Team Based Care in the Family Planning Setting
Susan Kendig, JD, WHNP-BC, FAANPTeaching Professor; Coordinator, Women’s Health
Emphasis AreaUniversity of Missouri-St. Louis
Director of Policy, National Association of Nurse Practitioners in Women’s Health
Disclosures
Susan Kendig, JD, WHNP-BC, FAANP
Commercial Interest Role Status
Nothing to disclose
Objectives
• Define core concepts of collaboration and team-based care as it applies to the family planning setting;
• Discuss the six core principles that support successful implementation of team-based care
Collaboration in Practice: Implementing Team-Based Care
Goal: Introduce ACOG’s “Collaboration in Practice: Implementing Team-Based Care”
Objectives: • Define core concepts of collaboration and team-
based care as it applies to the family planning setting;
• Discuss the six core principles that support successful implementation of team-based care;
Background Information• Response to demand for coordinated, value-driven care
models in the face of HCP shortages and shrinking resources;
• John Jennings, ACOG’s 2014 President, chose revision of ACOG’s Guidelines for Implementing Collaborative Practice (1995) as the priority issue during his presidential year;
• Convened interdisciplinary task force representing physicians, NPs, midwives, PAs, consumers, clinical pharmacists;
• Resulting document endorsed/supported by 21 national organizations thus far.
Why Team-Based care?Typical Medicare Beneficiary• Visits annually:
– Two primary care providers– Five specialists– Other health care providers in
diagnostics, pharmacy, other services
• More visits if multiple chronic conditions
• Discontinuity impedes care, decreases safety, increases cost. Bodenheimer, T. (2008). NEJM, 358, 1064-67; IOM. (2001). Crossing the Quality Chasm.
Women’s Reproductive Health• 45% of U.S. pregnancies
unintended– 42% result in AB– 68% paid for by public
insurance programs • Total U.S. Government
expenditures ~$2.1 billion annually (Guttmacher Institute (Feb. 2015). Public Health Costs from Unintended Pregnancy)
• Effectively planning for pregnancy, entering pregnancy in good health, and being fully informed about reproductive and general health improves birth outcomes (IOM, 1985)
Defining Team-Based CareTeam-Based Care – Provision of health services to individuals, families, and/or communities by at least two health care providers who work collaboratively with patients and their families – to the extent preferred by each patient – to accomplish shared goals within and across settings to achieve coordinated, high quality care.Collaboration – Process involving mutually beneficial active participation between autonomous individuals whose relationships are governed by negotiated shared norms and visions.
Quality Family Planning ServicesFamily Planning: Contraceptive, pregnancy testing/counseling,
assistance to achieve pregnancy, basic infertility, STD/HIV/AIDs, and other preconception health services;
Related Preventive Services: Services considered beneficial to reproductive health, closely linked to family planning services, and appropriate to deliver in the context of a family planning visit but that do not contribute directly to achieving or preventing pregnancy (e.g., breast and cervical cancer screening).
Other Preventive Health Services: Services important to primary care, but no direct link to family planning (e.g., lipid, osteoporosis, skin cancer screening)
Gavin, L, Moskosky, S., Carter, M, et al. (2014). MMWR, 63(RR04);1-29
The Women’s Health team
Women’s health team
Primary Care /Specialty
OB/GYN
Family Planning/QFP
Continuum of Women’s Health Care:“Team-based care provides an integrated process over the course of not just a specific or singular experience, but across a patient’s lifespan…” (Task Force on Collaborative Practice, 2016.)
l
Preconception
Prenatal
Intrapartum
Postpartum
Interconception
Post Reproduction
Another View: Virtual Women’s Health Team
Women’s Health Team
QFP/FP/OB-GYNPrimary Care
Specialty Care
Guiding Principles
Patient- Family Centric• ACOG: Patients and families are central to/actively engaged as
members of the health care team– Focus on Patient health needs – Respect patient values, preferences, goals– Patient is a partner in managing health and decision-making
• QFP: Client-centered approach– Client's primary purpose for visiting the service site must be
respected– Provide and maintain confidential services– Broad range of contraceptive methods available to meet individual
client needs and preferences– Organizational policies, governance, and provider attitudes and
practices support delivery of services in a culturally competent manner so as to meet the needs of all clients.
