Despite strong evidence that team-based care models do effectively achieve their goals of improved health outcomes, happier patients and more satisfied physicians and staff, most practices need more help than is currently available to learn how to transform, according to a study published in the journal Population Health Management.
For example, the "top-of-license team," one of three models studied by Dr. Debora Goetz Goldberg and colleagues from George Washington University, Virginia Commonwealth University and Carilion Family Medicine, has been proven to allow practices to significantly boost access, profits, patient satisfaction and disease control, but requires practices to hire and train more nurses to make the model work.
In addition, all three of the models reviewed require practices to incorporate technology such as electronic health records and patient registries into their patient flow. Responsibilities for inputting and sharing data are shared or delegated differently among various models, and practices need to figure out how to best assign those roles.
To prepare for the increase in primary care demand expected by the Affordable Care Act, an aging patient population and shortage of providers, the authors wrote that it is "incumbent upon health services researchers to continue to examine what team-based care models are most effective, what makes it possible to create and sustain these models, and how effective models can be disseminated to the majority of primary care practices in the United States." They added: "This is particularly important for independent practices, which generally have less access to expertise and capital to assist them to transform their practices into more efficient and effective models."
To solve this problem, primary care could benefit from a concept known in agriculture as "extension agent services," in which leaders in industry transformation coach others in the community to incorporate new technology and care-delivery mechanisms into their practices. Such coaches could be particularly valuable in educating their primary care peers on the topics of preventive medicine, health promotion, chronic disease management, mental and behavioral health services, evidence-based therapies and techniques, quality improvement techniques and practice transformation, according to researchers.
Although a primary care extension agent program is indeed included in the Affordable Care Act, it has yet to be funded, the authors noted.