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Read this report of inspiring stories from Phase One of the Be Our Voice project.

Care Teams Better Support Patients, Pediatric Practices

March 18, 2014
By Rachel Kremen

Staff at Martha Eliot Health Center wear lanyards in their team color, to help patients identify members of their team and promote the care team approach.

One characteristic of a medical home is coordinated care. That means medical professionals are acting as a team, sharing information, and predicting patient needs. Pediatric practices in NICHQ’s CHIPRA Massachusetts Medical Home Project, have been working to establish care teams within their practices to better support coordinated care. The impact, especially for children with complex healthcare needs, has been visible.
"If I've huddled with my care team prior to that visit, it's a big help," says Lara Antkowiak, a pediatrician at the Martha Eliot Health Center, where care teams were officially launched in January. "It lets me make the most of my limited time with the patient."

With a coordinated team caring for a patient there is the opportunity to look for emerging patterns of illness, debate treatment options or simply assign tasks the doctor would have typically done during a visit. For example, Antkowiak might have a nurse collect a patient’s head circumference and note it in the medical record prior to Antkowiak entering the exam room, freeing the doctor up to focus on other elements of the visit.

The members of a patient's team vary depending on the facility and the patient's needs, but teams can include nurses, doctors, social workers, therapists, and administrative staff. Everyone involved with the patient is involved in the conversation.

CHIPRA Green Team on Halloween
Team members from Martha Eliot Health Center wore their colors proudly last Halloween to build team spirit.

Sally Faggella, site nurse leader and manager of pediatrics for the Chelmsford practice of Harvard Vanguard Medical Associates, says that by sharing the responsibility of looking at the patient's case history with the entire care team, the team is better able to anticipate a patient's needs.  For example, medically complex children often require many prescriptions and it is easy for parents to forget to ask for all the refills they need. Using the coordinated team approach, a triage nurse might be charged with contacting the family and asking whether they'd like a new prescription for a child's inhaler, explains Faggella. In doing this proactive outreach, the team may discover two or three emergency room visits that the primary care physician was not aware of or discover that the patient’s insurance is about to lapse and offer help.

Care teams can also create a consistent experience for patients, because each time a patient visits the doctor they will only deal with people from their team. According to patient surveys conducted before care teams were implemented, patients at Martha Eliot often said they'd seen the same doctor before and appreciated the familiarity. But patients were less likely to know other staffers, such as social workers and clinical assistants, from past visits. With all staffers assigned to teams, the patients now have a more predictable experience.

Getting Started

Lexi Zonfrelli, a research assistant at Martha Eliot, says it was challenging to establish a schedule that included all of the appropriate members of each team, every day—especially with several part-time staffers. It took a lot of planning. Another challenge was attitudinal. Not all of the 46 staffers at Martha Eliot were immediately impressed with the idea of care teams. Some felt they were already on an unofficial team and others weren’t sure it would be productive.
Ellen Reisinger, a project manager at Martha Eliot Health Center, says it was critical to explain the benefits of the approach and promote the idea with staff first, and then introduce it to patients. "Developing a team culture was important," she says.

Care Team Bulletin Board
Bulletin boards at Martha Eliot Health Center show photos of each team member, to educate patients.

Team members were encouraged to wear their color for Halloween, for example, though the approach was still only discussed internally at that point. Martha Eliot waited several months before finally exposing patients to the system. Colorful balloons and bulletin boards were displayed around the center with team photos and information about the approach. Patients also wrote their names on appropriately colored stickers, to introduce them to their team color.
Reisinger says they will continue to conduct quarterly patient surveys to ensure the care team approach is improving the quality of care. "We want to make sure it continues to be a positive thing," she says.

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