Team-based Model Research Articles

Evaluating a multicomponent intervention for managing kidney outcomes among patients with moderate or advanced chronic kidney disease (CKD): protocol for the Strategies for Kidney Outcomes Prevention and Evaluation (SKOPE) randomized controlled trial

BackgroundChronic kidney disease (CKD) poses a global health challenge with high morbidity and mortality rates. Early detection and prompt intervention are critical in preventing progression to end-stage kidney disease (ESKD) and cardiovascular complications. Effective CKD management requires comprehensive care packages that integrate both pharmacological and non-pharmacological interventions within collaborative, team-based models, aiming to enhance patient outcomes and overall quality of life. The goal of the Strategies for Kidney Outcomes Prevention and Evaluation (SKOPE) study is to establish effective multicomponent intervention (MCI) strategies for evaluating and preventing kidney outcomes in patients with moderate to advanced CKD within primary care settings in Singapore.MethodsThis study is a 3-year randomized controlled trial among 896 participants aged between 40 and 80 years with moderate or advanced CKD in five government-subsidized polyclinics in Singapore. The components of the MCI are (1) nurses/service coordinators trained as health coaches for motivational conversation and CKD-specific lifestyle counseling on diet and exercise, using a hybrid follow-up approach of in-person, telephone, and secure video meetings; (2) training physicians in algorithm-based standardized management of CKD; (3) subsidy on SGLT2i medications for CKD; and (4) regular CKD case review meetings. The primary outcome is the estimated glomerular filtration rate (eGFR) total slope from randomization to final follow-up at 36 months.DiscussionIf shown to be effective, cost-effective, and acceptable, SKOPE should be considered for scaling country-wide and in similar regional healthcare systems.Trial registrationClinicalTrials.gov NCT05295368. Registered on March 25, 2022.

The effect of team-model on healthcare usage and treatment levels among people with type 2 diabetes

Abstract Background In North Karelia Finland, a team-based service model was implemented in some municipalities’ primary healthcare (PHC) centers during 2020. In this team-model, a healthcare customer contacts a nurse who initiates the service process immediately. Nurses can also consult or direct customers to other healthcare professionals and arrange physical appointments if needed. The aims of the model are improved customer and personnel experience and satisfaction, and improved quality and effectiveness of care. We assess the effect of this team-model on treatment levels, measurement activity, and health care usage among patients with type 2 diabetes (T2D). Methods Patients with T2D were identified using the ICD-10 code E11 from the regional electronic health records. The data include all patients diagnosed by 2016 who were alive and residing in North Karelia in 2023 (N = 6312). Diabetes-related contacts with nurses or doctors in outpatient PHC and specialized healthcare (SHC) were considered, along with measurement activity and levels of glycated hemoglobin (HbA1c) and low-density lipoproteins (LDL) between the years 2017 and 2022. Annual differences between areas were analyzed using logistic and linear mixed models. Results In 2017, patients’ mean age was 66 and age range 20-93. The proportion of men was 55% and 45% resided in team-model areas in 2023. The team-model increased T2D-related outpatient PHC remote contact with nurses for a couple of years. But eventually they decreased to a lower level than before. Additionally, the team-model reduced the number of other contacts. An increased difference between areas in measurement activity on HbA1c and LDL levels was also observed. But the difference between areas in proportion of those who achieved treatment targets stayed unchanged. Conclusions In the long-term, the team-model reduced the number of T2D-related contacts and increased the measurement activity of HbA1c and LDL, but it had no effect on treatment levels. Key messages • Team-based service models might potentially reduce service use in the long term. • More research and evidence are needed on the effectiveness and cost-effectiveness of team-based service models.

Evaluation and redesign of an internal medicine pharmacy practice model at a tertiary care hospital.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Clinical pharmacists are embedded into the care for patients admitted to internal medicine floors at Cleveland Clinic. The existing practice model utilized by the internal medicine pharmacy team had an uneven distribution of clinical activities among the various pharmacist roles. A study was completed to evaluate a potential adjustment to the pharmacy practice model. The objective of this study was to assess the type and quantity of clinical activities performed by each pharmacist role. These data were then utilized to evaluate the need for redistribution of care activities among the pharmacist roles and to determine the need for additional pharmacist full-time equivalents. From January to February 2023, data pertaining to the amount and type of clinical activities completed by the 9 internal medicine pharmacist roles was either manually collected or extracted from the electronic medical record. The data were then utilized to calculate a responsibility score for each role. Descriptive statistics were also calculated to assess the results. Each pharmacist role cared for an average of 34.4 patients (minimum, 24.4; maximum, 57.7) during the study period. The average responsibility score for each pharmacist role was 309.8 (minimum, 237.5; maximum, 447.8). On the basis of the data collected during the 4-week study period, a new pharmacy practice model was developed that incorporated 2 additional full-time equivalents. This model balanced patient care responsibilities among the pharmacist roles and moved the practice model from a location-based to a team-based coverage model.

