Friday, March 14, 2014

‘Teamwork Works’: Lessons Learned From the Front Line of Team-Based Care

This blog post first appeared on the Robert Wood Johnson Foundation Human Capital Blog.

As the patient-centered medical home (PCMH) has emerged as a model for providing effective team-based care that can help offset the impending primary care provider shortage, so, too, is there a growing need for educational strategies that promote interprofessional collaboration. A short report published online by the Journal of Interprofessional Care describes the strategies in place at the VA Connecticut Healthcare System Center of Excellence in Primary Care Education (CoEPCE) and indicates promising results in just one year: doubled productivity in patient care delivered by faculty providers, and a marked increase in same-day clinic access for patients receiving care from an interprofessional team.

The Connecticut CoEPCE, like four other program sites funded through the U.S. Department of Veterans Affairs Office of Academic Affiliations, builds on the VA’s system-wide PCMH model, known as Patient Aligned Care Teams (PACT). It seeks to develop exportable models of interprofessional education and patient care, according to the report, “Moving From Silos to Teamwork: Integration of Interprofessional Trainees Into a Medical Home Model.” The CoEPCE sites share four core curricular domains—shared decision-making, sustained relationships, interprofessional collaboration, and performance improvement—and the Connecticut center groups together physician, nurse practitioner (NP), pharmacy, and health psychology trainees.

The trainees divide their time evenly between interactive educational sessions and caring for patients, guided by faculty who provide supervision, mentorship, and collaborative shared care. Additionally, the Connecticut center incorporates a one-year post-master’s adult NP interprofessional clinical fellowship, to further enhance clinical proficiency and teamwork experience for NPs.

“The data behind teamwork are very powerful,” said the report’s lead author, Theodore Long, MD, an Robert Wood Johnson Foundation Clinical Scholar and one of the first physician residents at the CoEPCE in Connecticut, “but having strong data doesn’t necessarily mean that teamwork is universally appreciated. There can be uncertainty about the meaning and purpose of teamwork. Seeing it in action has made a big impression on me, and on other trainees, giving us all a personal understanding of what teamwork is about and why it’s crucial to promote it on a wide scale in health care.”

In addition to increases in productivity and clinic access, the report describes clinical innovations developed by trainees, including a tool for communicating about patients as trainees change rotations, and a tool focused on safe transitions of care for high-risk patients.

Long pointed out that the PCMH in the CoEPCE setting is geared toward specific needs of veterans, of course, and “there are different challenges in different populations.” There are also “financial challenges to implementing patient-centered medical homes in general,” he said. “In the VA environment, we were fortunate to have a strong degree of buy-in from leadership up front”—something the report emphasizes as important to the success of PCMHs.

“Our experience lends support to expansion of the PCMH model across care environments,” Long added. “Teamwork works, and let’s focus on that.”

Read the report “Moving From Silos to Teamwork.”

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