Wagner Edward H, Flinter Margaret, Hsu Clarissa, Cromp DeAnn, Austin Brian T, Etz Rebecca, Crabtree Benjamin F, Ladden MaryJoan D
MacColl Center for Health Care Innovation, Group Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA.
Community Health Center, Inc., Middletown, CT, USA.
BMC Fam Pract. 2017 Feb 2;18(1):13. doi: 10.1186/s12875-017-0590-8.
Team-based care is now recognized as an essential feature of high quality primary care, but there is limited empiric evidence to guide practice transformation. The purpose of this paper is to describe advances in the configuration and deployment of practice teams based on in-depth study of 30 primary care practices viewed as innovators in team-based care.
As part of LEAP, a national program of the Robert Wood Johnson Foundation, primary care experts nominated 227 innovative primary care practices. We selected 30 practices for intensive study through review of practice descriptive and performance data. Each practice hosted a 3-day site visit between August, 2012 and September, 2013, where specific advances in team configuration and roles were noted. Advances were identified by site visitors and confirmed at a meeting involving representatives from each of the 30 practices.
LEAP practices have expanded the roles of existing staff and added new personnel to provide the person power and skills needed to perform the tasks and functions expected of a patient-centered medical home (PCMH). LEAP practice teams generally include a rich array of staff, especially registered nurses (RNs), behavioral health specialists, and lay health workers. Most LEAP practices organize their staff into core teams, which are built around partnerships between providers and specific Medical Assistants (MAs), and often include registered nurses (RNs) and others such as health coaches or receptionists. MAs, RNs, and other staff are heavily involved in the planning and delivery of preventive and chronic illness care. The care of more complex patients is supported by behavioral health specialists, RN care managers, and pharmacists. Standing orders and protocols enable staff to act independently.
The 30 LEAP practices engage health professional and lay staff in patient care to the maximum extent, which enables the practices to meet the expectations of a PCMH and helps free up providers to focus on tasks that only they can perform.
团队协作式医疗如今被视为高质量初级医疗的一项基本特征，但指导实践转变的实证证据有限。本文旨在通过对30家被视为团队协作式医疗创新典范的初级医疗实践进行深入研究，描述实践团队在配置与部署方面取得的进展。
作为罗伯特·伍德·约翰逊基金会的一项全国性项目“提升初级医疗水平（LEAP）”的一部分，初级医疗专家提名了227家创新型初级医疗实践机构。我们通过审查实践描述和绩效数据，挑选出30家机构进行深入研究。2012年8月至2013年9月期间，对每家机构进行了为期3天的实地考察，记录了团队配置和角色方面的具体进展。实地考察人员确定了这些进展，并在一次由30家机构的代表参加的会议上得到了确认。
参与“提升初级医疗水平（LEAP）”项目的实践机构扩大了现有员工的职责，并增加了新员工，以提供履行以患者为中心的医疗之家（PCMH）预期任务和职能所需的人力和技能。参与“提升初级医疗水平（LEAP）”项目的实践团队通常配备了丰富多样的员工，尤其是注册护士（RN）、行为健康专家和非专业健康工作者。大多数参与“提升初级医疗水平（LEAP）”项目的实践机构将员工组织成核心团队，这些团队围绕提供者与特定医疗助理（MA）之间的伙伴关系建立，通常还包括注册护士（RN）以及健康教练或接待员等其他人员。医疗助理（MA）、注册护士（RN）和其他员工深度参与预防和慢性病护理的规划与实施。行为健康专家、注册护士护理经理和药剂师为更复杂患者的护理提供支持。长期医嘱和诊疗规范使员工能够独立行动。
30家参与“提升初级医疗水平（LEAP）”项目的实践机构让医疗专业人员和非专业员工最大限度地参与患者护理，这使这些实践机构能够满足以患者为中心的医疗之家（PCMH）的期望，并有助于解放提供者，使其专注于只有他们才能执行的任务。
