Indiana University: The Bloomington Nexus Project
Member since: November 2015
Intervention: The Bloomington Nexus Project: Interprofessional Team Care Navigation
Partners:
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Indiana University (IU) – Bloomington, Schools of Medicine and Nursing
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Indiana University Health Bloomington Hospital
Occupations represented: Students and professionals including nurses and physicians.
Overview: The Bloomington Nexus project creates a translational model for improving transitional care for patients who have been discharged from acute care. The primary goal of the project is to utilize interprofessional student navigation teams from Indiana University health professions schools to facilitate safe and effective transition across the continuum of care. Specifically, the navigation teams, who have already undergone TeamSTEPPS training and practice in simulation, will be making home visits on patients who were discharged after readmission. Student teams work with transitional care providers and faculty to facilitate safe passage for patients. The targeted learners are senior nursing students and 2nd year medical students.
Outcome measures studied for this project include readmissions, adherence to therapeutic regimens, missed doses of medication, process indicators such as appointment and referral records, patient satisfaction, and cost of care.
Intervention study question:
- In discharged acute care patients, what is the effect of student teams conducting a home discharge plan of care gap analysis on patient satisfaction, reduction in hospital readmission and reduction of care costs compared with similar patients not receiving discharge plan of care gap analysis within 12 months?