Team Model Research Articles

Development of multiprofessional teamwork in Finnish health and social service centers, achievements, and challenges

In Finland all health and social services are moved from the responsibility of municipalities to Well-being service counties in 2023. The reform emphasizes service integration. At practical level Health and social service centers (HSS) are developed for the first contact points in Finland. Long waiting times, shortage of staff and lack of coordination have been major problems in primary care. As a solution, multiprofessional teams of both health and social care professionals in HSS centers and better collaboration between professionals have been built. This study explores, how the teams work and what challenges they have. 
 Methods: The study is based on 16 interviews of 25 managers and so far on 8 interviews of 10 employees (interviews are ongoing) in 5 HSS centers. The study is carried out in the territory of one future well-being services county, which launched the new organization beforehand. The county provided specialized care in the whole area. The primary care and social services were provided by the county in in two HSS centers. One HSS center was provided by a municipality, and two by a private firm. In the interviews the participants were asked about work organization and the functioning of the team model. The participants were GPs, registered nurses, psychiatric and substance abuse nurses, social workers and managers from different levels. The interviews were analyzed using content analysis. 
 Results: The core team in HSS centers consisted of GPs and nurses, but also of psychiatric and substance abuse nurses, social worker and physiotherapist. The managers saw the team work as functioning rather well. The waiting times had shortened clearly. But the team model was only a part of the changes done. Ehealth services were started at the same time by an outsourced organization, which lowered the demands in the HSS centers. An important part of the changes was the new care process which highlighted the effective telephone services. Nurses answered the phone and started the care process. It was possible to guide the client to laboratory or directly (without referral) to some other professional (such as physiotherapist) or to prescribe medicine at phone. This was possible, because one GP was working as consulting the nurses without own appointments. The new service model included the task shifting and strengthening the role of nurses. 
 Common facilities and close connection of all team members was seen as crucial as it enabled getting to know each other and the services they provided. In the teams the responsibility of care was on teams, not on single professionals. This raised a discussion of care continuity and due this of efficacy. The professionals saw it important to have one contact person for the client with chronic conditions. 
 Conclusions: Multiprofessional work can streamline and improve the treatment process, but eHealth and task shifting are needed too. Teamwork requires participatory development and getting to know each other. Easy consultation of GP’s is required for task shifting. Despite the benefits of teamwork care continuity must be taken into account. 

Healthy Aging in Algoma: Tests of Change Program

Introduction: In Algoma District, Ontario, Canada, approximately 25% of the population is 65 years of age and older. The Ontario Provincial Geriatrics Leadership Office (2020) predicts that by 2040 this number will increase to 32% and that 29% of older adults will be living with frailty. In February of 2022, Tests of Change (ToC) Program work commenced to bring an integrated care approach to healthy aging in Algoma. Healthcare member organizations of the Algoma Ontario Health Team (AOHT) and community patient, family, and caregiver advisors identified older adults living with frailty as the target population. A driver diagram of change ideas was conceptualized to support improving care for the identified population. To enact the recommended changes, three priority projects - Outpatient Geriatric Rehabilitation Capacity, Coordinated Access to Geriatric Services and Early Frailty Identification - complement each other with the common purpose of improving early frailty intervention and increasing access to the most appropriate care.
 Aims: The ToC Program entails:
 Embedding a frailty screening tool into electronic medical records for use in primary care;
 Initiating coordinated access to geriatric services leveraging eReferral and a common platform for electronic referral management; and
 Designing an outpatient geriatric rehabilitation program.
 This Program aims to advance the following elements:
 Design upstream engagement strategies (e.g., screening, prevention, disease self-management) for the target population;
 Increase patient access to the appropriate level of care; and
 Transform care coordination, transitions and recovery at home.
 Highlights: The AOHT has engaged partners from across the continuum of care who provide services for frail older adults. Partners include: community support services, home and community care support services, primary care, acute care, specialized geriatric services, and patient advisors. These critical partners assume leadership roles in program design, implementation and evaluation.
 Conclusions: Early frailty identification can improve quality of life, increase intervention success, and delay the need for specialist care. This program is predicated on the establishment of foundational processes enabled by digital tools to identify frailty early, streamline referrals for access to the most appropriate geriatric services, and provide patients with the opportunity to fully participate in interventions such as outpatient geriatric rehabilitation to increase their ability to live independently in the community. By taking an integrated collaborative approach to program planning and execution, overall patient outcomes will be improved.
 Transferability: The WHO Guidelines on Integrated Care for Older People (ICOPE) recommend advancing integrated care through community collaboration, a patient centered approach and supportive leadership. In 2019, the Ontario Health Team (OHT) model was introduced provincially as a way for healthcare providers to partner to deliver coordinated, integrated care. Of significance, several of the 54 approved OHTs have identified older adults living with frailty as a target population. Globally, as older adults are living longer lives, it is anticipated that there will be proportionally more older adults living with frailty. Through collaboration and sharing of the ToC program results, program scalability can be achieved at the OHT level and support the global knowledge base on efforts to strengthen integrated care for older adults.