Feasibility of a nurse-led, mHealth-assisted, and team-based collaborative care model for heart failure care in India: Findings from a multi-stakeholder qualitative study

Background Heart failure (HF) management is often challenging due to poor adherence to GDMT and self-care. Continuous monitoring of patients by a dedicated care manager may enhance adherence to self-care and treatment and prevent hospitalisations. For the adoption and acceptance of a collaborative care model (CCM) for HF management in Indian settings, understanding the perspectives of all stakeholders regarding its various components and feasibility is needed. Therefore, we aimed to obtain perceptions of potential challenges to care and suggestions on multiple components of the proposed CCM in managing HF and its feasibility. Methods In-depth interviews were done among HF patients, caregivers, nurses, and cardiologists from private, co-operative, and public sector tertiary care hospital settings that cater to HF patients in Kerala, India. An in-depth interview guide was used to elicit the data. Data were analysed using Python QualCoder version 2.2. We used a framework method for the analysis of data. Results A total of 22 in-depth interviews were conducted. We found that the existing care for HF in many settings was inadequate for continuous engagement with the patients. Non-adherence to treatment and other self-care measures, was noted as a major challenge to HF care. Healthcare providers and patients felt nurses were better at leading collaborative care. However, various barriers, including technical and technological, and the apprehensions of nurses in leading the CCM were identified. The stakeholders also identified the mHealth-assisted CCM as a potential tool to save money. The stakeholders also appreciated the role of nurses in creating confidence in patients. Conclusions A nurse-led, mHealth-assisted, and team-based collaborative care was recognised as an excellent step to improve patient adherence. Effective implementation of it could reduce hospitalisations and improve patients' ability to manage their HF symptoms.

WhatsApp Groups as a Team-Based Learning Model for Ayurveda Undergraduate Students

WhatsApp Groups as a Team-Based Learning Model for Ayurveda Undergraduate Students

The Organization of Academic General Internal Medicine Practice at the Top Primary Care Schools.

While prior studies have explored staffing infrastructure for primary care practices in general, little is known about the range of academic primary care practice models and supports available for academic general internists. To characterize the range of practice arrangements and expectations for attending academic physicians in general internal medicine (GIM) practices at the top 22 medical schools across the USA. Cross-sectional survey administered electronically between October 30, 2022, and December 28, 2022. Clinical leaders in GIM at the top 22 primary care medical schools, as identified by the 2023 US News and World Report Rankings. Clinical load, productivity expectations, cross-coverage, and team-based care models. Twenty-two leaders responded, representing 68% (15/22) of medical schools surveyed. The practices were mostly in urban locations (18/22, 82%) and 86% (19/22) included residents. Practices ranged from 7 to 200 PCPs and from 3 to 112 clinical FTEs. A full-time (1.0 FTE) clinical role for academic attending GIM physicians entailed a median of 9 (IQR 8, 10) weekly half-day clinic sessions, with a median panel size expectation of 1600 (IQR 1450, 1850) patients and a median yearly RVU expectation of 5200 (IQR 4161, 5891) yearly RVUs generated. Staff support was most commonly present for prescription refills and patient portal message checks. It was less commonly available for time sensitive form completion. Occasional clinical coverage for other physicians was an expectation at all practices. In this study, we characterize the organization of and supports available in academic GIM practices affiliated with the top primary care medical schools. Our findings provide comparative information for leaders of academic GIM practices seeking to enhance primary care delivery for their faculty and trainees. They also highlight areas where standardization may be beneficial across academic GIM.

Assessing the Impact of Multidisciplinary Cancer Consultations on Cancer Quality Metrics

