. (20
05)
Impr
ovin
g di
abet
es c
are
in g
ener
al
prac
tice
usin
g a
nurs
e-le
d, G
P su
ppor
ted
clin
ic: a
coh
ort s
tudy
. Pr
actic
al D
iabe
tes I
nter
natio
nal,
22(8
) 295
-300
.
Coh
ort S
tudy
Stud
ying
pat
ient
cent
red
care
met
hods
surr
ound
ing
type
2 d
iabe
tes
uN
ITEd
K
ING
dO
mN
urse
-led
dia
bete
s Car
e
◥
Nur
ses u
nder
wen
t ext
ra tr
aini
ng
in d
iabe
tes c
are
man
agem
ent
◥
Nur
se c
reat
ed a
man
agem
ent p
lan
for e
ach
patie
nt th
at w
as v
erifi
ed
by th
e G
P (G
ener
al P
ract
ition
er)
◥
Nur
se d
iscu
ssed
fitn
ess/
heal
th
goal
s at a
ppoi
ntm
ents
◥
If n
eede
d, p
resc
riptio
ns w
ere
chan
ged/
alte
red
◥
The
nurs
e-le
d cl
inic
co
uld
prov
ide
patie
nts
with
the
inte
nsiv
e fo
llow
- up
they
nee
ded
that
the
G
P cl
inic
cou
ldn’
t due
to
tim
e co
nstr
aint
s
◥N
urse
-led
clin
ic im
prov
ed
chol
este
rol a
nd b
lood
gl
ucos
e le
vels
in p
atie
nts
31H
eale
, R., &
But
cher
, m. (
2010
). C
anad
a`s F
irst N
urse
Pra
ctiti
oner
le
d C
linic
: A C
ase
Stud
y in
H
ealth
care
Inno
vatio
n. N
ursin
g Le
ader
ship
, 23(
3), 2
1-29
.
Cas
e St
udy
CA
NA
dA
- O
NTA
RIO
Nur
se-le
d
Nor
ther
n O
ntar
io –
est
ablis
hmen
t of
first
NP-
led
clin
ic
◥
Ant
eced
ents
for s
ucce
ss: l
eade
rshi
p,
finan
cial
cons
ider
atio
ns, id
ea
gene
ratio
n, te
amw
ork,
cultu
re
(cul
tivat
ing
acce
ptan
ce, u
se o
f m
edia
and
dem
and
for c
are a
nd fo
r jo
bs fo
r NPs
)
◥A
dvoc
acy
wor
k hi
ghlig
hted
◥
Barr
iers
: com
plex
care
nee
ds;
resis
tanc
e fro
m o
rgan
ized
med
icin
e
◥m
odel
cha
ract
erist
ics:
boar
d
with
51%
NPs
on
boar
d –
cann
ot b
e em
ploy
ees,
NP
for
clin
ic d
irect
or, s
alar
ied
staff
, ph
ysic
ians
as c
onsu
ltant
s, di
etiti
an,
phar
mac
ist, r
egist
ered
nur
ses,
cler
ical
; sat
ellit
e sit
e(s)
◥
Not
app
licab
le
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation64
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
Nu
rSe
-led
mo
del
S32
Heb
ert,
P.l.
, Sisk
, J.E
., wan
t, J.J
., Tu
zzlo
, l., C
asab
lanc
a, J.m
., Cha
ssin
, m
.R., H
orow
its, C
., & m
clau
ghlin
, m
.A. (
2008
). C
ost-
effec
tiven
ess o
f nu
rse-
led
dise
ase
man
agem
ent f
or
hear
t fai
lure
in a
n et
hnic
ally
div
erse
ur
ban
com
mun
ity. A
nnal
s of I
nter
nal
Med
icin
e, 14
9(8)
, 540
-548
.
Ran
dom
ized
Con
trol
led
Tria
l
Can
nur
se-le
d he
art
failu
re c
linic
s red
uce
cost
an
d im
prov
e qu
ality
of l
ife
uN
ITEd
ST
ATES
Nur
se-le
d
Car
diov
ascu
lar d
isea
se
◥
Nur
se a
ssig
ned
203
patie
nts;
incl
uded
1 in
-per
son
appo
intm
ent
and
peri
odic
follo
w-u
ps b
y ph
one
over
12
mon
ths
◥
Patie
nts e
xpre
ssed
im
prov
emen
ts in
qua
lity
of li
fe
◥C
ost-
effec
tiven
ess
impr
oved
slig
htly
33H
ilton
, B.A
., Bud
gen,
C., m
o lza
hn, A
., &
Attr
idge
, C.B
. (20
01).
de v
elop
ing
and
Test
ing
Inst
rum
ents
to m
easu
re
Clie
nt O
utco
mes
at t
he C
omox
va
lley
Nur
sing
Cen
tre.
Publ
ic H
ealth
N
ursin
g, 18
(5),
327-
339.
Pilo
t Stu
dy w
ith m
ulti-
met
hod
Eval
uatio
n
Prog
ram
Eva
luat
ion
of
16 m
onth
dem
onst
ratio
n pr
ojec
t – su
rvey
and
qu
alita
tive
inte
rvie
ws
with
clie
nts
CA
NA
dA
- BR
ITIS
H
CO
lum
B IA
Nur
se-le
d
Prim
ary
care
Free
-sta
ndin
g nu
rse-
man
aged
cen
tre
offer
ing
drop
-ins,
grou
p an
d ou
trea
ch
serv
ices
in a
smal
l com
mun
ity o
f 58
,000
peo
ple.
Cen
tre
staff
ed b
y nu
rsin
g co
ordi
nato
r, 4
part
-tim
e nu
rses
an
d ha
lf- ti
me
secr
etar
y/re
cept
ioni
st.
Focu
sed
on:
◥
coor
dina
tion
and
inte
grat
ion
of
hea
lthca
re se
rvic
es
◥pr
ovid
e es
sent
ial h
ealth
care
in
the
com
mun
ity
◥in
crea
se c
lient
/pat
ient
self-
relia
nce
◥
focu
s on
stra
tegi
es to
redu
ce
the
effec
ts o
f soc
ial d
eter
min
ants
of
hea
lth
◥pr
ovid
e nu
rsin
g ca
re th
at is
eff
ectiv
e (in
term
s of c
ost a
nd
heal
th b
enefi
ts)
◥
Hig
h cl
ient
satis
fact
ion
◥
mor
e kn
owle
dgea
ble
abou
t he
alth
situ
atio
n
◥Im
prov
ed p
hysic
ally
an
d m
enta
lly
◥Pa
tient
s tak
ing
actio
n on
th
eir o
wn
beha
lf
◥Be
tter u
se o
f hea
lthca
re
reso
urce
s (i.e
. not
usin
g
the
hosp
ital e
mer
genc
y ro
om a
s muc
h)
◥C
an c
omm
unic
ate
m
ore
effec
tivel
y w
ith
heal
thca
re p
rovi
ders
◥
Hel
ping
oth
ers t
hrou
gh
com
mun
ity a
ctio
n an
d gr
oup
supp
ort
interProFeSSional CollaBorative teaMS 65
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
Nu
rSe
-led
mo
del
S34
Ism
ail,
N., R
atch
ford
, I., P
roud
foot
, C
., & G
ibbs
, J. (
2011
). Im
pact
of
a n
urse
-led
clin
ic fo
r chr
onic
co
nstip
atio
n in
chi
ldre
n. Jo
urna
l of
Child
Hea
lth C
are,
15(3
), 22
1-22
9.
Eval
uativ
e St
udy
Impa
ct o
f out
patie
nt
nurs
es m
anag
ing
child
ren
with
chr
onic
con
stip
atio
n us
ing
a qu
estio
nnai
re
uN
ITEd
K
ING
dO
mN
urse
-led
Chr
onic
Con
stip
atio
n
◥
Nur
se e
duca
tes p
atie
nts/
child
ren
abou
t the
con
ditio
n
◥Es
tabl
ish a
goo
d to
iletr
y ro
utin
e
◥Pr
ovid
ed li
tera
ture
on
ca
re m
anag
emen
t
◥Pr
ovid
e su
ppor
t/fol
low
-up
appo
intm
ents
◥
Redu
ctio
n in
def
ecat
ion
pain
◥
Chi
ldre
n m
ore
will
ing
to
use
the
toile
t
◥Pa
rent
kno
wle
dge
of th
e co
nditi
on in
crea
sed
◥
Satis
fact
ion
with
nur
se-le
d cl
inic
incr
ease
d fr
om 3
4-90
%
35K
ovne
r, C
., & w
alan
i, S.
(201
0). N
urse
m
anag
ed H
ealth
Cen
ters
(Nm
HC
s)
- Res
earc
h Br
ief.
Robe
rt W
ood
John
son
Foun
datio
n N
ursin
g Re
sear
ch
Net
wor
k, 1
-2. R
etri
eved
from
: ht
tp://
ww
w.rw
jf.or
g.
Rese
arch
Bri
ef
des
crib
ing
Nur
se
man
aged
Cen
tres
as a
so
urce
of P
rim
ary
care
uN
ITEd
ST
ATES
Nur
se-le
d
Prim
ary
Car
e
◥
mod
el: N
urse
-man
aged
hea
lth
cent
res (
Nm
HC
); us
ually
und
er
the
lead
ersh
ip o
f an
adva
nced
pr
actic
e nu
rse;
emph
asis
on h
ealth
ed
ucat
ion,
pre
vent
ion,
an
d pr
omot
ion;
◥u
sual
ly p
rovi
de c
are
to
unde
rser
ved
com
mun
ities
◥
Som
e evi
denc
e tha
t if N
mH
Cs
oper
ated
at fu
ll ca
pacit
y, th
e co
st of
care
per
visit
wou
ld
decr
ease
; less
expe
nsiv
e tha
n lo
cal m
edica
l car
e
◥So
me
evid
ence
that
Nm
HC
s pr
escr
ibe
high
er ra
tes o
f ge
neri
c m
edic
atio
n
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation66
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
Nu
rSe
-led
mo
del
S36
laur
ant,
m., R
eeve
s, d
., Her
men
s, R.
, Br
aspe
nnin
g, J.
, Gro
l, R.
, & S
ibba
ld,
B. (R
epri
nted
200
9). S
ubst
itutio
n of
do
ctor
s by
nurs
es in
pri
mar
y ca
re.
Coch
rane
Dat
abas
e of S
yste
mat
ic
Revi
ews 2
004,
4(C
d00
127)
, dO
I: 10
.100
2/14
6518
58.C
d00
1271
.pub
2.
Syst
emat
ic R
evie
w
dem
and
for p
rim
ary
care
se
rvic
es h
as in
crea
sed
and
supp
ly o
f phy
sicia
ns
is co
nstr
aine
d –
resu
lt is
nurs
e-do
ctor
subs
titut
ion
GEN
ERA
l N
urse
-led
Car
e
doc
tor-
nurs
e su
bstit
utio
n
◥
In 7
stud
ies t
he n
urse
as
sum
ed re
spon
sibili
ty fo
r firs
t co
ntac
t and
ong
oing
car
e fo
r all
pres
entin
g pa
tient
s (m
ixed
resu
lts,
som
e po
sitiv
e)
◥In
5 st
udie
s the
nur
se a
ssum
ed
resp
onsib
ility
for fi
rst c
onta
ct
care
for p
atie
nts w
antin
g ur
gent
co
nsul
tatio
ns d
urin
g offi
ce
hour
s or o
ut-o
f-ho
urs (
patie
nts
mor
e sa
tisfie
d w
ith n
urse
-led
cons
ulta
tions
/car
e)
◥In
4 st
udie
s, nu
rse
took
re
spon
sibili
ty fo
r the
ong
oing
m
anag
emen
t of p
atie
nts w
ith
part
icul
ar c
hron
ic c
ondi
tions
(no
signi
fican
t diff
eren
ces)
◥
Find
ings
sugg
est t
hat
appr
opri
atel
y tr
aine
d nu
rses
ca
n pr
oduc
e as
hig
h qu
ality
ca
re a
s pri
mar
y ca
re d
octo
rs
and
achi
eve
as g
ood
◥
heal
th o
utco
mes
for p
atie
nts
(mor
e st
udie
s req
uire
d)
◥N
urse
s hav
e th
e po
tent
ial
to re
duce
doc
tor w
orkl
oads
an
d he
alth
care
cos
ts b
ased
on
con
text
37le
wis,
R., N
eal,
R.d
., will
iam
s, N
.H.,
Fran
ce, B
., & w
ilkin
son,
C. (
2009
) N
urse
-led
vs. c
onve
ntio
nal p
hysic
ian-
led
follo
w-u
p fo
r pat
ient
s with
ca
ncer
: sys
tem
atic
revi
ew. J
ourn
al o
f Ad
vanc
ed N
ursin
g, 65
(4),
706–
723.
Syst
emat
ic R
evie
w
Revi
ew o
f effe
ctiv
enes
s an
d co
st e
ffect
iven
ess o
f nu
rse-
led
follo
w u
p fo
r pa
tient
s with
can
cer
GEN
ERA
lN
urse
-led
Can
cer C
are
◥
The
role
of t
he sp
ecia
list n
urse
w
as to
pro
vide
info
rmat
ion
and
supp
ort,
co-o
rdin
ate
inpu
t fro
m
othe
r age
ncie
s or s
ervi
ces,
and
faci
litat
e co
mm
unic
atio
n w
ith G
Ps
and
prim
ary
heal
thca
re te
ams
◥
Cos
t-effi
cien
t, fe
asib
le
◥
Patie
nts p
refe
rred
the
conv
enie
nce
of n
urse
- le
d fo
llow
-ups
by
phon
e
but e
njoy
in p
erso
n fo
llow
-up
s ove
rall
interProFeSSional CollaBorative teaMS 67
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
Nu
rSe
-led
mo
del
S38
lyon
, S. (
2011
). Sm
all,
Inde
pend
ent,
and
Out
in F
ront
. Sto
ries
from
the
field
, Nur
se-le
d M
edic
al H
omes
: In
crea
sing A
cces
s to
Qua
lity
Care
, A
pril,
1-2
.
Cas
e St
udy
Exam
inin
g th
e fir
st n
urse
-le
d pr
actic
e in
the
u.S
. to
rece
ive
leve
l 3 P
atie
nt
Cen
tred
med
ical
hom
e re
cogn
ition
from
the
Nat
iona
l Com
mitt
ee fo
r Q
ualit
y A
ssur
ance
uN
ITEd
ST
ATES
Nur
se-le
d
Chr
onic
dis
ease
man
agem
ent
◥
Faci
lity
whe
re a
dvan
ced
prac
tice
regi
ster
ed n
urse
s hav
e th
e au
tono
my
to p
ract
ice
with
out
phys
icia
n ov
ersig
ht
◥u
se o
f Em
Rs, e
lect
roni
c pr
escr
ibin
g, re
gist
ries
for c
hron
ic
dise
ase
patie
nts
◥
Adv
ance
d pr
actic
e
regi
ster
ed n
urse
s can
del
iver
th
e sa
me
qual
ity o
f car
e as
fa
mily
pra
ctiti
oner
s
◥Pa
tient
s fee
l com
fort
able
in
thei
r hea
lthca
re en
viro
nmen
t; pr
ovid
ed w
ith ed
ucat
ion
and
coun
selli
ng to
take
ow
ners
hip
of th
eir h
ealth
39m
a rtin
-mi s
ener
, R., R
eilly
, S.m
., &
vol
lman
, A.R
. (20
10).
defi
ning
th
e ro
le o
f pri
mar
y he
alth
car
e nu
rse
prac
titio
ners
in ru
ral N
ova
Scot
ia. C
anad
ian
Jour
nal o
f Nur
sing
Rese
arch
, 42(
2), 3
0-47
.
mix
ed m
etho
ds S
tudy
Exam
inin
g th
e in
fluen
tial
fact
ors f
or th
e fu
ll in
tegr
atio
n of
NP`
s in
to p
rim
ary
and
acut
e ca
re (l
egis
lativ
e, ed
ucat
iona
l, pr
actic
e)
CA
NA
dA
- N
OvA
SC
OTI
AN
urse
-led
Prim
ary
Hea
lthca
re
◥
9 C
hair
pers
ons –
6 fe
mal
e an
d
3 m
ale
– w
ere
inte
rvie
wed
◥
In ru
ral N
ova
Scot
ia, w
ait t
imes
to
acc
ess a
fam
ily p
ract
ice i
s 3-4
w
eeks
, so
man
y pe
ople
go
to th
e ER
◥
Expa
nd ro
le o
f the
NP
and
enco
urag
e nu
rse-
led
prac
tices
in
orde
r to
perf
orm
mor
e pr
oced
ures
, pr
escr
ibe
mor
e m
edic
atio
ns, a
nd
adm
it pa
tient
s whe
n ne
cess
ary
◥
The
NPs
are
the
link
betw
een
the
com
mun
ity a
nd fa
mily
pra
ctic
e an
d th
eir r
ole
is to
pro
vide
ou
trea
ch se
rvic
es
◥
Find
ings
sugg
est t
hat
nurs
e pra
ctiti
oner
s are
not
be
ing
enco
urag
ed o
r giv
en
oppo
rtun
ities
to w
ork
to th
eir
full
pote
ntia
l; ba
rrie
rs in
thei
r pr
actic
e nee
d to
be r
emov
ed
◥Th
is ca
n be
acc
ompl
ished
by
educ
atin
g th
e co
mm
unity
on
the
role
of t
he n
urse
pr
actit
ione
r and
incr
easin
g pa
tient
acc
ess t
o nu
rse
prac
titio
ners
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation68
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
Nu
rSe
-led
mo
del
S40
mcA
iney
, C.A
., Hau
ghto
n, d
., Je
nnin
gs, J
., Far
r, d
., Hill
ier,
l., &
m
orde
n, P
. (20
08).
A u
niqu
e pr
actic
e m
odel
for n
urse
pra
ctiti
oner
s in
long
-ter
m c
are
hom
es. J
ourn
al o
f Ad
vanc
ed N
ursin
g, 62
(5),
562-
571.
Pilo
t Pro
ject
Can
NPs
incr
ease
staff
co
nfide
nce,
prev
ent
hosp
ital a
dmiss
ion
and
prom
ote
early
dis
char
ge
CA
NA
dA
- O
NTA
RIO
Nur
se-le
d
Ger
onto
logy
◥
NP
wou
ld p
rovi
de a
sses
smen
t and
tr
eatm
ent f
or c
omm
on c
ompl
ex
cond
ition
s; ra
pid
care
◥
Prev
ent u
nnec
essa
ry
hosp
italiz
atio
ns a
nd p
rom
ote
ea
rly d
isch
arge
s
◥In
crea
se st
aff c
apac
ity to
del
iver
op
timal
car
e
◥N
P w
ould
wor
k al
ongs
ide
phys
icia
ns an
d ot
her s
taff
mem
bers
◥
In th
e st
udy,
nurs
es p
rosp
ectiv
ely
colle
ct d
ata
on th
eir c
linic
al
activ
ities
and
pat
ient
out
com
es
◥
Sign
ifica
nt d
ecre
ase
in
hosp
italiz
atio
ns
◥In
crea
se in
staff
confi
denc
e; st
rong
disp
lay
of tr
ust
betw
een
othe
r tea
m m
embe
rs
and
the n
urse
pra
ctiti
oner
s
◥lo
w n
urse
pra
ctiti
oner
-re
siden
t rat
io st
ill e
nhan
ces
qual
ity o
f car
e
41m
clou
ghne
y, C
R., K
han,
A., &
Ahm
ed,
A.B
. (20
007)
. Effe
ctiv
enes
s of a
sp
ecia
list n
urse
-led
inte
rven
tion
clini
c in
the m
anag
emen
t of c
ardi
ovas
cula
r ris
k fa
ctor
s in
diab
etes
. Eur
opea
n D
iabe
tes N
ursin
g, 4(
3) 1
00-1
05.
Inte
rven
tion
Clin
ical
St
udy
The
effec
tiven
ess o
f a
spec
ialis
ed n
urse
-led,
pr
otoc
ol d
riven
, doc
tor-
supe
rvis
ed c
linic
uN
ITEd
K
ING
dO
mN
urse
-led
dia
bete
s Car
e
Spec
ialis
t nur
se-le
d in
terv
entio
n cl
inic
in
the
man
agem
ent o
f car
diov
ascu
lar
risk
fact
ors
◥
Nur
se h
ad p
revi
ous e
xper
ienc
e with
di
abet
es/h
yper
tens
ion/
hype
rlipi
-de
mia
; phy
sicia
ns, c
linic
ians
, ph
arm
acist
s, tr
aine
d th
e nur
se o
n ho
w to
impl
emen
t pro
toco
ls
◥N
urse
per
form
ed te
sts,
crea
ted
a
patie
nt m
anag
emen
t pla
n
◥Ea
ch v
isit i
nclu
ded
feed
back
, go
al e
valu
atio
n an
d pl
anni
ng,
asse
ssm
ent o
f sm
okin
g/ob
esity
w
here
app
licab
le
◥
Impr
oved
pat
ient
sa
tisfa
ctio
n, sy
mpt
om
cont
rol,
data
col
lect
ion,
m
edic
al a
nd li
fest
yle
chan
ges
◥
Patie
nts a
chie
ved
bl
ood
pres
sure
con
trol
an
d lip
id ta
rget
s
◥d
iabe
tes c
ontr
ol
signi
fican
tly im
prov
ed
interProFeSSional CollaBorative teaMS 69
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
Nu
rSe
-led
mo
del
S42
mile
s, K
. (20
03).C
ompa
ring
doc
tor-
an
d nu
rse-
led
care
in a
sexu
al
heal
th c
linic
: pat
ient
satis
fact
ion
ques
tionn
aire
. Jou
rnal
of A
dvan
ced
Nur
sing,
42(1
), pp
. 64–
72.
Qua
litat
ive
Stud
y
dev
elop
men
t of a
pat
ient
sa
tisfa
ctio
n qu
estio
nnai
re:
Com
pari
ng th
e sa
tisfa
ctio
n of
nur
se-
led
vs. d
octo
r led
ge
nito
urin
ary
clin
ics
uN
ITEd
K
ING
dO
mN
urse
-led
Com
pari
son
doc
tor v
s. N
urse
-led
Clin
ic: G
enito
urin
ary
med
icin
e
◥
Nur
se a
ttend
s edu
catio
nal
inte
rven
tions
; mak
es c
linic
al
asse
ssm
ents
; per
form
s fol
low
-ups
, ap
poin
tmen
t rem
inde
rs; p
rovi
des
regu
lar f
eedb
ack
to p
atie
nt’s
prim
ary
care
pro
vide
r
◥
Syst
emat
ic fo
llow
-ups
with
pa
tient
s had
a p
ositi
ve
outc
ome
on d
etec
ting
depr
essio
n ea
rlier
43m
inist
ry o
f Hea
lth a
nd l
ong-
Term
C
are.
(200
7) N
urse
Pra
ctiti
oner
Led
Cl
inic
s. Re
trie
ved
from
:http
://w
ww.
heal
th.g
ov.o
n.ca
/tra
nsfo
rmat
ion/
np_c
linic
s/np
_mn.
htm
l.
