The Complexity, Diversity, and Science of Primary Care Teams
The Complexity, Diversity, and Science of Primary Care Teams
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DOI：
10.1037/amp0000244
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发表时间：
2018-05-01
影响因子：
16.4
通讯作者：
McDaniel, Susan H.
中科院分区：
文献类型：
--
作者：
Fiscella, Kevin;McDaniel, Susan H.
本文探讨了初级保健和团队合作的过去、现在和未来。它首先对初级保健进行定义和描述——其独特性、多样性和复杂性，包括初级保健团队的历史作用。然后，本文回顾了创新初级保健团队的出现，包括那些基于新流程的团队，例如以患者为中心的医疗之家和包括新型卫生专业人员，特别是心理学家和其他综合行为健康临床医生的跨专业团队。本文描述了支持或阻碍初级保健团队合作的关键因素，以及这些基于团队的模型对患者结果、成本和团队成员影响的证据。它还讨论了初级保健团队在多团队系统（或“团队的团队”）中的作用，这些系统是围绕患者和家庭的需求而组织的，以及这些系统对协调护理带来的独特挑战。文章最后提出了推进初级保健团队的建议，包括支付方式的变化、团队能力的描述、初级保健团队培训的模型以及弥补科学知识差距所需的研究。
This article examines the past, present and future of primary care and teamwork. It begins with a definition and description of primary care-its uniqueness, diversity and complexity, including the historical role of teams within primary care. The article then reviews the emergence of innovative primary care teams, including those grounded in new processes such as the Patient-Centered Medical Home and interprofessional teams that include new types of health professionals, particularly psychologists and other integrated behavioral health clinicians. The article describes key factors that support or hinder primary care teamwork, as well as evidence of the impact of these team-based models on patient outcomes, costs, and team members. It also discusses the role of primary care teams within multiteam systems (or 'teams of teams'), which are organized around the needs of patients and families, and the unique challenges these systems pose to coordinating care. The article concludes with recommendations for advancing teams in primary care, including changes in payment, descriptions of team competencies, models for primary care team training, and research necessary to inform the gaps in scientific knowledge.