Introducing the “Teamlet”: Initiating a Primary Care Innovation at San Francisco General Hospital

Laing, Brian Yoshio; Ward, Lisa; Yeh, Thomas; Chen, Ellen; Bodenheimer, Thomas

doi:10.7812/tpp/07-142

Cited by 13 publications

(15 citation statements)

References 5 publications

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“…Patients in the referral system can receive care from higher-level health care institutions. An effective referral system is strictly based on a clear classification of diseases (26). In order to encourage Chinese patients to use PHC as their first choice, it is recommended that the PHC institution should improve the construction of the referral system.…”

Section: Discussionmentioning

confidence: 99%

Factors Contributing to Patients' Preferences for Primary Health Care Institutions in China: A Qualitative Study

Zhang

Ung

Lin

et al. 2020

Front. Public Health

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Background: Primary health care (PHC) is a key component of the health care system in many countries. In China, however, PHC institutions are less preferred by patients, leading to the underuse of PHC services. Factors affecting patients' preferences for PHC institutions in China remain unreported in the current literature, which was first explored in this study. Method: A qualitative interview study was conducted in Nanjing, Jiangsu Province of China. A semi-structured interview guide was applied to ask patients' opinions regarding the PHC institutions in China. Qualitative data analysis was conducted using the thematic framework approach. Results: A total of 142 participants were interviewed. Three themes and their sub-themes emerged from the study: (1) attributes of PHC services, including accessibility of primary healthcare services, consultation time, drug cost, continuity of care, referral system, opening hours, waiting time, and drug accessibility; (2) attributes of PHC doctors' workforce, including doctors' attitude, competence, and accessibility; (3) attributes of PHC facility infrastructure, including basic facilities, diagnostic facilities and department settings. It was identified that some attributes of PHC services had positive impacts on participants' preferences for PHC institutions, while the same attributes of PHC doctors were the opposite. Conclusion: There are three major factors that contribute to patients' preferences for PHC institutions in China. Policy interventions to improve doctors' workforce and facility infrastructure of PHC institutions are needed to promote patients' preferences for PHC.

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Section: Discussionmentioning

confidence: 99%

Factors Contributing to Patients' Preferences for Primary Health Care Institutions in China: A Qualitative Study

Zhang

Ung

Lin

et al. 2020

Front. Public Health

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“…Program Description In 2006, the Teamlet Model was piloted on a small scale at the FHC 8 . Building upon the pilot, during the 2007–8 academic year, we expanded the Teamlet Model to 13 first-year residents, 11 health coaches, and approximately 150 patients.…”

Section: Methodsmentioning

confidence: 99%

Using the Teamlet Model to Improve Chronic Care in an Academic Primary Care Practice

et al. 2010

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BackgroundTeam care can improve management of chronic conditions, but implementing a team approach in an academic primary care clinic presents unique challenges.ObjectivesTo implement and evaluate the Teamlet Model, which uses health coaches working with primary care physicians to improve care for patients with diabetes and/or hypertension in an academic practice.DesignProcess and outcome measures were compared before and during the intervention in patients seen with the Teamlet Model and in a comparison patient group.ParticipantsFirst year family medicine residents, medical assistants, health workers, and adult patients with either type 2 diabetes or hypertension in a large public health clinic.InterventionHealth coaches, in coordination with resident primary care physicians, met with patients before and after clinic visits and called patients between visits.MeasurementsMeasurement of body mass index, assessment of smoking status, and formulation of a self-management plan prior to and during the intervention period for patients in the Teamlet Model group. Testing for LDL and HbA1C and the proportion of patients at goal for blood pressure, LDL, and HbA1C in the Teamlet Model and comparison groups in the year prior to and during implementation.ResultsTeamlet patients showed improvement in all measures, though improvement was significant only for smoking, BMI, and self-management plan documentation and testing for LDL (p = 0.02), with a trend towards significance for LDL at goal (p = 0.07). Teamlet patients showed a greater, but non-significant, increase in the proportion of patients tested for HbA1C and proportion reaching goal for blood pressure, HgbA1C, and LDL compared to the comparison group patients. The difference for blood pressure was marginally significant (p = 0.06). In contrast, patients in the comparison group were significantly more likely to have had testing for LDL (P = 0.001).ConclusionsThe Teamlet Model may improve chronic care in academic primary care practices.

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“…Previous research has underscored that effective work teams have clearly bounded membership (Hackman, 2002;Wageman, Hackman, & Lehman, 2005), meaning individuals understand which individuals are ''on'' versus ''off'' their team, because clear team boundaries, stable membership, and interdependence can facilitate better teamwork. The teamlet model of primary care (Bodenheimer & Laing, 2007;Laing, Ward, Yeh, Chen, & Bodenheimer, 2008) and the Veterns Health Administration's teamlet model (Rosland et al, 2013) use tight team structures in efforts to ensure more consistent availability of members and to foster effective working relationships among primary care personnel. Tighter team structures and high-functioning teams have been associated with less burnout among staff (Willard-Grace et al, 2014), suggesting that other individual worker and organizational outcomes may be affected by dimensions of team structure such as the availability of team members.…”

Section: Conceptual Frameworkmentioning

confidence: 99%

Availability of primary care team members can improve teamwork and readiness for change

Rodríguez

Chen

Martínez

et al. 2016

Health Care Manage Rev

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Ensuring that members perceive that their teammates are routinely available to them may improve readiness for implementing organizational changes like adopting patient-centered medical home models. Given that better teamwork only partially explained the availability-readiness relationship, additional research to identify the mechanisms through which consistent team member availability increases change readiness could lend insight into how to more effectively support clinicians and staff undergoing complex organizational changes.

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Introducing the “Teamlet”: Initiating a Primary Care Innovation at San Francisco General Hospital

Cited by 13 publications

References 5 publications

Factors Contributing to Patients' Preferences for Primary Health Care Institutions in China: A Qualitative Study

Factors Contributing to Patients' Preferences for Primary Health Care Institutions in China: A Qualitative Study

Using the Teamlet Model to Improve Chronic Care in an Academic Primary Care Practice

Availability of primary care team members can improve teamwork and readiness for change

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