Commentary

Team-based care: Worth a second look

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In this issue, Dr. Zawora and colleagues make a strong case that team-based care is a large part of the solution to the many challenges we face in providing high-quality, modern primary care. (See "Turning team-based care into a winning proposition.")

Team care is not a new idea. For many years, our office teams have included physicians, nurse practitioners, physician assistants, nurses, medical assistants, front office staff, and administrative staff who functioned quite well in caring for our patients.

But primary care changed drastically after the publication of 2 landmark Institute of Medicine reports: To Err is Human: Building a Safer Health System1 (in 1999) and Crossing the Quality Chasm: A New Health System for the 21st Century2 (in 2001). These scathing reports told us we were providing inadequate care to our patients, and they contained plenty of truth. What followed is that expectations increased exponentially, and we found our offices were not prepared to deal with the new mandates for computerized medical records, high performance on quality and patient satisfaction measures, and population management.

It’s time to consider whether your team would benefit from the addition of a nurse care coordinator, a “navigator,” a clinical pharmacist, or maybe even a practice facilitator.

Addressing these expanded expectations requires redefining roles and adding new players to our office teams, including nurse care coordinators, “navigators,” clinical pharmacists, psychologists, information technologists, and who knows what else. One innovative role that has seen limited testing is what some call practice facilitators.3 These are trained agents who do some of the heavy lifting required to change things like office systems and work flow.

I think that expanding the role of nurses and medical assistants is one of best ways to ensure that all of our patients get the care they deserve. Each office is unique, however, and physicians need to do the hard work of selecting the best team configuration to care for their patients. One of the more successful team-based practices is the Nuka System of Care in Alaska, which was crafted in collaboration with the tribal council. Read this fascinating story at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3752290 and then create your own story of a successful, high-quality primary care office.

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