During the past decade, health care has rapidly evolved to become more team-based while shifting from primarily hospitals- into community-based settings. The 2010 landmark Institute of Medicine report: The Future of Nursing: Leading Change, Advancing Health, recommended that nurses should not only be active health care team members but also can be leaders of these emerging collaborative care models. To embrace this idea, the John A. Hartford Foundation, the Robert Wood Johnson Foundation, the Josiah Macy Jr. Foundation, and the Gordon and Betty Moore Foundation came together to fund an implementation study of the role of advanced practice nurses developing and leading collaborative care models, resulting in the Accelerating Interprofessional Community-Based Education and Practice Initiative. These foundations selected the National Center for Interprofessional Practice and Education to lead this initiative and disseminate its evaluation results.

The goal of the Accelerating Initiative is more effective health care in the place where it’s primarily delivered—in the community. The team-based model of care focuses primarily on people/patients/clients,1 families and communities rather than focusing first on the needs of students and systems. It is robust, innovative, and sustainable, engaging advanced practice nurse leaders, diverse health professionals, students and community leaders to form teams to learn and work together with patients and their families. This new model is resulting in more effective education and training as students are closely taught and guided by teams in community-based settings. It is also demonstrating that working in teams with patients can improve the health of populations, increase patient and health care workers' satisfaction and potentially reduce costs.

Over the two-years, the National Center provided intense coaching and mentoring to the cohort of nursing school faculty members and their teams to launch, lead and sustain education programs to teach collaborative care and team skills in community-based settings. Sixteen education-community practice teams attended a three-day kick-off institute to introduce them to the National Center’s NexusIPE^© Learning System and tools. These education-community practice teams implemented programs serving high-risk, underserved populations in diverse community-based settings. These settings include an addiction treatment center, low income housing, primary care clinics, home visits, a middle school and a skilled nursing facility. Over a thousand people receiving services in these sites are benefiting from expertise provided by teams of nurses, pharmacists, social workers, physicians, and other professionals who also are collectively teaching thousands of students simultaneously.

• Arizona State University, Tempe, Arizona
• University of Arkansas for Medical Sciences, Little Rock, Arkansas
• University of California, San Francisco, San Francisco, California
• University of Colorado, Aurora, Colorado
• Creighton University, Omaha, Nebraska
• University of Hawaiʻi at Mānoa, Honolulu, Hawaiʻi
• University of Maryland, Rockville, Maryland
• University of Michigan, Ann Arbor, Michigan
• University of Missouri-Kansas City, Kansas City, Missouri
• University of Nebraska Medical Center, Omaha, Nebraska
• New York University, New York, New York
• Oregon Health and Science University, Portland, Oregon
• University of Pittsburgh, Pittsburgh, Pennsylvania
• University of Rochester, Rochester, New York
• University of Utah, Salt Lake City, Utah
• Washburn University, Topeka, Kansas

Click here to see executive summaries of their original proposals. Many programs have expanded or evolved since their original submission.

More than fifty nursing schools submitted proposals to the National Center describing the needs of high-risk populations that would benefit from a team-based, collaborative care model in settings other than hospitals. Such populations include the economically disadvantaged, older adults, school-aged children, people experiencing homelessness, chronic diseases, mental health issues and addictions. The proposals also described how health professional education would be delivered and how students would add value to the program. After reviewing the proposals, a national advisory committee of experts selected the cohort of sixteen schools. The selected sites distinguished themselves by demonstrating innovative collaboration with community partners and engagement of students in the community-based setting. As part of the grant award, the National Center provided an average of 85 hours of technical assistance to each site over two years, including coaching and mentoring and in-person team site visits to all sixteen sites.

