Residency Practice Transformation: Implementation of Team-Based Care in an Academic Continuity Clinic

Abstract

Background Team-based primary care has the potential to improve care delivery. However, residency scheduling and precepting models make creating functional ambulatory teams challenging. Objective We describe the team-based care transformation at a large academic internal medicine residency practice. Methods On July 1, 2016, the program transitioned to a 6+2 schedule and the clinic was divided into teams. Residents were precepted by 2 team preceptors, social work and care coordination needs were met by team-specific staff, and front desk staff were trained on maintaining primary care physician (PCP) and team continuity. Weekly team meetings provided opportunities for proactive patient and panel management, and preclinic huddles incorporated staff into team functions. Pre-transformation (June 2016) and post-transformation (June 2017) surveys were distributed to residents (n = 131), faculty (n = 14), and staff (n = 65) to assess team functioning. Patient-PCP continuity was monitored on a quarterly basis. Results Three hundred sixty-two of 420 surveys were returned (86%). The intervention was associated with significant improvements in resident satisfaction (from 3.05 baseline to 4.07 of 5, P < .001) and perceptions of teamwork (4.14 to 4.61 of 6, P < .001), with moderate to large effect sizes. Patient-PCP continuity significantly increased (45% to > 70%). While domain-specific improvements were seen for faculty and staff, no overall changes were noted in their perceptions of teamwork or team-based care. Conclusions Team-based care was implemented with significant improvements in continuity and resident satisfaction and perceptions of teamwork; however, the impact on faculty and staff was limited.

Analysis of Variation in Organizational Definitions of Primary Care Panels

“…As shown in Figure 1, the literature search yielded 1671 articles. Title and abstract review identified 294 potentially relevant articles that underwent full text review, with 74 including relevant data …”

“…Table 2 shows the findings for rules for adding and removing patients from panels and the frequency of updating panel lists as reported by 29 different health care systems and 5 empanelment guides . Details for each system or guide is provided in eTable 2 in the Supplement.…”

Interprofessional practice and health care: a study in a Multi-professional Health residence

“…Whether in Family Health, Mental Health or within the hospital environment, this should be a behavior adopted by the team and the service. However, reality shows us that this was often an action sought by the resident in the face of daily life difficulties and the absence of spaces that provided this case discussion, such as team meetings 21 .…”

Advance care planning clinic: A structured clinical experience for internal medicine residents

“…All IM residents in the Mount Sinai Hospital residency program have continuity clinic at the Internal Medicine Associates (IMA) clinic, with a 6 + 2 schedule (alternating blocks of inpatient rotations or elective/vacation with dedicated ambulatory blocks). 22 As part of their ambulatory education, all residents participate in the previously described Goals of Care Ambulatory Resident Education (GOCARE) communication skills curriculum during the spring of their PGY1 year, which includes 8 h of didactics, facilitated discussion, and simulation. 13 In addition, residents historically received lectures on prognostication and ACP (3 h total) during their ambulatory didactics in the PGY2 year.…”