Multidisciplinary Team Meetings—a Venue to Improve Team Engagement and Quality in Resident Continuity Clinic

Lyons, Amalia; Walker, Rebekah J.; Prigmore, Heather L.; Muntz, Martin

doi:10.1007/s11606-019-05084-6

Cited by 4 publications

(6 citation statements)

References 3 publications

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“…It seemed that advising providers on the lowest two ECLS had significant impact on increasing effective care over time. This was an anticipated outcome supported by literature evidence (Dean, 2021; Lyons et al, 2019) that team communication leads to improved outcomes. Finally, NPs were willing to continue focusing on incorporating two lower effective care areas (Table 3) of sleep hygiene and exercise (USPSTF, 2016, VA, 2022) in future appointments.…”

Section: Discussionsupporting

confidence: 57%

“…Nurse practitioners were willing to review and document PHQ-9 scores, review weekly ECLS, and address the lowest scoring items each week. The team's willingness to communicate, attend meetings, discuss difficulties, and refer patient concerns was predicted in recent literature (Dean, 2021;Inness et al, 2022;Lyons et al, 2019) and reflected in improved team engagement scores at project completion.…”

Section: Discussionmentioning

confidence: 93%

“…Patient Health Questionnaire-9 completion began at 70% in cycle 1. After cycle 1, a weekly staff PHQ-9 office hour (Arora et al, 2020; Lyons et al, 2019) was initiated as an evidence-based test of change (TOC). Patient Health Questionnaire-9 completion rate declined to 67% in cycle 2, possibly because of being the first full cycle with three NPs participating.…”

Section: Resultsmentioning

confidence: 99%

“…Before implementation, mean scores were 26.1 (on a scale of 6–30). Throughout project implementation, evidence-based team engagement activities included frequent communication, role clarity, clear instructions and reminders, support, and result transparency and updates (Arora et al, 2020; Inness et al, 2022; Lyons et al, 2019). The questionnaire was provided again at project completion, showing an increase in mean team engagement scores to 27.5.…”

Section: Resultsmentioning

confidence: 99%

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Improving effective depression care in an outpatient psychiatric clinic

Moore,

Johnson

2023

J Am Assoc Nurse Pract

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Background: With more than 20 million adults experiencing a major depressive episode in 2020, depression is one of the most widespread and costly illnesses in the United States. Local problem: An audit of medical records at an outpatient psychiatric clinic revealed that none of the patients (0/56) were receiving standardized depression screening at follow-up appointments. Methods: An 8-week rapid cycle Plan-Do-Study-Act model for change was used to spearhead a quality improvement (QI) project for effective depression care. The QI project comprised ongoing data collection through chart audit every 3 days, which drove tests of change (TOC). Team engagement surveys were also assessed for change in team engagement scores. Interventions: The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression, and an effective care log (ECL) measured effective depression care. Every 2 weeks, a TOC was implemented, which guided further iterative changes throughout the project. Results: Effective depression care increased to 74% over the course of the project, surpassing the initial aim of 50%. Completion rates of the PHQ-9 (76%) and ECL (91%) increased. Team engagement (27.1) also increased over the course of the project. Conclusions: This project improved effective depression care. The success was largely due to the iterative TOCs, ECL, and team engagement.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 93%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Improving effective depression care in an outpatient psychiatric clinic

Moore,

Johnson

2023

J Am Assoc Nurse Pract

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“…As such, resident integration into teams can be challenging, although one recent study demonstrated the benefits of multidisciplinary team meetings. 20 Faculty preceptors often also conduct clinical work part-time, making functional teams and management continuity difficult. Many residency practices are hospital-based and provide care to medically and psychosocially complex patients, making team-based care even more critical.…”

Section: Introductionmentioning

confidence: 99%

Residency Practice Transformation: Implementation of Team-Based Care in an Academic Continuity Clinic