The groundbreaking Accelerating Initiative has been a two-year project to design models of interprofessional community-based education and practice, using a standardized approach across 16 communities. The implementation study demonstrates the value of focusing first on people, including patients and their families, rather than starting with what students need to learn and the health care system. It also reinforces the effectiveness of advanced practice nurse-led health teams, community partners and the broad engagement of students as valued team members in community-based settings. Most importantly, the initiative is showing that health can be positively impacted with this model, creating the potential for costs to be reduced. More specifically, the initiative:

• demonstrates improvements in the health status of high-risk and underserved patients when health and other professionals practice in teams in community-based settings.
• educates students and health professionals together in teams to practice in communities where health care is shifting from the hospitals.
• prepares students and the workforce for the significant changes occurring in the health care system and in the way health care providers are paid.

Harder+Company Community Research conducted an evaluation of the Accelerating Initiative and reported lessons learned:

• Many Accelerating Initiative programs increased access to primary care for underserved populations.
• Some programs have seen reduced readmissions and emergency department visits and improvements in health indicators.
• In many programs, patients report being more satisfied with their care and the additional time and attention that they received from a team-based approach to care.
• Interprofessional collaborative practice care teams that implement a spontaneous leadership model can build team member confidence and improve patient care.
• Working in a community-based setting provides students hands-on experience with the ways in which social determinants of health such as income, social status, employment and working conditions, education level, and their living environments impact overall health.
• By working in teams of different professions and community members, students are learning how their own profession’s expertise contributes to improving underserved patient population’s health and wellbeing.
• Working on interprofessional teams helped students learn more about effective team-based care and collaboration, an important necessary skill for the future of health care.
• Spontaneous leaders have emerged at various times to lead various aspects of the program.

By starting with the needs of specific populations, rather than starting with the needs of the students and the systems, highly effective, integrated care and education programs in community-based settings can be designed and implemented. Traditionally, existing clinical sites accept students regardless of interest or need. The new model is changing the mindset from ‘placing students’ in a site to matching students to community-based programs where they can add value and learn at the same time. The other important shift in mindset is to accept the idea that nurses and other health professionals are highly capable of leading and managing teams when trained and prepared. In the end, both students and practice partners meet their goals. As a result of innovative implementation and positive, demonstrable impact, sites have also garnered new financial resources and support to help sustain programs.

• Health system leaders who need to train the current workforce for new models of care
• Community leaders who are seeking innovative, cost-effective ideas to serve citizens
• Health professions educators who are charged with new accreditation standards to educate students in teams
• Nursing school faculty and advanced nurse practitioners implementing interprofessional education programs in community-based settings
• Students who, in the future, will practice in health care teams and will be paid by demonstrating that they can keep patients healthy
• National organizations that support their members to learn about effective strategies for implementing team-based care and interprofessional education programs

Accelerating Initiative program leaders have been implementing innovative interprofessional practice and education programs that challenge conventional thinking. Two examples are especially important. First, health professions schools traditionally educate students in their own programs -- in silos -- creating political and logistical challenges when trying to develop interprofessional teams. By redesigning both health care education and health care delivery to focus on people and communities, students now can gain experience in authentic clinical environments and are able to add value to a community site. Students are also able to learn about broader issues that impact health beyond just health care. Both learning and health have been impacted. Second, initial resistance existed to the concept that nurses and other professionals can lead teams effectively. The most successful Accelerating Initiative teams have developed a leadership model in which any team member can lead at any time, based on the specific situation and expertise needed to address specific needs.

• Seven of the sixteen sites were chosen for case studies written by Harder+Company Community Research to be released this fall.
• A starter NexusIPE^© toolkit will be released. Initial tools support interprofessional practice and education program design for academic-practice teams.
• Monthly webinars will be offered, featuring Accelerating Initiative programs and how each site used the NexusIPE^© tools to implement and sustain their interprofessional practice and education programs in the communities.
• National Center will offer online learning, coaching, workshops, and institutes to accelerate and scale interprofessional practice and education programs in community-based and other practice settings.

Interested parties are welcome to participate in the monthly webinars to learn more about the study from the Accelerating Initiative leaders. By using the starter NexusIPE^© toolkit, they will learn more about the approach and how to launch similar community-based interprofessional practice and education programs in their own settings.