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Paciocco S, Kothari A, Licskai CJ, Ferrone M, Sibbald SL. Evaluating the implementation of a chronic obstructive pulmonary disease management program using the Consolidated Framework for Implementation Research: a case study. BMC Health Serv Res 2021; 21:717. [PMID: 34289847 PMCID: PMC8293496 DOI: 10.1186/s12913-021-06636-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/14/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a prevalent chronic disease that requires comprehensive approaches to manage; it accounts for a significant portion of Canada's annual healthcare spending. Interprofessional teams are effective at providing chronic disease management that meets the needs of patients. As part of an ongoing initiative, a COPD management program, the Best Care COPD program was implemented in a primary care setting. The objectives of this research were to determine site-specific factors facilitating or impeding the implementation of a COPD program in a new setting, while evaluating the implementation strategy used. METHODS A qualitative case study was conducted using interviews, focus groups, document analysis, and site visits. Data were deductively analyzed using the Consolidated Framework for Implementation Research (CFIR) to assess the impact of each of its constructs on Best Care COPD program implementation at this site. RESULTS Eleven CFIR constructs were determined to meaningfully affect implementation. Five were identified as the most influential in the implementation process. Cosmopolitanism (partnerships with other organizations), networks and communication (amongst program providers), engaging (key individuals to participate in program implementation), design quality and packaging (of the program), and reflecting and evaluating (throughout the implementation process). A peer-to-peer implementation strategy included training of registered respiratory therapists (RRT) as certified respiratory educators and the establishment of a communication network among RRTs to discuss experiences, collectively solve problems, and connect with the program lead. CONCLUSIONS This study provides a practical example of the various factors that facilitated the implementation of the Best Care COPD program. It also demonstrates the potential of using a peer-to-peer implementation strategy. Focusing on these factors will be useful for informing the continued spread and success of the Best Care COPD program and future implementation of other chronic care programs.
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Affiliation(s)
- Stefan Paciocco
- Health and Rehabilitation Sciences, Western University, London, Canada
| | - Anita Kothari
- School of Health Studies, Faculty of Health Sciences, Western University, London, Canada
| | - Christopher J Licskai
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | | | - Shannon L Sibbald
- School of Health Studies, Faculty of Health Sciences, Department of Family Medicine, Schulich School of Medicine and Dentistry, The Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, Canada.
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Experiences of Patient-Centered Medical Home Staff Team Members Working in Interprofessional Training Environments. J Gen Intern Med 2020; 35:2976-2982. [PMID: 32728958 PMCID: PMC7573084 DOI: 10.1007/s11606-020-06055-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Evidence is growing that interprofessional team-based models benefit providers, trainees, and patients, but less is understood about the experiences of staff who work beside trainees learning these models. OBJECTIVE To understand the experiences of staff in five VA training clinics participating in an interprofessional team-based learning initiative. DESIGN Individual semi-structured interviews with staff were conducted during site visits, qualitatively coded, and analyzed for themes across sites and participant groups. PARTICIPANTS Patient-centered medical home (PCMH) staff members (n = 32; RNs, Clinical and Clerical Associates) in non-primary care provider (PCP) roles working on teams with trainees from medicine, nursing, pharmacy, and psychology. APPROACH Benefits and challenges of working in an interprofessional, academic clinic were coded by the primary author using a hybrid inductive/directed thematic analytic approach, with review and iterative theme development by the interprofessional author team. KEY RESULTS Efforts to improve interprofessional collaboration among trainees and providers, such as increased shared leadership, have positive spillover effects for PCMH staff members. These staff members perceive themselves playing an educational role for trainees that is not always acknowledged. Playing this role, learning from the "fresh" knowledge imparted by trainees, and contributing to the future of health care all bring satisfaction to staff members. Some constraints exist for full participation in the educational efforts of the clinic. CONCLUSIONS Increased recognition of and expanded support for PCMH staff members to participate in educational endeavors is essential as interprofessional training clinics grow.
