Healthc (Amst) - Flexible implementation and integration of new team members to support patient-centered care.

Tópicos

{ care(1570) inform(1187) nurs(1089) }
{ patient(2315) diseas(1263) diabet(1191) }
{ health(1844) social(1437) communiti(874) }
{ survey(1388) particip(1329) question(1065) }
{ import(1318) role(1303) understand(862) }
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{ model(2220) cell(1177) simul(1124) }
{ general(901) number(790) one(736) }
{ data(3963) clinic(1234) research(1004) }
{ system(1050) medic(1026) inform(1018) }
{ research(1218) medic(880) student(794) }
{ medic(1828) order(1363) alert(1069) }
{ result(1111) use(1088) new(759) }
{ can(774) often(719) complex(702) }
{ data(1737) use(1416) pattern(1282) }
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{ studi(1119) effect(1106) posit(819) }
{ blood(1257) pressur(1144) flow(957) }
{ record(1888) medic(1808) patient(1693) }
{ health(3367) inform(1360) care(1135) }
{ monitor(1329) mobil(1314) devic(1160) }
{ ehr(2073) health(1662) electron(1139) }
{ state(1844) use(1261) util(961) }
{ patient(2837) hospit(1953) medic(668) }
{ model(2656) set(1616) predict(1553) }
{ age(1611) year(1155) adult(843) }
{ signal(2180) analysi(812) frequenc(800) }
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{ group(2977) signific(1463) compar(1072) }
{ sampl(1606) size(1419) use(1276) }
{ gene(2352) biolog(1181) express(1162) }
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{ first(2504) two(1366) second(1323) }
{ intervent(3218) particip(2042) group(1664) }
{ activ(1138) subject(705) human(624) }
{ time(1939) patient(1703) rate(768) }
{ use(2086) technolog(871) perceiv(783) }
{ can(981) present(881) function(850) }
{ analysi(2126) use(1163) compon(1037) }
{ structur(1116) can(940) graph(676) }
{ cancer(2502) breast(956) screen(824) }
{ use(976) code(926) identifi(902) }
{ use(1733) differ(960) four(931) }
{ drug(1928) target(777) effect(648) }
{ decis(3086) make(1611) patient(1517) }
{ method(1969) cluster(1462) data(1082) }
{ detect(2391) sensit(1101) algorithm(908) }

Resumo

CKGROUND: Central to the patient-centered medical home model are high functioning interdisciplinary teams, which aim to improve care coordination and patient self-management of chronic conditions. We examined the facilitators and barriers of implementing a primary care team redesign intended to augment physician-medical assistant dyads by adding two new care team members - registered nurse care managers [NCM] and patient health coaches [PHC].METHODS: To assess respondents experiences of role integration, 22 key informant interviews were conducted of primary care physicians, NCMs, PHCs, and medical assistants at pilot practices (n=5). Additionally, a clinician and staff survey of 400 respondents was conducted at pilot and non-pilot (n=28) practices to contextualize the redesign results.RESULTS: Respondent experiences differed due to flexible protocols in program implementation, intended to allow each care teams approach to be site specific. Three sites struggled in developing processes that best used each new member, often due to poor comprehension of the members scope. Successful practices (n=2) reported increased team communication and functioning as a result of high physician engagement and local leadership facilitation.CONCLUSIONS: Flexible implementation protocols gave practice stakeholders significant discretion to integrate new care team roles to best fit local needs. The flexibility, however, created ambiguous expectations of the redesign, resulting in inconsistent implementation of key features of the intended redesign in some practices.IMPLICATIONS: When implementing primary care teams across practice networks, standardized scope of practice of personnel, common quality improvement priorities, and shared performance metrics may be helpful in disseminating effective redesign strategies.

Resumo Limpo

ckground central patientcent medic home model high function interdisciplinari team aim improv care coordin patient selfmanag chronic condit examin facilit barrier implement primari care team redesign intend augment physicianmed assist dyad ad two new care team member regist nurs care manag ncm patient health coach phcmethod assess respond experi role integr key inform interview conduct primari care physician ncms phcs medic assist pilot practic n addit clinician staff survey respond conduct pilot nonpilot n practic contextu redesign resultsresult respond experi differ due flexibl protocol program implement intend allow care team approach site specif three site struggl develop process best use new member often due poor comprehens member scope success practic n report increas team communic function result high physician engag local leadership facilitationconclus flexibl implement protocol gave practic stakehold signific discret integr new care team role best fit local need flexibl howev creat ambigu expect redesign result inconsist implement key featur intend redesign practicesimpl implement primari care team across practic network standard scope practic personnel common qualiti improv prioriti share perform metric may help dissemin effect redesign strategi

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