Sinai Urban Health Institute, 1500 South Fairfield Avenue, Chicago, IL, 60608, USA.
Sinai Chicago, 1500 South Fairfield Avenue, Chicago, IL, 60608, USA.
BMC Health Serv Res. 2024 Jun 18;24(1):746. doi: 10.1186/s12913-024-11062-4.
Individuals facing socioeconomic hardship experience higher than average rates of chronic disease, such as diabetes, with less access to evidence-based treatment. One solution to address these inequities is a team-based care (TBC) model, defined as one in which at least two providers work collaboratively with a patient and their caregiver(s) to make healthcare decisions. This paper seeks to describe the implementation of a TBC model within a safety-net healthcare setting and determine the extent to which it can be an effective, patient-centered approach to treating individuals with diabetes.
Semi-structured interviews were conducted with staff (n = 15) and patients (n = 18). Clinical data were extracted from the electronic medical record of patients (n = 1,599) seen at a safety-net health system in Chicago, Illinois, United States. The mixed methods study was guided by implementation science and participatory research principles. Staff interviews were 60 min and covered patient care activities, work flow, perceived patient experience, and facilitators/barriers to care coordination. Patient interviews were 60 min and covered satisfaction, attitudes about diabetes management, quality of life, and technology. Patient interviews were co-analyzed by research staff and members of a patient advisory committee. Clinical data were collected at an index visit, two years prior and at one-year follow up (n = 1,599).
Four themes emerged from the interviews: (1) patients perceived the TBC model to be patient centered and of high quality; (2) technology can be an innovative tool, but barriers exist; (3) diabetes management is a complex process; and (4) staff communication enhances care coordination, but misinterpreting roles reduces care coordination. From pre-enrollment to the follow-up period, we found a statistically significant increase in missed visits, decrease in hemoglobin A1c (HbA1c), decrease in body mass index, and decrease in the percent of patients with high blood pressure. We found that each medical visit during the follow-up period was associated with an HbA1c decrease of 0.26 points.
A TBC model is a patient-centered approach to providing care to patients with complex health needs, such as diabetes, patients were satisfied with the care they were receiving, and the model was associated with an improvement in clinical outcomes.
面临社会经济困难的个体患慢性病（如糖尿病）的比例高于平均水平，获得循证治疗的机会也较少。解决这些不平等问题的一种方法是团队式护理（TBC）模式，这种模式定义为至少有两名医护人员与患者及其护理人员共同协作，做出医疗决策。本文旨在描述 TBC 模式在医疗保障体系中的实施情况，并确定其作为一种有效、以患者为中心的治疗糖尿病患者方法的程度。
对员工（n=15）和患者（n=18）进行半结构化访谈。从美国伊利诺伊州芝加哥一家医疗保障体系的电子病历中提取患者（n=1599）的临床数据。该混合方法研究以实施科学和参与式研究原则为指导。员工访谈时长为 60 分钟，涵盖患者护理活动、工作流程、感知患者体验以及护理协调的促进因素/障碍。患者访谈时长为 60 分钟，涵盖满意度、对糖尿病管理的态度、生活质量和技术。患者访谈由研究人员和患者咨询委员会成员共同进行分析。临床数据在索引就诊时、两年前和一年随访时（n=1599）收集。
访谈中出现了四个主题：（1）患者认为 TBC 模式以患者为中心且质量高；（2）技术可以是一种创新工具，但存在障碍；（3）糖尿病管理是一个复杂的过程；（4）员工沟通增强了护理协调，但角色误解会降低护理协调。从预登记到随访期间，我们发现错过就诊的比例显著增加，糖化血红蛋白（HbA1c）下降，体重指数下降，高血压患者比例下降。我们发现，随访期间每次就诊与 HbA1c 下降 0.26 点相关。
TBC 模式是为有复杂健康需求（如糖尿病）的患者提供护理的以患者为中心的方法，患者对他们所接受的护理感到满意，而且该模式与临床结果的改善相关。
