Powering-Up Primary Care Teams: Advanced Team Care With In-Room Support

Abstract

Primary care teams are underpowered. Teams do not maximally redistribute team functions when clinicians are diverted from activities where they add the most value. This commentary describes "advanced team care with in-room support" as a way to "power-up" primary care teams. In this core team model, each clinician is paired with 2 or 3 highly trained medical assistants or nurses-care team coordinators (CTCs).Early evidence suggests that this model is more satisfying to clinicians, staff, and patients and is financially sustainable. Yet its spread has been hobbled by several misguided beliefs, such as that the physician can and should do most tasks, that technology replaces people, that health care is a transactional endeavor more than a therapeutic relationship, that regulation is the main lever by which to advance quality, and that the principal way to increase net revenue is to reduce overhead. A shift in mindset is needed to energize primary care.

Electronic Medical Records in the American Health System: challenges and lessons learned

“…Team-based care is an essential component of comprehensive integrated primary care and a well-functioning EMR can be strategically deployed to support the essential functions of the multidisciplinary team 9, 38,39 . High functioning primary care practices have teams composed of physicians, advanced practice nurses, physician assistants, clinical pharmacists, nurse care managers (for coordination of chronic disease care and for patient education), behavioral health specialists, social workers, nutritionists, medical assistants, nurses, receptionists and population health managers.…”

“…This care model has been shown to improve quality of care and to increase the capacity to care for more patients, while simultaneously decreasing physician workload. Ideal staffing requires the deployment of 2 or 2.5 full-time-equivalent well-trained medical assistants per full time physician 38 . An important task of the medical assistant in these settings is to assist with record keeping of the clinical encounter as a "scribe", carefully documenting the clinical encounter in the EMR, in real time, as the physician cares for the patient 38 .…”

“…Ideal staffing requires the deployment of 2 or 2.5 full-time-equivalent well-trained medical assistants per full time physician 38 . An important task of the medical assistant in these settings is to assist with record keeping of the clinical encounter as a "scribe", carefully documenting the clinical encounter in the EMR, in real time, as the physician cares for the patient 38 . "Scribes" have been shown to document clinical notes that are as accurate, or more accurate, than those of a physician 40 .…”

“…These clinical processes and pathways make care more reliable and result in more efficient and effective patient visits. With routine interventions managed by an information-system driven protocol that guides the activities of non-physician team members, physicians are able to better focus on care activities that depend on their specialized knowledge, training and professional expertise to establish and strengthen the patient-physician relationship 38,41 and attend to the subtleties of formulating difficult diagnoses, engaging in shared decision making, and attending to the patient's psycho-social needs (Chart 2).…”

The Present and Future of Team Documentation: The Role of Patients, Families, and Artificial Intelligence

“…The advantage here is that it is team-based care, with all the benefits of teamwork that have been shown in the literature. 6 When implemented correctly, this model may also lead to lower overall staffing ratios compared with hiring commercial scribes. Done poorly, some people worry that it may push the burden of burnout onto other care team members, without really creating additional capacity for documentation support.…”