Neighbourhood Care Teams: Integrating Health Care and Social Services for Seniors in Toronto Community Housing

Toronto Seniors Housing Corporation (TSHC), owned by the City of Toronto, provides housing for 15,000 low-income seniors in 83 seniors-designated buildings across Toronto. The North Toronto Ontario Health Team (including primary care, hospital, community and home-care) partnered with one of the TSHC buildings in North Toronto to develop and implement a Neighbourhood Care Team (NCT) model to support TSHC’s Integrated Service Model to address tenants' health and social needs, co-designed with the tenants. The goal of the NCT is to provide an integrated model of care that is accountable to meeting the needs of people living within a specific neighbourhood so that people experience one system that provides simple access to service, and care that is coordinated with streamlined communication of health care providers.
 The NCT objectives include:
 
 Increasing primary care provider connections
 Increasing mental health & addictions care access and support options
 Increase Digital Health access and literacy to support primary care and specialist access, reduce social isolation and increase wellness
 Reduce avoidable ED and hospital use.
 
 The service design is guided by a co-design process with the tenants as follows:
 
 Door to door survey to engage tenants in identifying their barriers and the services and supports most meaningful to them
 Eliciting and voting on key education and support initiatives at an influenza vaccination clinic
 Communication back to tenants regarding the results of the survey and how the strategies/activities planned for the building have been prioritized based on their feedback.
 Multi-organization Education Fair focusing on the top issues addressed during the vaccination clinic survey which was well attended
 Regular educational sessions in response to tenant interest, combined with a self-screening component to help link the information to a concrete service/intervention to promote better health.
 Providing translation support to enable access and engagement by tenants from a variety of cultural backgrounds.
 Ongoing commitment to continue and co-design services and elicit tenants’ feedback.
 
 The team has worked to design structures to strengthen coordination and collaboration among the various delivery partners:
 
 Multi-organizational bi-weekly huddles to discuss residents identified with unmet needs (with consent or anonymized without consent) and identify options for improving their access to health care/social services and respond to their needs in a timely manner
 Designed pathways for ensuring attachment to primary care, access to primary care and specialist support, access to home care services and assistance with social determinants of health
 Established mechanisms to obtain informed consent and enable information sharing between delivery partners.
 
 Multi-modality tenant engagement to tailor services and supports to a TSHC building has led to increased involvement by tenants and a growing interest by tenants in strategies to improve their health and social inclusion. Cross-sector collaboration is an efficient and effective way to establish needs-based integration of health and social care services in this setting. Strong leadership as well as co-developed processes, frequent building meetings and cross-sector huddles were effective ways of sharing innovative ways of meeting needs with limited resources.
 
 
 

Healthcare interventions to improve transitions from hospital to home in low-income countries: a scoping review of systematic reviews.

Background: The quality of transition from hospital to home is important for effective healthcare delivery. Hospital discharge is often associated with a lack of continuity that results in fragmented care. Over the past two decades, there have been sustained research activities with intervention addressing transitions. This has generated hundreds of primary studies and lots of systematic reviews. Most of the available guidelines are designed for developed countries. To our knowledge, no study has considered applicability of these interventions in the context of low-income countries.
 Objective: We aimed to determine the effectiveness of interventions for transition of care from hospital to home and informed about the relevance of the identified interventions to the context of low-income countries.
 Methods: A scoping review of systematic reviews and meta-analyses was performed. The scoping review followed the framework by Arksey and O’Malley. Interventions were classified into effective, ineffective, uncertain or undesirable, based on estimated effects of outcomes (readmission rate, mortality, cost, quality of life and adverse outcomes) and certainty of evidence. Authors from low income country assessed the relevance of the effective interventions for low-income countries using the SUPPORT summary criteria.
 Results and discussion: Of 3276 articles that were identified and 72 that were reviewed, a total of 10 were included in the scoping review. A total of 279 individual studies were included across all systematic reviews. Of the 279 trials, 250 (87%) were conducted in high-income countries, none in a low-income country. We created 16 summaries of finding tables. We found seven effective interventions, one ineffective and no intervention with undesirable effect. We were uncertain about the effect of eight interventions. The uncertainty is mainly caused by heterogeneity of included interventions and high risk of bias. The effective interventions were includes home visits, , self-management, virtual ward, case management model and multidisciplinary team models. The relevancy of these interventions to low-income countries is threatened by scarcity of human resources, telecommunication instability and anticipated inequality. 
 Conclusions: The wide variation in the type of interventions, outcomes, and study designs, suggests that caution be advised in attributing those interventions to all contexts. This study highlights the importance of studies that focus on in-depth understanding of the contextual factors influencing implementations and their dynamics.

