Partnered Evaluation Engages VA Employees in Interprofessional Training
Since 2010, VA has funded seven Centers of Excellence in Primary Care Education (COEPCEs) to create, evaluate, and disseminate innovative methods of interprofessional education. Through QUERI's new Partnered Evaluation Initiatives (PEIs), the COEPCEs and their coordinating office - the Office of Academic Affiliation - now collaborate with the Interprofessional Learning and Practice Partnered Evaluation Center (ILPPEC), based at the VA Portland Health Care System in Portland, Oregon. ILPPEC's cross-site evaluation of the COEPCE's innovations emphasizes action-oriented and realist approaches. Realist evaluation, with its focus on identifying "what works, for whom, in what circumstances?" is inherently suited to a collaborative evaluation process that includes program implementers - in this case, VA faculty educators and Patient-Aligned Care Teams (PACTs) - in making sense of what makes new interventions effective in a particular context.
The aim of the COEPCEs is to improve VA clinical training programs' abilities to deliver high-quality training and patient care that is organized around a focus on four core domains:
Focusing on these core domains aligns with VA's critical role in building the workforce of the future, both for VA and for primary care in general, which will require professionals with strong skills in team-based care and practice. The COEPCEs are developing curricular innovations that bring trainees from advanced practice nursing, health psychology, medicine, and pharmacy together in the clinical learning environment. As the work of the COEPCEs matures, the ILPPEC brings additional resources to take a comparative, cross-site look at both qualitative and quantitative data to understand how the COEPCEs' innovations work in different contexts and meet the diverse needs of different kinds of trainees. In defining the success of the COEPCE's innovations, ILPPEC is looking not just at trainee program impacts on patient care, but also on employee experience, satisfaction, and interest in primary care careers among trainees.
ILPPEC is engaging VA employees in its evaluation work in a number of ways, many of which build on and deepen approaches simultaneously emerging in the COEPCEs themselves. One key area has been the recognition of PACT clinical team members who are not academic teaching faculty as stakeholders whose experiences matter in the evaluation of COEPCE innovations. ILPPEC is developing quantitative and qualitative tools for data collection to ensure that PACT - team members have a voice in identifying what works well, and what doesn't within interprofessional trainee teams in academic PACT clinics. This complements work being done by the COEPCEs to expand inclusion of PACT team members in activities like trainee-led quality improvement projects and reaffirms the importance of all team members' contributions to positive patient outcomes and a fulfilling workplace experience.
Another way in which ILPPEC is engaging VA employees is through the creation of multi-site workgroups that include members from OAA's coordinating center as well as from each of the COEPCEs. In these workgroups, VA employees participate not just as "subjects" of the evaluation, from whom information is extracted, but as active collaborators in analyzing what the data from their sites mean in terms of identifying key contextual factors, facilitators and barriers to successful innovation, as well as potential for dissemination to other VA and non-VA sites. Workgroups are actively encouraged to include VA employees from a variety of clinical and administrative roles at the COEPCE sites. This deliberate focus on inclusivity creates a process better able to ensure that evaluation results will be relevant to a wide audience.
Anais Tuepker, PhD, MPH