Publ
ic In
form
atio
nC
AN
Ad
A -
ON
TARI
ON
urse
-led
Prim
ary
Car
e
◥
In 2
007
the
min
istry
of H
ealth
and
lo
ng-T
erm
Car
e an
noun
ced
the
crea
tion
of 2
5 nu
rse
prac
titio
ner-
led
clin
ics t
o be
fully
ope
ratio
nal
by th
e en
d of
201
2
◥Th
ese
clin
ics w
ould
del
iver
co
mpr
ehen
sive
and
holis
tic
prim
ary
care
that
wou
ld e
nhan
ce
heal
th p
rom
otio
n, c
hron
ic d
isea
se
man
agem
ent a
nd p
reve
ntio
n
◥Fo
cus o
n in
tegr
ated
car
e
thro
ugh
com
mun
ity p
artn
ersh
ips
and
care
coo
rdin
atio
n
◥
Com
preh
ensiv
e, ac
cess
ible
an
d co
ordi
nate
d fa
mily
he
alth
care
serv
ices
to
com
mun
ities
that
do
not
have
acc
ess t
o a
prim
ary
ca
re p
rovi
der
44m
olza
hn, A
., Bru
ce, A
., & S
hiel
ds,
l . (2
008)
. Sur
veill
ance
de
l’affe
ctio
n ré
nale
chr
oniq
ue d
ans u
ne c
liniq
ue
géré
e pa
r du
pers
onne
l infi
rmie
r et
supe
rvis
ée p
ar d
es m
édec
ins:
l’exp
érie
nce
Can
PREv
ENT.
CJN
R,
40(3
), 96
-112
.
Qua
litat
ive
Rese
arch
St
udy
Exam
inin
g th
e nat
ure o
f ca
re p
rovi
ded
to p
atie
nts
with
chro
nic k
idne
y dise
ase
CA
NA
dA
- BR
ITIS
H
CO
lum
BIA
Nur
se-le
d
Chr
onic
Kid
ney
di s
ease
◥
Clin
ic w
as ru
n by
a n
urse
and
su
ppor
ted
by a
nep
hrol
ogist
◥
Patie
nts c
ontin
ued
to re
ceiv
e ca
re
from
thei
r pri
mar
y ca
re p
hysic
ian
◥
Nur
se w
as w
orki
ng in
par
tner
ship
w
ith p
atie
nts a
nd th
eir f
amili
es to
im
prov
e th
eir h
ealth
and
ove
rall
qual
ity o
f life
◥
Patie
nts d
emon
stra
ted
a be
tter r
espo
nse
to so
me
of th
e no
n-m
edic
al
inte
rven
tions
such
as fl
uid
and
diet
rest
rict
ions
, cou
pled
w
ith re
gula
r sel
f-w
eigh
ing
and
inte
nsiv
e co
unse
lling
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation70
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
Nu
rSe
-led
mo
del
S45
mos
er, A
., Hou
tepe
n, R
. &
wid
ders
hove
n, G
. (20
07) P
atie
nt
auto
nom
y in
nur
se-le
d sh
ared
car
e: a
revi
ew o
f the
oret
ical
and
em
piri
cal
liter
atur
e. Jo
urna
l of A
dvan
ced
Nur
sing,
57(4
), 35
7–36
5.
Theo
retic
al a
nd E
mpi
rica
l li
tera
ture
Rev
iew
How
nur
ses c
an su
ppor
t pa
tient
aut
onom
y
uN
ITEd
K
ING
dO
mN
urse
-led
Hos
pice
Car
e
◥
Shar
ed e
xper
tise
betw
een
patie
nt a
nd p
rofe
ssio
nal;
shar
e re
spon
sibili
ty o
f pro
blem
-sol
ving
◥Pa
tient
sets
goa
ls, p
rofe
ssio
nal h
elps
th
em to
mak
e inf
orm
ed d
ecisi
ons
◥
Patie
nts g
ain
a be
tter
unde
rsta
ndin
g of
thei
r con
ditio
n/be
havi
ours
; pro
blem
s ide
ntifi
ed b
y pa
tient
and
car
egiv
er
◥
Impr
oves
pat
ient
self-
mas
tery
skill
s and
self-
effica
cy, p
ositi
vely
impa
ctin
g cl
inic
al o
utco
mes
46m
oyez
, J., H
alke
tt, G
., dea
s, K
., O’
Con
nor,
m., w
ard,
P., &
O’d
risc
oll,
C. (
2010
). H
ow d
o Sp
ecia
list B
reas
t N
urse
s hel
p br
east
can
cer p
atie
nts a
t fo
llow
-up?
Col
legia
n, 1
7, 1
43-1
49.
Them
atic
Ana
lysis
Con
sulta
tions
bet
wee
n Sp
ecia
list B
reas
t Nur
ses
(SBN
s) a
nd p
atie
nt
AuST
RAlI
AN
urse
-led
Brea
st C
ance
r
◥
The S
BN a
ccom
pani
es ea
ch w
oman
th
roug
h th
is ph
ase i
n he
r life
; th
e SBN
pro
vide
s a v
ery
stro
ng
supp
ortiv
e rol
e – n
orm
aliz
ing,
faci
litat
ion
of se
rvic
es, p
reve
ntio
n,
prom
otin
g se
lf-co
nfide
nce,
embr
acin
g a
proa
ctiv
e app
roac
h
◥
Posit
ive
– pa
tient
s re
spon
ded
effec
tivel
y to
the
fact
that
SBN
s wer
e off
erin
g m
ore
supp
orts
oth
er th
an a
fo
llow
-up
of sy
mpt
oms
47N
aylo
r, m
., Aik
en, l
., Kur
tzm
an, E
., &
Old
s, d
. (20
10).
The I
mpo
rtan
ce o
f Tr
ansit
iona
l Car
e in
Ach
ievi
ng H
ealth
Re
form
. Hea
lth A
ffairs
, 30(
4): 7
46-7
54.
Synt
hesis
Rev
iew
Nur
sing
cont
ribut
ion
to
care
coo
rdin
atio
n an
d tr
ansit
iona
l car
e
GEN
ERA
lN
urse
-led
Prim
ary
Car
e
◥
Chr
onic
Car
e m
odel
: Nur
se
focu
ses o
n pa
tient
edu
catio
n an
d se
lf-m
anag
emen
t to
redu
ce
hosp
italiz
atio
n an
d re
adm
issio
n;
how
to a
dher
e pr
oper
ly
to m
edic
atio
ns
◥
mod
el a
ppea
rs to
hav
e so
me
posit
ive
influ
ence
on
patie
nt
adhe
renc
e an
d qu
ality
of l
ife
◥N
o po
sitiv
e eff
ect o
n m
orta
lity
rate
s
◥N
o ev
iden
ce o
f cos
t-sa
ving
s
interProFeSSional CollaBorative teaMS 71
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
Nu
rSe
-led
mo
del
S48
Nel
son,
K., C
hist
ense
n, S
., Asp
ros,
B., m
cKin
lay,
E.,&
Arc
us, K
. (20
09).
less
ons f
rom
ele
ven
prim
ary
heal
th
care
nur
sing
inno
vatio
ns in
New
Ze
alan
d. In
tern
atio
nal N
ursin
g Re
view
, 56,
291
-298
.
Eval
uatio
n (R
esea
rch
and
dev
elop
men
t App
roac
h)
Eval
uatin
g an
d A
sses
smen
t of v
ario
us
inno
vativ
e m
odel
s in
the
Prim
ary
Car
e se
tting
NEw
- ZE
AlA
Nd
Nur
se-le
d
Prim
ary
Car
e
Nur
se-le
d m
odel
s
◥
Nur
ses h
ave
an e
ssen
tial r
ole
prov
idin
g m
ento
rshi
p, a
dvic
e, an
d ad
voca
cy fo
r pat
ient
s
◥Ro
le o
f nur
sing
lead
ersh
ip
◥Re
gula
tory
env
ironm
ent
◥
Num
erou
s con
text
ual f
acto
rs
◥
Redu
ctio
n in
frag
men
tatio
n in
nur
sing
serv
ices
49N
ew, J
.P., m
ason
, J.m
., Fre
eman
tle, N
., Te
ased
ale,
S., w
ong,
l.m
. & B
ruce
, N
.J. (2
003)
. Spe
cial
ist N
urse
–led
In
terv
entio
n to
Tre
at an
d C
ontr
ol
Hyp
erte
nsio
n an
d H
yper
lipid
emia
in
dia
bete
s (SP
lIN
T). D
iabe
tes C
are,
26,
2250
-225
5.
Ran
dom
ized
Con
trol
led
Impl
emen
tatio
n Tr
ial
Stud
y
det
erm
inin
g th
e eff
ectiv
enes
s of a
nur
se-
led
clin
ic fo
r hyp
erte
nsio
n an
d hy
perli
pide
mia
uN
ITEd
K
ING
dO
mN
urse
-led
◥
dia
bete
s Car
e: H
yper
tens
ion
an
d H
yper
lipid
emia
◥
Nur
ses h
elpe
d to
ass
ess l
ung
func
tion,
car
ried
out
exe
rcis
e te
stin
g, e
duca
tion
on h
ow to
im
prov
e qu
ality
of l
ife, h
ealth
pr
omot
ion;
stud
ied
infe
ctiv
e ex
acer
batio
ns o
f pat
ient
s
◥
No
signi
fican
t diff
eren
ce
betw
een
nurs
e-le
d,
phys
icia
n-le
d cl
inic
◥
Incr
ease
of h
ospi
taliz
ed
visit
s in
nurs
e-le
d ca
re a
nd
re-a
dmiss
ions
50N
urse
-led
Out
reac
h Te
ams o
n th
e Ri
se B
ring
a N
ew K
ind
of ‘H
ouse
C
all’ t
o lo
ng T
erm
Car
e ht
tp://
vote
hele
na.c
a/N
ews/
249?
l=EN
.
web
site A
rtic
leC
AN
Ad
A -
ON
TARI
ON
urse
-led
Prim
ary
Car
e
◥
A n
ew ty
pe o
f hou
se-c
all f
or
long
-ter
m c
are
resid
ents
in th
e C
entr
al l
ocal
Hea
lth In
tegr
atio
n N
etw
ork
(lH
IN)
◥
Gui
ded
by 3
nur
se-le
d ou
trea
ch
team
s, se
nior
s who
bec
ome
acut
ely
ill a
nd w
ho m
ay n
eed
to b
e tr
ansf
erre
d to
the
hosp
ital a
re n
ow
rece
ivin
g th
e ca
re a
nd su
ppor
t th
ey n
eed
in th
eir o
wn
hom
es
◥
Posit
ive
effec
t on
wai
t tim
es;
min
imiz
es tr
ansf
ers t
o th
e em
erge
ncy
depa
rtm
ent
◥
Prov
ides
safe
, hig
h qu
ality
ca
re in
a ti
mel
y m
anne
r
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation72
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
Nu
rSe
-led
mo
del
S51
Palfr
eym
an, S
., Tre
nder
, H., &
Bea
rd, J.
(2
004)
. do
patie
nts w
ith cl
audi
catio
n ne
ed to
see a
vasc
ular
surg
eon?
A
befo
re an
d aft
er st
udy o
f a n
urse
-led
claud
icatio
n cli
nic.
Prac
tice D
evelo
pmen
t in
Hea
lth C
are,
3(1)
53–
64.
Aud
it
Com
pari
ng p
atie
nt
outc
omes
and
qua
lity
indi
cato
rs b
efor
e an
d aft
er th
e in
trod
uctio
n of
a
vasc
ular
nur
se sp
ecia
list
clau
dica
tion
clin
ic
uN
ITEd
K
ING
dO
mN
urse
-led
Car
diov
ascu
lar H
ealth
◥
Nur
se re
ceiv
es re
ferr
al le
tters
fr
om g
ener
al p
ract
ition
er, n
urse
m
akes
app
oint
men
t with
vas
cula
r nu
rse
spec
ialis
t
◥Ph
ysic
al a
sses
smen
ts ar
e com
plet
ed
◥C
onfir
ms d
iagn
osis
of
inte
rmitt
ent c
laud
icat
ion
◥
Redu
ctio
n in
wai
t tim
es
◥Th
orou
gh e
xam
inat
ion
of
patie
nt’s
hist
ory
52Pa
ters
on, B
.l., d
uffet
t-le
ger,
l., &
C
rutte
rden
, K. (
2009
). C
onte
xtua
l Fa
ctor
s Infl
uenc
ing
the
Evol
utio
n of
N
urse
s’ Ro
les i
n a
Prim
ary
Hea
lth
Car
e C
linic
. Pub
lic H
ealth
Nur
sing,
26(5
), 42
1-42
9.
Qua
litat
ive
Stud
y (I
nter
pret
ive
des
crip
tion
des
ign)
Rese
arch
stud
y on
a n
urse
-m
anag
ed C
omm
unity
H
ealth
Clin
ic; e
xam
inin
g ho
w th
e nur
se ro
le
chan
ged
over
tim
e
CA
NA
dA
-
NEw
BR
uN
SwIC
K
Nur
se-le
d
Com
mun
ity H
ealth
Clin
ic –
Pr
imar
y C
are
◥
Soci
o, p
oliti
cal a
nd e
cono
mic
co
ntex
t sha
ped
the
deve
lopm
ent
and
sust
aina
bilit
y of
the
mod
el
◥In
this
mod
el th
e rol
e of t
he n
urse
is
exte
nded
bey
ond
prim
ary
care
to
prov
ide r
elatio
nshi
ps w
ith th
e clie
nts
and
thei
r fam
ilies
, and
to ac
tively
pa
rtic
ipat
e in
the c
omm
unity
◥
The c
linic
is ru
n by
a n
urse
pr
actit
ione
r who
wor
ks w
ith a
so
cial
wor
ker,
outr
each
nur
se, o
ffice
w
orke
r, an
d da
ta en
try
pers
on
◥vo
lunt
eers
in th
e CH
C in
clude
nu
rses
, den
tists
, mas
sage
ther
apist
s, ps
ycho
logi
sts,
men
tal h
ealth
co
unse
llors
, add
ictio
n co
unse
llors
, an
d fo
ot ca
re sp
ecia
lists
◥
The
fund
ing
that
was
pr
ovid
ed fo
r the
CH
C
was
not
suffi
cien
t so
the
nurs
es h
ad to
do
a lo
t of t
he
fund
raisi
ng th
emse
lves
to
enco
urag
e pr
ivat
e do
natio
ns
◥C
urre
nt fu
ndin
g m
echa
nism
s in
plac
e co
ntra
dict
col
labo
rativ
e re
latio
nshi
ps b
y cr
eatin
g co
mpe
titio
n be
twee
n co
mm
unity
age
ncie
s
◥In
this
inst
ance
, nur
ses u
sed
polit
ical
act
ion
as a
mea
ns o
f ca
ring
for i
ndiv
idua
l clie
nts
and
the
com
mun
ity
interProFeSSional CollaBorative teaMS 73
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
Nu
rSe
-led
mo
del
S53
Raft
ery,
J. P.
, Yao
, G.l
., mur
chie
, P.
, Cam
pbel
l, N
.C., &
Ritc
hie,
l.d
. (2
005)
. Cos
t Effe
ctiv
enes
s of N
urse
-le
d Se
cond
ary
Prev
entio
n C
linic
s for
C
oron
ary
Hea
rt d
isea
se In
Pri
mar
y C
are:
Follo
w u
p of
a R
ando
mis
ed
Con
trol
led
Tria
l. Br
itish
Med
ical
Jo
urna
l, 33
0(74
93),
707-
710.
Ran
dom
ized
Con
trol
led
Tria
l: C
ost E
ffect
iven
ess
Ana
lysis
Esta
blish
ing
the c
ost
effec
tiven
ess o
f nur
se
led
prev
entio
n cli
nics
for
coro
nary
hea
rt d
iseas
e ba
sed
on fo
ur ye
ars’
follo
w- u
p of
a ra
ndom
ized
co
ntro
lled
tria
l.
uN
ITEd
K
ING
dO
mN
urse
-led
Cor
onar
y H
eart
dis
ease
◥
Nur
ses h
elpi
ng p
atie
nts t
o de
sign
self-
sust
aina
ble
plan
s tha
t inc
lude
fr
eque
nt e
xerc
ise,
good
die
t, sm
okin
g ce
ssat
ion
◥
Stud
y re
sulte
d in
few
er
deat
hs o
f pat
ient
s
◥C
ost-
effec
tive
mod
el th
at
can
save
live
s
54RN
AO. (
2008
). Br
iefing
not
e: in
crea
sing
acce
ss to
prim
ary h
ealth
care
. Br
iefin
g N
ote:
Impr
ovin
g ac
cess
to c
are
thro
ugh
inte
rpro
fess
iona
l co
llabo
ratio
n an
d N
P-le
d C
linic
s
CA
NA
dA
- O
NTA
RIO
NP-
led
Clin
ics
Prim
ary
Car
e
◥
Impr
ove q
ualit
y an
d ac
cess
to
care
for i
ndiv
idua
ls w
ith ch
roni
c di
seas
es b
y en
hanc
ing
chro
nic
dise
ase m
anag
emen
t pro
gram
s; cr
eatin
g m
ore o
ppor
tuni
ties f
or
doct
ors,
nurs
es an
d ot
her h
ealth
care
pr
ovid
ers t
o w
ork
colla
bora
tively
an
d lia
ise w
ith o
ne an
othe
r
◥Fo
cus o
n in
vesti
ng an
d ex
pand
ing
the n
umbe
r of n
urse
pra
ctiti
oner
-le
d cli
nics
in th
e prim
ary
care
sect
or
to im
prov
e pat
ient
acce
ss to
care
◥
Impr
ovin
g ac
cess
to c
are
by
incr
easin
g th
e nu
mbe
r of
nurs
e pr
actit
ione
r pos
ition
s
◥In
crea
se fu
ndin
g fo
r chr
onic
di
seas
e m
anag
emen
t pr
ogra
ms a
nd c
linic
s in
Ont
ario
55Ry
an, S
., Has
sel, A
.B., l
ewis,
m.,
& F
arre
ll A
. (20
06).
Impa
ct o
f a
rheu
mat
olog
y ex
pert
nur
se o
n th
e w
ellb
eing
of p
atie
nts a
ttend
ing
a dr
ug m
onito
ring
clin
ic. J
ourn
al o
f Ad
vanc
ed N
ursin
g, 53
(3),
277-
286.
Ran
dom
ized
Con
trol
led
Tria
l Stu
dy
Nur
se-s
peci
alist
dru
g m
onito
ring
clin
ic w
ith
mea
sure
able
impa
ct o
n th
e w
ell-b
eing
of p
atie
nts
with
rheu
mat
oid
arth
ritis
uN
ITEd
K
ING
dO
mN
urse
-led
Rheu
mat
olog
y
Expe
rt N
urse
– d
rug
mon
itorin
g C
linic
◥
Nur
se ed
ucat
es p
atie
nts o
n st
artin
g ar
thrit
ic sp
ecifi
c med
icat
ion
◥
mon
itors
pat
ient
s for
side
effe
cts
◥
Prov
ides
pat
ient
s with
ong
oing
su
ppor
t and
edu
catio
n
◥
Posit
ive –
help
ed p
atie
nts t
o co
pe w
ith th
eir a
rthr
itis;
mor
e ad
here
nce t
o m
edic
atio
ns,
impr
ovem
ents
in li
festy
les
◥
No
chan
ge –
num
ber o
f co
nsul
tatio
ns o
r cha
nges
in
dru
g th
erap
y
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation74
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
Nu
rSe
-led
mo
del
S56
Scha
dew
aldt
, v. &
Sch
ultz
, T.
(201
1). N
urse
-led
clin
ics a
s an
effec
tive
serv
ice
for c
ardi
ac p
atie
nts:
resu
lts fr
om a
syst
emat
ic re
view
. In
tern
atio
nal J
ourn
al o
f Evi
denc
e Ba
sed
Hea
lthca
re, 9
, 199
-214
.
Syst
emat
ic R
evie
w
Revi
ew o
f effe
ctiv
enes
s of
a N
urse
-led
clin
ic fo
r pa
tient
s with
cor
onar
y he
art d
isea
se
GEN
ERA
lN
urse
-led
Cor
onar
y H
eart
dis
ease
◥
Nur
se-le
d ca
rdia
c cl
inic
s inc
lude
pa
tient
edu
catio
n, ri
sk fa
ctor
as
sess
men
t, co
ntin
uity
of c
are,
coun
selli
ng b
ehav
iour
cha
nge,
prom
otin
g he
alth
y lif
esty
les
◥
Nur
se-le
d ca
re e
quiv
alen
t to
non-
nurs
e-m
anag
ed c
linic
s
◥Pa
tient
s did
not
exp
erie
nce
any
harm
ful o
utco
mes
◥
Posit
ive i
nflue
nce o
n ov
eral
l qu
ality
of l
ife an
d he
alth
stat
us
57Sm
euld
ers,
E., v
an H
aast
regt
, J.,
Am
berg
en, T
., usz
ko-l
ence
r, N
., Jan
ssen
-Boy
ne, J
., & G
orge
ls,
A.(2
010)
Nur
se-le
d se
lf-m
anag
emen
t gr
oup
prog
ram
me
for p
atie
nts w
ith
cong
estiv
e he
art f
ailu
re: r
ando
miz
ed
cont
rolle
d tr
ial.
Jour
nal o
f Adv
ance
d N
ursin
g, 66
(7),
1487
–149
9.
Ran
dom
ized
Con
trol
led
Tria
l
Repo
rt
Ass
essin
g th
e effe
cts o
f th
e Chr
onic
di se
ase S
elf-
man
agem
ent p
rogr
am
(Cd
SmP)
on
patie
nts w
ith
Chr
onic
Hea
rt F
ailu
re
NET
HER
- lA
Nd
SN
urse
-led
Chr
onic
dis
ease
man
agem
ent
◥
Focu
s on
skill
s mas
tery
, in
terp
retin
g sy
mpt
oms,
beha
vior
al
and
soci
al c
hang
es
◥N
urse
s dis
cuss
goa
l-set
ting
and
plan
ning
with
pat
ient
s
◥
Impr
oved
shor
t-te
rm
outc
omes
(cog
nitiv
e sy
mpt
om m
anag
emen
t, se
lf-ca
re b
ehav
iour
, car
diac
-sp
ecifi
c qu
ality
of l
ife)
58So
usa,
K., &
Zun
kel,
G.m
. (20
03).
Opt
imiz
ing
men
tal H
ealth
in a
n A
cade
mic
Nur
se-m
anag
e C
linic
. Jo
urna
l of t
he A
cade
my
of N
urse
Pr
actit
ione
rs, 1
5(7)
, 313
-318
.
Eval
uatio
n (d
escr
iptiv
e Su
rvey
des
ign)
men
tal h
ealth
out
com
es
of c
linic
s in
an a
cade
mic
nu
rsin
g cl
inic
uN
ITEd
ST
ATES
Nur
se-le
d
me n
tal H
ealth
◥
Hel
ping
nur
se p
ract
ition
ers w
ith
the
early
det
ectio
n of
men
tal
heal
th d
isor
ders
so th
ey c
an c
reat
e a
bette
r car
e pl
an fo
r the
pat
ient
in
a m
ore
timel
y w
ay
◥N
urse
pra
ctiti
oner
rece
ives
hel
p w
ith o
nsite
con
sulta
tion
from
a
psyc
hiat
ric
clin
ical
nur
se sp
ecia
list
◥
Inte
grat
ion
of m
enta
l hea
lth
inte
rven
tion
in p
rim
ary
care
setti
ngs h
elps
pro
vide
rs
to o
ptim
ize
thei
r pat
ient
s’ ov
eral
l hea
lth
interProFeSSional CollaBorative teaMS 75
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
Nu
rSe
-led
mo
del
S59
Sten
ner K
., Car
ey, N
., & C
ourt
enay
, m
. (20
09) N
urse
pre
scrib
ing
in
derm
atol
ogy:
doc
tors
’ and
non
-pr
escr
ibin
g nu
rses
’ vie
ws.
Jour
nal o
f Ad
vanc
ed N
ursin
g, 65
(4),
851–
859.
Them
atic
Ana
lysis
Expl
orin
g nu
rse
pres
crib
ing
in
derm
atol
ogy
uN
ITEd
K
ING
dO
mN
urse
-led
der
mat
olog
y
◥
Cas
e st
udy
of n
urse
s pr
escr
ibin
g m
edic
atio
ns in
de
rmat
olog
ical
setti
ngs
◥
Patie
nts w
ere
posit
ive
abou
t th
eir e
xper
ienc
e bu
t had
ge
nera
l res
erva
tions
abo
ut
nurs
e pr
escr
ibin
g ov
eral
l
60Ta
ylor
, C.R
., Hep
wor
th, J
.T.,
Buer
haus
, P., d
ittus
, R., &
Spe
roff,
T.
