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Tandan M, Dunlea S, Cullen W, Bury G. Teamwork and its impact on chronic disease clinical outcomes in primary care: a systematic review and meta-analysis. Public Health 2024; 229:88-115. [PMID: 38412699 DOI: 10.1016/j.puhe.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/31/2023] [Accepted: 01/22/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE Teamwork positively affects staff performance and patient outcomes in chronic disease management. However, there is limited research on the impact of specific team components on clinical outcomes. This review aims to explore the impact of teamwork components on key clinical outcomes of chronic diseases in primary care. STUDY DESIGN Systematic review and meta-analysis. METHODS This systematic review and meta-analysis conducted searching EMBASE, PubMed, Cochrane Central Register of Controlled Trials. Studies included must have at least one teamwork component, conducted in primary care for selected chronic diseases, and report an impact of teamwork on clinical outcomes. Mean differences and 95% confidence intervals were used to determine pooled effects of intervention. RESULTS A total of 54 studies from 1988 to 2021 were reviewed. Shared decision-making, roles sharing, and leadership were missing in most studies. Team-based intervention showed a reduction in mean systolic blood pressure (MD = 5.88, 95% CI 3.29-8.46, P= <0.001, I2 = 95%), diastolic blood pressure (MD = 3.23, 95% CI 1.53 to 4.92, P = <0.001, I2 = 94%), and HbA1C (MD = 0.38, 95% CI 0.21 to 0.54, P = <0.001, I2 = 58%). More team components led to better SBP and DBP outcomes, while individual team components have no impact on HbA1C. Fewer studies limit analysis of cholesterol levels, hospitalizations, emergency visits and chronic obstructive pulmonary disease-related outcomes. CONCLUSION Team-based interventions improve outcomes for chronic diseases, but more research is needed on managing cholesterol, hospitalizations, and chronic obstructive pulmonary disease. Studies with 4-5 team components were more effective in reducing systolic blood pressure and diastolic blood pressure. Heterogeneity should be considered, and additional research is needed to optimize interventions for specific patient populations.
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Affiliation(s)
- Meera Tandan
- School of Medicine, University College Dublin (UCD), Dublin, Ireland.
| | - Shane Dunlea
- School of Medicine, University College Dublin (UCD), Dublin, Ireland.
| | - Walter Cullen
- School of Medicine, University College Dublin (UCD), Dublin, Ireland.
| | - Gerard Bury
- School of Medicine, University College Dublin (UCD), Dublin, Ireland.
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Chai XY, Bao XY, Dai Y, Dai XX, Zhang Y, Yang YL. Experience of humanistic nursing in hemodialysis nursing for patients with diabetic kidney disease. World J Diabetes 2024; 15:186-195. [PMID: 38464378 PMCID: PMC10921157 DOI: 10.4239/wjd.v15.i2.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/05/2023] [Accepted: 12/27/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Diabetic kidney disease (DKD) is a prevalent complication of diabetes that often requires hemodialysis for treatment. In the field of nursing, there is a growing recognition of the importance of humanistic care, which focuses on the holistic needs of patients, including their emotional, psychological, and social well-being. However, the application of humanistic nursing in the context of hemodialysis for DKD patients remains relatively unexplored. AIM To explore the experience of humanistic nursing in hemodialysis nursing for DKD patients. METHODS Ninety-six DKD patients treated with hemodialysis from March 2020 to June 2022 were included in the study and divided into the control cluster (48 cases) and the study cluster (48 cases) according to different nursing methods; the control cluster was given routine nursing and the study cluster was given humanized nursing. The variances of negative emotion mark, blood glucose, renal function, the incidence of complications, life mark and nursing satisfaction before and after nur-sing were contrasted between the two clusters. RESULTS No significant difference in negative emotion markers between the two clusters were observed before nursing (P > 0.05), and the negative emotion markers of the two clusters decreased after nursing. The Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale markers were lower in the study cluster than the control cluster. The healing rate of patients in the study cluster was significantly higher than the control cluster (97.92% vs 85.42%, P < 0.05). Blood glucose parameters were not significantly different between the groups prior to nursing (P > 0.05). However, after nursing, blood urea nitrogen and serum creatinine (SCr) levels in the study cluster were lower than those in the control cluster (P < 0.05). The incidence rate of complications was significantly lower in the study group compared to the control cluster (6.25% vs 20.83%, P < 0.05). There was no significant difference in the life markers between the two clusters before nursing. While the life markers increased after nursing for both groups, the 36-item health scale markers in the study cluster were higher than those within the control cluster (P < 0.05). Finally, the nursing satisfaction rate was 93.75% in the study cluster, compared to 75% in the control cluster (P < 0.05). CONCLUSION In hemodialysis for DKD patients, the implementation of humanistic nursing achieved ideal results, effectively reducing patients' psychological negative emotion markers so that they can actively cooperate with the diagnosis and nursing, facilitate the control of blood glucose and the maintenance of residual renal function, reduce the occurrence of complications, and finally enhance the life quality and nursing satisfaction of patients. It is worthy of being widely popularized and applied.
