title: Nurse practitioner-led multidisciplinary teams to improve chronic illness care: the unique strengths of nurse practitioners applied to shared medical appointments/group visits.
abstract: OBJECTIVE
  To describe the roles of nurse practitioners (NPs) in a novel model of healthcare delivery for patients with chronic disease: shared medical appointments (SMAs)/group visits based on the chronic care model (CCM). To map the specific skills of NPs to the six elements of the CCM: self-management, decision support, delivery system design, clinical information systems, community resources, and organizational support.
  
  
  METHODS
  Case studies of three disease-specific multidisciplinary SMAs (diabetes, heart failure, and hypertension) in which NPs played a leadership role.
  
  
  CONCLUSIONS
  NPs have multiple roles in development, implementation, and sustainability of SMAs as quality improvement interventions. Although the specific skills of NPs map out all six elements of the CCM, in our context, they had the greatest role in self-management, decision support, and delivery system design.
  
  
  CONCLUSIONS
  With the increasing numbers of patients with chronic illnesses, healthcare systems are increasingly challenged to provide necessary care and empower patients to participate in that care. NPs can play a key role in helping to meet these challenges.
authors.affiliation: Diabetes Clinic, Department of Endocrinology, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio 44106, USA. sharon.watts@va.gov
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Watts
authors.forename: Julie
authors.initials: J
authors.lastname: Gee
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: O'Day
authors.forename: Kimberley
authors.initials: K
authors.lastname: Schaub
authors.forename: Renee
authors.initials: R
authors.lastname: Lawrence
authors.forename: David
authors.initials: D
authors.lastname: Aron
authors.forename: Susan
authors.initials: S
authors.lastname: Kirsh
mesh_terms: D002908:Chronic Disease / Q000451:nursing*; D002983:Clinical Competence; D003920:Diabetes Mellitus / Q000451:nursing; D019468:Disease Management; D006333:Heart Failure / Q000451:nursing; D006801:Humans; D006973:Hypertension / Q000451:nursing; D033183:Interdisciplinary Communication; D007857:Leadership; D009722:Nurse Practitioners / Q000458:organization & administration*; D024802:Nurse's Role; D009730:Nursing Assessment / Q000379:methods*; D009746:Nursing, Team / Q000458:organization & administration*; D010043:Outcome and Process Assessment, Health Care; D011785:Quality Assurance, Health Care; D014481:United States