title: Across the divide: "Primary care departments working together to redesign care to achieve the Triple Aim".
abstract: BACKGROUND
  Primary care is considered the foundation of an effective health care system. However, primary care departments at academic health centers have numerous challenges to overcome when trying to achieve the Triple Aim.
  
  
  METHODS
  As part of an organizational initiative to redesign primary care at a large academic health center, departments of internal medicine, general pediatrics and adolescent medicine, and family medicine worked together to comprehensively redesign primary care. This article describes the process of aligning these three primary care departments: defining panel size, developing a common primary care job description, redesigning the primary care compensation plan, redesigning the care model, and developing standardized staffing.
  
  
  RESULTS
  Prior to the initiative, the rate of patient satisfaction was 85%, anticoagulation measurement 65%, pneumococcal vaccination 85%, breast cancer screening 79%, and colorectal cancer screening 69%. These rates all improved to 87%, 75%, 88%, 80%, and 80% respectively. Themes around key challenges to departmental integration are identified: (1) implementing effective communication strategies; (2) addressing specialty differences in primary care delivery; (3) working within resource limitations; and (4) developing long-term sustainability.
  
  
  CONCLUSIONS
  Primary care in this large academic health center was transformed through developing a united primary care leadership team that bridged individual departments to create and adopt a common vision and solutions to shared problems. Our collaboration has achieved improvements across patient satisfaction, clinical safety metrics, and publicly-reported preventive care outcomes.
  
  
  CONCLUSIONS
  The description of this experience may be useful for other academic health centers or other non-integrated delivery systems undertaking primary care practice transformation.
authors.affiliation: Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, United States; Primary Care Academics Transforming Healthcare Collaborative, UW Health, United States.
authors.forename: Steven
authors.initials: S
authors.lastname: Koslov
authors.affiliation: Department of Medicine, University of Wisconsin School of Medicine and Public Health, United States; Primary Care Academics Transforming Healthcare Collaborative, UW Health, United States.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Trowbridge
authors.affiliation: Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, United States; Primary Care Academics Transforming Healthcare Collaborative, UW Health, United States.
authors.forename: Sandra
authors.initials: S
authors.lastname: Kamnetz
authors.affiliation: Dartmouth Institute for Health Policy and Clinical Practice, United States; Primary Care Academics Transforming Healthcare Collaborative, UW Health, United States.
authors.forename: Sally
authors.initials: S
authors.lastname: Kraft
authors.affiliation: Department of Medicine, University of Wisconsin School of Medicine and Public Health, United States; University of Wisconsin Medical Foundation, United States.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Grossman
authors.affiliation: Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, United States; Primary Care Academics Transforming Healthcare Collaborative, UW Health, United States. Electronic address: nancy.pandhi@fammed.wisc.edu.
authors.forename: Nancy
authors.initials: N
authors.lastname: Pandhi
mesh_terms: D000046:Academic Medical Centers; D005194:Family Practice / Q000458:organization & administration; D006280:Health Workforce / Q000592:standards*; D006801:Humans; D033183:Interdisciplinary Communication; D007388:Internal Medicine / Q000458:organization & administration; D017146:Models, Organizational; D020380:Needs Assessment; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010372:Pediatrics / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration*; D014922:Wisconsin
keywords: Academic health centers; Practice redesign; Primary care