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Affiliation(s)
- Xiao-Ying Chai
- Department of Nephrology, The Affiliated Hospital of Jiangnan University, Wuxi 214000, Jiangsu Province, China
| | - Xiao-Yan Bao
- Department of Hemodialysis, The Affiliated Hospital of Jiangnan University, Wuxi 214000, Jiangsu Province, China
| | - Ying Dai
- Department of Endocrinology, The Affiliated Hospital of Jiangnan University, Wuxi 214000, Jiangsu Province, China
| | - Xing-Xing Dai
- Department of Nephrology, The Affiliated Hospital of Jiangnan University, Wuxi 214000, Jiangsu Province, China
| | - Yu Zhang
- Department of Endocrinology, The Affiliated Hospital of Jiangnan University, Wuxi 214000, Jiangsu Province, China
| | - Yu-Ling Yang
- Department of Nephrology, The Affiliated Hospital of Jiangnan University, Wuxi 214000, Jiangsu Province, China
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Whiting A, Poolman AE, Misra A, Gordon JE, Angstman KB. Comparison of Ambulatory Quality Measures Between Shared Practice Panels and Independent Practice Panels. Mayo Clin Proc Innov Qual Outcomes 2023; 7:256-261. [PMID: 37388418 PMCID: PMC10300043 DOI: 10.1016/j.mayocpiqo.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
Objective To assess for differences in patient care outcomes in the primary care setting for patients assigned to an independent practice panel (IPP) or a shared practice panel (SPP). Patients and Methods We retrospectively reviewed the electronic health records of patients of 2 Mayo Clinic family medicine primary care clinics from January 1, 2019 to December 31, 2019. Patients were assigned to either an IPP (physician or advanced practice provider [APP]) or an SPP (physician and ≥1 APP). We assessed 6 measures of quality care and compared them between IPP and SPP groups: diabetes optimal care, hypertension control, depression remission at 6 months, breast cancer screening, cervical cancer screening, and colon cancer screening. Results The study included 114,438 patients assigned to 140 family medicine panels during the study period: 87 IPPs and 53 SPPs. The IPP clinicians showed improved quality metrics compared with the SPP clinicians for the percentage of assigned patients achieving depression remission (16.6% vs 11.1%; P<.01). The SPP clinicians showed improved quality metrics compared with that of the IPP clinicians for the percentage of patients with cervical cancer screening (79.1% vs 74.2%; P<.01). The mean percentage of the panels achieving optimal diabetes control, hypertension control, colon cancer screening, and breast cancer screening were not significantly different between IPP and SPP panels. Conclusion This study shows a considerable improvement in depression remission among IPP panels and in cervical cancer screening rates among SPP panels. This information may help to inform primary care team configuration.
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Affiliation(s)
- Adria Whiting
- Department of Family Medicine, Mayo Clinic Health System, Southwest Minnesota Region, Fairmont, MN
| | - April E. Poolman
- Department of Family Medicine, Mayo Clinic Health System, Southwest Minnesota Region, Fairmont, MN
| | - Artika Misra
- Department of Family Medicine, Mayo Clinic Health System, Southwest Minnesota Region, Mankato, MN
| | - Joel E. Gordon
- Department of Family Medicine and Community Health Madison, University of Wisconsin, Madison
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Jafar TH, Shirore RM. Team-Based Care With Nonphysician Titration of Antihypertensive Medications in Collaboration With Physicians: A Cost-Effective Way to Control Blood Pressure? Hypertension 2023; 80:1209-1212. [PMID: 37196100 DOI: 10.1161/hypertensionaha.123.21100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Affiliation(s)
- Tazeen H Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore (T.H.J., R.M.S.)
- Duke Global Health Institute, Duke University, Durham, NC (T.H.J.)
| | - Rupesh M Shirore
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore (T.H.J., R.M.S.)
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Chaney A, Beliles G, Keimig A, Porter I. Advanced Practice Provider Care Team Models: Best Practices From an Academic Medical Center. J Ambul Care Manage 2022; 45:126-134. [PMID: 35202029 DOI: 10.1097/jac.0000000000000412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Health care leaders must be innovative to meet the demands of patient access and cost efficiency, all while never compromising patient safety or experience. A clear understanding of the care team model with optimal utilization of all team members is paramount to success. This article discusses 5 nurse practitioner and physician assistant (collectively called advanced practice providers) care team models that regularly occur in health care organizations across the country. Examples of each practice model, a discussion on when each model would be appropriate, as well as data on patient experience and financial return of investment of each model are provided.
