Principles Supporting Dynamic Clinical Care Teams: An American College of Physicians Position Paper

Doherty, Robert B.; Crowley, Ryan

doi:10.7326/0003-4819-159-9-201311050-00710

Cited by 80 publications

(46 citation statements)

References 9 publications

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“…Teamwork is a rising trend in primary care, [22][23][24] and our study revealed important details of interpersonal interactions. While scribes still expected physicians to lead, they also appreciated having opinions heard and considered.…”

Section: Iscussionmentioning

confidence: 65%

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

et al. 2016

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Section: Iscussionmentioning

confidence: 65%

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

et al. 2016

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“…34 Current attempts to improve the outpatient clinic experience include the development of patientcentered medical homes and accountable care organizations, 35,36 efforts to decrease panel size, and the creation of multidisciplinary, inter-professional teams. 10 These changes should help to train residents in team environments that allow physicians to work at the peak of their training levels and in more satisfying work conditions. 36 Additionally, increased support of non-face to face patient care encounters as well as ambulatory payment reforms 37 might entice debt-ridden residents 38,39 to enter the primary care field.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] Fewer physicians now enter into outpatient primary care, 6 and there is a looming attrition rate of PCPs, with almost one-quarter of practicing PCPs in 2011 being 56 years of age or older. 7 Current strategies to address the primary care shortage include payment structure reform, 8,9 implementation of team-based primary care with patient centered medical homes, 10,11 as well as increasing the number of primary care based graduate medical education residency positions. 12,13 Many internal medicine residency programs have emphasized ambulatory medicine by creating primary care tracks that are designed to highlight outpatient medicine.…”

Section: Introductionmentioning

confidence: 99%

Is Training in a Primary Care Internal Medicine Residency Associated with a Career in Primary Care Medicine?

et al. 2015

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PURPOSE: Professional and governmental organizations recommend an ideal US physician workforce composed of at least 40 % primary care physicians. They also support primary care residencies to promote careers in primary care. Our study examines the relationship between graduation from a primary care or categorical internal medicine residency program and subsequent career choice. METHODS: We conducted a cross-sectional electronic survey of a cohort of internal medicine residency alumni who graduated between 2001 and 2010 from a large academic center. Our primary predictor was graduation from a primary care versus a categorical internal medicine program and our primary outcome is current career role. We performed chi-square analysis comparing responses of primary care and categorical residents. RESULTS: We contacted 481 out of 513 alumni, of whom 322 responded (67 %). We compared 106 responses from primary care alumni to 169 responses from categorical alumni. Fifty-four percent of primary care alumni agreed that the majority of their current clinical work is in outpatient primary care vs. 20 % of categorical alumni (p<0.001). While 92.5 % of primary-care alumni were interested in a primary care career prior to residency, only 63 % remained interested after residency. Thirty of the 34 primary care alumni (88 %) who lost interest in a primary care career during residency agreed that their ambulatory experience during residency influenced their subsequent career choice. CONCLUSIONS: A higher percentage of primary care alumni practice outpatient primary care as compared to categorical alumni. Some alumni lost interest in primary care during residency. The outpatient clinic experience may impact interest in primary care.

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“…4 A cornerstone of these new care models is team-based care, in which staff work collaboratively with patients and their caregivers to achieve coordinated, high-quality care. [5][6][7][8][9][10][11][12] Traditional staff, such as medical assistants, often take on expanded roles, and new staff types may be added. The team is expected to collaborate to deliver high-quality, comprehensive care efficiently; however, we know little about the current or optimal practice team composition.…”

Section: Introductionmentioning

confidence: 99%

Staffing Patterns of Primary Care Practices in the Comprehensive Primary Care Initiative

Peikes

Reid

Day

et al. 2014

The Annals of Family Medicine

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PURPOSE Despite growing calls for team-based care, the current staff composition of primary care practices is unknown. We describe staffing patterns for primary care practices in the Centers for Medicare and Medicaid Services (CMS) Comprehensive Primary Care (CPC) initiative. METHODSWe undertook a descriptive analysis of CPC initiative practices' baseline staffing using data from initial applications and a practice survey. CMS selected 502 primary care practices (from 987 applicants) in 7 regions based on their health information technology, number of patients covered by participating payers, and other factors; 496 practices were included in this analysis.RESULTS Consistent with the national distribution, most of the CPC initiative practices included in this study were small: 44% reported 2 or fewer full-time equivalent (FTE) physicians; 27% reported more than 4. Nearly all reported administrative staff (98%) and medical assistants (89%). Fifty-three percent reported having nurse practitioners or physician assistants; 47%, licensed practical or vocational nurses; 36%, registered nurses; and 24%, care managers/coordinators-all of these positions are more common in larger practices. Other clinical staff were reported infrequently regardless of practice size. Compared with other CPC initiative practices, designated patient-centered medical homes were more likely to have care managers/coordinators but otherwise had similar staff types. Larger practices had fewer FTE staff per physician.CONCLUSIONS At baseline, most CPC initiative practices used traditional staffing models and did not report having dedicated staff who may be integral to new primary care models, such as care coordinators, health educators, behavioral health specialists, and pharmacists. Without such staff and payment for their services, practices are unlikely to deliver comprehensive, coordinated, and accessible care to patients at a sustainable cost. 2014;142-149. doi: 10.1370/afm.1626. Ann Fam Med INTRODUCTIONP ublic and private health care payers nationwide are testing whether making primary care more patient centered, accessible, coordinated, and comprehensive will improve health care quality, cost, and patient and clinician experiences. [1][2][3] Many are piloting versions of the patient-centered medical home (PCMH) model as defined by the primary care physician societies. 4 A cornerstone of these new care models is team-based care, in which staff work collaboratively with patients and their caregivers to achieve coordinated, high-quality care. [5][6][7][8][9][10][11][12] Traditional staff, such as medical assistants, often take on expanded roles, and new staff types may be added. The team is expected to collaborate to deliver high-quality, comprehensive care efficiently; however, we know little about the current or optimal practice team composition.Expanding staffing and shifting roles offers possible advantages. Expanded staffing could provide additional expertise and resources to support patient-centered, evidence-based primary care 13...

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Principles Supporting Dynamic Clinical Care Teams: An American College of Physicians Position Paper

Cited by 80 publications

References 9 publications

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

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

Is Training in a Primary Care Internal Medicine Residency Associated with a Career in Primary Care Medicine?

Staffing Patterns of Primary Care Practices in the Comprehensive Primary Care Initiative

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