Adam Roise, MD, MPHNortheast Iowa Family Medicine Residency Program

Jauch Symposium16 May 2014

Medicine’s Future: Team Based Care

I have no disclosures to report.

3

Patient care is becoming more complex

Physician led teams provide a platform for required care delivery

Working in teams requires new thinking and skills

This presentation will explore the delivery of patient care

4

1958

Patient care is becoming more multifaceted

5

Medical knowledge, diagnostics, and treatment options continue to grow and become more complex

http://jasonpriem.org/2010/10/medline-literature-growth-chart/

6

Medical knowledge, diagnostics, and treatment options continue to grow and become more complex

http://jama.jamanetwork.com/article.aspx?articleid=184654

7

Medical knowledge, diagnostics, and treatment options continue to grow and become more complex

8

Medical knowledge, diagnostics, and treatment options continue to grow and become more complex

http://www.ft.lk/2013/01/04/us-fda-new-drug-approvals-hit-16-year-high-in-2012/

9

Our populations are growing older and have more comorbidities

Percent of Medicare Beneficiaries, with multiple conditions, 2008

-

10

Our populations are growing older and have more comorbidities

http://mpkb.org/home/pathogenesis/epidemiology

11

Primary care providers alone cannot accomplish all they are expected to do

Acute

Chronic

Preventive

Total020406080

100120

Expectations of Primary Care

Current hrs/wkRequired hrs/wk

Yamall, et al. 2008

12

Physician performance measures are no longer private information

http://www.mslworldwide.com/dcblog/2013/04/17/reporting-on-physician-performance/

13

With all of these pressures on physicians, what’s a doc to do?

http://owndoc.com/lyme/lyme-controversy-cardinal-sins-instead-of-conspiracy/attachment/greedy-doc/http://www.pcdl-usanews.com/2014/04/30/need-more-patients-7/

Concierge practice

: ratios:

200-600 patients1 physician for

14

To compound this problem, there aren’t enough primary care physicians to alone provide all recommended care

http://medicinesocialjustice.blogspot.com/2011/05/primary-care-medical-school-debt-and-us.html

15

To compound this problem, there aren’t enough primary care physicians to alone provide all recommended care

Robert Grham Center. Available: http://www.graham-center.org/online/graham/home/tools-resources/data-tables.html . Accessed 5/9/14Picture credit : http://www.oneaccordnonprofit.com/how-to-get-broader-based-support-for-your-mission/

:Current ratio of workforce:

1 physician for 1500 patients

16

However, that doesn’t mean that services can’t be provided with current numbers of primary care physicians

Altschuler, et al. Annals of Fam Med. Oct 2012.

Table 1. Estimated Panel Sizes Under Different Models of Physician Task Delegation to Nonphysician Team Members

17

However, that doesn’t mean that services can’t be provided with current numbers of primary care physicians

http://medicinesocialjustice.blogspot.com/2011/05/primary-care-medical-school-debt-and-us.html

Table 1. Estimated Panel Sizes Under Different Models of Physician Task Delegation to Nonphysician Team Members

“Primary care is a team sport.” Bruce Bagley, MD, AAFP Medical Director of

Quality Improvement

18

Patient demographics, community factors, and the care setting affect the kinds of medical teams used

19

Effective care teams include a wide variety of members

Physician

20

High-performing primary care are able to use teams for maximum benefit

Physician: Clinical leader and mentor, fewer and longer patient visits, time for e-visits and phone visits

Other appointments available: e-visits, phone encounters, group visits, team member visits

Preventive care and chronic disease care largely managed by non-physician team members

Care coordination assist with continuity and handoffs with community team members

Bedenheimer et al. Annals Fam Med. Mar-Apr 2014.

21

Effective care teams include a wide variety of members, who can be arranged in several ways

Boon, et al. BMC Health Services Research, 2004.

22

Providers need to undergo a shift in thinking about how care is provided in order to be able to use effective teams

“I’m afraid you’ve had a paradigm shift.”

23

To effectively lead such teams, providers will need a different set of skills then the past

http://www.limebridge.com.au/cartoons/team-leader

24

To effectively lead such teams, providers will need a different set of skills then the past

Interprofessional collaborative

practice

Roett, Michelle. Collaborative Practice and Team Based Care. FP Essentials. AAFP. Nov 13.

Roles and responsibilities

Values and

ethics

Communication

Teams and teamwork

25

To function well, providers and teams will need to avoid certain barriers

BAD TEAM CARE

26

To function well, providers and teams will need to avoid certain barriers

27

To function well, providers and teams will need to avoid certain barriers

28

To function well, providers and teams will need to avoid certain barriers

Usual care Health

coaching

0%20%40%60%80%

Patients Highly Recommending Provider

Baseline1 Year

Thom, et al. Patient Educ Couns, 2014.

29

To function well, providers and teams will need to avoid certain barriers

30

To function well, providers and teams will need to avoid certain barriers

Team Culture and Structure on Exhaustion for Clinicians

Willard-Grace, et al. JABFM March-April 2014.

No Team Team Teamlet

Exha

ustio

n M

ean

Scor

e

Low Team Culture

High Team Culture

31

Questions?

In summary, the future will require physicians will need to effective employ health care teams to care for patients

There are too many patients and too much recommended care to not work in teams

If physicians want to be the leaders of these medical teams, they need to learn to be team leaders

http://www.startribune.com/local/117835103.html

33

Increasingly, care teams will come from outside of the typical setting