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Nurse practitioner-led multidisciplinary teams to improve chronic illness care: The unique strengths of nurse practitioners applied to shared medical appointments/group visits |
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| Authors: | Sharon A Watts ND RN-C CDE NP Julie Gee MSN CNP Mary Ellen O'Day PharmD BCPS CDE Kimberley Schaub PhD Renee Lawrence PhD David Aron MD MS & Susan Kirsh MD |
| Institution: | Diabetes Clinic, Department of Endocrinology, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio; Heart Failure Clinic, Department of Cardiology, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio; Pharmacy Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio; Department of Cardiology and Organ Transplant, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio; HSR&D Center for Quality Improvement Research, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio; Department of Medicine and Epidemiology and Biostatistics, and Department of Organizational Behavior, Weatherhead School of Management, Case Western Reserve University School of Medicine, Cleveland, Ohio; Staff/Education, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio; Department of Internal Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio |
| Abstract: | Purpose: To describe the roles of nurse practitioners (NPs) in a novel model of healthcare delivery for patients with chronic disease: shared medical appointments (SMAs)/group visits based on the chronic care model (CCM). To map the specific skills of NPs to the six elements of the CCM: self-management, decision support, delivery system design, clinical information systems, community resources, and organizational support. Data sources: Case studies of three disease-specific multidisciplinary SMAs (diabetes, heart failure, and hypertension) in which NPs played a leadership role. Conclusions: NPs have multiple roles in development, implementation, and sustainability of SMAs as quality improvement interventions. Although the specific skills of NPs map out all six elements of the CCM, in our context, they had the greatest role in self-management, decision support, and delivery system design. Implications for practice: With the increasing numbers of patients with chronic illnesses, healthcare systems are increasingly challenged to provide necessary care and empower patients to participate in that care. NPs can play a key role in helping to meet these challenges. |
| Keywords: | Chronic disease nurse practitioners models of care |