(200
7). E
ffect
of c
rew
reso
urce
m
anag
emen
t on
diab
etes
car
e an
d pa
tient
out
com
es in
an
inne
r-ci
ty
prim
ary
care
clin
ic. Q
ual S
af H
ealth
Ca
re 1
6, 2
44–2
47.
Tim
e Se
ries
Ana
lysis
det
erm
inin
g th
e eff
ectiv
enes
s and
in
nova
tions
in c
hron
ic
dise
ase
man
agem
ent
invo
lvin
g nu
rses
uN
ITEd
K
ING
dO
mN
urse
-led
Chr
onic
dis
ease
man
agem
ent –
Chr
onic
Obs
truc
tive
Pulm
onar
y d
isea
se (C
OPd
)
◥
In th
e ca
se m
anag
emen
t pro
gram
nu
rses
per
form
at-
hom
e vi
sits,
tele
phon
e fo
llow
-ups
, and
pat
ient
ed
ucat
ion
on ta
king
med
icat
ions
an
d sm
okin
g ce
ssat
ion
◥
Nur
se-le
d pr
ogra
ms r
esul
t in
few
er h
ospi
tal a
dmiss
ions
an
d re
adm
issio
ns; s
houl
d be
m
ore
wid
ely
used
; fur
ther
re
sear
ch re
quire
d
61Th
omps
on, K
., Par
ahoo
, K., &
Bla
ir,
N. (
2007
). A
nur
se-le
d sm
okin
g ce
ssat
ion
clin
ic –
qui
t rat
e re
sults
an
d vi
ews o
f par
ticip
ants
. Hea
lth
Educ
atio
n Jo
urna
l, 66
(4),
307-
322.
Eval
uatio
n of
a
Qua
ntita
tive
and
Qua
litat
ive
Stud
y
Eval
uatin
g th
e su
cces
s of
a co
mm
unity
nur
se-le
d sm
okin
g ce
ssat
ion
clin
ic
NO
RTH
ERN
IR
ElA
Nd
Nur
se-le
d
Smok
ing
cess
atio
n
◥
Gro
up th
erap
y ap
proa
ch: n
urse
w
ould
use
a co
mbi
natio
n of
di
rect
ives
to p
rom
ote s
mok
ing
cess
atio
n: g
roup
cons
ulta
tion,
in
divi
dual
s cha
ts, t
elep
hone
follo
w-
ups,
soci
al su
ppor
t, co
ping
skill
s, ca
rbon
mon
oxid
e mon
itorin
g
◥Sm
oker
s cou
ld b
e re
ferr
ed to
the
clin
ic o
r com
e on
thei
r ow
n
◥
Alm
ost 3
0% o
f par
ticip
ants
w
ho a
ttend
ed th
e 6-
wee
k pr
ogra
m q
uit s
mok
ing
◥
wee
kly
carb
on m
onox
ide
mon
itori
ng w
as a
gre
at
ince
ntiv
e to
qui
t
◥m
ost p
artic
ipan
ts w
ould
ha
ve li
ked
a pr
ogra
m lo
nger
th
an 6
wee
ks
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation76
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
Nu
rSe
-led
mo
del
S62
Torr
isi, d
.l. (
2011
). A
Hom
e N
ext
doo
r. St
orie
s fro
m th
e Fie
ld, N
urse
-led
Med
ical
Hom
es: I
ncre
asin
g Acc
ess t
o Q
ualit
y Ca
re, A
pril,
1-2
.
Cas
e St
udy
The fi
rst n
urse
-led
fede
rally
qu
alifi
ed h
ealth
cent
re
uni
ted
Stat
esN
urse
-led
Prim
ary
Car
e
◥
Inte
grat
ed b
ehav
iour
al m
odel
that
al
low
s a th
erap
ist to
see
patie
nts
need
ing
extr
a ca
re fo
r 20-
30
min
utes
up
fron
t on
each
visi
t
◥Pa
tient
s can
dro
p in
or g
et a
sa
me-
day
appo
intm
ent;
48-h
our
turn
arou
nd ti
me
for r
efer
rals;
sh
uttle
to tr
ansp
ort p
atie
nts
with
bar
rier
s
◥
Patie
nts v
ery
satis
fied
with
the
care
they
rece
ive,
allo
win
g th
e pr
ogra
m to
ex
pand
, ser
ving
mor
e th
an
17,0
00 p
atie
nts
◥
Nur
ses fi
nd a
deg
ree
of
auto
nom
y an
d ca
n w
ork
in
a di
vers
e pr
actic
e
63u
nder
woo
d, J.
m., m
owat
, d.l
., m
eagh
er-S
tew
art,
d.m
., deb
er,
R.B.
, Bau
man
n, A
.O., m
acd
onal
d,
m.B
., & A
khta
r-d
anes
h, N
. (20
09).
Build
ing
Com
mun
ity a
nd P
ublic
H
ealth
Nur
sing
Cap
acity
: A S
ynth
esis
Repo
rt o
f the
Nat
iona
l Com
mun
ity
Hea
lth N
ursin
g St
udy.
Cana
dian
Jo
urna
l of P
ublic
Hea
lth, 1
00(5
), 1-
11.
Synt
hesis
Rep
ort
(de m
ogra
phic
Ana
lysis
)
de s
crib
e th
e co
mm
unity
he
alth
nur
sing
wor
kfor
ce
in C
anad
a
CA
NA
dA
Nur
se-le
d
Prim
ary
Car
e
◥
An
effec
tive c
omm
unity
nur
se
mod
el in
clude
s pro
fess
iona
l co
nfide
nce,
stro
ng te
am
rela
tions
hips
, a su
ppor
tive
wor
kpla
ce an
d co
mm
unity
supp
ort
◥
An
envi
ronm
ent t
hat s
uppo
rts
crea
tive
auto
nom
ous p
ract
ice
◥
Fact
ors t
hat c
ontr
ibut
e to
succ
essfu
l pub
lic h
ealth
nu
rsin
g: so
und
polic
y, su
ppor
tive o
rgan
izat
iona
l cu
lture
, goo
d m
anag
emen
t; vi
sion
driv
en b
y co
mm
unity
ne
eds a
nd v
alue
s; fle
xibi
lity
in
fund
ing;
clear
job
desc
riptio
ns
64va
n Zu
lien,
A.d
., Bla
nkes
teijn
, P.J.
, va
n Bu
ren,
m., T
en d
am, m
.A.G
..J.,
Kaa
sjage
r, K
.A.H
., lig
hten
berg
, G.,
& S
ijpke
ns, Y
.w.J.
(201
1). N
urse
pr
actit
ione
rs im
prov
e qu
ality
of c
are
in c
hron
ic k
idne
y di
seas
e: tw
o-ye
ar
resu
lts o
f a ra
ndom
ised
stud
y. Th
e Jo
urna
l of M
edic
ine,
69(1
1), 5
17-5
26.
Ran
dom
ized
Con
trol
led
Clin
ical
Tri
al S
tudy
Is th
e ca
re b
y N
Ps m
ore
effici
ent t
han
phys
icia
ns
for p
atie
nts w
ith c
hron
ic
kidn
ey d
isea
se?
NET
HER
- lA
Nd
SN
urse
-led
Chr
onic
Kid
ney
dis
ease
◥
Nur
ses p
rovi
ding
pat
ient
ed
ucat
ion,
enc
oura
ging
life
styl
e ch
ange
s, be
havi
oura
l cha
nges
in
die
t, in
crea
sing
the
use
of
vita
min
s, he
alth
pro
mot
ion;
pe
rfor
min
g ro
utin
e te
sts s
uch
as
bloo
d pr
essu
re a
nd li
pid
◥
Inte
rven
tion
grou
p le
d by
th
e nu
rse
prac
titio
ner s
aw
a sig
nific
ant i
ncre
ase
in
bloo
d pr
essu
re, l
ipid
and
m
edic
atio
n co
ntro
l. In
crea
se
use
of a
spir
in, v
itam
in d
and
A
CE
inhi
bito
rs
interProFeSSional CollaBorative teaMS 77
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
Nu
rSe
-led
mo
del
S65
wat
ts, S
.A., G
ee, J
., O’d
ay, m
.E.,
Scha
ub, K
., law
renc
e, R.
, & K
irsh,
S.
(200
9). N
urse
pra
ctiti
oner
-led
mul
tidis
cipl
inar
y te
ams t
o im
prov
e ch
roni
c ill
ness
car
e: Th
e un
ique
st
reng
ths o
f nur
se p
ract
ition
ers
appl
ied
to sh
ared
med
ical
ap
poin
tmen
ts/g
roup
visi
ts. J
ourn
al
of th
e Am
eric
an A
cade
my
of N
urse
Pr
actit
ione
rs, 2
1¸16
7-17
2.
Cas
e St
udie
s
Exam
inin
g ca
se st
udie
s w
here
NPs
pla
y a
lead
ersh
ip ro
le; i
nflue
nce
of N
Ps o
n sh
ared
med
ical
ap
poin
tmen
ts fo
r pat
ient
s w
ith c
hron
ic il
lnes
s
uN
ITEd
ST
ATES
Nur
se-le
d
Chr
onic
Illn
ess C
are
◥
Nur
se p
ract
ition
er a
dher
ing
to
Chr
onic
Car
e m
o del
gui
delin
es
(wag
ner’s
mod
el)
◥
Nur
se p
ract
ition
er p
artic
ipat
es
in e
duca
ting
patie
nt in
se
lf-m
anag
emen
t, off
erin
g de
cisi
on su
ppor
t, he
lps p
atie
nt to
de
sign
a c
are
plan
that
fits
them
, off
ers c
omm
unity
reso
urce
s, ke
eps t
rack
of p
atie
nt in
a re
gist
ry
and
note
s clin
ical
pro
gres
s (w
hich
m
etho
ds a
re w
orki
ng)
◥
wor
ks w
ith p
hysic
ians
, pha
rmac
ists,
othe
r hea
lth p
rofe
ssio
nals
◥
Nur
se p
ract
ition
er p
rovi
des
holis
tic a
ppro
ach
to c
hron
ic
dise
ase
man
agem
ent
◥
Prom
otes
beh
avio
ural
and
he
alth
cha
nges
in p
atie
nt
66w
i llia
ms,
F.l.
, Bea
ton,
S., G
olds
tein
, P.
, mai
r, F.
, may
, C., &
Cap
ewel
l, S.
(2
005)
. Pat
ient
s’ an
d N
urse
s’ v
iew
s of
Nur
se-l
e d H
eart
Fai
lure
Clin
ics i
n G
ener
al P
ract
ice:
A Q
ualit
ativ
e Stu
dy.
Chro
nic I
llnes
s, 1,
39-
47.
Qua
litat
ive
Stud
y
Nur
ses’
and
patie
nts’
view
s an
d ex
perie
nces
of a
nur
se-
led
hear
t fai
lure
clin
ic
uN
ITEd
K
ING
dO
mN
urse
-led
Car
diov
ascu
lar H
ealth
◥
Nur
ses f
ocus
ed o
n im
prov
ing
nurs
e-pa
tient
com
mun
icat
ion
◥
Educ
ated
pat
ient
s, in
crea
sed
thei
r kn
owle
dge
and
unde
rsta
ndin
g
◥Pr
ovid
ed se
lf-ca
re a
dvic
e
◥Im
prov
ed p
atie
nt’s
unde
rsta
ndin
g of
med
icat
ions
◥
Incr
ease
d pa
tient
’s kn
owle
dge
and
unde
rsta
ndin
g of
th
eir c
ondi
tion
◥
Som
e co
nfus
ion
arou
nd
adhe
ring
to m
edic
ine
and
rem
embe
ring
nur
se’s
advi
ce
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation78
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
Nu
rSe
-led
mo
del
S67
won
g, F
. & C
hung
, l. (
2006
). Es
tabl
ishin
g a
defin
ition
for a
nu
rse-
led
clin
ic: s
truc
ture
, pro
cess
an
d ou
tcom
e. Jo
urna
l of A
dvan
ced
Nur
sing,
53(3
), 35
8-36
9.
Expl
orat
ory
Stud
y
defi
ning
a n
urse
-led
clin
ic th
roug
h st
ruct
ure,
proc
ess a
nd o
utco
me
HO
NG
KO
NG
Nur
se-le
d
80%
par
tner
ed w
ith p
hysic
ian
Am
bula
tory
Hea
lth
◥
Nur
ses h
elpe
d w
ith m
edic
atio
n ad
just
men
ts, i
nitia
ted
ther
apie
s, di
agno
stic
test
s, pe
rfor
med
as
sess
men
ts, h
ealth
cou
nsel
ing,
co
ncen
trat
ed o
n sy
mpt
om
man
agem
ent
◥
Hig
h sc
ores
of s
atisf
actio
n fr
om p
atie
nts;
patie
nts
in n
urse
-led
wou
nd a
nd
cont
inen
ce c
linic
s sho
wed
th
e m
ost i
mpr
ovem
ents
68w
orki
ng In
Par
tner
ship
Pro
gram
me
(N/Y
). N
urse
-led
chro
nic d
iseas
e m
anag
emen
t, d
onca
re.
Acc
redi
ted
Revi
ew
Redu
cing
the
wor
kloa
d in
gen
eral
pra
ctic
e by
re
dist
ribut
ing
task
s
uN
ITEd
K
ING
dO
mN
urse
-led
Chr
onic
dis
ease
man
agem
ent
◥
4-pa
rtne
r gen
eral
pra
ctiti
oner
pr
actic
e an
d a
1-ph
ysic
ian
gene
ral
prac
titio
ner p
ract
ice
com
bine
d th
eir p
atie
nts t
o ad
dres
s cha
lleng
es
usin
g a
larg
er su
ppor
t sta
ff
◥N
urse
s tak
ing
the
lead
on
man
agin
g lo
ng-t
erm
chr
onic
co
nditi
ons;
resp
irato
ry c
linic
s, bl
ood
pres
sure
con
trol
, and
oth
ers
◥
dec
reas
e in
wai
t tim
es;
phys
icia
ns co
uld
exte
nd th
eir
appo
intm
ents
with
pat
ient
s
◥Re
duce
s wor
kloa
d, st
ress
le
vels,
hos
pita
l visi
tatio
ns
by p
atie
nts,
impr
ove j
ob
satis
fact
ion
of n
urse
s/do
ctor
s
interProFeSSional CollaBorative teaMS 79
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
CA
Se m
AN
Ag
emeN
t m
od
elS
1C
icco
ne, m
.m., A
quili
no, A
., &
Cor
tese
, F. (
2010
). Fe
asib
ility
and
eff
ectiv
enes
s of a
dis
ease
and
car
e m
anag
emen
t mod
el in
the
prim
ary
heal
th c
are
syst
em fo
r pat
ient
s w
ith h
eart
failu
re a
nd d
iabe
tes
(pro
ject
leo
nard
o). D
ove P
ress
Jo
urna
l: Va
scul
ar H
ealth
and
Risk
M
anag
emen
t, 6,
297
-305
.
Feas
ibili
ty S
tudy
Stud
ying
a d
iseas
e and
ca
re m
anag
emen
t mod
el
with
“car
e man
ager
’’ nur
ses
ITA
lYC
ase
man
agem
ent
Chr
onic
dis
ease
man
agem
ent
◥
Nur
se a
cts a
s the
car
e m
anag
er
and
is in
cha
rge
of e
mpo
wer
ing
the
patie
nt to
man
age
his/
her
own
heal
th
◥N
urse
pro
vide
s edu
catio
n on
be
havi
oura
l and
life
styl
e ch
ange
s
◥
Patie
nts a
chie
ved
bette
r co
ntro
l of t
heir
dise
ase
◥
very
feas
ible
to in
corp
orat
e th
ese
care
man
ager
s or
spec
ializ
ed n
urse
s to
supp
ort
gene
ral p
ract
ition
ers
2Fr
eund
, T., K
aylin
g, F
., mik
sch,
A.,
Szec
seny
i, J.,
& w
ensin
g, m
. (20
10).
Effec
tiven
ess a
nd e
ffici
ency
of
prim
ary
care
bas
ed c
ase
man
agem
ent
for c
hron
ic d
isea
ses:
ratio
nale
and
de
sign
of a
syst
emat
ic re
view
and
m
eta-
anal
ysis
of ra
ndom
ized
and
no
n-ra
ndom
ized
tria
ls. B
MC
Hea
lth
Serv
ices
Res
earc
h, 1
0(11
2), 1
-4.
Syst
emat
ic R
evie
w
(pro
toco
l)
Impo
rtan
ce o
f cas
e m
anag
emen
t for
ch
roni
cally
ill p
atie
nts
GEN
ERA
lC
ase
man
agem
ent
Cas
e m
anag
emen
t usu
ally
add
ress
es
elem
ents
of t
he c
hron
ic c
are
mod
el
◥
Prov
ides
con
tinui
ty o
f car
e in
th
edel
iver
y sy
stem
, enh
anci
ng
patie
nts’
self-
man
agem
ent s
kills
; co
ntrib
utes
to b
ette
r evi
denc
e-ba
sed
reco
mm
enda
tions
such
as
dia
gnos
is, p
harm
aceu
tical
tr
eatm
ent,
lifes
tyle
cou
nsel
ling,
pa
tient
mon
itori
ng
◥
Sinc
e m
ost c
hron
ical
ly
ill p
atie
nts r
ecei
ve m
edic
al
care
in p
rim
ary
care
se
tting
s, th
is is
whe
re c
ase
man
agem
ent p
rogr
ams a
re
mos
tly im
plem
ente
d
◥Ex
pect
ed o
utco
me:
redu
ctio
n of
hea
lth re
sour
ce
use
by e
nhan
cing
pat
ient
se
lf-m
aste
ry, m
edic
atio
n ad
here
nce,
and
med
icat
ion/
patie
nt m
onito
ring
3
Gid
dens
, J.F
., Tan
ner,
E., F
rey,
K., R
eide
r, l.
, & B
oult,
C. (
2009
). Ex
pand
ing
the
gero
ntol
ogic
al
nurs
ing
role
in g
uide
d ca
re. N
atio
nal
Ger
onto
logi
cal N
ursin
g Ass
ocia
tion,
30
(5),
358-
364.
Pilo
t Stu
dy
One
yea
r Pilo
t Stu
dy
exam
inin
g th
e G
uide
d C
are
Nur
se ro
le in
the
Gui
ded
care
mo d
el
uN
ITEd
ST
ATES
Cas
e m
a nag
emen
t G
uide
d C
are
mo d
el
Prim
ary
Car
e –
Ger
onto
logy
◥
Nur
se c
olla
bora
tes w
ith p
rim
ary
care
pro
vide
rs, p
atie
nts/
care
give
rs,
heal
th a
genc
ies
◥
In c
harg
e of
50-
60 p
atie
nts
◥
Nur
se h
elps
with
ass
essm
ents
, cr
eatin
g an
evi
denc
e-ba
sed
care
pl
an; p
erfo
rms f
ollo
w-u
ps a
nd
care
coo
rdin
atio
n
◥Fa
cilit
ates
acc
ess t
o ca
re,
tran
spor
tatio
n, m
eals,
hom
e m
odifi
catio
n re
sour
ces
◥
Gui
ded
Car
e m
odel
re
sults
in fe
wer
hos
pita
l ad
mis
sion
s; fa
mily
/ca
regi
vers
feel
less
bur
dene
d
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation80
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
CA
Se m
AN
Ag
emeN
t m
od
elS
4la
rsso
n, m
., Hed
elin
, B. &
Ath
lin, E
. (2
007)
. A S
uppo
rtiv
e Nur
sing
Car
e C
linic
: Con
cept
ions
of P
atie
nts w
ith
Hea
d an
d N
eck
Can
cer.
Euro
pean
Jo
urna
l of O
ncol
ogy
Nur
sing,
11, 4
9-59
.
Qua
litat
ive
Stud
y (P
heno
men
ogra
-phi
c A
ppro
ach)
des
crib
es h
ow c
ance
r pa
tient
s with
eat
ing
prob
lem
s rec
eive
supp
ort
in a
nur
sing
clin
ic,
befo
re, d
urin
g an
d aft
er
radi
othe
rapy
SwEd
ENC
ase
man
agem
ent
Can
cer C
are
◥
The
nurs
ing
care
clin
ic w
as
com
plem
enta
ry to
the
regu
lar c
are
and
part
icip
atio
n w
as v
olun
tary
◥Th
e fo
cus o
f the
car
e at
this
clin
ic w
as th
e pa
tient
s’ ne
eds o
f nu
triti
onal
car
e, sy
mpt
om c
ontr
ol,
and
soci
al a
nd e
mot
iona
l sup
port
◥
Trea
tmen
t was
mos
t val
uabl
e du
ring
the
peri
ods b
efor
e an
d aft
er c
ompl
etio
n of
the
trea
tmen
t
5N
orri
s, S.
l., N
icho
ls, J.
P., C
aspe
rsen
, C
.J., G
lasg
ow, R
.E., E
ngel
gau,
m.m
., le
onar
d, J.
J., &
Isha
m, G
. (20
02).
The
Effec
tiven
ess o
f dis
ease
and
C
ase
man
agem
ent f
or P
eopl
e w
ith
dia
bete
s. Am
eric
an Jo
urna
l of
Prev
enta
tive M
edic
ine,
22(4
S), 1
5-38
.
Syst
emat
ic R
evie
w
Effec
tiven
ess/
eco
nom
ic
effici
ency
of c
ase/
dise
ase
man
agem
ent f
or p
eopl
e w
ith d
iabe
tes
GEN
ERA
lC
ase
man
agem
ent
◥
Patie
nt re
ceiv
es c
ouns
ellin
g,
addi
tiona
l hea
lth e
duca
tion,
re
min
ders
and
supp
ort
inte
rven
tions
(com
mun
ity
or h
ealth
care
) for
dis
ease
m
anag
emen
t and
cas
e m
anag
emen
t whe
n ne
cess
ary
◥
Impr
ovin
g pa
tient
gly
cem
ic
cont
rol a
nd m
onito
ring
of
gly
cem
ic c
ontr
ol b
y th
e he
alth
care
pro
vide
r
◥Eff
ectiv
e w
ith o
r with
out
dise
ase
man
agem
ent b
ut
in c
onju
nctio
n w
ith o
ne o
r m
ore
educ
atio
n, re
min
der
of su
ppor
t int
erve
ntio
n6
van
de r
Slu
is, C
.K., d
a tem
a, l.
, Saa
n,
I., S
tant
, d., &
dijk
stra
, P.u
. (20
08).
Effec
ts o
f a n
urse
pra
ctiti
oner
on
a m
ultid
isci
plin
ary
cons
ulta
tion
team
. Jo
urna
l of A
dvan
ced
Nur
sing,
65(3
), 62
5-63
3.
Tim
e Se
ries
Ana
lysis
wh a
t are
the
effec
ts o
f an
NP
on a
mul
tidis
cipl
inar
y te
am fo
r pat
ient
s with
rh
eum
atoi
d ar
thrit
is;
com
pari
son
of a
n in
terv
entio
n an
d co
ntro
l gr
oup
usin
g a
time
se
ries
des
ign
NET
HER
- lA
Nd
SC
ase
man
agem
ent
Rheu
mat
olog
y/A
rthr
itis
◥
Team
con
siste
d of
a
rheu
mat
olog
ist, r
ehab
ilita
tion
phys
icia
n, p
last
ic su
rgeo
n,
occu
patio
nal t
hera
pist
◥
NP
gath
ered
pat
ient
dat
a, di
d a
prel
imin
ary
asse
ssm
ent,
coor
dina
ted
surg
ery
and
acte
d
as th
e ca
se m
anag
er
◥
Impr
oved
wai
t tim
es, p
atie
nt
satis
fact
ion
leve
ls, a
nd
orga
niza
tion
of th
e offi
ce
interProFeSSional CollaBorative teaMS 81
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
PAt
IeN
t N
AVIg
AtIo
N m
od
elS
1C
ampb
ell,
C., C
raig
, J., E
gger
t, J.,
& B
aile
y-d
orto
n, C
. (20
10).