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Thomas DC, Kessler C, Sachdev N, Fromme HB, Schwartz A, Harris I. Residents' Perspectives on Rewards and Challenges of Caring for Ambulatory Care Patients Living With Chronic Illness: Findings From Three Academic Health Centers. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:1684-1690. [PMID: 26107882 DOI: 10.1097/acm.0000000000000793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To elicit residents' perspectives on rewards and challenges of caring for ambulatory patients with chronic illness and ways to improve their education in caring for these patients. METHOD The authors conducted a qualitative study with internal medicine residents during ambulatory medicine block rotations at three academic health centers from October 2011 through February 2012. Focus group questions covered rewards and challenges of caring for patients with chronic illness and strengths and weaknesses of residency education therein, and the Chronic Care Model provided a framework for interpretation. Qualitative analysis was used to identify themes. RESULTS Five focus groups were conducted with 28 residents. Discussions yielded 224 comments, which were categorized into 5 domains and 36 themes. Twelve themes related to perceptions of challenges in providing care, and 3 themes related to perceptions of rewards in providing care. Eight themes focused on strategies to improve the patient experience. Strengths of the residency program were identified in 7 themes. Six themes related to ways for improving learning about caring for patients with chronic disease in the ambulatory setting. CONCLUSIONS Residents perceived rewards, challenges, and barriers in caring for patients with chronic illness in the ambulatory setting, from providers' and patients' perspectives. They have developed strategies to provide effective patient care. Residents identified best practices in their residency for resident education and patient care and also made suggestions for improvement. Findings have significant implications for residency education and practice redesign in the 21st century for care of patients with chronic illness.
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Affiliation(s)
- David C Thomas
- D.C. Thomas is vice chair for education and professor of medicine, medical education, and rehabilitation medicine, Departments of Medicine, Medical Education, and Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. C. Kessler is deputy chief of staff, Durham VA Medical Center, and associate professor of medicine and emergency medicine, Duke University School of Medicine, Durham, North Carolina. N. Sachdev is associate program director, Internal Medicine-Pediatrics Program, and assistant professor of medicine and pediatrics, Departments of Medicine and Pediatrics, University of Michigan Health System, Ann Arbor, Michigan. H.B. Fromme is associate program director, Pediatric Residency Program, and associate professor of pediatrics, Department of Pediatrics, Pritzker School of Medicine, University of Chicago, Chicago, Illinois. A. Schwartz is professor, associate head, and director of research, Department of Medical Education, University of Illinois College of Medicine at Chicago, Chicago, Illinois. I. Harris is professor, head, and director of graduate studies, Department of Medical Education, University of Illinois College of Medicine at Chicago, Chicago, Illinois
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Bogetz JF, Rassbach CE, Bereknyei S, Mendoza FS, Sanders LM, Braddock CH. Training health care professionals for 21st-century practice: a systematic review of educational interventions on chronic care. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:1561-1572. [PMID: 26039140 DOI: 10.1097/acm.0000000000000773] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To systematically review the evidence for high-quality and effective educational strategies to train health care professionals across the education continuum on chronic disease care. METHOD A search of English-language publications and conference proceedings was performed in November 2013 and updated in April 2014. Studies that evaluated a newly developed curriculum targeting chronic disease care with learner outcomes were included. Two primary reviewers and one adjudicating reviewer evaluated the studies and assessed their quality using the validated Medical Education Research Study Quality Instrument (MERSQI). Studies were also mapped onto elements of Wagner's chronic care model (CCM) to evaluate their use of established evidence-based models for chronic care delivery. Miller's classification of clinical competence was used to assess the quality of learner achievements for each educational intervention. RESULTS A total of 672 articles were found for this review. Twenty-two met criteria for data extraction. The majority of studies were of moderate quality according to MERSQI scoring. Only three studies reported both learner and patient outcomes. The highest-quality studies incorporated more elements of Wagner's CCM and showed high-level learner competence according to Miller's classification. Successful interventions redesigned health care delivery systems to include team-based care, emphasized training of health care professionals on patient self-management, and included learner-based quality improvement initiatives. CONCLUSIONS The growing number of children and adults with chronic disease necessitates improved educational interventions for health care professionals that involve evidence-based models for restructuring chronic care delivery, aim for high-level learner behavioral outcomes, and evolve through quality improvement initiatives.
