Using the Teamlet Model to Improve Chronic Care in an Academic Primary Care Practice

Abstract

BackgroundTeam care can improve management of chronic conditions, but implementing a team approach in an academic primary care clinic presents unique challenges.ObjectivesTo 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.DesignProcess and outcome measures were compared before and during the intervention in patients seen with the Teamlet Model and in a comparison patient group.ParticipantsFirst year family medicine residents, medical assistants, health workers, and adult patients with either type 2 diabetes or hypertension in a large public health clinic.InterventionHealth coaches, in coordination with resident primary care physicians, met with patients before and after clinic visits and called patients between visits.MeasurementsMeasurement 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.ResultsTeamlet 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).ConclusionsThe Teamlet Model may improve chronic care in academic primary care practices.

Building Teams in Primary Care: What Do Nonlicensed Allied Health Workers Want?

“…7 We did not intend to assess which of the 2 types of nonlicensed allied health workers gave better health coaching but rather to gather the perceptions of both types of workers of filling the new role of health coach. The study was approved by the institutional review board of the University of California, San Francisco.…”

“…Total training time ranged from 14 to 16 hours, and competency was determined through direct observation by the trainers. 7 The health coaches also met regularly throughout the year with teamlet model faculty members to provide input about their experience, which helped shape the model during its implementation.…”

“…A separate analysis of clinical and process outcomes of this pilot intervention did reveal trends toward improvement. 7 Other sites using MAs in diabetes care have also shown significant improvement in clinical outcomes such as control of blood sugar levels, blood pressure, and cholesterol level. 11 Although the experiences of the physicians and patients who participated in this pilot intervention based on the teamlet model were recorded, their analyses will be forthcoming in a future study.…”

“…However, our findings suggest that if the principals of a reconfigured practice want to use MAs as health coaches, they would do better by hiring more of them to accomplish both sets of tasks rather than asking one person to simply expand his or her role. 7 Another variable to consider is the size of the patient caseload for health coaches, because practices would have to allow adequate time for panel management and between-session contacts. More studies are needed to quantify the optimal caseload and the time needed for experienced health coaches to integrate health coaching into MAs' work.…”

Peer Coaching to Improve Diabetes Self-Management: Which Patients Benefit Most?

“…2,3 As such, it has been incorporated into a number of innovations that use the health care team to augment the work of the physician. 4,5 A further refinement of this general approach includes training laypeople to serve as members of the primary care team:…”