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Improving team-based care could lead to better outcomes in patients with diabetes

Better team-based care led to reductions in HbA1C and LDL cholesterol for some patients, according to a study published in the Journal of Primary Care and Community Health.

“Consistent, long-term leadership facilitation is a key component in improving and maintaining team functioning,” Lori A. Bilello, PhD, research assistant professor and associate director of the Center for Health Equity and Quality Research at the University of Florida, and colleagues wrote. “The personal and professional responses by staff and clinicians to role redefinition can also affect practice transformation; sometimes leading to changes in personnel at a practice. The more successful practices have strong physician facilitation, clearly defined roles and practice guidelines for all levels of staff and strong communication structures (such as team huddles, frequent team meetings) in place.”

To determine if improving team-based care would impact the quality of care for patients with diabetes, researchers implemented a team-based care training program, based on the Agency for Healthcare Research and Quality TeamSTEPPS framework, in six primary care practices that were affiliated with a Primary Care Practice Based Research Network. There were 90 employees involved, including 26 clinicians and 61 office staff, and 1,050 patients with diabetes (median age of patients, 63 years; 61% women).

A physician that specializes in diabetes care served as a trainer for clinicians and staff for a 12-month period. Training focused on four areas of TeamSTEPPS, including team leadership, mutual performance monitoring, mutual support and communication, and on the concepts of team-based care in a patient-centered medical home model, which included uniform mission and shared goals, clear expectations of team roles, enhanced communication, system improvement and advanced training.

Clinicians and staff also completed the AHRQ Medical Office Survey on Patient Survey Culture before the training program and again at the midpoint and upon completion.

Researchers then performed an analysis of patients’ HbA1c levels and LDL cholesterol before and after the training program.

Researchers found that, for all the practices combined, mean HbA1c levels decreased from 7.48% to 7.32% (P < .001) and LDL cholesterol decreased from 92.34 mg/dL to 88.34 mg/dL (P = .002), with three practices seeing improvements individually.

Researchers also observed that two practices had leadership turnover and these did not see an improvement in patient outcomes.

“Even though there may be significant variation on how practices are managed and how practice transformation is implemented, there are some basic strategies or elements to improve team-based care,” the researchers wrote. “The TeamSTEPPS curriculum addressed these core elements; however, in order to have long-term improvements in primary care team functioning, practice leaders and team members need to fully embrace these core elements and continuously monitor teamwork experiences to support effective team-based care.” – by Melissa J. Webb

Disclosures: The authors report no relevant financial disclosures.