Impl
emen
ting
and
mea
suri
ng th
e im
pact
of p
atie
nt n
avig
atio
n at
a
com
preh
ensiv
e co
mm
unity
can
cer
cent
re. O
ncol
ogy
Nur
sing
Foru
m,
37(1
), 61
-68.
Prog
ram
Eva
luat
ion
Are
pat
ient
s mor
e sa
tisfie
d w
ith p
atie
nt
navi
gatio
n in
Com
mun
ity
Can
cer C
entr
es
uN
ITEd
ST
ATES
Patie
nt N
avig
atio
n
Can
cer C
are
◥
Nur
se n
avig
ator
car
ing
for p
atie
nt
from
dia
gnos
is to
end
of t
reat
men
t
◥
Surv
ey sh
owed
im
prov
emen
ts in
pat
ient
sa
tisfa
ctio
n of
car
e
◥St
aff sa
tisfie
d w
ith p
atie
nt-
navi
gate
d ca
re
2C
ance
r Car
e Ont
ario
. (20
10).
Onc
olog
y N
ursin
g Pr
ogra
m
New
slette
r. O
ncol
ogy
Nur
sing P
rogr
am.
Toro
nto:
Ont
ario
, 1-6
, Ret
rieve
d fro
m:
ww
w.ca
ncer
care
.on.
ca.
New
slette
rC
AN
Ad
A
ON
TARI
OPa
tient
Nav
igat
ion
Onc
olog
y
◥
Ove
rvie
w o
f CC
O P
atie
nt
Nav
igat
ion
pilo
t pro
gram
. Cou
rse
deve
lope
d w
ith d
e Sou
za In
stitu
te
cove
rs co
mm
unic
atio
n, a
sses
smen
t, sc
reen
ing
for d
istre
ss, c
ultu
re
and
dive
rsity
, soc
ial s
uppo
rt, a
nd
com
mun
ity re
sour
ces.
Base
d on
Su
ppor
tive C
are m
odel
(Fitc
h,
2000
) and
the S
ocia
l Cog
nitiv
e Tr
ansit
iona
l mod
el o
f Adj
ustm
ent
(Bre
nnan
, 200
5).
◥
No
outc
omes
dis
cuss
ed
3C
arro
ll, J.K
., Hum
iston
, S.G
., me ld
rum
, S.
C., S
alam
one,
C.m
., Jea
n-Pi
erre
, P.,
Epste
in, R
.m., &
Fisc
ella,
K. (
2009
). Pa
tient
s’ ex
perie
nces
with
nav
igat
ion
for c
ance
r car
e. Pa
tient
Edu
catio
n an
d Co
unse
ling,
80, 2
41-2
47.
Ran
dom
ized
Con
trol
led
Tria
l
Patie
nt e
xper
ienc
es w
ith
patie
nt n
avig
atio
n
uN
ITEd
ST
ATES
Patie
nt N
avig
atio
n
Can
cer C
are
◥
Nur
se n
avig
ator
wor
ks w
ith
patie
nts w
ith a
bnor
mal
bre
ast/
colo
rect
al c
ance
r fro
m d
iagn
osis
to e
nd o
f tre
atm
ent
◥
Patie
nts r
ecei
ving
nav
igat
ion
expe
rien
ce le
ss is
olat
ion;
un
ders
tand
the
info
rmat
ion
proc
ess b
ette
r; di
agno
sis/
trea
tmen
t opt
ions
◥
Patie
nts p
refe
r not
to h
ave
mal
e pa
tient
nav
igat
ors f
or
brea
st c
ance
r cas
es
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation82
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
PAt
IeN
t N
AVIg
AtIo
N m
od
elS
4El
l, K
., vou
rleki
s, B.
, lee
, P-J
., & X
ie,
B. (2
006)
. Pat
ient
nav
igat
ion
and
case
m
anag
emen
t fol
low
ing
an a
bnor
mal
m
amm
ogra
m: a
rand
omiz
ed c
linic
al
tria
l. Pr
even
tativ
e Med
icin
e, 44
, 26-
33.
Ran
dom
ized
C
ontr
olle
d Tr
ial
uN
ITEd
ST
ATES
Patie
nt N
avig
atio
n an
d
Cas
e m
anag
emen
t
low
inco
me,
ethi
c w
omen
– k
eepi
ng
appo
intm
ents
for m
amm
ogra
ms
◥
Scre
enin
g Adh
eren
ce F
ollo
w u
p (S
AFe
) mod
el w
as u
sed:
stru
ctur
ed
telep
hone
-bas
ed, p
atien
t-cen
tred
adhe
renc
e risk
asse
ssm
ent, e
duca
tion,
co
unse
lling
, nav
igat
ion
assis
tanc
e, tra
ckin
g, re
min
ders
and
refe
rrals
to
com
mun
ity re
sour
ces;
asse
ssm
ent o
f ba
rrier
s; us
e of c
linica
l alg
orith
m to
as
sign
serv
ice le
vels
◥
Sign
ifica
nt in
crea
se in
ad
here
nce
to a
ppoi
ntm
ents
◥
Adh
eren
ce v
arie
d w
ith le
vel
of in
tens
ity o
f int
erve
ntio
n
5Fe
rran
te J.
m., C
hen
P.H
. & K
im
S. (2
007)
. The
effec
t of p
atie
nt
navi
gatio
n on
tim
e to
dia
gnos
is,
anxi
ety
and
satis
fact
ion
in u
rban
m
inor
ity w
omen
with
abn
orm
al
mam
mog
ram
s: a
rand
omiz
ed
cont
rolle
d tr
ial.
Jour
nal o
f Urb
an
Hea
lth, 8
5, 1
14–1
24.
Ran
dom
ized
C
ontr
olle
d Tr
ail
Patie
nt N
avig
atio
n
Follo
w u
p w
ith a
bnor
mal
m
amm
ogra
ms –
impr
ove
timel
ines
s to
dia
gnos
is an
d pa
tient
satis
fact
ion
◥
Nav
igat
ion
– m
eetin
g sp
ecifi
c ne
eds o
f wom
en –
em
otio
nal
and
soci
al su
ppor
t, m
akin
g ap
poin
tmen
ts, b
eing
pre
pare
d fo
r app
oint
men
t, ap
plic
atio
n fo
r fin
anci
al a
ssist
ance
, lin
king
to
reso
urce
s and
supp
ort s
yste
ms,
faci
litat
ing
inte
ract
ions
and
co
mm
unic
atio
n w
ith h
ealth
care
st
aff a
nd p
rovi
ders
◥
Sign
ifica
nt p
ositi
ve fi
ndin
gs
– im
prov
emen
ts in
tim
e to
di
agno
sis, d
ecre
ased
anx
iety
an
d in
crea
sed
satis
fact
ion
interProFeSSional CollaBorative teaMS 83
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
PAt
IeN
t N
AVIg
AtIo
N m
od
elS
6G
ilber
t, J.E
., Gre
en, E
., lan
kshe
ar, S
., H
ughe
s, E.
, Bur
kosk
i, v., &
Saw
ka, C
. (2
010)
. Nur
ses a
s pat
ient
nav
igat
ors i
n ca
ncer
dia
gnos
is: re
view
, con
sulta
tion
and
mod
el d
esig
n. E
urop
ean
Jour
nal
of C
ance
r Car
e, 20
, 228
-236
.
lite
ratu
re R
evie
w
(Syn
thes
is)G
ENER
Al
- C
AN
Ad
APa
tient
Nav
igat
or
Can
cer C
are
◥
Nur
se a
ssist
s pat
ient
s thr
ough
th
e di
agno
stic
pha
se o
f can
cer
◥
Nur
se e
xpos
es p
atie
nt to
va
riou
s hea
lthca
re su
ppor
ts;
com
mun
icat
es w
ith p
hysic
ians
an
d on
colo
gist
s
◥N
urse
take
s par
t in
mul
tidis
cipl
inar
y ca
se c
onfe
renc
es
on th
e pa
tient
in q
uest
ion
◥
dia
gnos
is tim
e is
redu
ced
with
an
incr
ease
in fo
llow
-up
s; sh
orte
r wai
t tim
es;
hosp
ital s
tays
◥
Phys
icia
n ha
s mor
e tim
e to
fo
cus o
n co
mpl
ex c
ases
and
pa
tient
anx
iety
is re
duce
d
◥C
are
is m
ore
coor
dina
ted,
or
gani
zed;
pat
ient
is
bette
r inf
orm
ed a
nd c
are
plan
exp
edite
d
7G
uada
gnol
o, B.
A., C
ina,
K., K
oop,
d.,
Brun
ette
, d., &
Pet
erei
t, d
.G. (
2011
). A
pr
e-po
st su
rvey
anal
ysis
of sa
tisfa
ctio
n w
ith h
ealth
care
and
med
ical
m
istru
st aft
er p
atie
nt n
avig
atio
n fo
r A
mer
ican
Indi
an ca
ncer
pat
ient
s. Jo
urna
l of H
ealth
care
for t
he P
oor a
nd
Und
erse
rved
, 22,
1331
-134
3.
Pre-
Post
Coh
ort
Stud
y Su
rvey
Patie
nt n
avig
atio
n sa
tisfa
ctio
n am
ong
Am
eric
an In
dian
ca
ncer
pat
ient
s
uN
ITEd
ST
ATES
Patie
nt N
avig
atio
n
Am
eric
an In
dian
can
cer p
atie
nts
◥
Nur
ses r
ecei
ving
spec
ific
educ
atio
n in
nur
se n
avig
atio
n;
cultu
rally
trai
ned
◥
Focu
s on
redu
cing
ba
rrie
rs a
nd a
cces
s to
care
fo
r vul
nera
ble
popu
latio
ns
◥
Impr
oved
satis
fact
ion
of
patie
nts a
fter r
ecei
ving
pa
tient
nav
igat
ion
◥
No
signi
fican
t im
prov
emen
ts
in m
istru
st, b
ut h
igh
satis
fact
ion
rate
s of p
atie
nts
duri
ng c
ance
r tre
atm
ent
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation84
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
PAt
IeN
t N
AVIg
AtIo
N m
od
elS
8m
ande
rson
, B., m
cmur
ray,
J., P
irain
o,
E., &
Sto
lee,
P. (2
012)
. Nav
igat
ion
Role
s Sup
port
Chr
onic
ally
Ill
Old
er A
dults
thro
ugh
Hea
lthca
re
Tran
sitio
ns: A
Sys
tem
atic
Rev
iew
of
the
l ite
ratu
re. H
ealth
and
Soc
ial C
are
in th
e Com
mun
ity, 2
0(2)
, 113
-127
.
Syst
emat
ic R
evie
w
Avoi
ding
too
man
y he
alth
care
tran
sitio
ns
whi
ch u
sual
ly re
sults
in
frag
men
ted
care
; cas
e in
poi
nt c
hron
ical
ly il
l ol
der a
dults
GEN
ERA
lPa
tient
Nav
igat
ion
◥
Role
of a
nav
igat
or fo
r the
ch
roni
cally
ill o
lder
per
son
is a
rela
tivel
y ne
w o
ne; i
nclu
des t
he
crea
tion
of p
atie
nt-p
rovi
der c
are
plan
s and
trea
tmen
t goa
ls
◥m
ost s
tudi
es fo
cuse
d on
hos
pita
l-ho
me
tran
sitio
ns fo
r pat
ient
s (d
isch
arge
pla
nnin
g)
◥Pa
tient
nav
igat
ion
incl
uded
ph
one
supp
ort,
hom
e vi
sits,
patie
nt e
duca
tion,
acc
ess t
o co
mm
unity
serv
ices
◥
vari
ous b
ased
on
st
udy/
cont
ext
◥
Posit
ive:
impr
ovem
ents
in
car
egiv
er a
nd p
atie
nt
com
mun
icat
ion,
self-
man
agem
ent t
echn
ique
s, ad
here
nce
to m
edic
atio
ns,
decr
ease
in E
R us
e, im
prov
ed m
enta
l hea
lth,
mor
e co
mm
unity
refe
rral
s
◥N
egat
ive:
disc
ontin
uity
of
care
, (la
ck o
f tra
nsiti
on) f
or
chro
nica
lly il
l old
er a
dults
, es
peci
ally
thos
e with
mul
tiple
ch
roni
c dise
ases
; too
man
y ho
spita
l adm
issio
ns9
Ngu
yen,
T. &
Kag
awa-
Sing
er, m
. (2
008)
. Ove
rcom
ing
Barr
iers
to
Can
cer C
are
Thro
ugh
Hea
lth
Nav
igat
ion
Prob
lem
s. Se
min
ars i
n O
ncol
ogy
Nur
sing,
24(4
), 27
0-27
8.
Ove
rvie
w o
f Theo
retic
al
Con
cept
s
Theo
retic
al co
ncep
ts in
co
mm
unity
bas
ed cu
ltura
lly
tailo
red
healt
h na
viga
tion
uN
ITEd
ST
ATES
Patie
nt N
avig
ator
Com
mun
ity N
avig
ator
or l
ay H
ealth
Can
cer C
are
◥
Com
mun
ity N
avig
ator
s ass
ist
with
task
s suc
h as
sche
dulin
g ap
poin
tmen
ts, p
rovi
ding
tr
ansp
orta
tion,
coo
rdin
atin
g ca
re, e
nsur
ing
follo
w-u
ps a
re in
pl
ace,
arra
ngin
g fin
anci
al su
ppor
t, co
mm
unity
out
reac
h
◥
Nur
ses n
eed
to b
e m
ore
proa
ctiv
e in
del
iver
ing
care
th
at is
cul
tura
lly se
nsiti
ve,
com
mun
ity b
ased
interProFeSSional CollaBorative teaMS 85
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
PAt
IeN
t N
AVIg
AtIo
N m
od
elS
10Pe
ders
en, A
., & H
ack,
T. (
2010
). Pi
lots
of
Onc
olog
y H
ealth
Car
e: A
Con
cept
A
naly
sis o
f the
Pat
ient
Nav
igat
or R
ole.
Onc
olog
y N
ursin
g For
um, 3
7(1)
, 55-
60.
Con
cept
Ana
lysis
Role
of p
atie
nt n
avig
ator
in
onc
olog
y
uN
ITEd
ST
ATES
Patie
nt N
avig
atio
n
Can
cer C
are
◥
Role
of t
he P
atie
nt N
avig
ator
(PN
): Fa
cilit
ates
acc
ess t
o ca
re, p
rovi
des
educ
atio
n, li
nks t
o re
sour
ces,
redu
ces b
arrie
rs su
ch a
s lan
guag
e/cu
ltura
l/ tr
ansp
orta
tion
issue
s
◥
Fam
ilies
rece
ive
acce
ss
to h
ealth
reso
urce
s in
a ti
mel
y m
anne
r
◥Pa
tient
s fee
l mor
e em
pow
ered
thro
ugh
educ
atio
n se
ssio
ns
◥PN
s are
wel
l tra
ined
in th
e ca
ncer
syst
em, a
llevi
atin
g pa
tient
inse
curit
ies
11Ps
ooy,
Bria
n, S
chre
uer,
J., B
orga
onka
r, d
., Cai
nes,
J. &
Judy
, S. (
2004
). Pa
tient
N
avig
atio
n: Im
prov
ing
Tim
elin
ess i
n th
e dia
gnos
is of
Bre
ast A
bnor
mal
ities
. Ca
nadi
an A
ssoc
iatio
n of
Rad
iolo
gists
Jo
urna
l, 55
(3),
145-
150.
Retr
ospe
ctiv
e
Coh
ort S
tudy
Rese
arch
stud
y de
term
inin
g th
e im
pact
of
pat
ient
nav
igat
ion
and
timeli
ness
whe
n di
agno
sing
brea
st ab
norm
aliti
es
CA
NA
dA
- N
OvA
SC
OTI
APa
tient
Nav
igat
ion
Brea
st C
ance
r
◥
Patie
nt n
avig
ator
con
tact
s th
e ph
ysic
ian
dire
ctly
whe
n a
brea
st le
sion
requ
irin
g fu
rthe
r in
vest
igat
ion
occu
rs
◥Pa
tient
nav
igat
or w
ill b
ook
a di
agno
stic
imag
ing
or c
ore
need
le
biop
sy a
ppoi
ntm
ent
◥
Early
not
ifica
tion
allo
ws t
he
phys
icia
n tim
e to
con
tact
the
patie
nt in
adv
ance
and
pro
vide
su
rgic
al c
onsu
ltatio
n if
need
ed
◥C
ases
are
follo
wed
dili
gent
ly to
en
sure
that
pat
ient
s do
not l
ose
out o
n fo
llow
-ups
◥
The
patie
nt n
avig
ator
will
m
inim
ize
patie
nt a
nxie
ty a
nd
ther
e is
min
imal
inte
rfer
ence
with
pa
tient
or p
hysic
ian
auto
nom
y
◥
Posit
ive
resu
lts re
sulti
ng in
a
decr
ease
in w
ait-
times
from
20
to 1
4 da
ys
◥Po
tent
ially
impr
ove
qual
ity
of li
fe fo
r pat
ient
s with
be
nign
con
ditio
ns a
nd
prov
ide
earli
er tr
eatm
ent f
or
thos
e w
ith m
alig
nant
cas
es
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation86
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
PAt
IeN
t N
AVIg
AtIo
N m
od
elS
12w
ells,
K.J.
, mea
de, .C
.d., &
Cal
cano
, E.
(201
1). I
nnov
ativ
e App
roac
hes t
o Re
duci
ng C
ance
r Hea
lth d
ispar
ities
. Jo
urna
l of C
ance
r Edu
catio
n, 26
, 649
-657
.
Ran
dom
ized
C
ontr
olle
d Tr
ial
(Coh
ort S
tudy
des
ign)
Effica
cy in
pat
ient
na
viga
tion
in re
duci
ng
scre
enin
g de
lays
uN
ITEd
ST
ATES
Patie
nt N
avig
atio
n
Can
cer C
are
◥
An
acce
ptab
le p
atie
nt n
avig
atio
n pr
ogra
m w
as d
esig
ned;
a
rand
omiz
ed c
ontr
ol tr
ial e
valu
ated
th
e pr
ogra
m; d
issem
inat
ion
of
the
rese
arch
find
ings
det
erm
ined
if
patie
nt n
avig
atio
n re
duce
d sc
reen
ing
dela
ys
◥Pr
actic
e Nur
ses (
PNs)
rece
ive
trai
ning
in d
iagn
ostic
and
treat
men
t fo
r bre
ast/c
olor
ecta
l can
cer
◥
PNs a
ssist
with
rem
ovin
g pa
tient
ba
rrie
rs: t
rans
latio
n, in
terp
reta
tion,
pa
perw
ork,
hos
pice
serv
ices
◥
Nee
d fo
r new
mat
eria
ls su
rfac
ed d
ue to
pat
ient
la
ngua
ge b
arri
ers;
crea
tion
of ‘’i
nstr
uctio
ns fo
r a
colo
nosc
opy
prep
arat
ion’
’
◥N
o co
nclu
sive
resu
lts y
et o
n w
heth
er p
atie
nt n
avig
atio
n re
duce
s scr
eeni
ng d
elay
s
◥O
utco
me
resu
lts w
ere
not
avai
labl
e –
stud
y in
pro
gres
s
13w
hite
, S. R
., Con
roy,
B., S
lavi
sh, K
.H.,
& R
osen
zwei
g, m
. (20
10).
Patie
nt
Nav
igat
ion
in B
reas
t Can
cer.
Canc
er
Nur
sing,
33(2
), 12
7-14
0.
Syst
emat
ic R
evie
w
Eval
uatin
g pa
tient
na
viga
tion
in b
reas
t ca
ncer
car
e
GEN
ERA
lPa
tient
Nav
igat
ion
Brea
st C
ance
r
◥
Patie
nt N
avig
atio
n m
odel
– so
me
mod
els i
nclu
de so
cial
wor
kers
and
la
y-he
alth
per
sons
◥
Focu
s on
redu
cing
dia
gnos
is tim
e, ad
dres
sing
lingu
istic
, soc
ial,
cultu
ral,
econ
omic
bar
rier
s, co
mm
unity
out
reac
h, im
prov
e sc
reen
ing
rate
s
◥
Patie
nt n
avig
atio
n
impr
oved
adh
eren
ce to
br
east
can
cer c
are;
scre
enin
g,
diag
nosis
, tre
atm
ent
interProFeSSional CollaBorative teaMS 87
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
ShA
red
CA
re
mo
del
S1
Ake
royd
, J., O
anda
san,
I., A
lsaffa
r, A
., whi
tehe
ad, C
., & l
inga
rd, l
. (2
009)
. Per
cept
ions
of t
he R
ole
of
the
Regi
ster
ed N
urse
in a
n u
r ban
In
terp
rofe
ssio
nal A
cade
mic
Fam
ily
Prac
tice
Setti
ng. N
ursin
g Le
ader
ship
, 22
(2) 7
3-84
.
Cas
e St
udy
util
izat
ion
of th
e nu
rsin
g w
orkf
orce
and
the
nurs
ing
role
CA
NA
dA
- G
ENER
Al
Shar
ed C
are
Prim
ary
care
◥
Fam
ily p
hysic
ian
(FP)
and
re
gist
ered
nur
se (R
N) w
orki
ng
in c
olla
bora
tion
to m
axim
ize
the
need
and
car
e of
pat
ient
s
◥d
ecre
ase
role
am
bigu
ity
◥In
crea
se tr
ustw
orth
ines
s bet
wee
n th
e FP
and
RN
◥
Impr
oved
wai
t tim
es, p
atie
nt
acce
ss to
car
e
◥C
ontin
uing
edu
catio
n in
cent
ives
for R
Ns t
o in
crea
se le
vels
of tr
ust
2A
llen,
J K
., den
niso
n, C
.R.,
Him
mel
farb
, d., S
zant
on, S
.l.,
Bone
, l., H
ill, m
.N., &
le v
ine,
d. m
. (2
011)
. Coa
ch T
rial
: A ra
ndom
ized
co
ntro
lled
tria
l of n
urse
pra
ctiti
oner
/ co
mm
unity
hea
lth w
orke
r ca
rdio
vasc
ular
dis
ease
risk
redu
ctio
n in
urb
an c
omm
unity
hea
lth c
ente
rs:
Rat
iona
le a
nd d
esig
n. C
onte
mpo
rary
Cl
inic
al T
rial
s, 32
, 403
-411
.
Cas
e St
udy
Car
diov
ascu
lar H
ealth
Tr
ial i
n fe
dera
lly q
ualifi
ed
com
mun
ity h
ealth
cen
tres
uN
ITEd
ST
ATES
Shar
ed C
are
(N
P an
d C
Hw
)
Car
diov
ascu
lar d
isea
se
◥
Focu
s on
nurs
e ca
se m
anag
ers
and
com
mun
ity h
ealth
wor
kers
to
bein
g eff
ectiv
e th
erap
y st
rate
gies
to
poo
rly fu
nded
hea
lth c
entr
es
◥Fo
cus o
n pa
tient
edu
catio
n,
coun
selli
ng a
nd te
leph
one
follo
w-
ups t
o in
crea
se p
atie
nt a
dher
ence
◥
Nur
ses a
nd co
mm
unity
he
alth
wor
kers
dev
elop
stron
g re
latio
nshi
ps w
ith p
atie
nts
◥
Prov
ide
heal
thca
re se
rvic
es
to th
e un
ders
erve
d w
here
tr
aditi
onal
out
reac
h st
rate
gies
fail
3Be
aulie
u, m
.d. (
2007
). Fa
mily
pr
actic
e Te
ams:
Prof
essio
nal R
ole
Iden
tity.
