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

描述（由申请人提供）：确保患者，特别是那些社会弱势群体，在他们的医疗保健中有有意义的声音，同时确保他们获得高价值的护理，需要新的以患者为中心的结果研究（PCOR）。在初级保健中优化患者的声音和价值需要将医疗保健服务从单独的临床医生转变为团队护理。这份职业提升建议旨在为我提供必要的指导、技能、经验和伙伴关系，使我的研究重新集中在PCOR的这个新领域，即将团队合作科学转化为初级保健，特别是在联邦合格的医疗中心（fqhc）。我将通过利益相关者合作实现这一目标，包括改进、试点和评估患者-团队沟通（PTC）模型。这种基于团队（由临床医生和护理人员组成的团队）的新模式，将以患者为中心的沟通科学与团队合作科学相结合。该项目的目标是建立在我的知名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，以及将PCOR方法应用于FQHC内PTC模式的试点来完成。PTC模式通过关注初级保健办公室访问期间的关键任务和团队合作，包括了解患者的担忧和偏好，以团队为基础提供循证预防护理和其他高价值流程，提高了患者的声音和价值。该模型侧重于以下关键的就诊流程：就诊前计划，团队会议和汇报，团队使用临床决策支持系统，充分了解患者的担忧，以及就诊后对理解和计划的确认。拟议的项目将采用与家庭健康服务中心有关的可行策略，发展培训单元。我的具体教育目标是：1)提高我直接观察初级保健就诊的技能，重点是任务和团队合作；2)掌握适用于基层医疗的团队合作培训技能；3)提高与利益相关者和患者参与相关的技能；4)掌握团队合作评估技能。我的具体研究目标是：1)在FQHC中完善和试点PTC模型；2)试点与PTC模型各方面相关的关键PCOR措施；3)研究实施PTC模式的关键促进因素和障碍。这些教育和研究目标的实现将为我提供必要的经验、技能、伙伴关系、措施和初步数据，以启动对PCOR这一全新领域的调查。这项研究为改变fqhc服务的数百万服务不足和社会弱势患者的护理提供了希望，并为减少医疗保健差距提供了希望。

DESCRIPTION (provided by applicant): 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.