Designing Human-Centered AI to Prevent Medication Dispensing Errors: Focus Group Study With Pharmacists.

Medication errors, including dispensing errors, represent a substantial worldwide health risk with significant implications in terms of morbidity, mortality, and financial costs. Although pharmacists use methods like barcode scanning and double-checking for dispensing verification, these measures exhibit limitations. The application of artificial intelligence (AI) in pharmacy verification emerges as a potential solution, offering precision, rapid data analysis, and the ability to recognize medications through computer vision. For AI to be embraced, it must be designed with the end user in mind, fostering trust, clear communication, and seamless collaboration between AI and pharmacists. This study aimed to gather pharmacists' feedback in a focus group setting to help inform the initial design of the user interface and iterative designs of the AI prototype. A multidisciplinary research team engaged pharmacists in a 3-stage process to develop a human-centered AI system for medication dispensing verification. To design the AI model, we used a Bayesian neural network that predicts the dispensed pills' National Drug Code (NDC). Discussion scripts regarding how to design the system and feedback in focus groups were collected through audio recordings and professionally transcribed, followed by a content analysis guided by the Systems Engineering Initiative for Patient Safety and Human-Machine Teaming theoretical frameworks. A total of 8 pharmacists participated in 3 rounds of focus groups to identify current challenges in medication dispensing verification, brainstorm solutions, and provide feedback on our AI prototype. Participants considered several teaming scenarios, generally favoring a hybrid teaming model where the AI assists in the verification process and a pharmacist intervenes based on medication risk level and the AI's confidence level. Pharmacists highlighted the need for improving the interpretability of AI systems, such as adding stepwise checkmarks, probability scores, and details about drugs the AI model frequently confuses with the target drug. Pharmacists emphasized the need for simplicity and accessibility. They favored displaying only essential information to prevent overwhelming users with excessive data. Specific design features, such as juxtaposing pill images with their packaging for quick comparisons, were requested. Pharmacists preferred accept, reject, or unsure options. The final prototype interface included (1) checkmarks to compare pill characteristics between the AI-predicted NDC and the prescription's expected NDC, (2) a histogram showing predicted probabilities for the AI-identified NDC, (3) an image of an AI-provided "confused" pill, and (4) an NDC match status (ie, match, unmatched, or unsure). In partnership with pharmacists, we developed a human-centered AI prototype designed to enhance AI interpretability and foster trust. This initiative emphasized human-machine collaboration and positioned AI as an augmentative tool rather than a replacement. This study highlights the process of designing a human-centered AI for dispensing verification, emphasizing its interpretability, confidence visualization, and collaborative human-machine teaming styles.

PENGARUH MODEL PEMBELAJARAN COOPERATIVELEARNING TIPE TEAMS GAMES TOURNAMENTS DIINTEGRASIKAN DENGAN MEDIA PUZZLE TERHADAP HASIL BELAJAR IPS SISWA SDN GUGUS II BENGKULU UTARA

ABSTRACTLearning Models of Teams Games Tournaments Type Integrated with Media Puzzles on student learning outcomes in social studies subjects of class V SDN Gugus II Bengkulu Utara. The type used is quantitative research. The method used is quasy experiment with research design The Matching Only Pretest-Postest Group Design. The population is SDN Gugus IIBengkulu Utara. The sampling technique uses cluster random sampling. The sample is B-accredited SDN and KTSP curriculum. Class V at SDN 090 with the number of students as many as 15 students as the experimental class and class V students at SDN 099 with the number of students as many as 15 students as the control class. The t-test results get tcount (4.132)> t table (1.666). The tcount obtained is higher than ttable, it can be concluded that there is a significant influence of the Cooperative Learning learning model Teams Games Tournaments Type Integrates With Media Puzzle on Social Studies learning outcomes of students in class V SDN Gugus II Bengkulu Utara.Keywords: Cooperative Learning Teams Games Tournaments Type, Media Puzzle, Social Studies Learning Outcomes

EVALUATING THE BEHAVIORAL RECOVERY OUTREACH (BRO) TEAM MODEL: TEAM MEMBERS’ PERSPECTIVES

Abstract The VA’s Behavioral Recovery Outreach (BRO) Team model seeks to address the unmet needs of aging Veterans with complex behavioral, psychological, neurocognitive, and medical concerns. Consisting of a core team of a social worker, nurse, and psychologist, BRO teams collaborate with the broader VA Community Living Center or inpatient team on behavioral assessment and treatment planning to help stabilize the Veterans’ behaviors and ready them for discharge to the community. Then, upon discharge the BRO Team provides ongoing behaviorally focused transitional support services to help ensure the Veterans’ sustained stability in the community and prevent unnecessary rehospitalizations. While dissemination efforts have demonstrated positive clinical outcomes for the Veterans served, little was known about the factors that support or hinder successful implementation of this complex program. This paper presents results from qualitative interviews with ten members from seven BRO Teams (out of ten active teams at the time) undertaken in late 2021 as part of a larger BRO program evaluation. The BRO Team model, including the goals and core components of BRO, are defined. Determinants of successful BRO implementation and team operations, including staffing, inter-departmental relationships, model clarity, and support, are described. BRO Team members’ views of the impact on and response of BRO recipients (BRO-enrolled Veterans, family members, and VA and community care partners), such as helping family members understand dementia, assistance with navigating the VA system, and support with behavioral health care planning and modification leading up to and following transitions to community care, are also detailed.

