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Health Care Delivery

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Researchers identify key features of effective collaborative health care teams

Health care delivery is moving toward collaboration among diverse health care professionals who provide comprehensive patient care. These collaborative health care teams often manage the care of outpatients with less redundancy, more efficiency, and fewer omissions than individual clinicians, conclude the authors of a study that analyzed the detailed workings of a collaborative care team at one outpatient center. They found that the types of professionals attending a patient were determined by the patient's problem.

A primary care physician saw all patients, determined which additional health care services were required, and initiated arrangements to obtain the necessary services for the patient. Many patients were also seen by a nurse practitioner, particularly those with cardiac difficulties and AIDS, illnesses requiring the type of comprehensive, frequent followup provided by nurses. However, only patients whose needs required additional consultation were also seen by medical consultants, such as those with gastrointestinal, urological, and gynecological difficulties, and only patients with cardiac diseases were seen by a cardiologist.

Communication focused primarily on the care of specific patient-related problems. Other issues, such as moving patients through the clinic and hospital efficiently, coordinating team activities, and other administrative issues also were discussed as needed to meet patient needs (22 percent of interactions were concerned with team functioning and organizational issues).

Face-to-face verbal communication (most often used), E-mail, and voice mail were the most effective means of communication (effective nearly 100 percent of the time). The pager was found to be an ineffective means of communication, accounting for 33 percent of all failed messages. Team members interacted frequently, especially physicians and nurse practitioners, who communicated more with each other than with professionals who had more distinct roles, such as mental health practitioners. Distributed responsibilities allowed the team to process massive amounts of patient information, reducing the cognitive load on individuals, according to the researchers. The research was supported in part by the Agency for Healthcare Research and Quality (HS08749; Charles Safran, M.D., of Harvard Medical School, principal investigator).

See "The collaborative health care team: The role of individual and group expertise," by Vimla L. Patel, Ph.D., D.Sc., Kayla N. Cytryn, R.N., Ph.D., Edward H. Shortliffe, M.D., Ph.D., and Charles Safran, M.D., in Teaching and Learning in Medicine 12(3), pp. 117-132, 2000.

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