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Affiliation(s)
- Jori F Bogetz
- J.F. Bogetz is postdoctoral fellow and clinical instructor, Division of General Pediatrics, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California. C.E. Rassbach is associate residency program director, pediatric hospitalist, and clinical assistant professor, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California. S. Bereknyei is a research scholar, Stanford Center for Medical Education Research and Innovation (SCeMERI), Stanford University School of Medicine, Palo Alto, California. F.S. Mendoza is professor of pediatrics and chief, Division of General Pediatrics, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California. L.M. Sanders is associate professor of pediatrics, Division of General Pediatrics, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California. C.H. Braddock III is professor of medicine and vice dean for education, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California
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Davy C, Bleasel J, Liu H, Tchan M, Ponniah S, Brown A. Factors influencing the implementation of chronic care models: A systematic literature review. BMC FAMILY PRACTICE 2015; 16:102. [PMID: 26286614 PMCID: PMC4545323 DOI: 10.1186/s12875-015-0319-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 08/07/2015] [Indexed: 12/16/2022]
Abstract
Background The increasing prevalence of chronic disease faced by both developed and developing countries is of considerable concern to a number of international organisations. Many of the interventions to address this concern within primary healthcare settings are based on the chronic care model (CCM). The implementation of complex interventions such as CCMs requires careful consideration and planning. Success depends on a number of factors at the healthcare provider, team, organisation and system levels. Methods The aim of this systematic review was to systematically examine the scientific literature in order to understand the facilitators and barriers to implementing CCMs within a primary healthcare setting. This review focused on both quantitative and qualitative studies which included patients with chronic disease (cardiovascular disease, chronic kidney disease, chronic respiratory disease, type 2 diabetes mellitus, depression and HIV/AIDS) receiving care in primary healthcare settings, as well as primary healthcare providers such as doctors, nurses and administrators. Papers were limited to those published in English between 1998 and 2013. Results The search returned 3492 articles. The majority of these studies were subsequently excluded based on their title or abstract because they clearly did not meet the inclusion criteria for this review. A total of 226 full text articles were obtained and a further 188 were excluded as they did not meet the criteria. Thirty eight published peer-reviewed articles were ultimately included in this review. Five primary themes emerged. In addition to ensuring appropriate resources to support implementation and sustainability, the acceptability of the intervention for both patients and healthcare providers contributed to the success of the intervention. There was also a need to prepare healthcare providers for the implementation of a CCM, and to support patients as the way in which they receive care changes. Conclusion This systematic review demonstrated the importance of considering human factors including the influence that different stakeholders have on the success or otherwise of the implementing a CCM. Electronic supplementary material The online version of this article (doi:10.1186/s12875-015-0319-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carol Davy
- South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia.
| | - Jonathan Bleasel
- The George Institute for Global Health, Camperdown, New South Wales, Australia.
| | - Hueiming Liu
- The George Institute for Global Health, Camperdown, New South Wales, Australia.
| | - Maria Tchan
- The George Institute for Global Health, Camperdown, New South Wales, Australia.
| | - Sharon Ponniah
- The George Institute for Global Health, Camperdown, New South Wales, Australia.
| | - Alex Brown
- South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia.