Objective: Multidisciplinary cancer consultations play a critical role in the delivery of quality cancer care by promoting treatment planning and collaborative decision-making. The objective of this study was to evaluate associations between multidisciplinary cancer consultations and receipt of guideline-recommended adjuvant treatments among breast, colorectal, or non-small cell lung cancer patients and assess these associations between and within racial and ethnic groups. Materials and Methods: This is a population-based retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER), Medicare-linked data (2006–2016) to identify Medicare beneficiaries diagnosed with nonmetastatic breast, colorectal, or non-small cell lung cancer. Multidisciplinary cancer consultation was based on encounters with 2 or more oncology providers within 2 months of diagnosis. Cancer quality metrics assessed included receipt of guideline-recommended adjuvant cancer treatment for each cancer type. Results: Patients with multidisciplinary cancer consultations were more likely to receive adjuvant cancer treatment compared with patients without multidisciplinary cancer consultations within racial and ethnic groups. However, non-Hispanic Black and Hispanic breast cancer patients with multidisciplinary cancer consultations were 24% and 41% less likely to receive hormone and radiation therapy, respectively, compared with NHWs with multidisciplinary cancer consultations. Conclusions: Patients with multidisciplinary cancer consultations were more likely to receive adjuvant cancer treatment, but racial and ethnic disparities in cancer care persist. Multidisciplinary cancer consultations are likely an important, but not fully sufficient, contributor to the receipt of adjuvant cancer treatment and may be a tool in the implementation of multipronged, team-based cancer care delivery models to reduce inequities in cancer-related outcomes.

Characteristics of family physicians with additional training or focused practices in caring for older adults: Population-based retrospective cohort study.

To identify FPs with additional training and focused practice activities relevant to the needs of older patients within health administrative data and to describe their medical practices and service provision in community-based primary care settings. Retrospective cohort study. Ontario. Family physicians with Certificates of Added Competence in care of the elderly from the College of Family Physicians of Canada or focused practice billing designations in care of the elderly. Evidence of additional training or certification in care of the elderly or practice activities relevant to the care of older adults. Of 14,123 FPs, 242 had evidence of additional scope to better support older adults. These FPs mainly practised in team-based care models, tended to provide comprehensive care, and billed for core primary care services. In an unadjusted analysis, factors statistically significantly associated with greater likelihood of having additional training or focused practices relevant to the care of older patients included physician demographic characteristics (eg, female sex, having completed medical school in Canada, residential instability at the community level), primary care practice model (ie, focused practice type), primary care activities (eg, more likely to provide consultations, practise in long-term care, refer patients to psychiatry and geriatrics, bill for complex house call assessments, bill for home care applications, and bill for long-term care health report forms), and patient characteristics (ie, older average age of patients). The FP workforce with additional training or focused practices in caring for older patients represents a small but specialized group of providers who contribute a portion of the total primary care activities for older adults. Health human resource planning should consider the contributions of all FPs who care for older adults, and enhancing geriatric competence across the family medicine workforce should be emphasized.

Exploring innovative revenue-enhancing and cost-saving initiatives for medical practices

Health systems and medical groups are currently facing unprecedented challenges, including the highest inflation rates in four decades. These challenges are compounded by post-pandemic issues, such as the Great Resignation, staffing shortages, financial constraints and increased competition in new markets. Moreover, there is a pressing need to work towards achieving the Triple Aim of healthcare: improving the individual experience of care, enhancing population health and reducing per capita costs. Against this backdrop, this paper aims to explore successful strategies implemented by health systems and medical groups across the USA. It will highlight numerous initiatives focused on either enhancing revenue or reducing costs, all aimed at achieving long-term, sustainable outcomes. By drawing upon the experiences of high-performing healthcare organisations and medical groups, readers can gain insights into reimagining patient care delivery through effective dyad partnerships, innovative team-based care models and the cultivation of a positive organisational culture.

Implementing a team-based model of care in a rural hospital emergency department: An evidence-based practice strategy.

Implementing a team-based model of care in a rural hospital emergency department: An evidence-based practice strategy.

Advancing the Art and Science of Professional Nursing Practice With the Virtually Integrated CareSM Model.

The purpose of this article is to share the transformative vision of 2 nurse executives and how this vision paved the way for the development of a revolutionary model that changed care delivery. The CommonSpirit Health Virtually Integrated Care Team operationalized the vision by leveraging technology to develop a team-based care model that seamlessly integrates a virtual nurse as part of the care team. This article will discuss the spark that created the impetus for the creation of this metamorphic, interprofessional care delivery model and how this model unburdens the workload of the nurses to idealize the art and science of professional nursing practice.

A Team-Based Partner-Driven Model for Delivering Outpatient Exposure Treatment for Pediatric Anxiety and OCD

A Team-Based Partner-Driven Model for Delivering Outpatient Exposure Treatment for Pediatric Anxiety and OCD

Barriers and Facilitators to Staff Recruitment and Retention for ACT Teams: Perspectives of Staff and Participants.

