Impact of Primary Care Clinician Interdependence and Coordination on Quality of Care Delivered to Complex Older Patients with Diabetes

初级保健临床医生相互依赖和协调对复杂老年糖尿病患者护理质量的影响

基本信息

批准号：
9908029
负责人：
Christine M Everett
金额：
$ 12.23万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-08-01 至 2022-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9908029
关键词：
Address Aging Americas Area Caring Case Manager Chronic Disease Clinic Clinical Clinical Pathways Clinical Research Communication Complement Complex Coupled Data Development Diabetes Mellitus Disease Management Elderly Electronic Health Record Foundations Goals Growth Health Health Policy Health Professional Health Services Health Services Research Intervention Intervention Trial Interview Knowledge Lipids Measures Mediating Mediation Medical Medical Care Team Medical Records Mentors Mentorship Methods Modeling North Carolina Nurse Practitioners Outcome Patient Care Patient-Focused Outcomes Patients Physician Assistants Physicians Population Positioning Attribute Prevalence Primary Care Physician Primary Health Care Psychology Quality of Care Regression Analysis Research Research Methodology Research Personnel Research Training Role Sampling Services Specialist Surveys Testing Training Universities Work aging population base care coordination care delivery career development comparative effectiveness study design electronic data experience human old age (65+)implementation science improved meetings multiple chronic conditions older patient phase 1 study pre-clinical skills social success successful intervention theories

项目摘要

ABSTRACT A shortage of primary care physicians makes it difficult to deliver quality diabetes care to America’s aging population. A frequently recommended approach to compensate for escalating primary care physician shortages, while still meeting the chronic illness care needs of an aging population, is to incorporate physician assistants (PAs) and nurse practitioners (NPs) into primary care teams. While a number of team models incorporating PA&NPs have delivered quality care to patients with chronic illnesses such as diabetes, data is limited regarding which clinician team approaches are most effective. Identifying effective approaches to incorporating PA&NPs into primary care teams that care for older patients will require identification of effective PA&NP roles, as well as features of PA&NP and physician interaction (interdependence and coordination) that can improve patient outcomes. Interdependence between primary care PA&NPs and physicians occurs when they provide care to, or “share” common patients. Managing shared patients between clinicians requires coordination. Coordination can be accomplished through multiple methods including routines (ex: clinical pathways), boundary spanners (ex: case managers), team meetings (ex: huddles), and relational coordination (i.e., communication and relationships) and is believed to be a key mechanism by which clinician teams will improve patient outcomes, particularly for older, complex patients with multiple chronic conditions. Focus has been placed on improving patient outcomes by coordinating care between settings, such as between specialists and primary care. To our knowledge, however, no studies have evaluated the impact of interdependence and/or coordination within primary care on patient diabetes outcomes such as glycemic and lipid control or development of patient treatment goals. My long-term goal is to improve chronic illness care for older complex patients through identification and implementation of effective primary care teams. In order to develop and evaluate team interventions, it is critical to address the medical and social aspects of team-based care delivery. Designing and evaluating interventions that address both aspects of team care require a range of knowledge and skills, including expertise in mixed methods research approaches, organizational theory, and implementation science. The objective of this application is to determine if PA&NP and physician interaction (interdependence and coordination) on teams impacts outcomes for older patients with diabetes. My health policy background, clinical experience as a PA, and formal quantitative research training will provide the foundation for the proposed project. I will pursue career development in mixed methods, and implementation science and organizational theory at both Duke University and the University of North Carolina Chapel Hill (UNC). The specific aims of the proposed project are to describe the methods of coordination utilized between PA&NPs and physicians on primary care teams (Aim 1), to evaluate the relationship between the interdependence of PA&NPs and physicians on primary care teams and outcomes (glycemic and lipid control as well as patient treatment goals) for older patients with diabetes (Aim 2), and to determine if methods of coordination mediate the relationship between PA&NP role, interdependence and outcomes for older patients with diabetes (Aim 3). To achieve these aims, I propose a mixed methods approach. I will collaborate with Duke Primary Care to conduct interviews and surveys with health care professionals from Duke’s clinics regarding the full range of coordination mechanisms used within their teams and practices (Aim 1). This information will be combined with data derived from electronic health records for medically complex patients over the age of 65 with diabetes in order to match PA&NP and physician interactions (Aim 2) with patient outcomes (Aim 3). Synthesis of Aims 1-3 will inform development of a primary care team-based intervention involving clinician interdependence and coordination for an R01 proposal aimed at improving chronic disease management in complex older patients with diabetes. This proposal sets forth essential development steps that are analogous to preclinical/phase 1 studies that are pivotal to guide later successful intervention trials. Skills gained in organizational psychology, mixed methods and implementation science will complement my prior clinical and research training to position me for success as an independent health services researcher with the skills to design and implement health care teams that improve chronic disease management for complex older patients.