Intr
oduc
tion
to th
e Ses
sion,
O
verv
iew
of t
he L
itera
ture
: Hea
lth
Cana
da F
MF
Sess
ion.
Pow
er P
oint
Sl
ides
, 1-8
9.
Pres
enta
tions
of
seve
ral a
utho
rsC
AN
Ad
ASh
ared
Car
e an
d
Inte
rpro
fess
iona
l tea
m
Gen
eral
◥
Ove
rvie
w o
f fam
ily p
ract
ice
in
Can
ada;
Nov
a Sc
otia
surv
ey w
ith
fam
ily p
ract
ice
nurs
es; a
cces
s to
prim
ary
care
; qua
lity
indi
cato
rs
◥
No
spec
ific o
utco
mes
; fac
tors
fo
r suc
cess
ful t
eam
s disc
usse
d
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation88
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
ShA
red
CA
re
mo
del
S4
Brow
n, J.
B., S
mith
, C., S
tew
art,
m.,
Trim
, K., F
reem
an, T
., Bec
khoff
, C.,
& K
aspe
rski
, J.m
. (20
09).
leve
l of
acce
ptan
ce o
f diff
eren
t mod
els o
f m
ater
nity
car
e. Th
e Can
adia
n N
urse
, 10
5(1)
, 19-
23.
Cro
ss-S
ectio
nal S
urve
y
Exam
inin
g fiv
e pr
opos
ed
mat
erni
ty m
odel
s
CA
NA
dA
- O
NTA
RIO
Shar
ed C
are
mat
erni
ty C
are
A:
labo
ur a
nd d
eliv
ery
care
for
phys
icia
n’s p
atie
nts
B:
labo
ur a
nd d
eliv
ery
care
for
phys
icia
ns’ a
nd m
idw
ives
’ pat
ient
sC
: la
bour
and
del
iver
y ca
re fo
r ph
ysic
ians
pat
ient
s, pa
rtne
ring
w
ith m
idw
ives
d:
labo
ur a
nd d
eliv
ery
care
for
phys
icia
ns p
atie
nts a
nd a
ssist
ing
mid
wiv
es a
t bir
thE:
In
terp
rofe
ssio
nal c
linic
setti
ng
◥
Pref
erre
d m
etho
d of
the
73
0 nu
rses
that
wer
e su
rvey
ed w
as th
e fir
st o
ne
(44.
8% a
ppro
val)
◥
Nur
ses w
ere
wea
ry o
f co
llabo
ratin
g w
ith m
idw
ives
; ex
pres
sing
resis
tanc
e to
cha
nge
and
lack
of
com
mun
icat
ion
that
wou
ld
prev
ent a
n IP
setti
ng
◥If
the I
P m
odel
was
gui
ded
by
nurs
es an
d em
phas
ized
role
cl
arity
, the
n nu
rses
wou
ld b
e m
ore w
illin
g to
impl
emen
t it
5El
y, d
.S., d
el-m
ar C
.B., &
Pat
ters
on,
E. (2
008)
. A N
urse
-led
mod
el o
f C
hron
ic d
isea
se C
are
– A
n In
teri
m
Repo
rt. A
ustr
alia
n Fa
mily
Phy
sicia
n,
37(1
2), 1
030-
1032
.
Inte
rim
Rep
ort -
qu
alita
tive
Inve
stig
atin
g a
nurs
e-le
d ch
roni
c co
nditi
on m
odel
; its
cos
t, eff
ectiv
enes
s,
and
feas
ibili
ty
AuST
RAlI
ASh
ared
Car
e
◥
The
nurs
e w
orks
in p
artn
ersh
ip
with
the
GP
and
each
pat
ient
is
revi
ewed
on
a 6-
mon
th b
asis
by
the
GP
and
the
prac
tice
nurs
e
◥
Incr
ease
d effi
cien
cy
and
com
mun
icat
ion
◥
Incr
ease
d at
tent
ion
to d
etai
l an
d sy
stem
atic
car
e
◥Re
latio
nshi
ps b
etw
een
the
nurs
e and
pat
ient
s wer
e str
engt
hene
d; p
atie
nts m
ore
will
ing
to v
oice
thei
r con
cern
s
◥ F
ollo
w-u
ps w
ith p
atie
nts
wer
e m
ore
cons
isten
t an
d co
mpl
eted
with
in
appr
opri
ate
time
fram
es
◥Pa
tient
s bec
ame
mor
e m
otiv
ated
and
resp
onsi
ve
to c
hron
ic d
isea
se
man
agem
ent c
are
interProFeSSional CollaBorative teaMS 89
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
ShA
red
CA
re
mo
del
S6
Gri
ffith
s, C
., mile
s, K
., Ald
am, d
., C
ornf
orth
, d., m
into
n, J.
, Edw
ards
, S.
, & w
illia
ms,
I. (2
007)
. A n
urse
-ph
arm
acist
-led
trea
tmen
t adv
ice
clin
ic fo
r pat
ient
s atte
ndin
g an
HIv
o
outp
atie
nt c
linic
. Jou
rnal
of A
dvan
ced
Nur
sing,
54(5
), 32
0-32
6.
Qua
litat
ive
Stud
y
Can
diff
eren
t tre
atm
ent
advi
sors
impr
ove a
dher
ence
to
HIv
trea
tmen
t
uN
ITEd
K
ING
dO
mSh
ared
Car
e
HIv
Clin
ic
2 re
sear
ch n
urse
s and
pha
rmac
ist: H
Iv
Out
patie
nt c
linic
◥
wor
ked
in a
trea
tmen
t adv
isor
y cl
inic
(TA
C) t
o in
crea
se p
atie
nt
know
ledg
e su
rrou
ndin
g H
Iv
and
the
HA
ART
(hig
hly
activ
e an
tivira
l the
rapy
) to
help
with
pa
tient
dec
ision
-mak
ing
and
long
-te
rm a
dher
ence
to th
e th
erap
y
◥
Tele
phon
e su
ppor
t inc
reas
ed
patie
nt a
dher
ence
7H
ickm
an, m
., dr u
mm
ond,
N., &
G
rim
shaw
, J. (
1994
). A
Tax
onom
y of
Sha
red
Car
e fo
r Chr
onic
dis
ease
. Jo
urna
l of P
ublic
Hea
lth M
edic
ine,
16(4
), 44
7-45
4.
Two-
Phas
e Po
stal
Q
uest
ionn
aire
Sur
vey
Cre
atin
g a
com
posit
ion
of
shar
ed-c
are
appr
oach
es
to a
ddre
ss a
reas
of
chro
nic
dise
ase
uN
ITEd
K
ING
dO
mSh
ared
Car
e
Shar
ed C
are
was
cla
ssifi
ed in
to
6 m
odel
s:
1.
Com
mun
ity c
linic
s2.
Ex
chan
ge o
f let
ters
/rec
ord
shee
ts3.
li
aiso
n be
twee
n ho
spita
l tea
m
and
GP
4.
Com
pute
r ass
isted
shar
ed c
are
(GP
and
hosp
ital s
peci
alist
)5.
Sh
ared
car
e re
cord
car
ds (p
atie
nt
is gi
ven
book
lets
)6.
El
ectr
onic
mai
l (G
P an
d
hosp
ital s
peci
alist
)
◥
Taxo
nom
y off
ers c
hoic
e to
heal
thca
re w
orke
rs w
ishin
g to
in
tegr
ate/
deve
lop
shre
d ca
re
◥
Posit
ive:
shar
ed ca
re is
ap
prov
ed b
y pa
tient
s and
GPs
, ju
st as
effec
tive a
s out
-pat
ient
ca
re; c
ost-e
ffect
ive;
patie
nts
rece
ive s
peci
aliz
ed ad
vice
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation90
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
ShA
red
CA
re
mo
del
S8
Kel
ly, B
., Per
kins
, d.A
., Ful
ler,
J.d.,
Park
er, S
.m. (
2011
). Sh
ared
car
e in
m
enta
l illn
ess:
A ra
pid
revi
ew to
in
form
impl
emen
tatio
n. In
tern
atio
nal
Jour
nal o
f Men
tal H
ealth
Sys
tem
s, 5(
31),
1-12
.
Rap
id R
evie
w
Exam
inin
g ev
iden
ce
of sh
ared
car
e m
odel
s of
am
bula
tory
men
tal
heal
th se
rvic
es
GEN
ERA
lSh
ared
Car
e m
enta
l Hea
lth
Effec
tive
shar
ed c
are
mod
els i
nclu
ded:
◥
Cro
ss o
rgan
izat
iona
l com
mitm
ent;
care
fully
des
igne
d an
d de
liver
ed
inte
rven
tions
; atte
ntio
n to
staff
tr
aini
ng a
nd se
lect
ion;
link
s acr
oss
serv
ice
leve
ls; c
linic
al m
onito
ring
, ag
reed
trea
tmen
t pro
toco
ls;
com
preh
ensiv
e se
rvic
es
* dep
ends
on
clin
ical
setti
ng
◥
Posit
ive:
impr
oved
soci
al
func
tion,
self-
man
agem
ent
skill
s, se
rvic
e ac
cept
abili
ty
redu
ced
hosp
italiz
atio
n,
impr
oved
acc
ess t
o sp
ecia
list
care
, bet
ter e
ngag
emen
t an
d ac
cept
abili
ty o
f men
tal
heal
th se
rvic
es
◥Si
gnifi
cant
set-
up c
osts
, re
duce
d pa
tient
cos
ts, s
ervi
ce
savi
ngs i
n th
e lo
ng-r
un9
law
n, S
. & l
awto
n, K
. (20
11).
Chr
onic
co
nditi
on se
lf-m
anag
emen
t sup
port
w
ithin
a re
spira
tory
nur
sing
serv
ice.
Jour
nal o
f Nur
sing a
nd H
ealth
care
of
Chro
nic I
llnes
s, 3,
372-
380.
Eval
uativ
e St
udy
Exam
inin
g an
inno
vativ
e ch
roni
c co
nditi
on
self-
man
agem
ent
supp
ort p
rogr
amm
e
AuST
RAlI
ASh
ared
Car
e
Chr
onic
Obs
truc
tive P
ulm
onar
y d
iseas
e
◥
Nur
ses p
laye
d a
cent
ral r
ole i
n cr
eatin
g a
mor
e coo
rdin
ated
serv
ice
for p
atie
nts w
ith C
OPd
acr
oss t
he
inpa
tient
/com
mun
ity co
ntin
uum
◥
mod
el b
roug
ht to
geth
er tw
o re
spira
tory
nur
ses (
RNs)
and
on
e Re
spira
tory
Chr
onic
dis
ease
N
urse
(RC
dN
)
◥G
oal w
as to
incr
ease
pat
ient
se
lf-m
anag
emen
t tec
hniq
ues a
nd
educ
atio
n on
resp
irato
ry co
nditi
ons,
devi
ses,
at-h
ome o
xyge
n us
e, (r
espi
rato
ry n
urse
s dea
ling
with
m
ore c
ompl
ex ca
ses,
and
RCd
Ns
with
less
com
plex
one
s)
◥
Impr
oved
pat
ient
ed
ucat
ion
(mor
e pa
tient
s un
ders
tand
ing
wha
t to
do w
hen
an e
xace
rbat
ion
occu
rs, n
ot a
lway
s nec
essa
ry
to a
dmit
ones
elf t
o ho
spita
l or
use
thei
r em
erge
ncy
pack
; dev
elop
men
t of b
ette
r in
form
atio
n sh
eets
◥
Stud
y sh
owed
a la
ck
of c
omm
unity
pro
vide
rs
prac
tisin
g ch
roni
c di
seas
e su
ppor
t; ba
rrie
r for
full
inte
grat
ion
of c
hron
ic c
are
into
the
com
mun
ity
as p
lann
ed
interProFeSSional CollaBorative teaMS 91
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
ShA
red
CA
re
mo
del
S10
mac
leod
, A., B
ranc
h, A
., Cas
sidy,
J., m
cdon
ald,
A., m
oham
med
, N.
& m
a cd
o nal
d, l
. (20
07).
A n
urse
-/ph
arm
acy-
led
cape
cita
bine
clin
ic
for c
olor
ecta
l can
cer:
Resu
lts o
f a
pros
pect
ive
audi
t and
retr
ospe
ctiv
e su
rvey
of p
atie
nt e
xper
ienc
es. J
ourn
al
of O
ncol
ogy
Nur
sing,
11, 2
47-2
54.
Pros
pect
ive A
udit
and
Retr
ospe
ctiv
e Su
rvey
Redu
cing
toxi
citie
s in
colo
rect
al c
ance
r pat
ient
s th
roug
h ed
ucat
ion
an
d su
ppor
t
uN
ITEd
K
ING
dO
mSh
ared
Car
e
Col
orec
tal C
ance
r
Nur
se-P
harm
acy
◥
Patie
nts w
ere s
een
by ei
ther
the
nurs
e or t
he p
harm
acist
; wer
e pr
ovid
ed v
erba
l/writ
ten
info
rmat
ion
rega
rdin
g do
sage
s, sid
e effe
cts,
stora
ge, fo
od/d
rug
inte
ract
ions
◥
Emph
asis
on e
duca
tion
and
patie
nts b
eing
abl
e to
reco
gniz
e gr
ade
2 to
xici
ties i
n th
erap
y
◥
All
of th
e pa
tient
s who
re
spon
ded
in th
e st
udy
repo
rted
satis
fact
ion
◥
Satis
fied
with
trea
tmen
t ex
plan
atio
ns a
nd
clin
ic e
xper
ienc
e
11m
cCan
n, T
.v. &
Bak
er, H
. (20
03).
mod
els o
f men
tal h
ealth
nur
se–
gene
ral p
ract
ition
er li
aiso
n:
prom
otin
g co
ntin
uity
of c
are.
Jour
nal
of A
dvan
ced
Nur
sing,
41(5
), 47
1–47
9.
Qua
litat
ive
Stud
y
Iden
tify
mod
els o
f GP
colla
bora
tion
and
men
tal
heal
th n
urse
s
AuST
RAlI
ASh
ared
Car
e
men
tal H
ealth
GP
and
Nur
se
◥
Shar
ed C
are
mod
el: N
urse
m
aint
ains
clo
se c
onta
ct w
ith
GP
(Gen
eral
Pra
ctiti
oner
) and
is
the
case
man
ager
; dec
ision
s ar
e m
ade
join
tly
◥Sp
ecia
list l
iais
on m
odel
: C
omm
unity
men
tal h
ealth
team
as
sum
es o
vera
ll re
spon
sibili
ty o
f ca
re a
nd tr
eatm
ent,
cont
act w
ith
GP
is in
term
itten
t
◥
Shar
ed c
are
mod
el
is m
ore
cons
isten
t with
su
ppor
ting
pers
onal
an
d or
gani
zatio
nal
cont
inui
ty o
f car
e;
Spec
ialis
t mod
el li
mite
d
to p
erso
nal c
ontin
uity
12Re
tchi
n, S
.m. (
2008
). A
con
cept
ual
fram
ewor
k fo
r int
erpr
ofes
siona
l an
d co
-man
aged
car
e. Ac
adem
ic
Med
icin
e, 83
(10)
, 929
-933
.
Con
cept
ual F
ram
ewor
k
Impl
icat
ions
of I
P ca
re
mod
els o
n pr
actic
e an
d cu
rric
ula
chan
ges
uN
ITEd
ST
ATES
Shar
ed C
are
Prim
ary
Car
e –
Ger
iatr
ics,
m
enta
l Hea
lth
◥
Co-
man
aged
car
e sy
stem
; NP
or
phys
icia
n as
sista
nt c
o-m
anag
e th
e ca
re a
nd c
ondi
tion
of th
e pa
tient
◥
less
bur
den
on th
e ph
ysic
ian
◥
Redu
ces r
edun
danc
y of
task
s
◥le
ss fr
agm
enta
tion
in
patie
nt c
are
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation92
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
ShA
red
CA
re
mo
del
S13
Scie
nce-
In-B
rief
. (20
11).
Syno
psis:
co
mm
unity
out
reac
h an
d ca
rdio
vasc
ular
hea
lth (C
OA
CH
) tri
al.
Syno
psis
of th
e C
OA
CH
Tr
ial (
Com
mun
ity
Out
reac
h an
d C
ardi
ovas
cula
r Tri
al)
uN
ITEd
ST
ATES
Shar
ed C
are
Chr
onic
dis
ease
man
agem
ent
◥
Nur
se p
ract
ition
er a
nd
com
mun
ity h
ealth
wor
ker
wor
k to
geth
er –
CO
AC
H
mod
el, t
o co
ntro
l cho
lest
erol
/BP
man
agem
ent o
f pat
ient
s
◥
und
erse
rved
pop
ulat
ions
be
nefit
from
this
mod
el;
mut
ual g
oal-s
ettin
g;
shar
ed d
ecisi
on- m
akin
g;
enco
urag
ed se
lf-m
onito
ring
an
d tr
acki
ng o
f pro
gres
s
14w
ilson
, C. (
2009
). N
urse
-man
aged
Fr
ee C
linic
Fos
ters
Car
e C
onne
ctio
n fo
r Hom
eles
s Pop
ulat
ion.
Re
habi
litat
ion
Nur
sing,
34(3
), 10
5-9.
Qua
litat
ive
Stud
y
Twel
ve y
ears
of
obse
rvat
ions
at a
nur
se-
man
aged
hea
lth c
entr
e; im
prov
ing
care
del
iver
y fo
r dis
enfr
anch
ised
po
pula
tions
uN
ITEd
ST
ATES
Shar
ed C
are
Add
ictio
n/Re
habi
litat
ion
◥
Nur
se an
d so
cial
wor
ker –
exam
ples
of
nur
se-m
anag
ed cl
inic
s
◥N
urse
pro
vide
s psy
chia
tric
as
sess
men
ts, c
ouns
ellin
g, H
Iv/T
B te
stin
g, h
ealth
edu
catio
n ad
dict
ion
and
soci
al se
rvic
es
◥Fo
cus o
n de
velo
ping
col
labo
rativ
e re
latio
nshi
ps b
etw
een
nurs
es
and
patie
nts
◥
very
pop
ular
clin
ic; 4
,000
en
coun
ters
per
yea
r/38
0 pe
ople
per
mon
th
◥N
egat
ive
to p
ositi
ve
perc
eptio
ns o
f hom
eles
snes
s du
e to
one
-one
inte
ract
ions
by
car
e pr
ovid
ers
interProFeSSional CollaBorative teaMS 93
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
ot
her
mo
del
S o
r P
APe
rS
rel
Ated
to
mo
del
S IN
geN
erA
l1
Barlo
w, J.
, wri
ght,
C., S
heas
by, J
., Tu
rner
, A., &
Hai
nsw
orth
, J. (
2002
). Se
lf-m
anag
emen
t app
roac
hes f
or
peop
le w
ith c
hron
ic c
ondi
tions
: a
revi
ew. P
atie
nt E
duca
tion
and
Coun
selli
ng, 4
8, 1
77-1
87.
lite
ratu
re R
evie
w
Ove
rvie
w o
f se
lf-m
anag
emen
t ap
proa
ches
for p
erso
ns
with
chr
onic
con
ditio
ns
GEN
ERA
lo
t her
Chr
onic
Con
ditio
ns
Self-
man
agem
ent A
ppro
ache
s
◥
Gro
up ap
proa
ch: c
ombi
natio
n of
gr
oup/
indi
vidu
al co
unse
lling
with
a
nurs
e, te
lepho
ne ch
ats,
cons
ulta
tions
, ta
ke-h
ome m
ater
ials
such
as m
ovie
s, bo
oklet
s, au
dio
tape
s
◥In
divi
dual
app
roac
h: o
ne-o
n-on
e se
ssio
ns w
ith a
nur
se, t
ake-
hom
e m
ater
ials
to st
udy/
read
◥
Com
bina
tion:
indi
vidu
al
sess
ions
, gro
up se
ssio
ns, t
ake-
hom
e w
ork/
mat
eria
ls
◥
mul
ti-co
mpo
nent
pro
gram
s ar
e con
sider
ed th
e ‘’b
est
pack
age’’
for s
elf-m
anag
emen
t
◥Be
nefit
s to
patie
nts i
nclu
de
know
ledg
e-ga
in, b
ehav
iour
al
impr
ovem
ents
in se
lf-effi
cacy
and
ove
rall
heal
th
2Bo
denh
eim
er, T
., lo r
ig, K
., Hol
man
, H
., & G
rum
bach
, K. 2
002.
Pat
ient
Se
lf-m
anag
emen
t of C
hron
ic
dis
ease
in P
rim
ary
Car
e. Jo
urna
l of
the A
mer
ican
Med
ical
Ass
ocia
tion,
28
8(19
), 24
69-2
475.
Com
para
tive
Stud
y
The d
iffer
ence
bet
wee
n co
llabo
rativ
e car
e and
self-
man
agem
ent e
duca
tion
uN
ITEd
ST
ATES
Self-
man
agem
ent
Prim
ary
Car
e –
Chr
onic
dis
ease
◥
Stro
ng fo
cus o
n pa
tient
edu
catio
n;
prov
idin
g a
plan
that
allo
ws
patie
nt to
pro
blem
-sol
ve th
eir
chro
nic
cond
ition
◥
Impr
oved
pat
ient
self-
effica
cy
impr
oves
clin
ical
out
com
es
◥Pa
tient
bec
omes
mor
e in
depe
nden
t and
empo
wer
ed;
know
ledg
e to
iden
tify
and
solv
e chr
onic
issu
es
◥A
pply
pro
blem
-sol
ving
te
chni
ques
to 3
are
as o
f pa
tient
’s lif
e: m
edic
al,
soci
al, e
mot
iona
l3
Bons
al, K
., & C
heat
er, F
.m. (
2008
). w
hat i
s the
impa
ct o
f adv
ance
d pr
imar
y ca
re n
ursin
g ro
les o
n pa
tient
s, nu
rses
, and
thei
r col
leag
ues –
A
liter
atur
e rev
iew.
Inte
rnat
iona
l Jou
rnal
of
Nur
sing S
tudi
es, 4
5, 10
90-1
102.
lite
ratu
re R
evie
w
Ass
essi
ng th
e im
pact
of
adv
ance
d pr
imar
y
care
nur
sing
role
s on
th
e pa
tient
s, nu
rses
, and
th
eir c
olle
ague
s
GEN
ERA
lVa
riou
s mod
els
Prim
ary
Car
e
◥
Adv
ance
d Pr
actic
e N
urse
pro
vide
s ‘’fi
rst c
onta
ct c
are’’
◥H
elps
with
dia
gnos
is, tr
eatm
ent,
refe
rral
s, he
alth
pro
mot
ion,
pr
even
tativ
e ca
re
◥
Patie
nts w
ho h
ave
nurs
es a
s th
eir fi
rst p
oint
of c
onta
ct
tend
to e
xper
ienc
e hi
gher
le
vels
of sa
tisfa
ctio
n
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation94
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
ot
her
mo
del
S o
r P
APe
rS
rel
Ated
to
mo
del
S IN
geN
erA
l4
Can
adia
n N
urse
s Ass
ocia
tion.
(2
008)
. Adv
ance
d N
ursin
g Pr
actic
e: A
Nat
iona
l Fra
mew
ork.
Can
adia
n N
urse
s Ass
ocia
tion,
Otta
wa,
ON
. Av
aila
ble
at: w
ww.
can-
aiic
.ca.
