Registered nurses (RNs) are the backbone of a primary care team, delivering a variety of clinical services to patients. A Group Health research team is taking advantage of the close connection between RNs and patients to improve care for people with multiple chronic conditions.
The researchers started with the TEAMcare program for patients with depression and either heart disease, diabetes, or both. In TEAMcare, patients work with their primary care doctors, nurses, and psychiatrists to set treatment goals and coordinate care for their different conditions. Group Health studies show that this form of collaborative care leads to better patient function, satisfaction, and quality of life—and pays for itself.
To date, TEAMcare had been led by primary care doctors. But can TEAMcare led by nurses achieve the same positive results? Group Health Research Institute Affiliate Investigator Elizabeth Lin, MD, MPH, Senior Investigator Paul Fishman, PhD, and Group Health Vice President for Clinical Excellence and Nursing Barbara Trehearne, PhD, RN, did a pilot project to find out. At a primary care clinic that already had a plan for managing chronic conditions under the Group Health patient-centered medical home, the researchers trained RNs to lead collaborative teams managing care for patients with multiple chronic conditions. Patient health before and one year after nurse-led TEAMcare was monitored with clinical tests to measure depression, diabetes, and blood pressure.
Patients receiving nurse-led TEAMcare improved on all clinical tests, the researchers report in Nursing Economic$. Compared to similar patients receiving regular care, TEAMcare patients had more appropriate use of health services, measured as medication use, and primary care and emergency room visits. The pilot program was efficient because the nurses had focused, effective, structured time with patients. The researchers conclude that giving RNs a larger role in the increasingly popular patient-centered medical home could make this clinical model more efficient—while delivering the same high-quality care.
Drs. Lin, Fishman, and Trehearne are also professors at the University of Washington Schools of Medicine, Public Health, and Nursing, respectively.
by Chris Tachibana