Care guides: an examination of occupational conflict and role relationships in primary care.
BACKGROUND
Improving the efficiency and effectiveness of primary care treatment of patients with chronic illness is an important goal in reforming the U.S. health care system. Reducing occupational conflicts and creating interdependent primary care teams is crucial for the effective functioning of new models being developed to reorganize chronic care. Occupational conflict, role interdependence, and resistance to change in a proof-of-concept pilot test of one such model that uses a new kind of employee in the primary care office, a "care guide," were analyzed. Care guides are lay individuals who help chronic disease patients and their providers achieve standard health goals.


OBJECTIVE
The aim of this study was to examine the development of occupational boundaries, interdependence of care guides and primary care team members, and acceptance by clinic employees of this new kind of health worker.


METHODS
A mixed methods, pilot study was conducted using qualitative analysis; clinic, provider, and patient surveys; administrative data; and multivariate analysis. Qualitative analysis examined the emergence of the care guide role. Administrative data and surveys were used to examine patterns of interdependence between care guides, physicians, team members, and clinic staff; obtain physician evaluations of the care guide role; and evaluate the effect of care guides on patient perceptions of care coordination and follow-up.


RESULTS
Evaluation of implementation of the care guide model showed that (a) the care guide scope of practice was clearly defined; (b) interdependent relationships between care guides and providers were formed; (c) relational triads consisting of patient, care guide, and physician were created; (d) patients and providers were supported in managing chronic disease; and (e) resistance to this model among traditional employees was minimized.


CONCLUSIONS
The feasibility of implementing a new care model for chronic disease management in the primary care setting, identifying factors associated with a positive organizational experience, was shown in this study.
Douglas R. Wholey, PhD, is Professor, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis. E-mail: whole001@umn.edu. Katie M. White, EdD, is Research Associate, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis. E-mail: kmwhite@umn.edu. Richard Adair, MD, is Internal Medicine Physician, Allina Hospitals and Clinics, Abbott Northwestern Hospital, Minneapolis, Minnesota. E-mail: adair001@umn.edu. Jon B. Christianson, PhD, is Professor, James A. Hamilton Chair in Health Policy and Management, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis. E-mail: chris001@umn.edu. Suhna Lee, MPA, is Research Assistant, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis. E-mail: Leex3515@umn.edu. Deborah Elumba, RN, is Care Guide Supervisor, Allina Hospitals and Clinics, Abbott Northwestern Hospital, Minneapolis, Minnesota. E-mail: Deborah.Elumba@allina.com.
Douglas R
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Katie M
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Jon B
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Lee
Deborah
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D003220:Conflict, Psychological; D006282:Health Personnel / Q000458:organization & administration; D006801:Humans; D007400:Interprofessional Relations; D010348:Patient Care Team / Q000458:organization & administration; D017060:Patient Satisfaction; D058007:Physicians, Primary Care / Q000458:organization & administration; D010865:Pilot Projects; D011320:Primary Health Care / Q000379:methods* / Q000458:organization & administration / Q000592:standards; D024382:Professional Role; D016730:Program Development