Translating Team Science into Primary Care: PCOR on teamwork in FQHCs

确保患者，特别是那些处于社会不利地位的患者，在 他们的医疗保健在确保他们获得高价值护理的同时，需要以患者为中心的新成果 研究(PCOR)。优化患者在初级保健中的声音和价值需要医疗保健转型 从单独的临床医生的护理到团队的护理。这份职业提升提案旨在 为我提供必要的指导、技能、经验和合作伙伴关系，以便将我的研究重新集中在 变革和组织振兴方案的这一新领域，即将团队合作科学转化为初级保健，特别是在联邦政府内部 合格的健康中心(FQHC)。我将通过利益相关者协作实现这一目标，包括提炼、 试行和评估患者-团队沟通(PTC)模型。这一新模式基于 Teamlet(由临床医生和护理人员组成的团队)，融合了以患者为中心的沟通科学 团队合作的科学。Aim项目建立在我著名的导师和顾问的工作基础上 并将通过指导自学、场外和现场培训以及PCOR的应用来完成 在FQHC中试行PTC模型的方法。 PTC模式通过专注于关键任务工作和团队合作来提高患者的发言权和价值 初级保健办公室访问，包括激发患者的关切和偏好以及以团队为基础提供 循证预防护理和其他高价值程序。该模型重点关注以下关键问题 办公室访问流程：访问前计划、团队会议和汇报、团队对临床决策支持的使用 系统，充分激发患者关注的问题，以及访问后对理解和规划的确认。这个 拟议的项目将利用与FQHC相关的可行战略开发培训模块。 我的具体教育目标是：1)提高我直接观察初级保健的技能 以任务和团队合作为重点的访问；2)获得适用于初级保健的团队合作培训技能；3) 提高与利益相关者和患者接触相关的技能；4)获得团队合作评估 技能。 我的具体研究目标是：1)完善和试行FQHC中的PTC模型；2)试行关键 变革和组织振兴方案与技术和技术合作模式各方面有关的措施；3)审查关键的促进者和障碍，以 实施PTC模型。这些教育和研究目标的实现将为我提供 对此展开调查所需的经验、技能、伙伴关系、措施和初步数据 变革与合作组织的全新领域。这项研究提供了改变数百万未得到充分服务的人的护理的希望 以及由初级卫生保健中心提供服务的社会弱势患者，并减少医疗保健差距。

Ensuring that patients, particularly those who are socially disadvantaged, have a meaningful voice in their healthcare while also ensuring they receive high value care, requires new Patient-Centered Outcomes Research (PCOR). Optimizing patients' voice and value in primary care requires transformation of healthcare delivery from care by lone clinicians to care by teams. This career enhancement proposal is designed to provide me with the mentoring, skills, experiences, and partnerships necessary to re-focus my research on this new area of PCOR, i.e. translation of teamwork science into primary care, particularly within federally qualified health centers (FQHCs). I will achieve this aim through stakeholder collaboration, including refining, piloting, and evaluating the Patient-Teamlet Communication (PTC) model. This new model, based on teamlets (teams of clinicians and nursing staff), integrates the science of patient-centered communication with the science of teamwork. The project aim builds on the work of my renowned mentors and consultants and will be accomplished through guided self-study, offsite and onsite training, and application of PCOR methods to piloting of the PTC model within an FQHC. The PTC model enhances patients voice and value by focusing on critical taskwork and teamwork during primary care office visits, including elicitation of patient concerns and preferences and team-based delivery of evidence-based preventive care and other high value processes. The model focuses on the following key office visit processes: pre-visit planning, team huddles and debriefing, team use of clinical decision support systems, full elicitation of patients concerns, and post-visit confirmation of understanding and planning. The proposed project will develop training modules using feasible strategies relevant to FQHCs. My specific educational objectives are: 1) To enhance my skills in direct observation of primary care visits with a focus on tasks and teamwork; 2) To acquire teamwork training skills applicable to primary care; 3) To enhance my skills relevant to stakeholder and patient engagement; 4) To acquire teamwork assessment skills. My specific research aims are: 1)To refine and pilot the PTC model within an FQHC; 2) To pilot key PCOR measures relevant to facets of the PTC model; 3) To examine key facilitators and barriers to implementation of the PTC model. Achievement of these educational and research aims will provide me with the experiences, skills, partnerships, measures, and preliminary data necessary to launch inquiry into this entirely new area of PCOR. This research offers the promise for transforming care for millions of underserved and socially disadvantaged patients served by FQHCs and for reducing health care disparities.