Shared Vision• ACOG: Team has a shared vision
– Integrated body of knowledge and skills that works together toward common goals
– Embraces patient expertise, perspectives, priorities, needs
– Identify goals that all team members, including patient, agree on.
• QFP: Underpinning of recommendations is that improving the quality of family planning services will lead to improved reproductive health outcomes.
Role Clarity• ACOG: Role clarity is essential to optimal team building and
team functioning– Each member recognized for his/her expertise– Team focus is on meeting patient needs while maximizing
expertise of providers on the team• QFP: Accessibility
– Remove barriers to contraceptive use, – Family planning visit provides access to a broader range of
primary care and behavioral health services, – Create and strengthen links to other sources of care.– Exemplar: Standardized tiered counseling by trained non-
clinicians; shared contraceptive decision-making between patient and provider; method prescribed/placed. (Madden, T. (2012) Contraception)
Accountability• ACOG: All team members are accountable for
their own practice and to the team– Practice to the best of abilities– Consistently act in best interest of patient considering
cost, quality, timeliness of care– Accept responsibilities within scope of practice and
experience– Integrate profession specific recommendations with
other team members recommendations for care– Maintain education necessary for licensure and
credentialing.
Accountability• QFP: Strong QI component
– Safety. Integrate MEC, CDC and USPSTF recommendations on STD, preconception, related preventive health services.
– Effectiveness. Support offering a full range of FDA–approved methods, and appropriate counseling, highlights effectiveness of specific clinical preventive health services and identifies clinical preventive health services for which the potential harms outweigh the benefits.
– Timeliness. Ensure services provided in a timely manner.– Efficiency. Identify core set of services providers can focus
on delivering, and ways to maximize the use of resources.– Value. Highlight services shown to be very cost-effective
Effective Communication• ACOG: Effective communication is key to quality
teams– Opportunity to relay important information about
team tasks– Evidence of team’s interprofessional nature– Enables continuous learning environment; translates
to better, more efficient care• QFP: Provision of family planning and related
services requires communication among internal team as well as external (virtual) team members
Team Leadership• ACOG: Team leadership is situational/dynamic
– Team member who can best address patient priority needs assumes lead provider role.
– One type of training or perspective not felt to be uniformly superior to others
• QFP: – Consistent use of provider neutral language– Successful models incorporate non-clinicians and
clinicians to achieve high quality, safe and efficient practice.
Continuum of Women’s Health Care:Fluid Team Leadership
PreconceptionFP provider PCPWH providerPediatrician
PrenatalOB Provider
IntrapartumOB ProviderHospitalist
PostpartumOB ProviderPCPFP ProviderNo one?
InterconceptionFP ProviderWH ProviderPCPNo one?
Post ReproductionFP ProviderWH providerPCP Specialist
Implementation of Team-Based, Integrated Care in the Family Planning Setting
• Telehealth, use of technology to deliver clinical services, can be considered as a non-traditional method for delivering team-based care, especially when access is limited.– Diagnostic test interpretation– Patient counseling – Disease management/health promotion
• Connectivity via health information exchange (HIE)
Other Considerations• Scope of practice and licensure laws and
requirements are not uniform across states. • Payment challenges may be internal (RVUs,
incentives) or external (payer or licensure implications)
• Multiple opportunities for change.
Where Does the Family Planning Provider Fit In?
Contact InformationSusan Kendig, JD, MSN, WHNP-BC, FAANP
Teaching Professor; WHNP Emphasis Area Coordinator, University of Missouri- St. LouisDirector of Policy, National Association of Nurse Practitioners in Women’s Health (NPWH)314-629-2372; [email protected]
Access “Collaboration in Practice: Implementing Team-Based Care” at http://www.acog.org/Resources-And-Publications/Task-Force-and-Work-Group-Reports/Collaboration-in-Practice-Implementing-Team-Based-Care
Access the Executive Summary at http://www.acog.org/Resources-And-Publications/Task-Force-and-Work-Group-Reports/Executive-Summary-for-Collaboration-in-Practice-Implementing-Team-Based-Care