抽象的短缺的初级保健医师使得很难将优质的糖尿病护理提供给美国人口老龄化。经常推荐的方法来补偿不断升级的初级保健医生短缺的同时仍满足人口老龄化的慢性病护理需求，但要纳入身体。助理（PAS）和护士从业人员（NP）加入初级保健团队。而许多团队模型纳入PA＆NP已为患有糖尿病等慢性疾病的患者提供优质护理，数据是关于哪些临床团队方法最有效的有限。确定有效的方法将PA和NP纳入护理老年患者的初级保健团队将需要确定有效 PA和NP角色以及PA＆NP的特征以及物理互动（相互依存与协调）可以改善患者的预后。初级保健PA＆NP与医生之间的相互依赖性在提供护理或 “共享”普通患者。管理临床医生之间的共享患者需要协调。协调可以通过多种方法（包括例程（例如：临床途径），边界跨度来完成（例如：案件经理），团队会议（例如：huddles）和关系协调（即沟通和关系），被认为是临床团队可以改善患者预后的关键机制，特别是对于具有多种慢性病的老年人，复杂的患者。重点放在改进上通过协调设置之间的护理（例如专家和初级保健之间的护理）的患者预后。到但是，我们的知识尚无研究评估相互依赖和/或协调的影响对患者糖尿病结果的初级保健，例如血糖和脂质控制或患者的发育治疗目标。我的长期目标是通过识别来改善老年复杂患者的慢性病护理并实施有效的初级保健团队。为了制定和评估团队干预措施，这是解决基于团队的护理交付的医学和社会方面至关重要。设计和评估解决团队护理两个方面的干预措施需要一系列知识和技能，包括混合方法研究方法，组织理论和实施科学方面的专业知识。此应用的目的是确定PA＆NP和身体互动是否（相互依赖性和对团队的协调会影响老年糖尿病患者的结局。我的健康政策背景，作为PA的临床经验和正式的定量研究培训将为拟议项目。我将追求混合方法，实施科学以及杜克大学和北卡罗来纳大学教堂山（UNC）的组织理论。拟议项目的具体目的是描述在之间使用的协调方法 PA＆NP和初级保健团队的医生（AIM 1），以评估 PA＆NP和医生在初级保健团队和结果（血糖和脂质控制）的相互依赖性以及患有糖尿病患者的患者治疗目标（AIM 2），并确定是否的方法是配位调解了老年患者的PA和NP角色，相互依赖性和结果之间的关系糖尿病（AIM 3）。为了实现这些目标，我提出了一种混合方法方法。我将与杜克大学初级保健，对杜克诊所的医疗保健专业人员进行访谈和调查考虑其团队和实践中使用的各种协调机制（AIM 1）。这信息将与医学复杂患者的电子健康记录得出的数据结合在65岁以上患有糖尿病以使PA＆NP和身体互动（AIM 2）与患者相匹配（AIM 2）结果（目标3）。 AIMS 1-3的综合将为基于初级保健团队的干预提供信息，涉及 R01提案旨在改善慢性病的R01提案的临床相互依赖和协调复杂的老年糖尿病患者的管理。该提案阐述了基本的发展步骤类似于临床前/第1阶段的研究，这些研究是指导以后成功干预试验的关键。在组织心理学，混合方法和实施科学方面获得的技能将完成我的以前的临床和研究培训，使我成为独立卫生服务研究人员的成功具有设计和实施医疗团队的技能，以改善慢性病管理复杂的老年患者。

项目成果

期刊论文数量（2）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Teaming up in primary care: Membership boundaries, interdependence, and coordination.

DOI：
10.1097/01.jaa.0000805840.00477.58
发表时间：
2022-02-01
期刊：
JAAPA-JOURNAL OF THE AMERICAN ACADEMY OF PHYSICIAN ASSISTANTS
影响因子：
1.1
作者：
Everett, Christine M.;Docherty, Sharron L.;Matheson, Elaine;Morgan, Perri A.;Price, Ashley;Christy, Jacob;Michener, Lloyd;Smith, Valerie A.;Anderson, John B., Jr.;Viera, Anthony;Jackson, George L.
通讯作者：
Jackson, George L.

Impact of primary care usual provider type and provider interdependence on outcomes for patients with diabetes: a cohort study.