Fram
ewor
k to
pro
mot
e a
com
mon
und
erst
andi
ng
of A
dvan
ced
Nur
sing
Prac
tice
(AN
P)
CA
NA
dA
oth
er
Nur
sing
Fram
ewor
k
Prim
ary
Car
e
◥
Onl
y tw
o A
dvan
ced
Nur
sing
Pr
actic
e ro
les a
re re
cogn
ized
in
Can
ada;
Clin
ical
Nur
se S
peci
alis
t, (p
rovi
de e
xper
t nur
sing
car
e fo
r sp
ecia
lized
pop
ulat
ions
, pro
mot
es
the
use
of e
vide
nce)
; and
Nur
se
Prac
titio
ner (
prov
ides
dir
ect c
are
focu
sing
on
heal
th p
rom
otio
n,
trea
tmen
t/m
anag
emen
t of
chro
nic
cond
ition
s, au
tono
my
to
diag
nose
, ord
er, i
nter
pret
test
s an
d pr
escr
ibe
med
icat
ions
)
◥
why
Adv
ance
d
Nur
sing
Prac
tice?
◥
Impr
oved
clie
nt o
utco
mes
; qu
ality
of l
ife, s
atisf
actio
n of
car
e, co
st e
ffici
ency
; d
ecre
ase
ER v
isits
; ER
stay
s; fe
wer
read
miss
ions
; allo
ws
nurs
es to
wor
k at
adv
ance
d le
vels
of c
linic
al p
ract
ice
5d
e G
uzm
an, A
., Cili
ska,
d.,
& d
iCen
so, A
. (20
10).
Nur
se
prac
titio
ner r
ole
impl
emen
tatio
n in
Ont
ario
pub
lic h
ealth
uni
ts.
Can
adia
n Jo
urna
l of P
ublic
Hea
lth,
101(
4), 3
09-3
13.
de s
crip
tive
Stud
y
How
to in
tegr
ate
NPs
in
to P
ublic
Hea
lth u
nits
, un
ders
tand
bar
rier
s, m
easu
re N
P sa
tisfa
ctio
n
CA
NA
dA
- O
NTA
RIO
oth
er
Publ
ic H
ealth
uni
ts (P
Hu
)
Prim
ary
Car
e
◥
Abo
ut 6
% o
f NPs
wor
king
in
Ont
ario
wor
k w
ith P
Hu
s
◥Re
spon
sibili
ties i
nclu
de
perf
orm
ing
diag
nost
ic te
sts,
inte
rpre
ting
the
test
s, pr
escr
ibin
g ph
arm
aceu
tical
s, m
onito
ring
m
anag
ing
chro
nic
dise
ases
, tr
eatin
g ac
ute,
min
or il
lnes
ses a
nd
perf
orm
ing
Pap
test
s if s
peci
fied
by th
e PH
u
◥
No
clin
ical
out
com
es
◥Su
rvey
reve
aled
that
ph
ysic
ians
and
hea
lth
prov
ider
s had
trou
ble
defin
ing
and
unde
rsta
ndin
g th
e nu
rse
prac
titio
ner r
ole;
la
ck o
f sta
ff to
supp
lem
ent
the
wor
k of
the
nurs
e pr
actit
ione
rs if
they
wer
e aw
ay; s
peci
alis
ts h
esita
nt
to ta
ke re
ferr
als f
rom
nu
rse
prac
titio
ners
◥
If n
urse
pra
ctiti
oner
s are
go
ing
to b
e a
perm
anen
t par
t of
pub
lic h
ealth
uni
ts, t
hen
impr
ovin
g ro
le in
tegr
atio
n th
roug
h ed
ucat
ion
and
trai
ning
is re
quire
d
interProFeSSional CollaBorative teaMS 95
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
ot
her
mo
del
S o
r P
APe
rS
rel
Ated
to
mo
del
S IN
geN
erA
l6
diC
enso
, A., &
Bry
ant-
luko
sius,
d.
(201
0). Th
e lo
ng a
nd w
indi
ng R
oad:
In
tegr
atio
n of
Nur
se P
ract
ition
ers
and
Clin
ical
Nur
se S
peci
alist
s int
o th
e C
anad
ian
Hea
lthca
re S
yste
m.
CJRN
, 42(
2), 3
-8.
Edito
rial
CA
NA
dA
ot h
er –
rol
e d
e vel
opm
ent
◥
Spec
ial i
ssue
focu
sing
on
Can
adia
n ex
peri
ence
s – e
ach
pape
r rep
orts
par
t of a
bro
ader
sc
opin
g re
view
and
find
ings
from
ke
y in
form
ants
◥
No
outc
omes
7d
onal
d, F
., mar
tin-m
isen
er, R
., Br
yant
-luk
osiu
s, d
., Kilp
atri
ck, K
., K
aasa
lain
en, S
., & C
arte
r, N
. (20
10).
The
Prim
ary
Hea
lthca
re N
urse
Pr
actit
ione
r Rol
e in
Can
ada.
Nur
sing
Lead
ersh
ip, 2
3, 8
8-11
3.
lite
ratu
re R
evie
w
(Syn
thes
is)
dev
elop
a b
ette
r un
ders
tand
ing
of
Adv
ance
d N
ursin
g Pr
actic
e Ro
les
CA
NA
dA
- G
ENER
Al
oth
er
Role
of th
e PH
CN
P (P
rimar
y H
ealth
care
N
urse
Pra
ctiti
oner
) in
Can
ada
PHC
NPs
hav
e th
e au
thor
izat
ion
to
carr
y ou
t the
follo
win
g: m
ake
and
com
mun
icat
e a
diag
nosis
of d
isea
se;
orde
r and
inte
rpre
t dia
gnos
tic a
nd
scre
enin
g te
sts;
pres
crib
e m
edic
atio
ns
* In
Que
bec,
esta
blish
ing
a pr
imar
y di
agno
sis re
mai
n th
e ex
clus
ive
dom
ain
of th
e ph
ysic
ian
◥
Add
ed c
osts
and
in
effici
enci
es in
syst
em
deliv
ery
whe
n nu
rse
prac
titio
ners
wai
t for
ph
ysic
ians
to si
gn a
pr
escr
iptio
n or
requ
est a
test
8El
-Jard
ali, F
., & l
avis,
J.N
. (20
11).
Add
ress
ing
the I
nteg
ratio
n of
Nur
se
Prac
titio
ners
in P
rimar
y H
ealth
care
Se
tting
s in
Can
ada.
Ham
ilton
, Can
ada:
M
cMas
ter H
ealth
For
um, 1
-30.
Repo
rt –
Issu
e Br
ief
CA
NA
dA
oth
er
◥
Prob
lem
: chr
onic
dis
ease
m
anag
emen
t; op
timal
use
of
nur
se p
ract
ition
ers
◥
laun
ch m
ulti-
stak
ehol
der p
lann
ing
initi
ativ
e to
addr
ess i
ssue
of
inte
grat
ion
of n
urse
pra
ctiti
oner
s in
PHC
setti
ngs i
n C
anad
a
◥Su
ppor
t con
siste
ncy
in
educ
atio
nal a
nd re
gula
tory
st
anda
rds,
requ
irem
ents
and
pr
oces
ses (
stan
dard
s) fo
r nur
se
prac
titio
ners
acr
oss t
he c
ount
ry
◥la
unch
info
rmat
ion/
educ
atio
n ca
mpa
ign
on in
nova
tion
s th
at
coul
d m
eet n
eeds
of p
atie
nts
in
prim
ary
care
◥
Bigg
est b
arrie
rs –
supp
ort o
f ph
ysic
ians
and
orga
nize
d m
edic
ine
◥
Not
app
licab
le
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation96
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
ot
her
mo
del
S o
r P
APe
rS
rel
Ated
to
mo
del
S IN
geN
erA
l9
Hut
chis
on, B
., Abe
lson,
J., &
lav
is, J.
(2
011)
. Pri
mar
y C
are
in C
anad
a: S
o m
uch
Inno
vatio
n, S
o li
ttle
Cha
nge.
Hea
lth A
ffairs
, 20(
3), 1
16-1
31.
dis
cuss
ion
Pape
r
Focu
s on
polic
y
CA
NA
dA
oth
er
◥
Polic
ies c
reat
e pat
h de
pend
enci
es
that
are d
ifficu
lt to
shift
due
to co
st,
chan
ge re
quire
men
ts, s
uppo
rts
◥
Polic
ies:
fede
ral/p
rovi
ncia
l di
visio
n of
pow
ers;
priv
ate
prac
tice
but p
ublic
fund
ing
(FFS
, clin
ical
au
tono
my
and
cont
rol i
nclu
ding
lo
catio
n of
pra
ctic
es);
priv
ilegi
ng
phys
icia
ns a
nd h
ospi
tals
◥
Inno
vatio
ns
◥1s
t wav
e (19
70s)
– al
tern
ate
paym
ents
e.g. C
HC
s (gl
obal
), H
SO (c
apita
tion)
, CSl
C
(hyb
rid);
boar
ds (C
HC
s, C
SlC
)
◥2n
d w
ave (
mid
‘80s
) – su
ppor
t fo
r alte
rnat
e non
-phy
sicia
n pr
ovid
ers i
n pr
imar
y ca
re
(mid
wiv
es, N
Ps) –
resu
lts
not u
ntil
‘90s
◥
3rd
wav
e (m
id ‘9
0s) –
refo
rm;
dem
onst
ratio
n pr
ojec
ts
◥
less
ons
◥
Big
bang
or t
rans
form
atio
n m
ay n
ot b
e po
ssib
le
◥A
ccep
t a p
lura
lism
of m
odel
s
◥Bl
ende
d fu
ndin
g m
odel
s –
addr
esse
s iss
ue o
f res
istan
ce
◥N
eed
for s
igni
fican
t in
vest
men
ts in
pri
mar
y ca
re
interProFeSSional CollaBorative teaMS 97
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
ot
her
mo
del
S o
r P
APe
rS
rel
Ated
to
mo
del
S IN
geN
erA
l10
Ken
dall,
S., w
ilson
, P., P
roct
er, S
., Br
ooks
, F., B
unn,
F., G
age,
H., &
m
cNei
lly, E
. (20
10).
The N
ursin
g Co
ntrib
utio
n to
Chr
onic
Dise
ase
Man
agem
ent:
A W
hole
Sys
tem
s Ap
proa
ch. N
atio
nal I
nstit
ute
for
Hea
lth R
esea
rch-
SdO
Pro
ject
, 1-7
.
Eval
uativ
e C
ase
Stud
y
Expl
ore,
iden
tify
and
char
acte
rize
effe
ctiv
e C
hron
ic d
isea
se
man
agem
ent m
odel
s
uN
ITEd
K
ING
dO
mVa
riou
s mod
els
Chr
onic
dis
ease
man
agem
ent
(who
le S
yste
ms A
ppro
ach,
Pub
lic
Hea
lth m
odel
, Pri
mar
y C
are
mod
el,
Com
mun
ity m
atro
ns m
odel
)
Who
le s
yste
ms a
ppro
ach:
Bas
ed o
n ch
roni
c di
seas
e m
anag
emen
t mod
el
(cau
sal s
yste
ms,
data
syst
ems,
patie
nt
expe
rien
ce)
Publ
ic H
ealth
: Sch
ool n
urse
s pro
vide
a
visio
n fo
r ast
hma
care
; foc
us o
n aw
aren
ess a
nd p
reve
ntio
n
Prim
ary
ca r
e Mod
el: G
ener
al
prac
titio
ner p
rovi
des c
are a
nd fo
llow
up
Nur
se s
peci
alis
t Mod
el: F
ocus
es o
n se
lf-m
anag
emen
t
co m
mun
ity M
atro
n M
odel
: Top
-dow
n ap
proa
ch, fi
rst p
oint
of c
onta
ct
◥
Spec
ialis
t mod
els
redu
ce h
ospi
taliz
atio
ns
and
read
miss
ions
◥
Furt
her e
duca
tion
of th
e pu
blic
is re
quire
d; c
hang
ing
perc
eptio
ns o
f tra
ditio
nal
nurs
ing
role
s and
scop
e
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation98
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
ot
her
mo
del
S o
r P
APe
rS
rel
Ated
to
mo
del
S IN
geN
erA
l11
Kor
en, I
., mia
n, O
., & R
ukho
lm,
E. (2
010)
. Int
egra
tion
of N
urse
Pr
actit
ione
rs in
to O
ntar
io’s
Prim
ary
Hea
lthca
re S
yste
m: v
a ria
tions
Acr
oss
Prac
tice
Setti
ngs.
CJN
R, 4
2(2)
, 48-
69.
Expl
orat
ory
stud
y
Trac
king
surv
ey o
f NPs
–
diffe
renc
es in
edu
catio
n,
empl
oym
ent,
IPC
CA
NA
dA
–
ON
TARI
Oo
ther
Educ
atio
n: 2
2% h
ad m
aste
r’s; 7
0%
had
CO
uPN
cer
tifica
te; s
light
ly h
ighe
r ed
ucat
ion
in h
ospi
tal N
Ps
geo
grap
hy: P
HC
nur
se p
ract
ition
er
high
est %
in N
orth
-Eas
t lH
IN (1
4%),
then
Cha
mpl
ain
lHIN
(11%
) and
To
ront
o C
entr
al (1
1); 4
0% w
ork
in
rura
l, re
mot
e, sm
all t
owns
Prac
tice
setti
ngs:
CH
Cs (
32%
), ph
ysic
ians
’ offi
ces (
23%
), FH
Ts (1
5%),
hosp
itals
(12%
), N
P-le
d cl
inic
s (3%
), an
d ot
her p
ract
ice
setti
ngs (
15%
), w
hich
incl
uded
men
tal h
ealth
clin
ics,
Abo
rigi
nal h
ealth
acc
ess c
entr
es,
nurs
ing
stat
ions
, uni
vers
ity o
r col
lege
he
alth
serv
ices
, lon
g-te
rm c
are
faci
litie
s, pu
blic
hea
lth u
nits
, hea
lth
serv
ices
org
aniz
atio
ns, a
nd m
ilita
ry
Expe
rien
ce: A
vera
ge 1
7 ye
ars a
s a
regi
ster
ed n
urse
; 5.9
yea
rs a
s a n
urse
pr
actit
ione
r; 4.
1 ye
ars a
s PH
NP
in
curr
ent p
ositi
on; C
HC
had
long
er y
ears
of
exp
erie
nce;
mos
t nur
se p
ract
ition
ers
wor
king
in h
ospi
tal w
ere
full
time;
25
% o
f CH
CN
Ps w
orke
d pa
rt ti
me
◥
Not
app
licab
le
interProFeSSional CollaBorative teaMS 99
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
ot
her
mo
del
S o
r P
APe
rS
rel
Ated
to
mo
del
S IN
geN
erA
l12
mar
tin-m
isen
er, R
. (20
10).
will
N
urse
Pra
ctiti
oner
s Ach
ieve
Ful
l In
tegr
atio
n in
to th
e H
ealth
care
Sy
stem
? CJN
R, 4
2(2)
, 9-1
6.
dis
cuss
ion
Pape
rC
AN
Ad
Ao
ther
Barr
iers
◥
legi
slatio
n, re
gula
tion
– st
reng
then
cre
dibi
lity
and
wor
kfor
ce m
obili
ty in
Can
ada;
po
licie
s and
act
s in
rela
tion
to
diag
nost
ic te
sts,
pres
crib
ing;
vita
l st
atist
ics a
cts –
dea
th, m
otor
ve
hicl
e lic
ense
, etc
.
◥N
eed
for p
an-C
anad
ian
stan
dard
s on
educ
atio
n be
yond
cons
ensu
s on
mas
ter’s
leve
l gra
duat
ion
for N
Ps
◥Pr
actic
e –
need
suffi
cien
t sup
ply;
in
com
patib
ility
with
phy
sicia
n fe
e-fo
r-se
rvic
e m
odel
s
◥
Not
app
licab
le
13m
o rga
n, P.
, & S
tran
d d
e Oliv
eira
, J.
(201
1). P
hysic
ian
assis
tant
s and
nur
se
prac
titio
ners
: a m
issin
g co
mpo
nent
in
stat
e wor
kfor
ce a
sses
smen
ts. J
ourn
al
of In
terp
rofes
siona
l Car
e, 25
, 252
–257
.
Ass
essm
ents
of s
tate
w
orkf
orce
s
Exam
inin
g th
e re
cent
tr
eatm
ent a
nd b
est
prac
tices
of P
hysic
ian
Ass
istan
ts a
nd N
urse
Pr
actit
ione
rs in
stat
e w
orkf
orce
s
uN
ITEd
ST
ATES
oth
er
Prim
ary
Car
e
◥
Incr
easin
g th
e nu
mbe
r of N
urse
Pr
actit
ione
rs (N
Ps) a
nd P
hysic
ian
Ass
istan
ts (P
As)
to a
ddre
ss la
ck o
f ph
ysic
ian
gaps
◥
Impr
ove
acce
ss to
car
e be
caus
e m
any
of th
eir d
utie
s ove
rlap
with
th
e ph
ysic
ians
’
◥
No
clin
ical
out
com
es
◥St
ates
shou
ld p
rovi
de
spec
ific
cens
us d
ata
to
pinp
oint
are
as w
here
ad
ditio
nal s
uppo
rt fr
om P
As
and
NPs
may
be
requ
ired
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation100
#r
efer
ence
(alp
habe
tical
)ty
pe o
f rep
ort/
Pape
rlo
catio
nd
escr
iptio
n of
Mod
elo
utco
mes
ot
her
mo
del
S o
r P
APe
rS
rel
Ated
to
mo
del
S IN
geN
erA
l14
Rout
, A., A
shby
, S., m
aslin
-Pro
ther
o,
S., m
aste
rson
, A., P
ries
t, H
., & B
each
, m
. (20
10).
A li
tera
ture
revi
ew o
f in
terp
rofe
ssio
nal w
orki
ng a
nd
inte
rmed
iate
car
e in
the
uK
. Jou
rnal
of
Clin
ical
Nur
sing,
20, 7
75–7
83.
lite
ratu
re R
evie
w
Rese
arch
avai
labl
e on
inte
rmed
iate
care
, and
w
hich
inte
rven
tions
wer
e us
ed to
dev
elop
IP w
orki
ng
in in
term
edia
te ca
re
GEN
ERA
lVa
riou
s mod
els
Inte
rmed
iate
Car
e
No
clea
r dis
cuss
ion
of m
odel
s – m
ore
the
fact
ors t
hat s
uppo
rt th
e us
e of
in
term
edia
te c
are
◥
Nur
se-le
d un
its fu
nctio
n su
cces
sful
ly a
s a fo
rm o
f in
term
edia
te c
are;
no a
dver
se
outc
omes
from
pat
ient
s rec
eivi
ng
less
rout
ine
care
◥
Nee
d fo
r a n
ew la
yer o
f ca
re b
etw
een
prim
ary
care
an
d sp
ecia
list s
ervi
ces t
o he
lp p
reve
nt u
nnec
essa
ry
hosp
italiz
atio
ns; s
uppo
rt
early
dis
char
ge, r
educ
e/de
lay
long
-car
e re
siden
ce
15St
even
son,
l., &
Saw
chen
ko, l
. (20
10).
Com
men
tary
. CJN
R, 4
2(2)
, 17-
18.
Com
men
tary
CA
NA
dA
oth
er
◥
Barr
iers
: nur
se p
ract
ition
er sc
ope
of p
ract
ice o
verla
ps w
ith p
hysic
ians
–
crea
tes t
ensio
n; n
on-s
usta
inab
le
fund
ing
mod
els;
legi
slatio
n,
regu
latio
n an
d ed
ucat
ion;
w
illin
gnes
s to
colla
bora
te
◥
Not
app
licab
le
16To
mbl
in m
urph
y C
onsu
lting
In
corp
orat
ed. (
2005
a). H
ealth
hu
man
reso
urce
com
pone
nt:
lite
ratu
re re
view
repo
rt. H
ealth
hu
man
reso
urce
pla
nnin
g: m
odel
ing
activ
ities
for p
rim
ary
heal
th c
are
nurs
e pr
actit
ione
rs. O
ttaw
a, O
N:
Cana
dian
Nur
ses A
ssoc
iatio
n &
Can
adia
n N
urse
Pra
ctiti
oner
In
itiat
ive.
Retr
ieve
d fr
om:
http
://20
6.19
1.29
.104
/ doc
umen
ts/
pdf/
tech
-rep
ort/
sect
ion4
/03_
HH
R_A
ppen
dixB
.
lite
ratu
re R
evie
wG
ENER
Al
ot h
er
Hum
an R
esou
rce
Plan
ning
◥
min
imal
pla
nnin
g in
PH
CN
P ed
ucat
ion,
dep
loym
ent
and
empl
oym
ent
◥
Not
app
licab
le
interProFeSSional CollaBorative teaMS 101
aPPenDIX c: case sTUDY – InTeRPRofessIonal MoDel of caReAlberta Primary Care Network (PCN)
headline: do you know what your nurses at the Primary Care Network can do for you?
The Challenge: Why establish Primary Care Networks?
Primary Care Networks (PCNs) in Alberta have been established in response to a number of concerns.
◥ many Albertans do not have access to primary care. ◥ There are increasing demands for effective management of chronic diseases, such as diabetes, as
well as a need for strategies to manage complex needs of patients with multiple diagnoses, poverty, substance abuse, and challenging family relationships.
◥ Primary care nursing roles are not fully optimized to meet the needs of the population. ◥ There is a need to address the comprehensive needs of patients, including a focus on the social
determinants of health.
Potential benefits of PCNs
It is anticipated that PCNs, when successfully implemented, will:
◥ Increase Albertans’ access to primary care. ◥ Improve interprofessional collaboration. ◥ Improve coordination of primary care with other healthcare sectors. ◥ Improve care through proactive planning and links to supports (housing, nutrition and comprehensive
care) in a timely manner. ◥ Increase emphasis on health promotion, disease and injury prevention, and attention to chronic
disease management. ◥ Reduce hospitalization. ◥ Help the patient navigate through the health and social systems, so that they don’t fall through
health system gaps.
About Primary Care Networks: history, purpose and scope
◥ PCNs are funded by the Alberta provincial government through its Primary Care Initiative. under the PCN model, groups of family physicians in local communities come together and voluntarily partner with Alberta Health Services to establish a PCN.
◥ The physicians receive $50 per patient, per year, from Alberta Health and wellness (AHw). Physicians also continue to receive fee-for-service or other payments through alternate payment mechanisms.
◥ The per-capita funds can be used to hire nurses and other healthcare providers, and also to provide patient education or other programs. under the model, family physicians, family health nurses and other health professionals work together as a multi-disciplinary team.
◥ The Primary Care Initiative was initially established in 2003, led by three organizations: Alberta Health Services (previously Alberta Regional Health Authorities); the Alberta medical Association; and Alberta Health and wellness (government department). A central Project management Office
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation102
(PmO) was established to assist interested groups of physicians in submitting their letters of intent. ◥ A detailed set of tools was developed to support the development of the PCNs. For example,
once a letter of intent was reviewed and approved by the Primary Care Initiative, the PmO team worked closely with the applicant group to develop operational and business plans. An important component of the planning and implementation process was to ensure that the PCN reflected local needs, context and partners.
The role of nurses in PCNs
Nurses play generalist and specialist roles in PCNs. As an example, here are some of the roles undertaken by nurses at the Red deer PCN.
◥ Family nurses who are registered nurses provide counseling, patient education and navigation support. The PCN offers diabetes education, education related to high blood pressure, and education for moms and new moms.
◥ doctors refer patients to the family nurse. The family nurse contacts the patient by phone and arranges appointments.
◥ Nurse practitioners run a Street Nurse Clinic, three days a week (with or without appointments), to serve the needs of vulnerable people in the downtown core. The nurse practitioner helps to provide essential healthcare services to people who may otherwise not have ready access to these services. Examples of services include communicable disease control, wound care, testing for sexually transmitted disease, management of chronic conditions such as diabetes and high blood pressure, and access to required resources.
Nurse practitioners also have their own panel of patients in PCNs, but with specific restrictions.
◥ Patients cannot have been seen by a family physician within a 36-month period. ◥ Patients cannot be already assigned to a PCN physician. ◥ The care provided by the nurse practitioner needs to be considered comprehensive. Examples of this
comprehensive care can include ordering and interpreting routine screening for all ages according to appropriate guidelines; diagnosing, ordering tests and prescribing treatments and medications for primary care patient populations (from birth throughout the life cycle) as authorized through legislation; working independently yet in a collaborative manner with PCN core physicians (managing patients with chronic conditions and mental health issues as part of his/her practice, for example); and responding to requests for routine episodic care needed by the patient population.