ENHANCING CARE FOR OLDER VETERANS WITH COMPLEX PHYSICAL, COGNITIVE, AND PSYCHOLOGICAL COMORBIDITIES

Abstract Older veterans present in healthcare settings with more diagnoses than younger veterans and non-veteran older adults. Older veterans are also more likely to present with co-occurring physical, cognitive, and psychological conditions that are difficult to assess and treat. This is further complicated by the fact that many older veterans reside in rural areas without easy access to specialty care and, even in non-rural settings, there is a dire shortage of providers with geriatric expertise both within and outside of the Veterans Health Administration (VHA) system. The current symposium highlights promising findings from a variety of VHA programs aimed at enhancing the quality and reach of care provided to older veterans with complex needs. First, Dr. Bamonti will present mixed-methods results from her work in the development of Step-Cognitive Behavioral Therapy, a novel virtual intervention for older veterans with COPD. Second, Ms. Carlson will describe program evaluation outcomes from a project aimed at expanding geriatric mental health services via telehealth to older veterans with complex needs residing in rural areas. Third, Dr. Peeples will discuss factors affecting the implementation of the VA Behavioral Recovery Outreach Team model, which is aimed at facilitating successful discharge from inpatient settings and preventing rehospitalization for older veterans. Finally, Dr. Gregg will describe qualitative findings examining a component of the Geriatric Scholars Program for Psychologists, a national post-licensure training program for psychologists treating older rural veterans with complex needs. Dr. Karel, National Director of VHA Geriatric Mental Health, will close with discussion and highlight future directions.

Closing the Gaps in Care of Dyslipidemia: Revolutionizing Management with Digital Health and Innovative Care Models.

Although great progress has been made in the diagnostic and treatment options for dyslipidemias, unawareness, underdiagnosis and undertreatment of these disorders remain a significant global health concern. Growth in digital applications and newer models of care provide novel tools to improve the management of chronic conditions such as dyslipidemia. In this review, we discuss the evolving landscape of lipid management in the 21st century, current treatment gaps and possible solutions through digital health and new models of care. Our discussion begins with the history and development of value-based care and the national establishment of quality metrics for various chronic conditions. These concepts on the level of healthcare policy not only inform reimbursements but also define the standard of care. Next, we consider the advances in atherosclerotic cardiovascular disease risk score calculators as well as evolving imaging modalities. The impact and growth of digital health, ranging from telehealth visits to online platforms and mobile applications, will also be explored. We then evaluate the ways in which machine learning and artificial intelligence-driven algorithms are being utilized to address gaps in lipid management. From an organizational perspective, we trace the redesign of medical practices to incorporate a multidisciplinary team model of care, recognizing that atherosclerotic cardiovascular disease risk is multifaceted and requires a comprehensive approach. Finally, we anticipate the future of dyslipidemia management, assessing the many ways in which atherosclerotic cardiovascular disease burden can be reduced on a population-wide scale.

Penerapan Model Pembelajaran Quiz Team Untuk Meningkatkan Hasil Belajar Siswa Pada Mata Pelajaran Geografi Kelas X Di MAN 8 Jombang

This research is motivated by the tendency of students to pay attention to the teacher when explaining the material, the low activity of students in re-explaining the material that has been conveyed by the teacher this is due to the low learning outcomes of students, so this can affect the learning outcomes obtained from the cognitive domain, psychomotor domain, students' affective domain. Therefore, by applying the quiz team learning model, students are expected to grow maximum learning outcomes. The focus of the research is: (1) What are the steps for implementing geography learning using the quiz team model to improve the learning outcomes of class X students at MAN 8 Jombang?, (2) What are the supporting and inhibiting factors in implementing geography learning using the quiz team model? to improve the learning outcomes of class X students at MAN 8 Jombang?, (3) What is the impact of implementing Geography learning using the quiz team model to improve student learning outcomes at MAN 8 Jombang?, The research objectives (1) To find out how the implementation steps Geography learning by using the Quiz Team model to improve student learning outcomes at MAN 8 Jombang, (2) To find out the supporting factors and inhibiting factors in the implementation of Geography learning by using the Quiz Team model to improve class X student learning outcomes at MAN 8 Jombang, (3 ) To find out how the impact of implementing Geography learning by using the quiz team model to improve student learning outcomes in class X at MAN 8 Jombang. This research uses a qualitative approach to the type of descriptive research. Descriptive research is presented in the form of words found from observations which are then analyzed, interpreted, and drawn a conclusion. The population in this study were students of class X IPS 3 MAN 8 Jombang and school residents. Data collection techniques using interviews, observation, and observation. The results of the research were taken from the conclusions which showed that the application of the quiz team learning model could improve student learning outcomes which would later influence student learning outcomes to be more optimal.

