The Effectiveness of Learning to Collaborate Interprofessionally on Healthcare Processes and Outcomes in Nursing Homes: a Cluster Randomized Controlled Trial in Primary Care.

1. Introduction

The extent to which different health care professionals work together can affect the quality of the health care that they provide. Government bodies and organizations of different medical and paramedical professions emphasize the importance of interprofessional collaboration in health care (IPCIHC). It assumes a model of working together particular with attention for the process by which professionals develop an integrated and cohesive answer to the needs of the client/family/population. The outcome is rather difficult to be evaluated and therefore it is important to understand the effectiveness of interventions aimed at improving IPCIHC and so improving quality of care.

Despite the large number of publications on interprofessional collaboration, a higher quality of research, evidence and more rigorous evaluation is needed to support decision makers. It is especially required to be specific when conclusions for certain population and context should be drawn. The ageing of the population is expected to be a major driver of increasing demand for long-term care services. Delivery of health care for this population requires high levels of coordinated teamwork and efforts to provide a good quality of care. But what is quality of care? To assess 'quality of care' it first has to be defined and that depends on whether one assesses only the performance of practitioners or also the contribution of patients and the health care system. As described by the American Medical Association, quality of care is "care that consistently contributes to the improvement or maintenance of quality and/or duration of life". Donabedian conceptualized quality of care as having an inter-related structure, process and outcome components. Structured such as for example 'staffing', process as actions on the patients such as for example restraint. And outcome indicators assess patient's end result such as for example falls.

Interprofessional collaboration as an intervention seems to result in a positive effect for health care outcomes. Nevertheless there is need for more concrete information on effect of interprofessional collaboration for chronic geriatric patients. Overall the positive effect of interprofessional collaboration as an intervention for chronic geriatric care is mainly found for outcomes such as fall incidence, transition, quality of life, medication change and costs. 2. Research question What are the effects of learning to collaborate according an interprofessional model on healthcare processes and outcomes for chronic geriatric patients in nursing homes? 3. Study objectives

3.1 Primary objective To investigate the effectiveness of learning to interprofessional collaborate on quality indicators of 'care and safety' (fall incidence, medication, hospital visits) and on quality indicators of 'caregivers and care organization' (absenteeism).