A Team-based Model of Primary Care Delivery and Physician-patient Interaction

Finance and Time Use Implications of Team Documentation for Primary Care: A Microsimulation

“…T eam documentation-referred to as scribing-involves staff documenting in the health record during patient visits concurrently with a clinician focusing on face-to-face patient time. 1 Data from observational implementation studies [2][3][4][5][6][7][8][9][10] and a randomized controlled trial 11 suggest that team documentation has the potential to improve clinician satisfaction and efficiency in primary care practices; yet the financial and time use implications, and generalizability to practices across the nation, remain unclear.…”

“…2 Alternatively, some practices have implemented an advanced team-based care (ATBC) strategy, which involves more than scribing functions. 7,10 The ATBC strategy employs a medical assistant or nurse to accompany the patient from the beginning of their appointment to its conclusion. The medical assistant or nurse performs room check-in, measures vital signs, takes and documents an initial template-aided history, and updates past medical history including medication reconciliation.…”

“…Generally, ATBC requires 2 medical assistants per physician, providing both clerical and clinical support. 7,10 The financial and time use implications of team documentation remain a critical and unresolved question. Here, we used data from a national sample of primary care practices to estimate how much more time efficiency and additional visit volume would be necessary to generate sufficient funds to cover the costs of team documentation.…”

Physician, Scribe, and Patient Perspectives on Clinical Scribes in Primary Care

“…Existing studies of clinical scribes are few with data restricted to efficiency 16 and patient-physician face time. 17 They offer little insight into the dynamic interactions and relationships among physician, clinical scribes, and patients. This project thus seeks to fill these gaps through eliciting and describing the perspectives of Electronic supplementary material The online version of this article (doi:10.1007/s11606-016-3719-x) contains supplementary material, which is available to authorized users.…”

Physician, Scribe, and Patient Perspectives on Clinical Scribes in Primary Care

“…We previously reported that having medical assistant scribes in the exam room increased the amount of face-to-face time with the patient. 2 In order to provide high-value care to populations of patients, team-based care is inevitable. As recently demonstrated, every hour of direct patient care generates almost 2 additional hours of documentation and other clerical work, which often spills over into the evenings.…”