title: Introducing the "teamlet": initiating a primary care innovation at san francisco general hospital.
abstract: BACKGROUND
  The 15-minute office visit to primary care clinicians cannot meet the health care needs of patients. Innovation is needed to address this limitation, but practice redesign is challenging in clinical settings.
  
  
  OBJECTIVE
  Here we describe the implementation of a practice innovation, the teamlet model, in a San Francisco safety-net clinic. The teamlet consists of a clinician and "health coach" who expand the traditional medical visit into previsit, visit, postvisit, and between-visit care.
  
  
  METHODS
  Teamlet implementation is occurring in phases. Phase 1 is evaluated using plan-do-study-act improvement cycles and interviews with a few patients, clinicians, and coaches. Phase 2 is evaluated using a pre- and postevent questionnaire, focused interviews, and focus groups with patients, faculty, clinicians, and coaches.
  
  
  METHODS
  Phase 1: Plan-do-study-act cycles generate ideas to improve implementation. Phase 2 evaluation will query demographics, satisfaction, knowledge of self-management support, access, teamwork, and benefits/challenges of the teamlet model. Future research would measure objective clinical outcomes.
  
  
  RESULTS
  Phase 1 of the teamlet project led to useful adaptations, with anecdotal evidence that patients and clinicians were satisfied overall with practice improvements. Logistic problems made implementation of the innovation challenging. Phase 2 is currently underway, with results expected in 2008.
  
  
  CONCLUSIONS
  Primary care innovation requires multiple perspectives and constant revision. Traditional randomized controlled trials and quantitative evaluation designs are not appropriate for assessing practice-improvement pilot projects because projects must change and develop in their early stages. Despite numerous challenges, the teamlet practice redesign has the potential for improving on the traditional 15-minute physician's office visit.
authors.forename: Brian Yoshio
authors.initials: BY
authors.lastname: Laing
authors.forename: Lisa
authors.initials: L
authors.lastname: Ward
authors.forename: Thomas
authors.initials: T
authors.lastname: Yeh
authors.forename: Ellen
authors.initials: E
authors.lastname: Chen
authors.forename: Thomas
authors.initials: T
authors.lastname: Bodenheimer