The Aortic Team Model for the Management of the Distal Arch, Descending Thoracic and Thoracoabdominal Aorta: Appraisal at 3 Years.

This study aimed to assess feasibility, logistical challenges, and clinical outcomes associated with the implementation of an Aortic Team model for the management of distal arch, descending thoracic and thoracoabdominal aortic disease. An Aortic Team care pathway was implemented in November 2019. Working as a unit, two cardiac surgeons, two vascular surgeons, an interventional radiologist, a cardiologist, and an anesthesiologist collectively determined care decisions via multispecialty presence at an Aortic Clinic. Cardiac and vascular surgeons operated in tandem for open procedures. Interventional radiology participated alongside cardiac and vascular for endovascular procedures. Cardiology aided in medical therapies for heritable and degenerative disease, and had a lead role for genetics and high-risk pregnancy referrals. The model spanned three hospitals. Clinical outcomes at 3 years were assessed. There were 35 descending thoracic and thoracoabdominal surgeries and 77 thoracic endovascular aortic repairs. Endoarch devices were used in 7 cases (Gore Thoracic Branch Endoprosthesis, 4, Terumo RelayBranch, 3) and an endothoracoabdominal device in 4 cases (Cook Zenith t-branch). The Aortic Clinic acquired 456 patients, with yearly increases (54 patients [year 1], 181 patients [year 2], 221 patients [year 3]). For surgery, mortality was 8.6% (3/35), permanent paralysis 5.7% (2/35), stroke 8.6% (3/35), permanent dialysis 0%, and reinterventions 8.6% (3/35). For endovascular cases, mortality was 3.9% (3/77), permanent paralysis 3.9% (3/77), stroke 5.2% (4/77), permanent dialysis 1.3% (1/77), and reinterventions 16.9% (13/77). An Aortic Team model is feasible and ensures all treatment options are considered. Conventional open thoracoabdominal procedures showed acceptable outcomes. Endoarch technology shows early promise.

Breast Cancer Screening Among Females With and Without Schizophrenia

Breast cancer screening with mammography is recommended in Ontario, Canada, for females 50 years or older. Females with schizophrenia are at higher risk of breast cancer, but in Ontario it is currently unknown whether breast cancer screening completion differs between those with vs without schizophrenia and whether primary care payment models are a factor. To compare breast cancer screening completion within 2 years after the 50th birthday among females with and without schizophrenia, and to identify the association between breast cancer screening completion and different primary care payment models. This case-control study analyzed Ontario-wide administrative data on females with and without schizophrenia who turned 50 years of age between January 1, 2010, and December 31, 2019. Those with schizophrenia (cases) were matched 1:10 to those without schizophrenia (controls) on local health integration network, income quintile, rural residence, birth dates, and weighted Aggregated Diagnosis Group score. Data analysis was performed from November 2021 to February 2023. Exposures were schizophrenia and primary care payment models. Outcomes included breast cancer screening completion among cases and controls within 2 years after their 50th birthday and the association with receipt of care from primary care physicians enrolled in different primary care payment models, which were analyzed using logistic regression and reported as odds ratios (ORs) and 95% CIs. The study included 11 631 females with schizophrenia who turned 50 years of age during the study period and a matched cohort of 115 959 females without schizophrenia, for a total of 127 590 patients. Overall, 69.3% of cases and 77.1% of controls had a mammogram within 2 years after their 50th birthday. Cases had lower odds of breast cancer screening completion within 2 years after their 50th birthday (OR, 0.67; 95% CI, 0.64-0.70). Cases who received care from a primary care physician in a fee-for-service (OR, 0.57; 95% CI, 0.53-0.60) or enhanced fee-for-service (OR, 0.79; 95% CI, 0.75-0.82) payment model had lower odds of having a mammogram than cases whose physicians were paid under a Family Health Team model. This case-control study found that, in Ontario, Canada, breast cancer screening completion was lower among females with schizophrenia, and differences from those without schizophrenia may partially be explained by differences in primary care payment models. Widening the availability of team-based primary care for females with schizophrenia may play a role in increased breast cancer screening rates.