The behavioral health workforce has been experiencing deepening problems with recruitment and retention, particularly in publicly funded settings serving individuals with serious mental illnesses. This quality improvement project gathered Assertive Community Treatment (ACT) participant (service user) and provider perspectives on workforce challenges. The authors conducted 8 interviews with ACT participants and 9 focus groups with ACT current staff, team leaders, and former staff. Interviewees discussed barriers to recruitment and retention, including inadequate compensation, work becoming more task-oriented during periods of short staffing, a lack of understanding of what ACT work entails, and elements of the team-based model of care; and facilitators of recruitment and retention, including other aspects of the team-based model of care, connections with colleagues and ACT participants, and flexibility. ACT participants had variable experiences regarding availability of their teams. Recommendations from focus groups and interviews include increasing flexibility, improving awareness of ACT work, optimizing team functioning, addressing staff wellness, and attending to risk. Findings include key insights that may help address the critical workforce shortages in public behavioral health settings.

Transformation of primary care settings implementing a co-located team-based care model: a scoping review

BackgroundIn Canada, primary care reforms led to the implementation of various team-based care models to improve access and provide more comprehensive care for patients. Despite these advances, ongoing challenges remain. The aim of this scoping review is to explore current understanding of the functioning of these care models as well as the contexts in which they have emerged and their impact on the population, providers and healthcare costs.MethodsThe Medline and CINAHL databases were consulted. To be included, team-based care models had to be co-located, involve a family physician, specify the other professionals included, and provide information about their organization, their relevance and their impact within a primary care context. Models based on inter-professional intervention programs were excluded. The organization and coordination of services, the emerging contexts and the impact on the population, providers and healthcare costs were analysed.ResultsA total of 5952 studies were screened after removing duplicates; 15 articles were selected for final analysis. There was considerable variation in the information available as well as the terms used to describe the models. They are operationalized in various ways, generally consistent with the Patient’s Medical Home vision. Except for nurses, the inclusion of other types of professionals is variable and tends to be associated with the specific nature of the services offered. The models primarily focus on individuals with mental health conditions and chronic diseases. They appear to generally satisfy the expectations of the overarching framework of a high-performing team-based primary care model at patient and provider levels. However, economic factors are seldom integrated in their evaluations.ConclusionsThe studies rarely provide an overarching view that permits an understanding of the specific contexts, service organization, their impacts, and the broader context of implementation, making it difficult to establish universal guidelines for the operationalization of effective models. Negotiating the inherent complexity associated with implementing models requires a collaborative approach between various stakeholders, including patients, to tailor the models to the specific needs and characteristics of populations in given areas, and reflection about the professionals to be included in delivering these services.

Designing Health Center Self-Measured Blood Pressure Program Models to Improve Hypertension Control

Summary: With the aim of achieving higher, equitable hypertension control rates, 350 nationwide federally qualified health centers implemented self-measured blood pressure programs (SMBP) over a three-year grant initiative. Various SMBP program designs with systematic processes, team-based care models, and culturally sensitive approaches with improved BP control are highlighted.

Use of an electronic wellness instrument in the integrated health and social care of older adults: a group concept mapping study

BackgroundHealth system fragmentation directly contributes to poor health and social outcomes for older adults with multiple chronic conditions and their care partners. Older adults often require support from primary care, multiple specialists, home care, community support services, and other health-care sectors and communication between these providers is unstructured and not standardized. Integrated and interprofessional team-based models of care are a recommended strategy to improve health service delivery to older adults with complex needs. Standardized assessment instruments deployed on digital platforms are considered a necessary component of integrated care. The aim of this study was to develop strategies to leverage an electronic wellness instrument, interRAI Check Up Self Report, to support integrated health and social care for older adults and their care partners in a community in Southern Ontario, Canada.MethodsGroup concept mapping, a participatory mixed-methods approach, was conducted. Participants included older adults, care partners, and representatives from: home care, community support services, specialized geriatric services, primary care, and health informatics. In a series of virtual meetings, participants generated ideas to implement the interRAI Check Up and rated the relative importance of these ideas. Hierarchical cluster analysis was used to map the ideas into clusters of similar statements. Participants reviewed the map to co-create an action plan.ResultsForty-one participants contributed to a cluster map of ten action areas (e.g., engagement of older adults and care partners, instrument’s ease of use, accessibility of the assessment process, person-centred process, training and education for providers, provider coordination, health information integration, health system decision support and quality improvement, and privacy and confidentiality). The health system decision support cluster was rated as the lowest relative importance and the health information integration was cluster rated as the highest relative importance.ConclusionsMany person-, provider-, and system-level factors need to be considered when implementing and using an electronic wellness instrument across health- and social-care providers. These factors are highly relevant to the integration of other standardized instruments into interprofessional team care to ensure a compassionate care approach as technology is introduced.

