Pullman Regional Hospital, as part of the Next Era of Excellence, is dedicated to transforming the traditional primary care delivery model to a Team Based Care model. Along with partners like the Whitman County Health Network, we have been using grant funding from Health Resources and Services Administration (HRSA) and the Greater Columbia Accountable Community of Health to implement these models in Pullman Regional Hospital and in medical practices, such as Pullman Family Medicine. We need the community’s support for physical space to expand this model at Pullman Regional Hospital.
In cases where a patient has multiple chronic conditions, e.g. diabetes, obesity, anxiety, depression, the cost of care is high and readmission rates to the hospital’s Emergency Department are common and expensive. A different approach is needed to manage the care of these patients. There are many names for a different approach, including integrated care, coordinated care, and a medical home model. We are calling it Team Based Care. There is a large body of evidence that shows this model improves patient outcomes and lowers cost.
Our long-standing, traditional medical model is arguably paternalistic. Elizabeth Hillman, MSW, Director of Care Coordination at Pullman Regional Hospital, said, “In the traditional model, the physician tells the patient what to do and the patient is either compliant or not.” This can be to stop drinking, take your medication, lose weight, etc. Hillman said that works well for some and that model will not go away. However, Team Based Care offers a different model for patients who may not have a clear cut, physical ailment or who have adverse determinants of health.
With Team Based Care, the patient and the medical professionals are part of the same team. Techniques are used to understand what the patient’s motive is for addressing their health issues and getting better. Issues such as childhood trauma and mental health are factored in to the overall care plan in a safe, team based approach.
A team of providers, for example, dietitian, mental health professional, social worker, nurse practitioner, meet with you – together or separate -- to help you put together a plan to improve your health. “One way to describe it is meeting the patient where they are at,” said Hillman. “The patient is equal with the doctor and care providers.”
Another way the patient may experience care differently is the typical 15 minute primary care visit. The physician will be trained to conduct a “motivational interview” to understand the patient’s motivation to get better as well as deeper environmental and social issues, such as food or housing insecurity, adverse childhood experiences (ACEs), anxiety, etc. After their appointment, the patient may meet with a social worker who may put together a team of healthcare providers who would meet with the patient or separately. The social worker, or care coordinator, would set up all the appointments for the patient before they leave the primary care office.
Originally developed in the 1980s to help clinicians guide patients through overcoming drug and alcohol abuse issues, motivational interviewing has emerged as a key strategy for helping patients to make different types of health behavior improvements.
“[Motivational interviewing] is a method for changing the direction of a conversation in order to stimulate the patient's desire to change and give him or her the confidence to do so,” the American Academy of Family Physicians (AAFP) wrote on its website.
“In contrast to many other change strategies employed by health care professionals (such as education, persuasion and scare tactics), motivational interviewing is more focused, goal directed and patient centered.
https://patientengagementhit.com/news/what-is-motivational-interviewing-in-patient-care-management
Another source of information on the benefits of this model can be found at: https://physicians.dukehealth.org/articles/benefits-patient-centered-medical-homes