Effective team-based primary care: observations from innovative practices.
BACKGROUND
Team-based care is now recognized as an essential feature of high quality primary care, but there is limited empiric evidence to guide practice transformation. The purpose of this paper is to describe advances in the configuration and deployment of practice teams based on in-depth study of 30 primary care practices viewed as innovators in team-based care.


METHODS
As part of LEAP, a national program of the Robert Wood Johnson Foundation, primary care experts nominated 227 innovative primary care practices. We selected 30 practices for intensive study through review of practice descriptive and performance data. Each practice hosted a 3-day site visit between August, 2012 and September, 2013, where specific advances in team configuration and roles were noted. Advances were identified by site visitors and confirmed at a meeting involving representatives from each of the 30 practices.


RESULTS
LEAP practices have expanded the roles of existing staff and added new personnel to provide the person power and skills needed to perform the tasks and functions expected of a patient-centered medical home (PCMH). LEAP practice teams generally include a rich array of staff, especially registered nurses (RNs), behavioral health specialists, and lay health workers. Most LEAP practices organize their staff into core teams, which are built around partnerships between providers and specific Medical Assistants (MAs), and often include registered nurses (RNs) and others such as health coaches or receptionists. MAs, RNs, and other staff are heavily involved in the planning and delivery of preventive and chronic illness care. The care of more complex patients is supported by behavioral health specialists, RN care managers, and pharmacists. Standing orders and protocols enable staff to act independently.


CONCLUSIONS
The 30 LEAP practices engage health professional and lay staff in patient care to the maximum extent, which enables the practices to meet the expectations of a PCMH and helps free up providers to focus on tasks that only they can perform.
MacColl Center for Health Care Innovation, Group Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA. wagner.e@ghc.org.
Edward H
EH
Wagner
Community Health Center, Inc., Middletown, CT, USA.
Margaret
M
Flinter
Center for Community Health and Evaluation, Group Health Research Institute, Seattle, WA, USA.
Clarissa
C
Hsu
Center for Community Health and Evaluation, Group Health Research Institute, Seattle, WA, USA.
DeAnn
D
Cromp
MacColl Center for Health Care Innovation, Group Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA.
Brian T
BT
Austin
Department of Family Medicine, Virginia Commonwealth University, Richmond, VA, USA.
Rebecca
R
Etz
Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, Piscataway Township, NJ, USA.
Benjamin F
BF
Crabtree
Robert Wood Johnson Foundation, Princeton, NJ, USA.
MaryJoan D
MD
Ladden
D005260:Female; D019538:Health Care Surveys; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D009936:Organizational Innovation; D010348:Patient Care Team / Q000458:organization & administration*; D018802:Patient-Centered Care / Q000379:methods; D011320:Primary Health Care / Q000458:organization & administration*; D016730:Program Development; D015397:Program Evaluation; D011785:Quality Assurance, Health Care; D014481:United States
Patient-centered medical home; Practice team; Primary care