◥ The nurse practitioner needs to have a current “Nurse Practitioner – Family/All Ages” Practice Permit with the College and Association of Registered Nurses of Alberta.
◥ The nurse practitioner needs to submit (or start submitting) shadow billings to AHw.
development and implementation of the PCN model
◥ Forty (40) PCNs have been implemented between 2005 and 2012, with over 2,500 physicians participating. ◥ depending on the needs of the community, PCNs have developed different programs–palliative
care, for example. ◥ many different models of PCNs currently exist (within the parameters of a provincial framework).
For example, a PCN can be one clinic or have several clinics with different configurations of physicians,
interProFeSSional CollaBorative teaMS 103
nurses and other staff. The model is determined at the local level with input from local community stakeholders. This means that no two PCNs are the same.
evaluation of the PCN initiative
Each PCN is expected to conduct its own evaluation. However, an evaluation of PCNs across the province was conducted between 2009 and 2011 by a private consulting firm contracted by the oversight bodies. The evaluation involved both a formative and summative evaluation. details of the evaluation methods are not available.
evaluation results
The evaluation findings were as follows:
◥ There has been a marked increase in the number of Albertans now attached to a family physician. ◥ PCN physicians have more time to spend with patients. ◥ Increased patient access to primary care is a priority for almost all PCNs. ◥ There has been improved access to primary care, including access to some specialized services
within the primary care setting. ◥ PCNs have developed linkages within Alberta Health Services and external agencies and providers,
most notably 100% with home care; 90% with community mental health and community health services; and 84% with public health, hospitals, emergency departments, and physician specialists.
◥ Expanding the multi-disciplinary teams has been a key priority for most PCNs. ◥ multi-disciplinary teams continue to be well-functioning units within PCNs. ◥ members of multi-disciplinary teams work to their full scope of practice in PCNs. ◥ There has been less utilization of emergency rooms by PCN patients. ◥ Targeting complex patients and/or patients with chronic disease is a priority in most PCNs. ◥ There is increased patient access to chronic disease management. ◥ Patients are informed of after-hours care alternatives. ◥ PCN physicians (compared with non-PCN physicians) more commonly screen for smoking
(93% vs. 77%); tetanus/diphtheria immunization (59% vs. 33%); clinical breast exam (99% vs. 84%); mammography (96% vs. 85%);and bone density (63% vs. 44%).
◥ PCN patients report greater satisfaction with regard to wait times. ◥ 96% of PCN physicians have changed how they practice. ◥ PCNs have contributed to the retention of family physicians.
looking ahead
◥ Nurses in PCNs need to continue to develop professional independence from physicians. ◥ The fee-for-service compensation model for physicians is not conducive to collaborative practice. ◥ Nurses have high workload and a high demand for their time, but are not working within their
Canadian HealtH ServiCeS reSearCH Foundation and Canadian nurSeS aSSoCiation104
full scope of practice. ◥ There are inadequate training opportunities for nurses working in primary care.
references
1. Building a primary care network. Available at: www.albertapci.ca. 2. ludwick, d.A. (2011). Primary Care Networks: Alberta’s primary care experiment is a success –
now what? Healthcare Quarterly, 14(4), 7-8.3. manns, B.J., Tonelli, m., Zhang, J., Campbell, d.J.T., Johnson, J., Sargious, P., et al. (2011). The
impact of primary care networks on the care and outcomes of patients with diabetes. Report to Alberta Health and wellness and Alberta Health Services. Available at: Interdisciplinary Chronic disease Collaboration (www.ICdC.ca).
4. Primary Care Initiative (PCI). Supporting Primary Care Networks. Available at: www.albertapci.ca. 5. white, P.J. (2011). The President’s letter. Alberta medical Association. Available at: www.albertadoctors.org.
interProFeSSional CollaBorative teaMS 105
aPPenDIX D: case sTUDY – InTeRPRofessIonal MoDel of caReCentre Local de Services Communautaires (Local Community Service Centres): The CLSC Model of Care
headline: Adopting the local Community Service Centre (ClSC) Solution
The Challenge: Why establish ClSCs?
◥ In the 1960s, Quebec recognized that it needed to modernize, redevelop, and expand its social and educational systems; prior to Quebec’s 1960s “quiet revolution,” all education, health and social services had been funded by the government, but remained under the patronage of the Roman Catholic Church.
◥ There was a need for greater responsiveness to the needs of local communities in the area of health and social services.
Potential benefits of ClSCs
It is anticipated that ClSCs, when successfully implemented, will:
◥ Provide preventive and curative health services to vulnerable groups (perinatality, senior citizens, youth, mental health, disabled).
◥ Enhance the social well-being of the population with a comprehensive (front-line) and community approach, bridging individual and community experiences, know-how and expertise.
◥ Allow individuals to confront problems and solutions autonomously. This means involving clients in the decision-making process and ensuring that the information passed on from healthcare workers to patients is well comprehended.
◥ Improve communication and collaboration between medical staff in the areas of patient referrals and follow-ups.
◥ Forge stronger partnerships with community pharmacies, community organizations, university hospitals, clinics, rehabilitation centres and newer entities such as GmFs (Family medicine Groups) and the CSSSs.
About ClSCs: history, purpose and scope
◥ The context in which the government of Quebec launched the ClSCs was a holistic one. The aim was to provide alternative non-private healthcare facilities comprising both preventive and social services, whereby residents and visiting persons in need of health and social services would be able to access the care that they required in a timely, affordable, and supportive way.
◥ ClSCs were first established in Quebec in 1972 as outlined by the Castonguay-Nepveu Commission. At the time, it was the only model of its kind in Canada. The idea was to provide a range of healthcare services in a single location within a community-sponsored governing body.
◥ The ClSC runs under a provincially planned regional network and its services are defined by provincial statutes. Each ClSC has an elected board composed of internal and external members (providers, centre users, community residents).
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◥ ClSCs fall under the jurisdiction of the provincial government’s ministry of Social Affairs, which is also the governing body from which it receives its funding. Funding is usually based on needs and is allocated according to the population of an area, not users of the centre.
◥ ClSCs are responsible for the individuals in their catchment area. users of the centre have access to multiple service providers – doctors, social workers, homecare workers, and others.
◥ ClSCs provide various services including health services (walk-in clinics); primary social services; integrated health and social services (home, school, mother-child); prevention services (lifestyle education, self-help); and community organization services (programs for specific groups such as women in need, mental health, alcohol and addiction).
The role of nurses in the ClSCs
◥ Nurses play a central role in ClSCs including telephone follow-ups, at-home visits, (within 48 hours for a post-natal follow-up), physician referrals for special problems, referrals for psycho-social support workers, and return visits to ClSCs.
◥ The work of nurses also encompasses patient education and monitoring, which includes health promotion and encouraging patients to be more proactive in their own health through preventive measures, lifestyle changes, and self-care management.
◥ Examples of nurse-led assistance include arranging medical consultations, carrying out vaccinations, and performing screenings, post-surgery treatments and diagnostic tests (pregnancy, blood, glucose).
development and implementation of the ClSC model
◥ 1st Phase: ClSCs were initially launched in 1972. By 1975, there were 50 active ClSCs across the province, all oriented towards prevention, participation, and local autonomy.
◥ 2nd Phase: Between 1976 and 1978, in order to control government spending and cost increases related to inpatient care, the focus was changed to that of expanding and strengthening external care services. ClSCs adopted general social services and CSSs (Centres of Social Services) absorbed specialized social services, with a plan for CSSs to transfer staff members to ClSCs. The planned transfer was delayed due to institutional resistance; implementation took place in 1984.
◥ 3rd Phase: Between 1979 and 1985, ClSCs received a new mandates: home, school, and child services; primary social service; and occupational health services. An evaluation commissioned by the ministry of Health and Social Services (the Brunet Report) was carried out to assess the performance of ClSCs.
◥ By the mid-1990s, there were 160 ClSCs across Quebec employing over 16,000 staff and 1,200 doctors, of which 95% were on salary and did not follow FFS (Fee for Service) practices.
◥ To improve Québec’s Primary Healthcare System and enhance collaboration, coordination and access to care, the CSSSs (Centres of Health and Social Services) model was designed in 2003 to encompass hospitals, community health centres, ClSCs (local community centres), CSSs (Centres of Social Services), and long-term care homes.
◥ CSSSs were established for stakeholders to provide health and social services under one agency, as ClSCs can support an even distribution of health and social personnel (physicians, nurses, nutritionists, dentists, lab technicians, social workers, domestic aids, psychologists, community workers, and others). This network of health centres and social service groups led to the establishment of 95 CSSSs throughout the province.
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◥ CSSSs act as a hub to provide both general and specialized services, and refer individuals to ClSCs and available health services in their area.
◥ CSSSs host public, not-for-profit contracted and private health centres (private hospitals, nursing homes).
evaluation of ClSCs
◥ In 1975, the Bilan report was commissioned to help classify the first groupings of ClSCs based on their adoptive approach of programs. The Bilan report was the first evaluation of the ClSCs.
◥ In 1980, marc Renaud carried out a tension headache simulation study, where his graduate students were sent to fee-for-service and to ClSC centres for the same health conditions. The goal of the study was to assess GPs (general practitioners) working in different practice settings in the montreal area.
◥ In 1983, Renaldo Battista and walter Spitzer carried out a study on adult prevention care, comparing different primary care settings in Quebec, including ClSCs.
◥ In 1987, the Quebec minister of the department of Health and Social Services commissioned a study (widely known as the Brunet Report) to evaluate the current state of the 150 ClSCs in Quebec, and to make recommendations for their future.
◥ In 2002, Sicotte et al. evaluated 150 Community Health Care Centres (CHCCs) in Québec by conducting an empirical research study. The purpose of the study was to measure the intensity of interprofessional collaboration among CHCCs.
evaluation results
◥ The 1975 Bilan report revealed that the ClSCs could be categorized in three ways: service-oriented model, community development model, or mixed model approach.
◥ This led to various important recommendations, 24 in total, several of which are now part of the ClSC mandate. As a result of these recommendations:
◥ ClCSs now follow a mixed model approach. ◥ ClSCs are small institutions close to the populations that they serve. ◥ Staff are compensated by salary. ◥ Facilities provide accessible services that are public and private. ◥ Regional councils of health services and social services have responsibility for general
coordination of services provided in their territory. ◥ marc Renaud’s tension headache simulation study revealed that private practice doctors were more
likely to prescribe ‘’inadequate therapies.’’ ClSC doctors imposed stricter time limits on prescription drugs, offered explicit warnings on chronic drug use, and provided information on alternative treatment methods. The examination time was more thorough at the ClSC, and the ClSC physicians were more complete in investigating the cause and nature of the headaches as well as the patient’s medical history. This approach promoted a supportive relationship with the patient.
◥ Renaldo Battista’s and walter Spitzer’s study revealed that ClSC physicians tended to uphold the recommended notions for preventive practice, and were more keen to pursue prevention when examining patient-physician encounters. The authors of this report have suggested that this is because ClSCs and Family medical Groups are multidisciplinary, include more allied health professionals, and provide more preventive kits and information pamphlets on health issues, whereas the fee-for-service payment model does not adequately compensate preventive activities in private practice.
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◥ The 1987 Brunet Report revealed differences in the status of health between different economic and ethnic groups. The report also identified a number of difficulties faced by ClSCs, including:
◥ resistance from social service organizations and public health service to give ClSCs the resources they need
◥ lack of clear policy directions from the ministry of Health and Social Affairs ◥ evidence from ClSC management boards that they had difficulties in understanding their
mission; and ◥ issues with unions. (unions encouraged staff members who were sympathetic with their views
to be elected to ClSC boards.) ◥ The Brunet report outlined the following recommendations:
1) Establish a common level of service among all ClSCs. 2) Put emphasis on early detection and first-line treatment of medical and psychological
problems with appropriate referrals. 3) Expand the home care program.4) Establish four program areas for “groups at risk:” infants and families; youth in difficulty;
adults with mental health problems; and one other group at risk, selected by the ClSC, that has importance in the area it serves.
5) limit the activities of the community action component to avoid duplication with the work of other government services.
◥ The Sicotte et al. empirical research study produced modest results. It found that interprofessional collaboration was taking place, but that it was limited by internal working group dynamics. Professionals worked in monopolies to protect their fields of expertise and felt threatened in interprofessional environments, resulting in tension between disciplinary and interdisciplinary logics. The report recommended realigning professional training programs so that mixed, rather than like, professionals were receiving interprofessional education side by side, in order to foster more collaboration and collaborative relationships across different professional groups.
looking ahead
ClSC challenges include:
◥ expanding and meeting the 200-centre target due to lack of government support and opposition from the medical field; and
◥ attracting physicians to work in ClSCs where salaries are well below fee-for-service averages of physicians in private practices.
references
1. Battista, R., & Spitzer, w. (1983). “Adult Cancer Prevention in Primary Care: Contrasts Among Primary Care Practice Settings in Quebec” in the American Journal of Public Health, 73,(9).
2. Bozzini, l. (1988). local Community Service Centres in Quebec: description, Evaluation, Perspectives. Journal of Public Health Policy, 9(3), 346-375.
3. Cawley, R. (1996). The Incomplete Revolution: The development of Community work in Quebec ClSCs. Community Development Journal, 31(1), pg. 54-65.
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4. Centre de santé et de services sociaux, la Pommeraie. (2008). list of Services : Nursing Care at the ClSC. Gouvernement du Québec. Retrieved from: www.santemonteregie.qc.ca/lapommeraie/services/ser/fiche/infirmiersg.en.html.
5. Centre de santé et de services sociaux de Gatineau. (2012). mission, vision, values. Retrieved from: http://www.csssgatineau.qc.ca/en/our_organization/mission_vision_ values/.
6. CuPE. (1996). Community Health Centres: Primary Care Providers Performance Re Health Promotion and Illness Prevention. Retrieved from: http://cupe.ca/primary-health-care/community-health-centres.
7. Gaumer, B., & desrosier, G. (2004). l`Histoire des ClSC au Québec : Reflet des contradictions et des luttes a lìntérieur du système. Ruptures, revue transdisciplinaire en santé, 10(1), 52-70.
8. Health Index: The Quebec Health directory. (2007-2012). The network of health centres and social services in Quebec. Retrieved from: http://www.indexsante.ca/articles/ article-47.html.
9. lois et reglements du Quebec, c . S-s, s.l., art I. Aprili, I986.10. Renaud, m. (1980). Practice Settings and Prescribing Profiles: The Simulation of Tension
Headaches to General Practitioners working in different Practice Settings in the montreal Area. American Journal of Public Health, 70(10).
11. Sicotte C., d`Amour, d., & moreault, m.P. (2002). Interdisciplinary Collaboration within Québec Community Healthcare Centres. Social Science and Medicine, 55, 991-1003.
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aPPenDIX e: case sTUDY – nURse-leD MoDel of caReNurse-Practitioner Led Clinic (NPLC) Model of Care in Sudbury, Ontario
headline: NP-led Clinics win hearts of many who have not had a primary care provider for years
The Challenge: Why establish Nurse Practitioner-led Clinics (NPlCs)?
NPlCs in have been established to address a number of concerns.
◥ There are thousands of Canadians who are “unattached” or labelled as “orphaned patients” – patients with no primary care physician.
◥ There is a chronic shortage of family physicians, particularly in pockets of urban, rural and remote communities.
◥ There is an increasing demand for chronic disease management, along with an increasing awareness of the benefits of routine preventive primary care and of the merits of interprofessional care.
◥ Across Canada, there is an aging population living with chronic health conditions in the community (their own homes). This population requires heath support, care coordination, and care management over a longer lifespan.
◥ members of the population who are disadvantaged or who have special needs have access issues that need to be addressed.
◥ Patients experience long delays in getting seen by a physician in primary care. ◥ The high use of emergency rooms for non-urgent or emergent health issues in hospitals creates
congestion and inefficiencies. ◥ There is a need for comprehensive and integrated primary healthcare. ◥ Healthcare costs are increasing, and all levels of government are aggressively searching for cost-cutting
measures and cost-effective solutions.
Potential benefits of NPlCs
It is anticipated that NPlCs, when successfully implemented, will:
◥ Increase access to primary care in a timely manner and close to home. ◥ Increase interprofessional collaborative care, whereby the scope of practice of each provider is
optimized in a cost-effective and efficient manner. ◥ Address complex healthcare issues such as those associated with chronic diseases, health
promotion and disease prevention through screening and monitoring. ◥ Improve health and social outcomes of target groups. ◥ Provide cost-effective healthcare solutions. ◥ Provide continuity of care. (By registering with the NPlC itself rather than with a specific provider,
patients remain with the clinic and receive consistent care even if the provider leaves the clinic.) ◥ Improve coordination of care through linking primary care with community-based prevention
programs, home care, and hospital-based care. ◥ use NPs appropriately to their full scope of practice.
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About NPlCs: history, purpose and scope
◥ NPlCs are incorporated, not-for-profit entities with voluntary governing boards. ◥ The NPlCs are funded by the Ontario ministry of Health and long-Term Care and are supported
by various community groups or agencies, health organizations, academic institutions and other partners through in-kind support, expertise and sharing arrangements.
◥ Community-based programs at NPlCs are developed through a systematic process of community outreach, collaboration, needs assessment, planning, implementation and evaluation.
◥ Examples of programs provided by NPlCs include diabetes education sessions, smoking cessation, HPv immunization, and programs for weight-loss.
◥ under the NPCl model, physicians receive monthly stipends for consultations and fee-for-service for any appointments with patients.
◥ The first NPlC was started in Sudbury, Ontario in 2007 and served as the pilot. Successful acceptance, implementation and impact helped to build a case for an additional 25 NPlCs.
◥ NPlCs are located in areas of the province where there are shortages of physicians and many unattached patients as well as under-served populations. The Sudbury district NPlC model, for example, was built around the availability of qualified providers. In the case of Sudbury at the time the NPlC pilot model was introduced, there were eight unemployed nurse practitioners in the community. Some were working out of town or in the process of moving.
◥ In Sudbury, at the first NPlC, there are currently 5.5 nurse practitioners, two part-time physicians, a registered nurse, a pharmacist, a social worker, a dietitian, an office manager, and clerical staff. Two satellite clinics have been launched.
NPlCs are required to:
◥ Provide the same comprehensive family healthcare services that other models provide, using an interdisciplinary team of NPs, RNs, family physicians, and a range of other healthcare providers.
◥ Support their patients, through navigation and care coordination, to access care in other parts of the healthcare system as required, and connect them to community resources.
◥ Put emphasis on health promotion, illness prevention and early detection/diagnosis. ◥ develop and provide comprehensive community-based chronic disease management and
self-care programs. ◥ Involve the patient as a key member of the team and support the patient to make informed
decisions and manage his/her self-care needs. ◥ leverage information technology to support system integration by linking patient records across
different healthcare settings, ensuring timely access to diagnostic and other patient information.
The role of nurses at NPlCs
◥ Nurse practitioners at the NPlCs are salaried and paid by the ministry, as are other healthcare providers (except for physicians who work with them).
◥ Nurse practitioners provide comprehensive primary care with the ability to assess, diagnose, treat and monitor a range of health issues.
◥ Patients are registered with the clinic, but are assigned to a specific nurse practitioner.
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development and implementation of the NPlC model
The NPlC model was developed through a number of activities that occurred at several different levels, and through many different stakeholder groups. These activities included political advocacy, policy development, community engagement, research, and program planning/implementation.
Nursing leadership and political action were provided by Roberta Heale and marilyn Butcher, two nurse practitioners who conceptualized and put voice to the idea of NPlCs. As well, lobbying efforts were made by the Registered Nurses’ Association of Ontario.
Calls for proposals to establish NPlCs were issued in three waves, with the goal of having all 26 NPlCs in place by the end of 2012. The proposals followed a standard template and required the following:
◥ A description of catchment area and specific communities targeted by the NPlC, including population characteristics and a health profile.
◥ A description of existing family healthcare services in the proposed catchment area/community. ◥ Identified gaps in family healthcare services in the proposed catchment area/community. ◥ A proposed governance model for the NPlC (each NPlC was required to form a separate and
distinct not-for-profit corporation). ◥ A list of nurse practitioners who would be affiliated with the NPlC, and their letters of commitment. ◥ A list of collaborating physicians and their letters of commitment. ◥ Statistics on the priority populations for the NPlC. (Potential patients had to be those who did
not have a regular family healthcare provider and who were experiencing difficulty accessing family healthcare services.)
◥ Examples of specific programs that would meet the needs of the defined priority populations. ◥ Examples of other programs such as capacity development (student placements, research program). ◥ The intention to register 800 patients per nurse practitioner once the NPlC was fully operational. ◥ A description of community partners. ◥ A description of one-time and/or on-going financial or other supports from each source. ◥ A description of readiness to operate (length of time that would be required to get to full
operation; availability of location; detailed work plan). ◥ Evidence of support of professional associations, regulatory bodies, government nursing leaders,
and/or ministry of Health champions.
An agreement was made between the NPlCs and the Nursing Secretariat, ministry of Health, with the intention that the agreement would eventually also include the local Health Integration Networks.
various parallel activities in the province helped to support and expand the focus on NPlCs and other nurse practitioner roles in other models and healthcare sectors. These included:
◥ The establishment of the Nurse Practitioners’ Association of Ontario, along with its networking and advocacy efforts
◥ Educational programs and legislative changes
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◥ Attention to communication and collaboration between nurse practitioners and physicians and other health providers such as midwives, social workers and pharmacists
◥ mentorship of novice nurse practitioners by experienced nurse practitioners ◥ legislation that initially recognized nurse practitioners, and later, Bill 179, which removed
restrictions to nurse practitioners (prescribing medications, ordering laboratory and other diagnostic tests, admitting/discharging patients, and requiring all regulated healthcare providers to carry liability coverage)
◥ The development of a common post-baccalaureate primary care nurse practitioner education program at 10 Ontario universities
evaluation of the NPlCs
◥ The Sudbury pilot NPlC clinic developed and implemented its initial patient satisfaction survey after six months of operation, prior to the official ministry evaluation.
◥ In 2009, there was a ministry-led evaluation of the Sudbury clinic. The goal of the survey was to identify lessons learned in order to inform the establishment of additional 25 NPlCs.
◥ The evaluation included document review, key informant interviews (19), focus groups with 20 participants, and a survey of patients (603).
◥ The Sudbury NPlC has expanded to provide services in a remote community and has established a permanent clinic at a second site, for a total of three sites.
evaluation results
◥ The 2009 evaluation showed a high level of awareness of the clinic amongst the public. However, media attention to the NPlC had generated both positive and negative publicity, related largely to interprofessional tensions in the community at the time.
◥ Over 37 % of patients said that their nurse practitioner identified something about their health that they were previously unaware of.
◥ After only one appointment, patients developed a clear understanding of the nurse practitioner’s role and how it differed from the physician role.
◥ Targets for new patients could not be met within the expected timeframe because patients who were registered were highly complex, and many had not received medical attention.
◥ Concerns were raised about the inadequacy of the physician compensation model. Complex patients require more time, and the fee-for-service model was more conducive to seeing patients who required less time – patients who could also be seen by nurse practitioners.
◥ The NPlC model, compared to other models, does not provide funding for physicians to be on call or to receive educational stipends.
◥ The model of the NPlC was seen as appropriate. ◥ Nurse practitioners were working to full scope. ◥ Patients experienced improved access. No patients were turned away due to their medical
complexity, due largely to the physician’s role, which was to see these patients or provide consultation for them when their care fell outside the nurse practitioners’ scope of practice.
◥ There were high levels of patient satisfaction reported. Patients liked the attitude of nurse practitioners, the thoroughness of care, the emphasis on patient education, and the decreased wait times.
