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首页> 美国卫生研究院文献>The Permanente Journal >Introducing the Teamlet: Initiating a Primary Care Innovation at San Francisco General Hospital
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Introducing the Teamlet: Initiating a Primary Care Innovation at San Francisco General Hospital

机译：引入 Teamlet：在旧金山总医院开展基层医疗创新

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>Context: The 15-minute office visit to primary care clinicians cannot meet the health care needs of patients. Innovation is needed to address this limitation, but practice redesign is challenging in clinical settings.>Objective: Here we describe the implementation of a practice innovation, the teamlet model, in a San Francisco safety-net clinic. The teamlet consists of a clinician and “health coach” who expand the traditional medical visit into previsit, visit, postvisit, and between-visit care.>Design: Teamlet implementation is occurring in phases. Phase 1 is evaluated using plan-do-study-act improvement cycles and interviews with a few patients, clinicians, and coaches. Phase 2 is evaluated using a pre- and postevent questionnaire, focused interviews, and focus groups with patients, faculty, clinicians, and coaches.>Main outcome measures: Phase 1: Plan-do-study-act cycles generate ideas to improve implementation. Phase 2 evaluation will query demographics, satisfaction, knowledge of self-management support, access, teamwork, and benefits/challenges of the teamlet model. Future research would measure objective clinical outcomes.>Results: Phase 1 of the teamlet project led to useful adaptations, with anecdotal evidence that patients and clinicians were satisfied overall with practice improvements. Logistic problems made implementation of the innovation challenging. Phase 2 is currently underway, with results expected in 2008.>Conclusions: Primary care innovation requires multiple perspectives and constant revision. Traditional randomized controlled trials and quantitative evaluation designs are not appropriate for assessing practice-improvement pilot projects because projects must change and develop in their early stages. Despite numerous challenges, the teamlet practice redesign has the potential for improving on the traditional 15-minute physician's office visit.
机译：>背景：对初级保健临床医生的15分钟办公室拜访不能满足患者的医疗保健需求。解决这一局限性需要创新，但在临床环境中重新设计业务实践具有挑战性。>目标：在这里，我们描述了在旧金山安全网诊所中实施创新实践（团队模型）的过程。该小组由临床医生和“健康教练”组成，他们将传统的医疗就诊扩大到事前，就诊，事后访问和两次就诊之间。>设计：小组的实施分阶段进行。使用计划-研究-行为改进周期以及对少数患者，临床医生和教练的访谈来评估第一阶段。第2阶段使用事前和事后调查表，重点访谈和与患者，教职员工，临床医生和教练的焦点小组进行评估。>主要成果衡量指标：：第1阶段：计划研究行为周期产生想法以改善实施。第2阶段评估将查询人口统计信息，满意度，自我管理支持的知识，访问权限，团队合作以及小团队模型的收益/挑战。未来的研究将衡量客观的临床结果。>结果：团队项目的第一阶段带来了有益的适应，并有证据表明患者和临床医生总体上对实践改进感到满意。后勤问题使创新的实施具有挑战性。第二阶段目前正在进行中，预计将于2008年取得结果。>结论：基层医疗创新需要多种观点和不断修订。传统的随机对照试验和定量评估设计不适用于评估实践改进试点项目，因为项目必须在早期阶段进行更改和开发。尽管遇到了许多挑战，但小队实践的重新设计仍有望改善传统的15分钟医师就诊时间。

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