Gastala Nicole M, Wingrove Peter M, Gaglioti Anne H, Liaw Winston, Bazemore Andrew
University of Illinois Health Mile Square Community Health Center, Chicago, IL.
Robert Graham Center, Washington, DC.
Fam Med. 2018 Jul;50(7):526-530. doi: 10.22454/FamMed.2018.459897.
Team-based care with health coaches has improved the quality and cost effectiveness of chronic disease management and prevention. Clinical health coaches partner with patients to identify health goals, create action plans, overcome barriers to change, reinforce physician recommendations, and coordinate care. It is important to train resident physicians to practice in team-based settings. To date, there have been no studies of resident family physician exposure to health coaches.
We surveyed 465 residency directors through a larger omnibus survey sent out by CERA; the response rate was 53.7%. Directors were asked about resident exposure to health coaches, the types of patients seen by health coaches, and the training background of the health coaches. We used chi-square tests to examine the relationship among these variables and program characteristics including status as a patient-centered medical home.
Almost two-thirds of the programs reported at least some residents had exposure to health coaches. Residents who trained in continuity sites with a PCMH certification of level 3 were more likely to have any exposure to health coaches (P<.05). There were multiple significant relationships between populations of patients seen and the training background of health coaches.
To improve quality, reduce costs, and become more patient centered, primary care is rapidly transforming into a team sport with a broadening roster of new players, including health coaches. This study documents positive rates of resident exposure to health coaches but also great variability in types and amount of exposure that merit further investigation and exploration of ways to grow family medicine residency contact with a diversifying practice team.
由健康教练提供的团队式照护已提高了慢性病管理与预防的质量及成本效益。临床健康教练与患者合作,以确定健康目标、制定行动计划、克服改变的障碍、强化医生的建议并协调照护。培训住院医师在团队式环境中执业很重要。迄今为止,尚无关于住院家庭医生接触健康教练的研究。
我们通过CERA开展的一项更大规模的综合调查对465名住院医师培训项目主任进行了调查;回复率为53.7%。向项目主任询问了住院医师接触健康教练的情况、健康教练所诊治患者的类型以及健康教练的培训背景。我们使用卡方检验来研究这些变量与项目特征(包括以患者为中心的医疗之家的状态)之间的关系。
近三分之二的项目报告称至少有一些住院医师接触过健康教练。在具有3级PCMH认证的连续性机构中接受培训的住院医师更有可能接触过健康教练(P<0.05)。所诊治患者群体与健康教练的培训背景之间存在多种显著关系。
为了提高质量、降低成本并更加以患者为中心,初级保健正在迅速转变为一项团队运动,新参与者的名单不断扩大,包括健康教练。本研究记录了住院医师接触健康教练的积极比例,但接触的类型和数量也存在很大差异,值得进一步调查,并探索增加家庭医学住院医师与多元化实践团队接触的方法。