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Affiliation(s)
- Amanda Chaney
- Departments of Transplant (Dr Chaney) and Nephrology (Dr Porter), Mayo Clinic, Jacksonville, Florida; and Administration, Mayo Clinic, Jacksonville, Florida (Messrs Beliles and Keimig)
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Tzeng HM, Raji MA, Chou LN, Kuo YF. Impact of State Nurse Practitioner Regulations on Potentially Inappropriate Medication Prescribing Between Physicians and Nurse Practitioners: A National Study in the United States. J Nurs Care Qual 2022; 37:6-13. [PMID: 34483310 PMCID: PMC8608008 DOI: 10.1097/ncq.0000000000000595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The American Geriatrics Society regularly updates the Beers Criteria for Potentially Inappropriate Medication (PIM) to improve prescribing safety. PURPOSE This study assessed the impact of nurse practitioner (NP) practices on PIM prescribing across states in the United States and compared the change in PIM prescribing rates between 2016 and 2018. METHODS We used data from a random selection of 20% of Medicare beneficiaries (66 years or older) from 2015 to 2018 to perform multilevel logistic regression. A PIM prescription was classified as initial or refill on the basis of medication history 1 year before a visit. PIM use after an outpatient visit was the primary study outcome. RESULTS We included 9 000 224 visits in 2016 and 9 310 261 in 2018. The PIM prescription rate was lower in states with full NP practice and lower among NPs than among physicians; these rates for both physicians and NPs decreased from 2016 to 2018. CONCLUSIONS Changes could be due to individual state practices.
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Affiliation(s)
- Huey-Ming Tzeng
- School of Nursing (Dr Tzeng), Department of Internal Medicine (Drs Raji and Kuo), Sealy Center on Aging (Drs Tzeng, Raji, and Kuo), Department of Preventive Medicine and Population Health (Dr Kuo), and Office of Biostatistics (Ms Chou and Dr Kuo), University of Texas Medical Branch, Galveston
| | - Mukaila A. Raji
- School of Nursing (Dr Tzeng), Department of Internal Medicine (Drs Raji and Kuo), Sealy Center on Aging (Drs Tzeng, Raji, and Kuo), Department of Preventive Medicine and Population Health (Dr Kuo), and Office of Biostatistics (Ms Chou and Dr Kuo), University of Texas Medical Branch, Galveston
| | - Lin-Na Chou
- School of Nursing (Dr Tzeng), Department of Internal Medicine (Drs Raji and Kuo), Sealy Center on Aging (Drs Tzeng, Raji, and Kuo), Department of Preventive Medicine and Population Health (Dr Kuo), and Office of Biostatistics (Ms Chou and Dr Kuo), University of Texas Medical Branch, Galveston
| | - Yong-Fang Kuo
- School of Nursing (Dr Tzeng), Department of Internal Medicine (Drs Raji and Kuo), Sealy Center on Aging (Drs Tzeng, Raji, and Kuo), Department of Preventive Medicine and Population Health (Dr Kuo), and Office of Biostatistics (Ms Chou and Dr Kuo), University of Texas Medical Branch, Galveston
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Heisler M, Simmons D, Piatt GA. Update on Approaches to Improve Delivery and Quality of Care for People with Diabetes. Endocrinol Metab Clin North Am 2021; 50:e1-e20. [PMID: 34763822 DOI: 10.1016/j.ecl.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To translate improvements in diabetes management into improved outcomes, it is essential to improve care delivery. To help guide clinicians and health organizations in their efforts to achieve these improvements, this article briefly describes key components underpinning effective diabetes care and six categories of innovations in approaches to improve diabetes care delivery: (1) team-based clinical care; (2) cross-specialty collaboration/integration; (3) virtual clinical care/telehealth; (4) use of community health workers (CHWs) and trained peers to provide pro-active self-management support; (5) incorporating screening for and addressing social determinants of health into clinical practice; and (6) cross-sectoral clinic/community partnerships.
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Affiliation(s)
- Michele Heisler
- Department of Internal Medicine, University of Michigan Medical School; Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System; Department of Health Behavior and Health Education, School of Public Health, University of Michigan.
| | - David Simmons
- School of Medicine, Western Sydney University, Sydney, Australia; Macarthur Clinical School, Campbelltown Hospital, Therry Road, Campbelltown, New South Wales 2560, Australia
| | - Gretchen A Piatt
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan; Department of Learning Health Sciences, University of Michigan Medical School, 1111 E. Catherine Street, Victor Vaughan Building, Room 225, Ann Arbor, MI 48109, USA
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