Enhancing the Primary Care Team to Provide Redesigned Care: The Roles of Practice Facilitators and Care Managers

Abstract

Efforts to redesign primary care require multiple supports. Two potential members of the primary care team-practice facilitator and care manager-can play important but distinct roles in redesigning and improving care delivery. Facilitators, also known as quality improvement coaches, assist practices with coordinating their quality improvement activities and help build capacity for those activities-refl ecting a systems-level approach to improving quality, safety, and implementation of evidence-based practices. Care managers provide direct patient care by coordinating care and helping patients navigate the system, improving access for patients, and communicating across the care team. These complementary roles aim to help primary care practices deliver coordinated, accessible, comprehensive, and patient-centered care.

Overcoming Challenges to Teamwork in Patient-Centered Medical Homes: A Qualitative Study

“…It includes new approaches as well as confirmation of previously described tools. 3,4,9,12,24,[27][28][29][30][31][32] These included using data to show the team how patient care improves with teamwork, incremental delegation by physicians, 3,4 engaging staff in workflow redesign, creating a safe culture for feedback and questions, 9 using outside coaches or practice facilitators, 27,28 huddles, 21,22 using EHR templates to guide data collection by MAs and nurses, and tracking task completion to help prevent sliding back to pre-teamwork behaviors. When task redistribution maintained patient care safety, job satisfaction and interpersonal continuity of care improved both for physicians and for MAs and nurses who appreciated greater involvement in patient education and decisions about team care processes.…”

“…Some had a physician leader who had read about teamwork and then championed change within the practice. In Colorado, where HealthTeamWorks 27 is active, practices used practice coaches 28 and the military practice used PC TeamSTEPPS. 20 Other practices, however, could not identify formal teamwork training.…”

Disentangling the Linkage of Primary Care Features to Patient Outcomes: A Review of Current Literature, Data Sources, and Measurement Needs

“…4,14 Support for each of the defining primary care elements can come from different levels of a larger health system. For example, support for HIT adoption and implementation, data feedback, support for patient self-management, 86 and practice facilitators 106 could come from within a primary care practice or from the larger physician organization or hospital/health system affiliation. Patient-centered medical home (PCMH) initiatives, 107,108 which strive to bolster primary care through increased reimbursement and the creation of guideposts for practice capabilities, 109 include varying support for these tools.…”

Outcomes of a Partnered Facilitation Strategy to Implement Primary Care–Mental Health

“…IF strategies that bundle evidence-based implementation interventions 8 usually also focus on building relationships and partnering with sites. [8][9][10][11] Facilitators use particular activities and techniques depending on the purpose of facilitation and stakeholder needs. [12][13][14][15] Unfortunately, when funding ends, sites often have difficulty sustaining changes.…”