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Lo MC, Freeman M, Lansang MC. Effect of a multidisciplinary-assisted resident diabetes clinic on resident knowledge and patient outcomes. J Grad Med Educ 2013; 5:145-9. [PMID: 24404243 PMCID: PMC3613301 DOI: 10.4300/jgme-d-12-00065.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 06/25/2012] [Accepted: 10/01/2012] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Despite the rising prevalence of diabetes, there is a paucity of diabetes curricula in residency training. The multidisciplinary diabetes team approach is underused in residency education. OBJECTIVE To assess the feasibility of an innovative multidisciplinary resident diabetes clinic (MRDC) in enhancing (1) resident diabetes knowledge via a Diabetes Awareness Questionnaire, and (2) subsequent process and patient outcomes in patients with diabetes via a Diabetes Practice Behavior Checklist. METHODS From October 2008 to February 2010, 14 internal medicine residents managed patients with uncontrolled diabetes in a weekly half-day MRDC for 1 month (total 4-5 half-day sessions/resident), with a collaborative team of internists, diabetes educators, an endocrinologist, and a pharmacist. The curriculum included didactic sessions, required readings, and patient-specific case discussions. A 20-question Diabetes Awareness Questionnaire was administered to each resident prerotation and postrotation. Records of 47 patients with diabetes in the residents' own continuity clinics (not the MRDC) were audited 6 months before and after the MRDC for Diabetes Practice Behavior Checklist measures (glycated hemoglobin, blood pressure, low-density lipoprotein cholesterol, retinal referral, foot exam, microalbumin screen). Pre-MRDC and post-MRDC data were compared via paired t test. RESULTS The MRDC residents exhibited a modest increase in mean (SD) scores on the Diabetes Awareness Questionnaire (before, 8.2 [2.8]; after, 10.9 [2.8]; P = .02) and a modest mean (SD) performance increase in overall process outcomes from the Diabetes Practice Behavior Checklist (before, 74% [18%]; after, 84% [18%]; P = .004). No improvements occurred in patient outcomes. CONCLUSIONS Multidisciplinary diabetes teaching may be useful in fostering certain resident knowledge and performance measures but may not alter clinical outcomes. Further large-scale, longitudinal studies are needed to understand the effect of our curriculum on residents' diabetes knowledge and future practice behavior.
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Chronic care education in medical school: a focus on functional health and quality of life. Am J Phys Med Rehabil 2011; 88:798-804. [PMID: 21119311 DOI: 10.1097/phm.0b013e3181b72bbe] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The healthcare system is faced with a rapidly increasing number of individuals with chronic conditions and disabilities. The need for a chronic care model of health care with interdisciplinary treatment involving the patient and family with a focus on functional health is recognized but not fully established in the medical community. The education of medical students in a chronic care model is essential so that physicians in all specialties may provide effective and efficient care to their patients. Physiatrists and physicians trained in the specialty of Physical Medicine and Rehabilitation are uniquely situated to be leaders in the education of medical students in the appropriate care for individuals with chronic conditions and disabilities. Academic physiatrists must be involved in the education of medical students. This involvement will result in a higher level of patient care for all patients with chronic conditions and disabilities. In 2007, the Association of Academic Physiatrists formed a task force to evaluate educational models and make recommendations regarding the education of medical students in the management of individuals with chronic conditions and disabilities. The task force also evaluated opportunities for physiatrists to participate in the education of medical students. This article summarizes the work of the task force.
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Sisson SD, Dalal D. Internal medicine residency training on topics in ambulatory care: a status report. Am J Med 2011; 124:86-90. [PMID: 21187190 DOI: 10.1016/j.amjmed.2010.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 07/29/2010] [Accepted: 09/10/2010] [Indexed: 11/26/2022]
Affiliation(s)
- Stephen D Sisson
- Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Stevens DP, Bowen JL, Johnson JK, Woods DM, Provost LP, Holman HR, Sixta CS, Wagner EH. A multi-institutional quality improvement initiative to transform education for chronic illness care in resident continuity practices. J Gen Intern Med 2010; 25 Suppl 4:S574-80. [PMID: 20737232 PMCID: PMC2940442 DOI: 10.1007/s11606-010-1392-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is a gap between the need for patient-centered, evidence-based primary care for the large burden of chronic illness in the US, and the training of resident physicians to provide that care. OBJECTIVE To improve training for residents who provide chronic illness care in teaching practice settings. DESIGN US teaching hospitals were invited to participate in one of two 18-month Breakthrough Series Collaboratives-either a national Collaborative, or a subsequent California Collaborative-to implement the Chronic Care Model (CCM) and related curriculum changes in resident practices. Most practices focused on patients with diabetes mellitus. Educational redesign strategies with related performance measures were developed for curricular innovations anchored in the CCM. In addition, three clinical measures-HbA1c <7%, LDL <100 mg/dL, and blood pressure <or=130/80-and three process measures-retinal and foot examinations, and patient self-management goals-were tracked. PARTICIPANTS Fifty-seven teams from 37 self-selected teaching hospitals committed to implement the CCM in resident continuity practices; 41 teams focusing on diabetes improvement participated over the entire duration of one of the Collaboratives. INTERVENTIONS Teaching-practice teams-faculty, residents and staff-participated in Collaboratives by attending monthly calls and regular 2-day face-to-face meetings with the other teams. The national Collaborative faculty led calls and meetings. Each team used rapid cycle quality improvement (PDSA cycles) to implement the CCM and curricular changes. Teams reported education and clinical performance measures monthly. RESULTS Practices underwent extensive redesign to establish CCM elements. Education measures tracked substantial development of CCM-related learning. The clinical and process measures improved, however inconsistently, during the Collaboratives. CONCLUSIONS These initiatives suggest that systematic practice redesign for implementing the CCM along with linked educational approaches are achievable in resident continuity practices. Improvement of clinical outcomes in such practices is daunting but achievable.
