‘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.”

A Quick Round Up of Nurses Responses to The Supreme Court's Ruling on Health Care Reform

With the Supreme Court ruling to uphold the entire Patient Protection & Affordable Care Act (ACA), we thought it would be fitting to share with you some responses by nursing organizations across the country in response to this landmark ruling.

Ohio Nurses Association Questions Impact of Issue 3 with the Supreme Court's Decision to Uphold Health Care Reform

Last November, the citizens of Ohio voted in support of legislation (Issue 3) that said no law can force someone to have insurance, thus negating the individual mandate included in the ACA. The Ohio Nurses Association is now left wondering how will Ohio implement the provisions in the ACA and what effect will this have on the nursing workforce?

Nurse leaders happy with ruling on ACA

The ANA has touted the law’s potential to increase the profile of RNs in the healthcare system through new models such as accountable care organizations and medical homes. These models would rely on RNs’ expertise in care coordination, the ANA has said.

ANA Lauds Supreme Court Decision Upholding Health Care Reform Law

The American Nurses Association (ANA) lauds the U.S. Supreme Court's decision today to uphold the Affordable Care Act (ACA), including the "minimum coverage provision," hailing it as a victory for all patients and their families.

Nurses: 'Court Ruling Does Not End Healthcare Crisis Or the Need to Continue the Campaign for Reform'

The Supreme Court decision should not be seen as the end of the efforts by health care activists for a permanent fix of our broken healthcare system, said National Nurses United. The union pledged to step up a campaign for a reform that is not based on extending the grip of a failed private insurance system, but "on a universal program based on patient need, not on profits or ability to pay.

Pennsylvania's Nursing Homes Are in Crisis

Last week, Jim Hook, senior writer for PublicOpinionOnline.com, discussed in great detail how proposed Medicaid cuts in Pennsylvania will create a financially unsustainable environment for nursing home facilities. The proposed $102 million statewide cut in Medicaid funding would drastically effect the way in which care is delivered both inside and outside of these facilities, potentially resulting in home visits by case coordinators being drastically cut back. Mr. Hook does a fantastic job of covering numerous issues with the latest Medicaid cuts and we strongly encourage you to read the full article.

Click here to read the article.

New Jersey Nurses Train to Coordinate Their Patients' Care

Last week, Beth Fitzgerald, reporting for NJ Spotlight, discussed how new nurses are learning a variety of skills to act as population care coordinators. The program, which is a collaborative effort between Horizon Healthcare Innovations (HHI), Duke University School of Nursing and Rutgers University College of Nursing, emphasizes the importance of new nurses taking on the roles of coach and health advocate in order to improve coordinated follow-up and preventive and wellness care. The program is also based off of the patient-centered medical home model of care and focuses on patient engagement to improve the overall quality of care.

Click here to read more about the new initiative.

Patient-Centered Medical Home Poised to Transform Health Care

A recently released policy paper, written by the Urban Institute’s Robert Berenson, Kelly Devers and Rachel Burton, examines the promise of the medical home model of care and concludes it has the potential to transform health care delivery, but that organizations promoting the model should tread carefully. The paper reviews the positive feedback it has received but warns that providers, policy-makers and others should wait to implement it before evidence of the model’s effectiveness is available.

The paper notes that stakeholder organizations have yet to agree on a definition and set of standard components for a practice to be considered a medical home. The model is currently being tested in dozens of pilots nationwide that could answer questions about whether medical homes actually improve the quality of care and the health outcomes of patients, which components of the medical home model have the largest impact on these outcomes and what levels of reimbursement are needed to get providers to engage in the desired activities.

Click here to read a summary of the paper.

Click here to read the paper in its entirety.