Substance use approaches among peer support specialists in community mental health early psychosis programs.

Substance use (SU) is common among adolescents and young adults, including those experiencing early psychosis. Coordinated Specialty Care (CSC), a community-based multidisciplinary team-based service model, is increasingly used to support people experiencing first-episode psychosis. In addition to prescribers, clinicians, and vocational specialists, CSC includes peer support specialists who use their own living/lived experience with mental health and treatment to engage and support young people with their recovery goals. Peer support is also foundational in SU recovery. However, little is known about how peer support specialists navigate client SU in CSC. The purpose of this article is to detail CSC peer support SU practice. Informed by community-based participatory research methods, a PhD-level qualitative researcher and a former peer support specialist conducted virtual interviews with 20 CSC peer support specialists. A multidisciplinary team including researchers with lived mental health experiences thematically coded interview transcripts. A spectrum of CSC peer support specialist SU responses emerged: (a) leverages lived SU experiences; (b) does not explore SU with clients; (c) shares client SU information with the CSC team; (d) educates, mentors, and advocates; (e) shares SU consequences and/or challenges substance use; (f) nonjudgmental, nondirective SU exploration; and (g) promotes harm reduction. CSC peer specialist SU practice is influenced by several contextual tensions that must be better understood and addressed in future research to improve peer SU practice. Study findings speak to practice nuances that are helpful for CSC peer support training and supervision. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

"I Felt Like I Mattered": Caring is a key ingredient of collaborative care for chronic illness.

To identify perceptions and experiences related to caring science and collaborative care in intervention participants of the Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) study, a randomized, multi-site clinical trial for patients with chronic heart failure and reduced health status. Forty-five participants completed semi-structured, telephone interviews with a focus on intervention components, impact of the intervention on participants' lives, and recommendations for intervention change. Data were analyzed using an inductive content analysis approach focusing on the presence and frequency of text to identify patterns, categories, and themes across participants without an a priori code book. The validity of the identified categories was enhanced through triangulation. Three themes were identified: (1) intervention providers' caring/helping attitude and caring/helping communication; (2) care team availability to respond to concerns or questions; and (3) help with understanding and navigating the healthcare system. Patients highly value caring attitudes and communication, availability, and empowerment to understand and navigate healthcare systems. These attitudes and behaviors may be important mediators of the success of collaborative care programs. These are consistent with the theory of caring science, a framework that is relevant more broadly to patient-centered and team-based care models.

Improved Patient Engagement and Cost Savings Through a Novel Medication Review Process.

Pharmacist-led interventions are pivotal in identifying and resolving potential adverse drug events (pADEs) while enhancing blood pressure control and medication adherence through educational and counseling interventions. This practice brief outlines the outcomes of the Blue Bag Initiative (BBI), which enhanced pharmacist-led comprehensive medication reviews (CMRs) across community pharmacies in Virginia under Center for Disease Control Cooperative Agreement NU58DP006535. BBI yielded a rate of 131.6 pADEs identified per 100 participants and demonstrated cost savings of 1 to 3 million dollars for the health care system. This report underscores the significance of a standardized, pharmacist-led CMR as integral to interdisciplinary team-based care models within physician practices, facilitating medication therapy management implementation. Enhanced CMR can improve cardiovascular health outcomes while reducing health care expenditures by augmenting patient engagement and medication adherence. This study thus highlights the efficacy and potential of pharmacist-led interventions in increasing access to and optimizing patient care.

The Arduous Path Toward Equitable Access to Endocrinology Care.

Multiple factors contribute to the widening gap between supply and demand of endocrinology services. In addition to the inadequate growth of the workforce, the inefficient utilization of endocrinologists' expertise coupled with the rising prevalence of endocrine conditions has generated a crisis in access to specialty care. This mismatch is magnified in underserved communities and among certain racial/ethnic groups that carry a disproportionate burden of chronic diseases, like diabetes and osteoporosis, thus perpetuating the cycle of health disparities in vulnerable populations. Reorienting the framework of endocrine care toward more effective and equitable access will require comprehensive changes in operational processes, system-based policies, and in the diversity of our workforce. Specifically, the progressive transition to outcome-driven, team-based models of care can extend endocrinology services beyond the traditional boundaries of in-office referrals and promote job satisfaction. Further, the implementation of policies that directly tackle structural determinants of health is a prerequisite to a more precise and equitable deployment of specialty care. In this view, the recruitment and professional growth of clinicians underrepresented in medicine along the career ladder, including leadership roles, is a key conduit to revitalize our field and to innovate the delivery of endocrine care across all communities.