Coyle

Wajnberg

Fishman

2020

Journal of Graduate Medical Education

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Background Team-based primary care has the potential to improve care delivery. However, residency scheduling and precepting models make creating functional ambulatory teams challenging. Objective We describe the team-based care transformation at a large academic internal medicine residency practice. Methods On July 1, 2016, the program transitioned to a 6+2 schedule and the clinic was divided into teams. Residents were precepted by 2 team preceptors, social work and care coordination needs were met by team-specific staff, and front desk staff were trained on maintaining primary care physician (PCP) and team continuity. Weekly team meetings provided opportunities for proactive patient and panel management, and preclinic huddles incorporated staff into team functions. Pre-transformation (June 2016) and post-transformation (June 2017) surveys were distributed to residents (n = 131), faculty (n = 14), and staff (n = 65) to assess team functioning. Patient-PCP continuity was monitored on a quarterly basis. Results Three hundred sixty-two of 420 surveys were returned (86%). The intervention was associated with significant improvements in resident satisfaction (from 3.05 baseline to 4.07 of 5, P < .001) and perceptions of teamwork (4.14 to 4.61 of 6, P < .001), with moderate to large effect sizes. Patient-PCP continuity significantly increased (45% to > 70%). While domain-specific improvements were seen for faculty and staff, no overall changes were noted in their perceptions of teamwork or team-based care. Conclusions Team-based care was implemented with significant improvements in continuity and resident satisfaction and perceptions of teamwork; however, the impact on faculty and staff was limited.

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Factors influencing interprofessional collaboration in general and during multidisciplinary team meetings in long-term care and geriatric rehabilitation: a qualitative study

Doornebosch,

Achterberg,

Smaling

2024

BMC Med Educ

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Background Interprofessional collaboration is essential to maintain high-quality care in long-term care and geriatric rehabilitation. However, little is known regarding perceived factors influencing interprofessional collaboration by people involved in care. This concerns both long-term care and geriatric rehabilitation. Moreover, knowledge of using patient outcome measures to enhance interprofessional collaboration during multidisciplinary team meetings is insufficient. This study examined the perceived facilitators of and barriers to interprofessional collaboration in general and during multidisciplinary team meetings, specifically according to healthcare professionals, patients, and informal caregivers. Differences between long-term care and geriatric rehabilitation were also investigated. Finally, it was examined which patient outcome measures were used in multidisciplinary team meetings. Methods A constructivist qualitative study using 10 focus groups and 18 semi-structured interviews with 14 patients, 13 informal caregivers,10 managers, and 22 healthcare professionals from eight Dutch long-term care and geriatric rehabilitation facilities. A combined inductive and deductive approach to a thematic analysis was performed. Results The perceived influencing factors of interprofessional collaboration were classified into two general themes: (1) ‘Involvement of patient, informal caregiver, and healthcare professional’, categorised into: ‘participation of patients and informal caregivers’, ‘behaviour and attitude of team members’, ‘expectations of team members towards each other’, and ‘exchange of information, knowledge, and reciprocity in communication’; and (2) ‘A systematic approach to providing care for older people’, consisting of: ‘coordination of team procedures’, and ‘coordination of organisational procedures’. Also, one theme for multidisciplinary team meetings was identified: ‘Organised participation of patient, informal caregiver, and healthcare professional in multidisciplinary team meeting, categorised into: ‘team procedures’, ‘working systematically’, and ‘participation in multidisciplinary team meetings. Standardised patient outcome measures were scarcely used in multidisciplinary team meetings. Conclusion People involved in long-term care and geriatric rehabilitation indicated that, apart from working systematically, being involved in care and multidisciplinary team meetings are essential factors for interprofessional collaboration. These factors must be taken into consideration to provide valuable, high-quality care to older people residing in long-term care and geriatric. Trial registration Not applicable.

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Multidisciplinary Team Meetings—a Venue to Improve Team Engagement and Quality in Resident Continuity Clinic

Cited by 4 publications

References 3 publications

Improving effective depression care in an outpatient psychiatric clinic

Improving effective depression care in an outpatient psychiatric clinic

Residency Practice Transformation: Implementation of Team-Based Care in an Academic Continuity Clinic

Factors influencing interprofessional collaboration in general and during multidisciplinary team meetings in long-term care and geriatric rehabilitation: a qualitative study

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