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Affiliation(s)
- David P Stevens
- Center for Leadership and Improvement, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH 03766, USA.
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Chen EH, Thom DH, Hessler DM, Phengrasamy L, Hammer H, Saba G, Bodenheimer T. Using the Teamlet Model to improve chronic care in an academic primary care practice. J Gen Intern Med 2010; 25 Suppl 4:S610-4. [PMID: 20737236 PMCID: PMC2940441 DOI: 10.1007/s11606-010-1390-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Team care can improve management of chronic conditions, but implementing a team approach in an academic primary care clinic presents unique challenges. OBJECTIVES To implement and evaluate the Teamlet Model, which uses health coaches working with primary care physicians to improve care for patients with diabetes and/or hypertension in an academic practice. DESIGN Process and outcome measures were compared before and during the intervention in patients seen with the Teamlet Model and in a comparison patient group. PARTICIPANTS First year family medicine residents, medical assistants, health workers, and adult patients with either type 2 diabetes or hypertension in a large public health clinic. INTERVENTION Health coaches, in coordination with resident primary care physicians, met with patients before and after clinic visits and called patients between visits. MEASUREMENTS Measurement of body mass index, assessment of smoking status, and formulation of a self-management plan prior to and during the intervention period for patients in the Teamlet Model group. Testing for LDL and HbA1C and the proportion of patients at goal for blood pressure, LDL, and HbA1C in the Teamlet Model and comparison groups in the year prior to and during implementation. RESULTS Teamlet patients showed improvement in all measures, though improvement was significant only for smoking, BMI, and self-management plan documentation and testing for LDL (p = 0.02), with a trend towards significance for LDL at goal (p = 0.07). Teamlet patients showed a greater, but non-significant, increase in the proportion of patients tested for HbA1C and proportion reaching goal for blood pressure, HgbA1C, and LDL compared to the comparison group patients. The difference for blood pressure was marginally significant (p = 0.06). In contrast, patients in the comparison group were significantly more likely to have had testing for LDL (P = 0.001). CONCLUSIONS The Teamlet Model may improve chronic care in academic primary care practices.
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Affiliation(s)
- Ellen H Chen
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA 94110, USA.
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Abstract
INTRODUCTION While the Chronic Care Model (CCM) has been shown to improve the care of patients with chronic illnesses, primary care physicians have been unprepared in its use, and residencies have encountered challenges in introducing it into the academic environment. AIM Our residency program has implemented a diabetes management program modeled on the CCM to evaluate its impact on health outcomes of diabetic patients and educational outcomes of residents. SETTING University-affiliated, community-based family medicine residency program. PROGRAM DESCRIPTION Six residents, two faculty clinicians, and clinic staff formed a diabetes management team. We redesigned the outpatient experience for diabetic patients by incorporating elements of the CCM: multidisciplinary team care through planned and group visits; creation of a diabetes registry; use of guidelines-based flow sheets; and incorporation of self-management goal-setting. Residents received extensive instruction in diabetes management, quality improvement, and patient self-management. PROGRAM EVALUATION We achieved overall improvement in all metabolic and process measures for patients, with the percentage achieving HbA1c, LDL, and BP goals simultaneously increasing from 5.7% to 17.1%. Educational outcomes for residents, as measured by compliance with review of provider performance reports and self-management goal-setting with patients, also significantly improved. DISCUSSION Through a learning collaborative experience, residency programs can successfully incorporate chronic care training for residents while addressing gaps in care for patients with diabetes.