The Effect of Comprehensive Leadership Style on Team Performance: The Role of Promoting A Team's Innovation Culture

Objective: Inclusive leadership style is considered an effective leadership method in any organization. The aim of this study is to its impact on project team performance, a common form of outsourcing in Hanoi, Vietnam. While also considering the mediating role of innovation culture in this relationship. Method: The study provides empirical evidence from a sample of 876 project team members at outsourcing companies in Hanoi by evaluating the measurement model and testing the structural equation model (PLS-SEM). Results: The results of empirical research show that innovation culture has an important role in mediating the relationship between inclusive leadership style and team performance. In addition, innovation culture also positively affects individual creativity, thereby helping to improve work results in teams. From there, it shows the need to build an innovation culture framework that includes people, process, data, and technology aspects to evaluate the innovation approach of enterprises. Finally, some implications of working group governance and team leadership are discussed, such as increasing the application of collaboration technologies, the stronger establishment of the virtual team model, and digital leadership orientation. There are ways to promote and strengthen a culture of innovation in IT businesses to reach maturity in digital transformation and how to respond to challenges for faster recovery in today's context. Conclusions: The regression model showed a significant relationship between leadership style and team performance, leadership style and innovation culture, and innovation culture and team performance. The study provided policy recommendations to support leadership style and team performance.

Understanding Human-Autonomy Teams Through a Human-Animal Teaming Model.

The relationship between humans and animals is complex and influenced by multiple variables. Humans display a remarkably flexible and rich array of social competencies, demonstrating the ability to interpret, predict, and react appropriately to the behavior of others, as well as to engage others in a variety of complex social interactions. Developing computational systems that have similar social abilities is a critical step in designing robots, animated characters, and other computer agents that appear intelligent and capable in their interactions with humans and each other. Further, it will improve their ability to cooperate with people as capable partners, learn from natural instruction, and provide intuitive and engaging interactions for human partners. Thus, human-animal team analogs can be one means through which to foster veridical mental models of robots that provide a more accurate representation of their near-future capabilities. Some digital twins of human-animal teams currently exist but are often incomplete. Therefore, this article focuses on issues within and surrounding the current models of human-animal teams, previous research surrounding this connection, and the challenges when using such an analogy for human-autonomy teams.

Evaluating Web-Based Care for Mental Health and Substance Use Issues for Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, and 2-Spirit Youths in the Context of the COVID-19 Pandemic: Community-Based Participatory Research Study.

Mental health (MH) and substance use (SU) care supports are often difficult to access for the lesbian, gay, bisexual, transgender, queer, questioning, and 2-spirit (LGBTQ2S+) population. There is little known on how the shift to web-based care has affected and changed the experiences of LGBTQ2S+ youths within the MH care system. This study sought to examine how web-based care modalities have affected access to care and quality of care for LGBTQ2S+ youths seeking MH and SU services. Researchers used a web-based co-design method to explore this population's relationship with MH and SU care supports, focusing on the experiences of 33 LGBTQ2S+ youths and their relationship with MH and SU supports during the COVID-19 pandemic. A participatory design research method was used to gain experiential knowledge of LGBTQ2S+ youths' lived experience with accessing MH and SU care. Thematic analysis was used to examine the resulting audio-recorded data transcripts and create themes. Themes related to web-based care included accessibility, web-based communication, provision of choice, and provider relationship and interactions. Barriers to care were identified in particular for disabled youths, rural youths, and other participants with marginalized intersecting identities. Unexpected benefits of web-based care were also found and emphasize the idea that this modality is beneficial for some LGBTQ2S+ youths. During the COVID-19 pandemic, a time where MH- and SU-related problems have increased, programs need to reevaluate current measures so that the negative effects of web-based care modalities can be reduced for this population. Implications for practice encourage service providers to be more empathetic and transparent when providing services for LGBTQ2S+ youths. It is suggested that LGBTQ2S+ care should be provided by LGBTQ2S+ folks or organizations or service providers who are trained by LGBTQ2S+ community members. Additionally, hybrid models of care should be established in the future so that LGBTQ2S+ youths have the option to access in-person services, web-based ones, or both as there can be benefits to web-based care once it has been properly developed. Implications for policy also include moving away from a traditional health care team model and developing free and lower-cost services in remote areas.

