Health care is a team sport. Although effective teamwork has been documented as a significant contributor to enhanced clinical outcomes and a requirement for health care reform, implementing team-based care models in practice can pose challenges.
To better understand the changing practice landscape and evolution of team-based care, the ACC conducted a survey of cardiovascular practices in 2010. Over 2,400 unique practices in the U.S. participated in this research representing almost 14,000 cardiologists.
Four-in-seven (57%) report that their approach to care delivery is “team-based” using non-physician practitioners and clinical staff to participate in the decision-making, coordination of care, and shared responsibility for the quality of care. It is not surprising to find that solo practitioners are less likely to employ a team-based care model while hospital-based, multi-specialty, and academic practices are more likely to utilize physician extenders in their care delivery.
“Alone we can do so little. Together we can do so much.” — Helen Keller
Those practices that have implemented team-based care identify a number of improvements resulting from the approach. Increased efficiency (63%), improved quality of care (53%) and increased patient satisfaction (50%) are the primary improvements occurring at team-based care practices. Other benefits of the team approach include increased staff satisfaction (36%) and improved financial outcomes (19%).
Although there are clear benefits to providing team-based care, many practices report that they do not provide team-based care because of no or minimal reimbursement (34%) and the inability to break the more traditional view (33%) of practicing medicine held by patients and providers. Lack of tools (18%) and no clear practice model (19%) are also cited as hurdles to more utilization of physician extenders.
The research also explored some of the team-based care systems or functions established as part of the provider infrastructure as well as the ways that physician extenders are utilized. Team-based care providers are most likely to implement patient education (69%) and internal communications (63%) as a part of their care protocol.
Performance improvement activities (56%) and data monitoring (56%) are also practiced followed by patient adherence (50%), objective feedback (47%) and clearly-defined roles (41%). Not surprisingly, hospitals and medical schools are more likely to engage in quality improvement types of team-based care – internal communications, data monitoring and performance improvement.
In team-based care, one focus is on shifting power to the team – physician extenders. Practices report utilizing a number of different models leveraging physician extenders. Nurse practitioners or physician assistants working collaboratively in outpatient clinics with physicians (49%) are the most popular type of model, followed by providing collaborative inpatient care with physicians and the physician billing for services (39%) or using thephysician extender to run the outpatient clinic device, coagulation, lipid, etc. (33%). Physician extenders as independent billers, such as billing “incident to” (18%), having independent outpatient clinics and billing independently (17%), providing inpatient care and billing for services (18%), or serving as rounding nurses for inpatient or outpatient services with physicians (18%), are less popular. Taking first call for after-hours patient phone calls is the least used model (9%).
These findings suggest that while most cardiovascular providers are practicing team-based care, opportunities exist for more interdisciplinary roles and responsibilities, increased tools for feedback and quality improvement, and increased responsibility for physician extenders.