Wang Emily S, Conde Michelle V, Simon Bret, Leykum Luci K
Audie L. Murphy Hospital Division, South Texas Veterans Health Care System, 7400 Merton Minter, Medicine Service, mail code 111, San Antonio, TX, 78229, USA,
J Gen Intern Med. 2014 Jul;29 Suppl 2(Suppl 2):S649-58. doi: 10.1007/s11606-013-2726-4.
End-of-residency transitions create disruptions in primary care continuity. The national implementation of Patient Aligned Care Teams (PACT) in Veterans Health Administration (VA) primary care clinics creates an opportunity to mitigate this discontinuity through the provision of team-based care.
To identify team-based solutions to end-of-residency transitions in a resident PACT continuity clinic by assessing the knowledge, attitudes, and perceptions of non-physician PACT members and resident PACT physicians.
Cross-sectional survey of 27 resident physicians and 24 non-physician PACT members in the Internal Medicine Clinic at the Audie L. Murphy VA Hospital in the South Texas Veterans Health Care System.
Twenty-seven residents and 24 non-physician PACT members completed the survey, with response rates of 90 % and 100 %, respectively. All residents and 96 % of non-physician PACT members agreed or strongly agreed that the residents were responsible for informing patients about end-of-residency transitions. Only 38 % of non-physician PACT members versus 52 % of residents indicated that non-physician PACT members should be responsible for this transition. Approximately 80 % of resident physicians and non-physician PACT members agreed there should be a formalized approach to these transitions; 67 % of non-physician PACT members were willing to support this transition. Potential barriers to team-based care transitions were identified. Major themes of write-in suggestions for improving the transition focused on communication and relationships between the patient and PACT and among the PACT members.
PACT implementation changes the roles and relationship structures among all team members. While end-of-residency transitions create a disruption in the relationship system, the remainder of the PACT may bridge this transition. Our results demonstrate the importance of a team-based solution that engages all PACT members by improving communication and fostering effective team relationships.
住院医师培训结束后的过渡会导致初级医疗连续性的中断。退伍军人健康管理局（VA）初级保健诊所全国范围内实施患者对齐护理团队（PACT），为通过提供基于团队的护理来缓解这种不连续性创造了机会。
通过评估非医师PACT成员和住院医师PACT医生的知识、态度和看法，确定在住院医师PACT连续性诊所中基于团队的住院医师培训结束后过渡的解决方案。
对南德克萨斯退伍军人医疗系统奥迪·L·墨菲VA医院内科诊所的27名住院医师和24名非医师PACT成员进行横断面调查。
27名住院医师和24名非医师PACT成员完成了调查，回复率分别为90%和100%。所有住院医师和96%的非医师PACT成员同意或强烈同意住院医师有责任告知患者住院医师培训结束后的过渡情况。只有38%的非医师PACT成员表示非医师PACT成员应负责这种过渡，而住院医师的这一比例为52%。大约80%的住院医师和非医师PACT成员同意应该有一个针对这些过渡的正式方法；67%的非医师PACT成员愿意支持这种过渡。确定了基于团队的护理过渡的潜在障碍。关于改善过渡的书面建议的主要主题集中在患者与PACT之间以及PACT成员之间的沟通和关系上。
PACT的实施改变了所有团队成员的角色和关系结构。虽然住院医师培训结束后的过渡会破坏关系系统，但PACT的其他部分可能会弥合这种过渡。我们的结果表明了一种基于团队的解决方案的重要性，该方案通过改善沟通和促进有效的团队关系来让所有PACT成员参与其中。