Patient perspectives of recovery following major musculoskeletal trauma: A systematic review and qualitative synthesis

Background Improved survival following major trauma has resulted in an increased number of patients with complex physical, functional and psychosocial needs requiring specialist multidisciplinary rehabilitation. A key challenge in modern trauma care is to deliver rehabilitation interventions that translate into improved outcomes. This study aimed to synthesise patient perceptions of recovery following major musculoskeletal trauma. Methods A pre-planned literature search (CINAHL, Medline, Embase, PsychInfo, and other sources) was performed 28/02/22–03/03/22 (updated 29/3/23–17/4/23 prior to submission) to capture all available qualitative or mixed methods studies describing major musculoskeletal trauma recovery from the patient perspective. Quality assessment was performed using the Joanna Briggs evaluation tool and the mixed methods appraisal tool. The qualitative data was thematically analysed. Findings Of 5648 distinct studies, 18 studies met the criteria for inclusion totalling 637 participants. Thematic analysis of the qualitative data found that recovery following major musculoskeletal trauma has physical, psychological and socio-functional dimensions. Successful recovery involves ‘crafting a new normal’ and is both a process and an outcome. Three major themes were identified: vulnerability; learning to manage; adaptation and adjustment. Patients do not experience each theme in a linear way; instead, they move through the recovery process in an individualised and cyclical manner. Conclusion This review highlights the individual experience of recovery, which requires flexible and holistic care to facilitate an occupational (or socio-functional) perspective on major musculoskeletal trauma recovery. Therefore, organisationally, an effective multi-disciplinary team model of care is essential to support survival as a long-term condition.

Abstract 18110: Assessing the Impact of a Multidisciplinary Cardio-Kidney Care Team on the Overall Care Satisfaction in Patients With Heart Failure With Reduced Ejection Fraction And Chronic Kidney Disease

Background: Patients with heart failure with reduced ejection fraction (HFrEF) and chronic kidney disease (CKD) experience fragmented care in the usual referral-based model given poor care coordination between subspecialists and primary care clinicians (PCCs). Multidisciplinary specialty care teams can improve care coordination, increase use of guideline-directed medical therapies (GDMT), and potentially increase patient satisfaction. Methods: We conducted a randomized controlled trial in a single-center tertiary care institution, enrolling patients with both HFrEF (ejection fraction <50%) and CKD (stages 2-5, not on hemodialysis) over 6 months. The patients’ PCCs were randomized to either the control arm in which usual care was continued, or to the treatment arm where PCCs were supported by a virtually organized cardio-kidney team with a heart failure specialist and nephrologist. Treatment arm PCCs received recommendations from the cardio-kidney team via electronic medical record secure messaging sharing guidance on GDMT use, necessary lab tests, etc. Patients’ quality of life and symptoms were assessed at both baseline and 3 months via the Kidney Disease Quality of Life (KDQoL) survey and Kansas City Cardiomyopathy Questionnaire (KCCQ), respectively. Results: 95 patients had 3 month follow-up data (treatment n=47, control=48). The mean patient age was 67.4±10.8, and 61% were male. The majority (76%) were African American with mean EF of 35.5 ±11.0. The treatment group had higher reported and clinically significant (>at least a 5-point change) improvement of KCCQ scores from baseline to 3 months (52%) compared to the control group (38%), however, this was not statistically significantly different (p=0.15). Meanwhile, the proportion of deterioration was 39% and 40% in the treatment and control groups, respectively. There were no significant differences in KDQOL scores between or within both groups when comparing the baseline to 3 month data. Conclusion: Implementing a multidisciplinary care team to support PCCs is a feasible intervention and at 3 months, there was an increase (although statistically insignificant) in KCCQ scores. A longer duration of follow-up may be better able to assess the effects of multidisciplinary care team models.

Abstract 325: Two-Year Outcomes of an Electronic Health Record Integrated Rapid Response Team Model

Background: Literature supports improved patient outcomes with dedicated resources for rapid response to patient deterioration in inpatient settings. However, studies of the association of centralized resource allocation and electronic health record (EHR) integration on patient outcomes are lacking. Aim: To improve early, centralized rapid response to patient deterioration and reduce unanticipated transfers to the ICU. Methods: Using a prospective longitudinal quality improvement design, we implemented a centralized, EHR supported patient response team (PRT) at an academic medical center in the southeastern United States. The model served 1,043 inpatient beds. Pre-intervention the PRT used episodic data capture and included 1 critical care RN, 1 physician, and 1 respiratory therapist; each expected to leave assigned patients to respond to non-ICU events. We implemented a dedicated PRT (4 critical care RNs and 1 hospitalist) to provide 24/7 response to code blue, RRT, and stroke code events. The team provided proactive rounding, preventive consultation, and assessment of patients from ICU or emergency within 24 hours. Standardized workflow and outcome documentation was integrated in the EHR. Improvement in processes and outcomes were analyzed using statistical process control charts with 25 data points over a 2-year period. Results: At baseline (FY 2020), the PRT responded to 1739 rapid response calls and 166 code blue events. Unanticipated transfer to ICU occurred in 935 (53.8%) patients. Post-implementation of the integrated PRT model, the rate of early rapid response calls improved (FY 2021 n=2099; FY 2022 n=2239), code blue events decreased (FY 2021 n=151; FY 2022 n=115), and unanticipated ICU transfers also decreased (25%; Figure 1). Conclusions: A centralized PRT model using technology-supported EHR integration, pre-defined workflows, and a dedicated team can reduce non-ICU cardiac arrests and decrease unanticipated transfers to ICU.

