Multidisciplinary Teams

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Multidisciplinary Teams StrategiesDisease
Management TrainingMarch 2008

• James A. Ellzy, LCDR, MC, USN
• Deputy Medical Director, TMA/OCMO

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Outline

• National Organizations
• AHRQ
• AAFP
• IHI
• MHS
• BUMED

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National organizations
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AHRQAgency for Healthcare Research and Quality

• Use of a multidisciplinary team can reduce
  hospital stays and costs without adverse effects
  on readmissions or outcomes
• "Hallmarks of quality Generating and using
  knowledge," by Dr. Cowan, in Communicating
  Nursing Research 37(1), pp. 3-12, 2004

http//www.ahrq.gov/RESEARCH/jan05/0105RA5.htm
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Excerpt from Hallmarks of Quality

• Compared with usual care, a multidisciplinary
  team of hospitalist/attending physicians and
  advance practice nurses coupled with daily
  instead of weekly multidisciplinary rounds
  improved the management of general medicine
  patients in a large medical center during
  hospital stays and for 30 days after discharge.
  This team approach reduced length of hospital
  stay and costs without affecting hospital
  readmissions, mortality, or compromising quality
  of life and patient satisfaction, according to a
  recent study supported by the Agency for
  Healthcare Research and Quality (HS10734).

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AHRQ - Closing the Quality GapA Critical
Analysis of Quality Improvement Strategies

• Multidisciplinary team interventions have been
  shown to
• reduce mortality and dependency in stroke
  patients
• reduce mortality and hospital admissions in heart
  failure patients
• improve service continuity for severely mentally
  ill patient
• and reduce symptoms for terminally ill patients.

AHRQ Publication No. 04(07)-0051-7 June 2007
http//www.ahrq.gov/downloads/pub/evidence/pdf/car
egap/caregap.pdf
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AAFP - TransforMEDAmerican Academy of Family
Physicians

• AAFP initiative, established in 2005
• Based on the Future of Family Medicine report
  published in March 2004
• Provides ongoing consultation and support to
  physicians looking to transform their practices
  to a model of care that is based on the concept
  of a relationship-centered personal medical home

http//www.transformed.com.
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TransforMEDs model

• TransforMED model of care consist of 8 areas that
  include 42 subcomponents
• The Team Approach area includes Multidisciplinary
  Teams
• Multidisciplinary teams recognize that everyone
  in the practice, from the receptionist to the
  billing manager, plays an important part in
  patient visits.

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IHI Effective TeamsInstitute for Healthcare
Improvement

• Including the right people on a process
  improvement team is critical to a successful
  improvement effort.
• Teams vary in size and composition.
• Each organization builds teams to suit its own
  needs.
• Include members representing three different
  kinds of expertise within the organization
• system leadership
• technical expertise
• day-to-day leadership

http//www.ihi.org/IHI/Topics/Improvement/Improvem
entMethods/HowToImprove/formingtheteam.htm
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System Leader

• Someone with enough authority in the organization
  to institute a change that has been suggested and
  to overcome barriers that arise.
• Must understand
• Implications of the proposed change for various
  parts of the system
• The more remote consequences such a change might
  trigger.
• Has authority
• In all of the areas that are affected by the
  change
• To allocate the time and resources the team needs
  to achieve its aim

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Technical Expert

• Clinical

• Improvement Methods

• Knows the subject intimately
• Understands the processes of care

• Helps the team determine what to measure
• Assists in design of simple, effective
  measurement tools
• Provides guidance on collection, interpretation,
  and display of data

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Day-to-Day Leader

• The driver of the project
• assures that tests are implemented
• oversees data collection
• must understand
• details of the system
• various effects of making changes in the system
• needs to be able to work effectively with the
  physician champion(s)

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Military Health System
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http//www.tricare.mil/PHMMSC/default.cfm
TRICARE Website
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MHS Guidance
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Medical Management Guide

• Practice guidelines must meet the following
  criteria (Field Lohr, 1990)
• Clinically applicable and flexible
• Developed through a multidisciplinary process
• Reviewed on a scheduled basis
• Valid, reliable, and reproducible
• Well-documented

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Implementing a Disease Management Program

• Involving the entire healthcare team in DM
  practices is the most effective means of
  implementing a DM plan or program.
• Implementation steps
• Establish MTFs goals for your DM program
• Plan details of implementation based on data
• Execute implementation
• Review what happened

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Establishing goals

• Base goals on your population
• Common goals of DM programs include
• Improving clinical outcomes (morbidity,
  mortality, and function)
• Reducing undesirable practice variation through
  evidence-based care, coordinated care, and
  improved continuity (quality of service)
• Improving economic outcomes (cost of care)

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Plan Details Execute

• Once established, goals are brought to the teams
  who will be managing the diseases/conditions.
• These teams should be multi-disciplinary
  including information management/information
  technology (IM/IT) personnel, as well as
  providers, nursing staff, administrative and
  ancillary support staff.
• Implementation must be a team effort and the team
  should use all existing resources available to
  prevent reinventing the wheel.

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BUMED
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NavMed Policy 06-011 (Aug 06)

• NAVY MEDICINE DISEASE STATE AND CONDITION
  MANAGEMENT PROGRAM
• Purpose To define Navy Medicines system-wide
  expectations and guidance for
• Diabetes
• Asthma
• Breast Health
• Dental

Formerly known as BUMED NOTE 6310
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NavMed Policy 06-011

• Required Standards
• Identification of cohorts
• Implementation of a clinical practice guideline
  (diabetes and asthma), and a clinical process
  (breast health)
• Disease management reengineering
• Patient education
• Outcome metrics

• Required Actions
• Identify Clinical Champion and Program
  Coordinator for each disease state or condition
• Training of staff (roles responsibilities)

The start of a Multidisciplinary Team!
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NavMed Policy 06-011

• Disease Management Reengineering
• Mapping out essential clinical business
  processes for
• Notification of PCM after diabetic or asthmatic
  patients seen in ED
• 24-hour telephonic access to primary care for
  diabetic asthmatic patients
• Determination remediation of process roadblocks
  that impede obtaining mammograms

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Navy Multidisciplinary Teams

• Primary Care Advisory Board (PCAB)
• Evidence-based Healthcare Advisory Board (EBHAB)
• Asthma Action Team (AAT)
• Diabetes Action Team (DAT)
• Tobacco Cessation Action Team (TCAT)
• Navy Medical Informatics Action Team (NMIAT)
• Breast Health Initiative Advisory Board (BHIAB)

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NMCSD Population-Based Health Care Delivery
Model
Chartered Population Health Clinical Quality
Teams (CQT) Identify-Educate-Implement- Evaluate
Sustain Clinical Outcomes, Metrics Tools

• Targeted
• Populations
• Diabetes
• Asthma
• Chronic Heart Failure
• Breast Health
• Weight Mgmt
• Combat Casualty
• Cancer
• Tobacco
• Pneumonia

Office of Clinical Quality Coordinates
Collaborates with CQTs, CMTs Dept of Clinical
Decision Support Provides Training Support to
Clinics Command-Level Analysis
Evaluation
Clinic Management Teams (CMT) Execute-Analyze-In
itiate Best Clinical Business
Practices Evaluate Healthcare Team Performance
using Clinical Metrics
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Think Populations, See Individuals
Navy Environmental Health Center (NEHC)