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Expanded Rooming and Discharge Case Report: North Shore Physicians Group

North Shore Physicians Group (NSPG), a 20-site organization with 365 employed providers, began a system-wide change to a team-based care delivery model in which the physician leads the care team of closely aligned professionals, each having a different role in the care of the patient.

The model is based on an expanded role for medical assistants (MAs), “so that the physicians wouldn't have to shoulder all of the work,” said Beverly Loudin, MD, MPH, former NSPG Director of Patient Safety and Quality, and director of the initiative. Dr. Loudin began by interviewing physicians regarding the skills and responsibilities they would want in a highly functional MA.

Once the role was designed, NSPG developed a week-long training program to ensure that all MAs in the system would have the same skillset aligned with their new responsibilities.

The following year, NSPG trained 80 MAs in the new model of care. They were taught additional clinical skills, health coaching, patient self-management techniques, and population management. MAs were also trained in process improvement methods.

The MA role transitioned to a care team partner within the practice. Each day, the physician, nurse, MA, and scheduler start with a morning huddle to review the coming day's schedule to plan for a smooth workflow. The rooming process previously took three minutes, but was expanded to an eight-minute process to include recording current medications and allergies, agenda-setting, form completion, and closing gaps in care (also known as “in-reach approach”). For example, the MAs review all health monitoring reminders, give immunizations, and proactively book appointments for preventive care. The goal is to identify patient needs while in the exam room, rather than leaving time-consuming loose ends to be addressed after the patient leaves.

The MA also assumes responsibility for documentation. As one NSPG leader reports, “a huge part of the change has been having the MA put extensive visit information into the electronic health record.” The MA starts the note and performs most of the structured text data entry components of the visit. The provider later edits these entries for accuracy and documents the narrative portion of the note.

Glossary

In-reach approachIn-reach approach: Planning in advance so that care gaps are closed at the time of each face-to-face visit.

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