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2 words
core team Kern-Team
core team Kernmannschaft
 
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The most important promoting factors were the formation of a core team committed to quality and improvement, and the clinic leadership that was supported strongly by the team members.

Susan R Kirsh et al.

Implementation science : IS 3 (7), 04 Jun 2008

Tailoring had to also take into account key innovation-hindering factors, including limited resources (such as space), potential to alter longstanding patient-provider relationships, and organizational silos (disconnected groups) with core team members reporting to different supervisors.

Susan R Kirsh et al.

Implementation science : IS 3 (7), 04 Jun 2008

In order to maximize success and meet demanding clinical care needs, we began with diabetes as a focus because of the existing core team and its openness to change, some collaboration between key disciplines was loosely in place, the volume of patients with diabetes, the cost to the organization, and the high demand of resources required to manage patients with diabetes.

Susan R Kirsh et al.

Implementation science : IS 3 (7), 04 Jun 2008

Analysis of SMAs Innovation: Translating SMA into Local Context (February 2005) Dimension of SMA Innovation – Basic guidelines that needed to be translated Starting Point: Initial Decisions Promoting Factor Hindering Factor Shared Medical Appointment Initiation Core team with strengths related to diabetes were open to change and working together Mandate from Central Office; Training provided; no specific guidelines; local facility has long history of supporting novel methods of care delivery No specific guidelines; limited resources Focus : disease-specific or non-specific Diabetes (reduce cardiovascular risk) Provided focus consistent with strong core team Drop-in or Schedule Patients Scheduled Able to call and remind; able to plan Limits number and requires more coordination Multi-disciplinary Professional Team Collaboration with key disciplines present Strong, committed core team, including one member representing key leadership within primary care clinic Difficulty coordinating, and finding and freeing up time to participate 1 or more with prescribing Authority Physician (Medical Director of Clinic); Endocrine nurse practitioner; Clinical pharmacist Built-in redundancy of prescribers assisted with efficiency Team members had different supervisors; Workload credit and credit for SMAs 1 or more variety of Disciplines Health Psychologist; Registered nurse Different supervisors; Workload credit Group of patients (8–20) 4–8 patients (8 invited) Flexibility to pilot test with small numbers of patients Questions raised about inefficiency Target population Local registry to identify patients Sufficient numbers who would benefit Primary care provider pool (pull from one or more) All Primary care providers' patients eligible Able to include all high- risk patients Threatened provider-patient relationship Patient pool A1c > 9%; systolic blood pressure > 130 mmHg; LDL-cholesterol > 100 mg/dL Getting several patients there; Viewed as difficult and non-compliant; concern about no-show rates Time and Frequency: Meet for 90–120 minutes and variable regarding frequency 90 minutes and to meet weekly (Friday afternoons) Techniques and Processes for conducting SMA Modification of chronic care model as a guide Didactics Keep at a minimum Many team members most comfortable with 'teaching' rather than facilitating group discussion Information display and Sharing Large board with patient lab values and other outcomes ( e . g ., A1c, systolic blood pressure and LDL-cholesterol); prepared by Clinical pharmacists Summarized key points and helped solidify take home messages despite concern about non-lecture format Group discussion Peer support Motivational interviewing by Health Psychologist Learning by all is possible even if not sharing; Simplified and focused individual session that followed group encounter Some patients uncomfortable in groups Clinical component Group chart display Forms: General information ABCs of diabetes care (A1c, blood pressure, cholesterol, etc), foot care, etc.

Susan R Kirsh et al.

Implementation science : IS 3 (7), 04 Jun 2008

At the mesosystem level, a strong core care team was essential that reflected multi-disciplinary members from the various services that would be linked.

Susan R Kirsh et al.

Implementation science : IS 3 (7), 04 Jun 2008

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