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looking ahead
◥ There needs to be greater awareness of the nurse practitioner’s role in the broader public as well as amongst healthcare providers, to avoid misunderstandings and to promote the benefits of the clinics.
◥ Greater interprofessional team development would allow for increased collaboration and further improvements in care.
references:
1. diCenso, A., & wyman, R. (2008). Report on visit to Sudbury district Nurse Practitioner-led clinic. mOHlTC.
2. diCenso, A., Bourgeault, I., Abelson, J., martin-misener, R., Kaasalainen, S., Carter, N., et al., (2010). utilization of nurse practitioners to increase patient access to primary healthcare in Canada – thinking outside the box. Nursing Leadership, 23(special issue), 239-259.
3. Heale, R., & Butcher, m. (2010). Canada’s first nurse practitioner-led clinic: a case study in healthcare innovation. Nursing Leadership, 23(3), 21-29.
4. Ontario ministry of Health and long Term Care (2008). Introduction to NP-led Clinics – Application document #1. Available at: www.health.gov.on.ca/transformation/fht/fht_mn.html.
5. PRA Inc. Research & Consulting (2009). Evaluation of the Sudbury district Nurse Practitioner Clinics. Final Report. mOHlTC.
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aPPenDIX f: case sTUDY – PaTIenT naVIGaTIon MoDel of caRePatient Navigation Model of Care, Initiative of Cancer Care Ontario (CCO)
headline: Is it cancer? Nurse-led patient navigation reduces wait times and improves patient experience from the time there is suspicion of cancer to diagnosis
The Challenge: Why establish the Patient Navigation model?
The Patient Navigation model for cancer care was implemented across Ontario based on a number of identified factors and needs.
◥ Patients were experiencing long wait times for diagnostic tests. ◥ There was a complicated process for diagnostic assessment. ◥ Patients reported high levels of anxiety and stress due to uncertainty. ◥ Patients were experiencing difficulty accessing information. ◥ limited supports were available for patients. ◥ There was a need to spread innovative practices in the field. (For example, the pilot project
included registered nurses performing flexible sigmoidoscopy and nurses using patient navigation strategies, both of which were highly appreciated by patients.)
Potential benefits of the Patient Navigation model
It is anticipated that Patient Navigation model, when successfully implemented, will:
◥ Reduce wait times for diagnostic tests. ◥ Improve patient experience and satisfaction. ◥ decrease patient anxiety and stress. ◥ Allow for early assessment of clinical status and interventions related to symptom management. ◥ Improve provider satisfaction. ◥ Address gaps in the healthcare system and/or mitigate or circumvent the gaps. ◥ Improve coordination between different parts of the system.
About the Patient Navigation model: history, purpose and scope
Patient navigators work collaboratively with surgeons, specialists and other health professionals, and support staff, managers and steering/advisory committees. They work closely with the referring physician or nurse practitioner, supporting the patients by addressing their questions; referring and coordinating diagnostic tests; triaging symptoms and clinical status; making referrals for symptom distress; addressing social supports; and managing patients’ anxiety and stress. under the model, patient navigators can be registered nurses or registered practical nurses, social workers, or lay persons.
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Cancer Care Ontario (CCO) piloted the role of patient navigator in January 2010 for two programs – thoracic/lung and colorectal cancer – to be part of the 14 newly established diagnostic Assessment Programs (dAPs). dAPS were established at the same time to provide patient-centred care, information and linkage to the care team. A dAP is a place where patients going through the process of diagnosing for cancer can manage and coordinate the care and treatment they need in one single and central location, have access multi-disciplinary healthcare teams that can provide medical services for diagnostic cancer, and receive support services in a patient-focused environment.
A two-phase pilot program was funded by the Nursing Secretariat within the Ontario ministry of Health and long-Term Care. Each phase involved implementing seven patient navigator positions.
The role of nurses as patient navigators
◥ Collaborates with the interprofessional team members and coordinates patient care from referral to definitive diagnosis.
◥ Assesses patients’ symptoms and clinical status that may lead to referrals for interventions; and provide patients with information and support.
◥ Addresses barriers to diagnostic tests and healthcare services. ◥ Identifies health system gaps and advocates to have these addressed.
development and implementation of the Patient Navigation model
◥ Exploratory work was done over a one-year time frame. This work included doing a literature review and conducting focus groups with existing patient navigators and other key informants.
◥ Steering committees and/or advisory committees composed of key stakeholders were established at each dAP to provide direction and oversight.
◥ A total of 14 navigators were identified and situated in dAPs. Programs were established to provide comprehensive diagnostic assessment to patients with suspicion of cancer.
◥ Phase 1 of the pilot was launched in January 2010 for seven patient navigators at seven dAPs. Phase 2 was launched in April 2011 for another seven patient navigators. lessons learned from phase 1 informed the implementation of phase 2.
◥ dAPs were spread across the province, which provided the opportunity to adapt the patient navigator role to different contexts.
◥ The navigators could be registered nurses or registered practical nurses. Several sites decided to utilize advanced practice nurses.
◥ Funding covered salary and benefits of the patient navigator, costs related to training, provincial meetings, and program evaluation. The dAPs contributed additional funding for clerical staff, office and other overhead costs.
◥ Patient navigators across the province participated in a national patient navigation working group of the Canadian Partnership Against Cancer (CPAC). This working group provided additional supports, knowledge exchange and networking across Canada.
◥ The de Souza Institute developed a course on patient navigation across the continuum of care. All 14 patient navigators took the course, which included online learning modules and a full-day clinical session using simulated patients. It is interesting to note that many other nurses also enrolled in the education program, applying the learning to other clinical roles.
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◥ The navigators worked with physicians and many other staff within the dAPs to develop medical directives, clinical pathways and other protocols to facilitate patient care.
◥ A number of planned meetings were held to bring the patient navigators together for cross-sharing, learning and problem-solving. These meetings helped provide additional supports to the dAPs and to the patient navigators.
evaluation of the Patient Navigation model
◥ Cancer Care Ontario established and implemented an evaluation plan, funded by CPAC. ◥ The program evaluation framework included evaluation of impact of patient navigation on system
efficiency (diagnostic wait times), patients’ experience, and provider feedback. ◥ data sources included the following:
◥ data on wait times, tracked by dAPs ◥ Assessment of patient physical and emotional symptoms using the Edmonton Symptom
Assessment System (ESAS) ◥ Problems identified through the Canadian Problem Checklist tool (used in phase 1 only) ◥ Patient experience surveys ◥ Interviews conducted with patient navigators, managers, physicians and support staff
evaluation results
◥ The patient navigator role was unique to each dAP as expected. Some differences were a result of the type of dAP and/or the way the dAP was designed, and involved different elements of virtual and in-person interactions with the patients. more mature dAPs had navigators who took on a lot more responsibility for tests and decision-making within the parameters of standing orders and/or medical directives.
◥ The level of education, confidence, interprofessional collaboration, and physicians’ knowledge of the nurses’ scope of practice, as well as mutual trust between providers, were factors that influenced the types of responsibilities held by the patient navigators. Some dAPs were underdeveloped to the extent that the navigators were not able to realize their clinical role.
◥ High levels of patient satisfaction were reported (91% satisfied or very satisfied). Areas of satisfaction included the availability of the navigator to the patients; information on tests and test results; and management of symptoms, anxieties, worries or concerns.
◥ Reductions in wait times were reported: after 18 months, pilot sites had a 50% reduction in their average time to diagnosis.
◥ There were reductions of more than 30% in symptom severity including anxiety, pain, well-being and tiredness.
◥ 30% of thoracic patients experienced improvement in breathlessness as a result of navigator support, which included use of the dyspnea Guide-to-Practice.
◥ There was improved information provision and support to assist patient decision-making. ◥ High satisfaction was reported among providers (navigator, physicians, managers, and support staff). ◥ There was evidence of improved referral systems (centralized), improved care paths, support
systems for patients, and decreased situations where patients were “falling through the cracks.” ◥ The program was a catalyst for system improvements through advocacy and facilitation by the navigator.
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looking ahead
◥ Based on promising results of the pilot project, a formal patient navigator program has been established across Ontario.
◥ The program will expand as dAPs expands, pending funding allocation. ◥ The current 14 patient navigators have base funding allocation from the ministry of Health and
long-Term Care. ◥ A community of practice for patient navigators has been established to continue to provide a
forum for ongoing work.
reference(s)
1. Cancer Care Ontario (march 2011). Patient Navigator Pilot – Progress Report 2010-2011. unpublished.2. Cancer Care Ontario (February 2012). Patient Navigation in Cancer diagnostics Pilot Project.
Final Report. unpublished.3. Gilbert, J., Green, E., lankshear, S., Hughes, E., Burkoski, v., & Sawka, C. (2011). European Journal
of Cancer Care, 20, 228-236.
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aPPenDIX G: case sTUDY – sHaReD caRe MoDelShared Care Model – Family Practice Nurses and Family Practice Physicians (The Family Practice Initiative)
headline: Nova Scotia improves access and quality of primary care to its citizens by supporting registered nurses to share primary care practice responsibilities with family physicians and/or nurse practitioners in family practices across the province
The Challenge: Why establish the Family Practice Initiative?
The Family Practice Initiative – an example of the shared care model – has been implemented across Nova Scotia based on a number of healthcare needs and factors.
◥ There is an identified need to increase primary care access for patients. ◥ A high demand exists for services for chronic disease management. ◥ Primary care physicians are working in isolation, particularly those in solo practices or rural areas. ◥ Physicians and patients are encountering difficulties in coordinating care and challenges in
navigating through the healthcare system. ◥ Registered nurses in primary care are not working to their full scope of practice.
Potential benefits of the Family Practice Initiative
It is anticipated that this initiative, once successfully implemented, will:
◥ Increase access to primary care. ◥ Improve quality of care (for example, outcomes related to chronic disease management, screening
and prevention). ◥ Increase satisfaction of providers, with less stress on physicians. ◥ Optimize nurses’ scope of practice by better defining and supporting the role of the family practice nurse. ◥ Provide collaborative support for complex patients who require more time. ◥ make peer support more available through collaborative practice, and in doing so, help to address
issues related to healthcare professionals working in isolation. ◥ Provide an economically feasible model of primary care.
About the Family Practice Initiative (shared care): history, purpose and scope
◥ A pilot project was initiated by Capital Health in 2008-2009, supported by the Nova Scotia department of Health.
◥ The business case was strong: the initiative was cost-neutral for the family practice, and it was anticipated that revenues generated from increased volume would offset costs for family practice nurses’ salary and other expenses.
◥ A recruitment strategy was initially developed to identify interested family practices. The strategy included marketing materials, presentations and one-on-one meetings. Enrolment of physicians and family practice nurses was voluntary.
◥ There was strong support from physician stakeholders.
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Key components of the program:
◥ Team manuals are disseminated as part of the program. The manual includes budget requirements, the business case, medical Service Insurance (mSI) guidelines, liability information, and information on nursing roles.
◥ A team resource kit has been developed that includes patient education materials and aides, assessment tools, and reference materials.
◥ An education and orientation program for the nurses is routinely provided by the Registered Nurses Professional development Centre (RNPdC). The program includes an initial five-day orientation program and 10 education modules completed over a one-year period.
◥ Governance and accountability structures and processes have been developed. These include medical directives, a certification program for advanced nursing skills, and billing guidelines.
◥ mentorship and support for the practices (assessment of workflow, collaboration, scheduling, approaches to care) were initially provided by the project lead and are now provided through the RNPdC.
◥ Collaborative team days are organized and held regularly. Nurses and physicians have joint time to strategize on changes needed to improve care.
◥ Financial support is provided to attend collaborative team days and partnership development. ◥ Partnerships have been developed with industry partners, to support collaborative team days and
team resource kits.
roles of nurses in the Family Practice Initiative
◥ under the model, registered nurses are employed in family practice (fee-for-service practice environment). The physicians and nurses build a team approach to patient care.
◥ Focus for care is on disease prevention, screening, complex patients, chronic disease management, follow-up, support, and coordination.
◥ Patient education and infection control practices are developed and coordinated at the practice. ◥ Nurses and physicians are encouraged to have greater involvement in primary care research. The
department of Health provides financial support for the education itself and for education time.
development and implementation of the Family Practice Initiative model
Primary Health Care (PHC) at Capital Health spearheaded a pilot initiative in 2008-2009 with a project lead support. After the pilot project was completed, the department of Health provided standards, supports and financial support to all districts to continue to implement the initiative.
evaluation of the Family Practice Initiative
◥ An evaluation plan was developed using a logic model and an evaluation matrix with defined indicators and key data sources.
◥ An evaluation consultant was hired to support the evaluation. ◥ Phase 1 evaluation was conducted in February 2009. The focus was on process evaluation using
document review, surveys, and the service tracking form. ◥ Phase 2 evaluation was conducted in June 2010. The focus was on the impact of the initiative, and
included client surveys and chart audits as well as data sources from phase 1.
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evaluation results
The evaluation of the pilot project revealed that local autonomy and decision-making had resulted in various physician and nurse collaborations.
◥ Of the 10 practices that provided information, the majority of them had hired one Family Practice Nurse (FPN). 6 out of the 10 practices reported that the FPN had her own patient appointments and in the remaining 4, they shared the appointment. 7 out of 10 FPNs had their own examination rooms.
◥ Fewer than half of the collaborations had policies/procedures for risk management, patient safety and medication errors.
◥ 6 out of 10 had job descriptions for nurses. ◥ 2 had medical directives, policies and procedures. ◥ 4 had an employment contract. ◥ The family practices incorporated learners and students in their practices. ◥ There was enhanced participation in primary healthcare research.
Findings from the process evaluation
◥ Provider satisfaction was noted in decision-making processes, clarity/understanding of roles in collaboration, and communication.
◥ different communication mechanisms were used by different practices. These included informal communication, e-mails, to-do lists, regular meetings, and team- building workshops.
◥ 80% of practices improved their clinical protocols or assessments to coordinate patient care, vaccine management, recording of current medications, and infection control.
◥ Improvements were found in documentation – both in information capture and use (patient profiles, quality indicators).
Findings from the outcome evaluation
◥ All physicians would recommend hiring family practice nurses to their colleagues. ◥ They identified improvements in time with patients and rapport; balance between patient care and
paperwork; and improvements in level of care. ◥ 60% of physicians had improved satisfaction on how care was coordinated within the healthcare system. ◥ The Family Health Initiative practices improved comprehensive screening and care for both
episodic and chronic disease management (particularly with cardiovascular patients). ◥ Improved access to primary care was achieved; 50% of practices accepted new patients; there were
decreased wait times for regular appointments and more patients scheduled per hour; and patients reported ease in getting an appointment.
◥ There was an increase in referrals to a variety of community programs. ◥ Patients provided top ratings on nurses’ listening, how seriously nurses took patients’ health concerns,
thoroughness of nurses’ assessments, and the ease at which the nurses put the patients. Over 90% reported overall satisfaction with the nurse and the clinic. All would recommend the nurse to others.
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◥ The majority of patients reported positively on health promotion and prevention items, indicating specifically the nurses’ role in providing lifestyle information, advice and influence.
◥ Improvements were found in annual testing for fasting lipid profile, foot assessments (for patients with diabetes), fasting blood sugar tests (patients with CAd), and blood pressure measurements (patients with CAd).
◥ There was an increase in patients with depression who were offered non-pharmacological treatments (nurses do not prescribe medications under this model).
looking ahead
Several recommendations and areas for improvement were identified through the pilot evaluation, to be considered as the Family Health Initiative continues to be implemented.
◥ There needs to be adequate time for physician-nurse collaboration, training and mentorship. ◥ There are continuing pressures on the financial feasibility and sustainability of including family
practice nurses in these practices. Practices can be cost-neutral only if they increase their volumes of patients. many of the practices are not covered by the fee codes, creating constraints for nurses.
◥ It is important to continue to build patient acceptability of the family practice nurse’s role and scope of practice.
◥ There needs to be a focus on preventive strategies and screening for specific areas that require improvement.
◥ Inefficiencies in billing practices should be addressed, so that the patient does not have to see the physician each time.
◥ There is a need for nursing leadership to address ongoing issues and practice development. ◥ Currently, the family practice nurses do not have a benefits package with their salaries.
references
1. magee, T., Hodder-malloy, C., mason, d. (2011). Family practice nursing on the rise in Nova Scotia. doctorsNS, September, 31.
2. Registered Nurses Professional development Centre, Family Practice Program (may 2011). Family Practice Program. Available at: rnpdc.nhealth.ca.
3. Registered Nurses Professional development Centre, Family Practice Program (April 2011). Are you struggling to keep up with the growing burden of chronic disease in your practice? Available at: http://www.gov.ns.ca/health/primaryhealthcare/documents/Family-Practice-Brochure-Physicians.pdf.
4. Research Power Inc. (2009). Capital Health FPN Initiative. Evaluation Report Phase 1. Accessed from Graeme Kohler at Capital Health.
5. Research Power Inc. (2011). Family Practice Nurse Initiative. Summary Report. Accessed from Graeme Kohler at Capital Health.
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aPPenDIX H: facToRs InflUencInG aPPlIcaTIon of MoDels of caRe In PRIMaRY caRe
Success Factors and/or Challenges references
PolICy/SyStem leVel FACtorSPolicy decision-makers understanding of roles such as of NP Sangster et al, 2010Pan-Canadian approach to legislative and regulatory framework development and implementation
diCenso et al, 2010
donald et al, 2010
Stevenson & Sawchenko, 2010Graduate level education for advanced nursing practice roles dICenso et al, 2010
donald et al, 2010Good data and research to understand current status and impact of changes in the system, for example to assess impact of NPs already in the system – patient volume, access. Health human resource planning to encourage collaboration and coordination of services (also appropriate numbers, distribution, skills)
donald et al, 2010
macAdam, 2008
minore & Bones, 2002
Tomblin murphy Consulting Inc, 2005Restrictive/barriers posed by legislation and regulation (restrictions on prescribing drugs, break down barriers that encourage silos)
donald et al, 2010
dufour & deborah-lucy, 2010
mcPherson et al, 2012
Oandasan et al, 2006Professional malpractice martin-misener et al, 2004
Oandasan et al, 2006Appropriate compensation models for physicians (has to have incentives if they are not to bill) and other providers (NPs, for example)
de Guzman et al, 2010
dufour & deborah-lucy, 2010
Goldman et al, 2009
mcPherson et al, 2012
Oandasan et al, 2006
Rosser et al, 2011
Schadewaldt et al, 2011Innovative funding mechanisms for teams to operate Baumann et al, 2009
mcPherson et al, 2012
Patterson et al, 2009
Stevenson & Sawchenko, 2010Interprofessional education, pre-licensure and post- licensure Goldman et al, 2009
mcPherson et al, 2012
Oandasan et al, 2006Curriculum for family practice nurse or family health nurse Alsaffar, 2005
Brynes et al, 2012Educate physicians, other team members and public at large on nursing roles
Alsaffar, 2005
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Success Factors and/or Challenges references
New standards for service delivery, evidence-based processes/interventions Goldman et al, 2009
Russel et al, 2009Global set of metrics mcPherson et al, 2012Standardized language across providers – support consistent and standardized measures
Barton et al, 2003
Greater networking on IPE/IPC Côté et al, 2008APProPrIAte model oF CAre
Community needs assessment – model must work for community of patients – what are the high needs such as extent of unattached patients (no physician); models may require changes as the needs of the population changes
dufour & lucy, 2010 Psooy et al, 2004
Ragaz et al, 2010
Patient population characteristics and needs Clement et al, 2006
minore & Bones, 2002Client-centred approaches Baker & denis, 2011
Clement et al, 2006Patient willingness to receive care from alternates, teams Byrnes, 2012
Craven et al, 2006Involvement of patient and family demiris et al, 2008
Pauzé, et al, 2005Involvement of stakeholders early on (for example, unions related to nurse practitioners)
de Guzman et al, 2010
Sangster et al, 2010multi-component model – important components – patient education, systematic follow-up, medication adherence
Craven et al, 2006
Humbert et al, 2009
malin & morrow, 2007length of engagement with patient/Intensity of interventions Schadewaldt & Schulz, 2011
Sicotte et al, 2004Process – holistic approach – assessment, including monitoring and evaluation, screening for complications, health teaching, case management (coordination of care, appropriate referrals), treatment and procedures for managing health issues, symptom management, diagnoses,
Goldman et al, 2009
wong & Chung, 2006
Group visits, shared appointments watts et al, 2009Presence of NPs in teams diCenso et al, 2010
Humbert et al, 2009
Soeren et al (2003)Scope of practice – based on roles Brynes, 2012
Cioffi et al, 2010
de Guzman et al, 2010
martin-misener et al, 2010
mcPherson et al, 2012
Oandasan et al, 2006
Sangster et al, 2010
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Success Factors and/or Challenges references
INdIVIduAl ANd teAm leVel FACtorSEffective teams – clear purpose, objectives, goals, communication, coordination and mechanisms to address conflicts; non-hierarchical/equity
Byrnes, 2012
Clement et al, 2006
Goldman et al, 2010
Hall et al, 2008
Hillier et al, 2011
Howard et al, 2011
Humbert et al, 2009
Huron Pert Health Alliance, 2010
martin-misener, 2004
Sangster et al, 2010mutual trust, power balance Akeroyd et al, 2009
Baxter & markle-Reid, 2009Knowledge and experience working in teams Reeves et al, 2009Knowledge of each other’s roles and scope of practice Byrnes, 2012
Ragaz et al, 2010willingness to collaborate, have a common goal, relinquishing professional “turf”, collaborative relationships
Baxter & markle-Reid, 2009
Byrnes, 2012
Craven et al, 2006
Thornhill et al, 2008Physicians have to share their role Goldman et al, 2010Physician leadership training Baker & denis, 2011Co-location of team members Craven et al, 2006
demiris et al, 2008
Oandasan et al, 2006Enable right tools and information to support teamwork, communication, client-centered approaches including involvement of patient/family in decision-making
Clement et al, 2006
Appropriate scheduling – flexible structures, time for team meetings, collaboration
Byrnes, 2012
orgANIzAtIoN FACtorSCommon grounding philosophy consistent with primary healthcare dufour & deborah-lucy, 2010Clear business plan Ragaz et al, 2010Selecting the most appropriate healthcare providers dufour & lucy, 2010Hire experience, competent nurses, confident wong & Chung, 2008medical directives Humbert 2009Need interprofessional organization interventions (staffing, policy, workspace, culture changes)
Goldman et al, 2009
New models of governance Goldman et al, 2009
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Success Factors and/or Challenges references
Electronic medical/health records plus unimpeded flow of information and communication; common tools
Baker & denis, 2011
Cioffi et al, 2010
Goldman et al, 2009
macAdam et al, 2010
Ragaz et al, 2010meeting space, other tools demiris et al, 2008
Hall et al, 2008
Humbert et al, 2009Sufficient funding for model to sustain required supports Craven et al, 2006
Patterson et al, 2009model ImPlemeNtAtIoN FACtorS
leverage existing toolkits that have been developed to implement models or roles such NP
Côté et al, 2008
Adequate time for system-level collaboration to develop – requiring staff buy-in, leadership support, formal policy changes, performance monitoring
Craven et al, 2006
Service restructuring to allow model to work – including integration of process (referral mechanisms, consultation processes)
Craven et al, 2006
Goldman et al, 2010
lacopino, 2010Support team development, transformation process from group to team practice
Clement et al, 2006
dufour & deborah-lucy, 2010Address inconsistencies in working relationships between nurses and physicians
donald et al, 2010
Protect from staff turnover, particularly during the implementation phase Taylor et al, 2007Training in chronic disease management Barlow et al, 2002
Giddens et al, 2009Satisfactory delegation of responsibilities Cioffi et al, 2010mentorship for nurses new in roles Alsaffar, 2005
Sangster et al, 2010Evidence-based guidelines/protocols Craven et al, 2006
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