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Eiser AR, Connaughton-Storey J. Experiential learning of systems-based practice: a hands-on experience for first-year medical residents. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2008; 83:916-923. [PMID: 18820520 DOI: 10.1097/acm.0b013e31818509ca] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Systems-based practice, a domain of expertise mandated for all residencies by the Accreditation Council for Graduate Medical Education, requires an interdisciplinary approach that involves communicating with the other members of the health care team as well as utilizing the many components of health care delivery. The Mercy Catholic Medical Center internal medicine residency leadership developed a two-week supervised experience in systems-based practice for first-year medical residents to give them firsthand experience with nonphysician providers' delivery of health care. The disciplines in the experience were home care services, hospice care, pharmacy services, laboratory services, utilization services, and nutrition services. Nonphysician health care providers willingly made themselves available for this educational activity because they felt that such face-to-face interaction fosters an improved understanding of their discipline and its services in the participating physicians. Surveys of resident knowledge pre- and postworkshop suggested that the residents' rudimentary understanding of these disciplines developed into both a deeper theoretical understanding and a greater knowledge of specific policies regarding these health care services. This type of experience is likely a necessary first step toward developing physicians who can provide interdisciplinary medical care that integrates the many other health care disciplines into a comprehensive plan to maximize health outcomes. As physicians become leaders of multidisciplinary teams in the 21st century, firsthand knowledge of the other health services enhances their capacity to maximize the services of these other disciplines for the benefit of patient care.
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Affiliation(s)
- Arnold R Eiser
- Mercy Catholic Medical Center, Mercy Health System of Southeast Pennsylvania, Philadelphia, Pennsylvania 19023, USA.
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Brand C, Scott I, Greenberg P, Sargious P. Chronic disease management: time for consultant physicians to take more leadership in system redesign. Intern Med J 2007; 37:653-9. [PMID: 17714207 DOI: 10.1111/j.1445-5994.2007.01442.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
There is a need for system redesign to meet the needs of individuals with chronic disease. New models of chronic disease care include team-based paradigms that focus on continuous and patient-centred care. In such models the roles of providers and patients must change. In this article we focus on new roles for consultant physicians, as well as barriers and incentives to these roles.
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Affiliation(s)
- C Brand
- Clinical Epidemiology and Health Services Evaluation Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
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Whitcomb ME. Who will lead? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2007; 82:115-6. [PMID: 17264685 DOI: 10.1097/acm.0b013e31802e4156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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Stevens DP, Wagner EH. Transform residency training in chronic illness care -- now. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2006; 81:685-7. [PMID: 16868418 DOI: 10.1097/00001888-200608000-00002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Identification of the drivers of change that hasten improvement of chronic illness care in resident practices serves as an effective strategy for transformative change. The Academic Chronic Care Collaborative (ACCC) is an ongoing network of 48 teams from 22 teaching hospitals and systems that have committed to implementation of the evidence-based Chronic Care Model in their residency practices. The teams track the results of their efforts by monthly reports of both clinical and educational outcomes. The authors' experience with these self-selected teams shows that the two most effective drivers of change have been organization-wide leadership -- from the CEO to the clinical manager -- and the academic culture, e.g., competitiveness, the aspiration for excellence, focus on the research mission, comfort with data, and commitment to the education mission. These ACCC teams and their sponsoring health systems have successfully harnessed these drivers for the implementation of evidence-based chronic illness care in resident practices.
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Affiliation(s)
- David P Stevens
- Institute for Improving Clinical Care, Association of American Medical Colleges, Washington, DC 20037, USA.
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