THE METHOD OF FORMING THE CREATIVE TEAM OF IT PROJECT

The specificity of project team formation is determined by the development of project management concepts, changes in society and in production. Management processes that are related to the human factor are a constant subject of interest for scientists. For effective management of IT projects, qualified people with certain competencies are needed, who create the core of the team in order to fulfill the assigned tasks. The future of the project will depend on how efficiently and "correctly" the team will be formed. The work offers the author's vision of the team formation procedure based on competence, psychological and quantitative criteria, taking into account the features of IT projects with a high degree of innovation, which require flexible management tools and self-managed, self-organizing teams. The task of forming a minimally viable IT project team is proposed to be solved by expanding the range of competencies of each member of the project team under the condition of minimizing its quantitative composition. The minimum complete team model of Raymond M. Belbin (idea generator, critic, and executor) was adopted as the basis for the formation of the IT project team. The application of a creative approach to the management of innovative IT projects, namely the design thinking technique, requires the allocation of an additional role - an empath. The generalized method of forming an IT project team with a high degree of innovation, which will use design thinking technology as a leading technology for software product development, is presented in the form of an algorithm.

Evaluating Inpatient Care Team Models in Hematology and Oncology Fellowship Programs in the United States

Introduction. In response to a growing and increasingly older population with complex medical needs, the hematology and oncology (HO) care system has integrated the hospitalist model into inpatient systems alongside HO trainees and faculty. The inclusive workforce is comprised of hospitalists and advanced practice providers (APPs) who co-manage patients with specialists or form separate non-trainee (NT) teams. Despite multiple advantages of the hospitalist model, the optimal care team structure and the impact on HO fellowship training have not been previously explored. We aimed to survey HO fellowship programs in the United States to identify the structure of inpatient HO staffing models implemented at their institution, and collect data on perceptions of the NT model within the fellowship programs. Methods. We constructed and distributed two national web-based surveys targeting all adult HO fellowship program directors (PDs) and fellows from Accreditation Council for Graduate Medical Education (ACGME)-accredited programs. The surveys were designed to assess various aspects of HO inpatient services, including team compositions, individual responsibilities, and availability of NT services. We also assessed the PDs' and fellows' perception on the impact of NT teams on their training and education. The surveys were emailed weekly between 6/20/23-7/29/23. Results.We identified 147 HO training programs.A total of 35 PDs and 101 fellows responded our survey (Table 1). The majority of PDs (83%) were from university training programs in the Midwest (43%) and Northeast (33%), with fellow class sizes of 6-12 (47%). Most (67%) programs had both trainee (T) and NT teams included in their inpatient medicine models (Figure 1). The most commonly reported NT team was the bone marrow transplant and cellular therapy service (BMT) (57%), supported primarily by APPs (55%). Only 33% of respondents reported a dedicated sickle cell disease (SCD) inpatient team within their institution. Hospitalists were included in the care model of the inpatient oncology (27%), inpatient malignant hematology (23%) and SCD (13%) teams. Most PDs agreed that the fellows are primarily responsible for most inpatient tasks and over 50% agreed that APPs are responsible for direct patient care, admissions and discharge planning. 83% of PDs reported that their program had an appropriate balance between inpatient and outpatient care. Half (50%) of PDs reported that fellows had a positive perception of NT teams at their institution, and 35% were neutral. The fellows who responded were predominantly second-year fellows (43%) in Northeastern (43%) university hospitals (92%) from programs with 6-12 fellows (63%). Most (71%) respondents had both T and NT teams included in their inpatient model. Inpatient malignant hematology (53%) and inpatient solid oncology (53%) teams were the most commonly reported NT teams, followed by BMT (40%) (Figure 1). Fellows reported their primary responsibilities to include procedures and tumor board discussions (94%), communication with outpatient teams (91%) and resident education and supervision (89%). APPs were primarily responsible for discharge planning (63%), admissions (59%) and direct patient care (58%). Most (85%) fellows agreed that their program had an appropriate balance between inpatient and outpatient care. Most fellows (69%) reported the impact of NT teams on fellows' inpatient and training experience to be neutral. Fellows from institutions without NT teams responded that the addition on NT team would have a positive impact in their training experience (69%). Most PDs and fellow respondents perceived a financial barrier to the implementation of NT teams at their institutions. Conclusions.Our findings highlight the existing heterogeneity in the distribution and composition of services among HO programs nationwide. PD respondents and fellows without NT teams perceived these teams as a beneficial addition to the program, in contrast to fellows in programs with existing NT teams who reported a neutral impact. Further investigation of the reasons for this discrepancy is essential to identify areas of improvement. Additional insights from the ongoing survey will be presented during the meeting.