Learning and Caring in Communities of Practice: Using Relationships and Collective Learning to Improve Primary Care for Patients with Multimorbidity
@article{Soubhi2010LearningAC, title={Learning and Caring in Communities of Practice: Using Relationships and Collective Learning to Improve Primary Care for Patients with Multimorbidity}, author={Hassan Soubhi and Elizabeth A. Bayliss and Martin Fortin and Catherine Hudon and Marjan van den Akker and Robert L. Thivierge and Nancy Posel and David Fleiszer}, journal={The Annals of Family Medicine}, year={2010}, volume={8}, pages={170 - 177} }
We introduce a primary care practice model for caring for patients with multimorbidity. Primary care for these patients requires flexibility and ongoing coordination, and it often must be tailored to individual circumstances. Such complex and flexible care could be accomplished within communities of practice, whose participants are willing to learn from their shared practice, further each other’s goals, share their stories of success and failure, and promote the continued evolution of…
106 Citations
Modelling successful primary care for multimorbidity: a realist synthesis of successes and failures in concurrent learning and healthcare delivery
- Medicine, PsychologyBMC Family Practice
- 2015
BackgroundPeople are increasingly living for longer with multimorbidity. Medical education and healthcare delivery must be re-orientated to meet the societal and individual patient needs that…
Achieving Coordinated Care for Patients With Complex Cases of Cancer: A Multiteam System Approach.
- MedicineJournal of oncology practice
- 2016
Challenges of care coordination in the context of an MTS are outlined through the care experience of "Mr Fuentes," a patient in the Dallas County integrated safety-net system, Parkland.
Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project
- Medicine, PsychologyBMC Family Practice
- 2018
Healthcare professionals’ views on communities of clinical practice (CoCPs) and the changes that need to be made in an uncontrolled real-life setting after more than two years of use are explored.
Joining-the-dots: caring for patients in advanced age
- Medicine, Political Science
- 2020
A range of potential strategies and solutions to the current fragmented services was offered by GPs, and obtaining the perspectives of general practice highlights the challenges and complexities of caring for those in advanced age.
Practice Inquiry: Uncertainty Learning in Primary Care Practice
- Medicine
- 2013
This chapter focuses on PI for practicing clinicians and reviews the need for workplace learning on set-aside time; describes PI group process using a scenario; reviews rationales underlying PI’s focus on ‘the colleague group,’ case-based uncertainty, follow-up, and group facilitation.
Interactions: understanding people and process in prescribing in primary care
- Medicine, Political ScienceBMJ Quality & Safety
- 2017
Despite rapidly accelerating changes in the composition of the primary care workforce and its practices, far less attention has been given to understanding the teams that support physicians in primary care and how these individuals work together.
Practice strategies to improve primary care for chronic disease patients under a pay-for-value program.
- MedicineHealthcare
- 2019
Challenges and strategies in patients’ health priorities-aligned decision-making for older adults with multiple chronic conditions
- Medicine, Political SciencePloS one
- 2019
The discrete set of challenges encountered and the implementable strategies identified suggest that patient priorities-aligned decision-making in the care of patients with multiple chronic conditions is feasible, albeit complicated.
Exploring interprofessional, interagency multimorbidity care: case study based observational research
- MedicineJournal of comorbidity
- 2017
The daily help-seeking behaviours of patients with multimorbidity are explored, including which health professionals they seek help from, how professionals work together, and perceptions and characteristics of effective interprofessional, interagency multimor bidity care.
Not just a talking shop: practitioner perspectives on how communities of practice work to improve outcomes for people experiencing multiple exclusion homelessness
- PsychologyJournal of interprofessional care
- 2014
The paper describes how organizational, educational and psychosocial theory was used to inform programme design and reflects on the utility of these approaches in the light of the evaluation findings.
References
SHOWING 1-10 OF 114 REFERENCES
Toward an Ecosystemic Approach to Chronic Care Design and Practice in Primary Care
- Medicine, PsychologyThe Annals of Family Medicine
- 2007
This essay argues for an ecosystemic understanding of chronic care founded on a communal and a dynamic view of the response of the patient, family, and health professionals to chronic illness.
Improving Primary Care: Strategies and Tools for a Better Practice
- Medicine
- 2008
The authors expertly weave together history, personal experience, and extensive evidence from the medical literature to put forth their suggestions for building the “New Practice Model” for primary care, which is difficult not to be convinced by their pragmatic approach.
Implementing a multidisease chronic care model in primary care using people and technology.
- MedicineDisease management : DM
- 2006
A generalist model of chronic disease management was formulated at Intermountain Healthcare to overcome the limitations associated with specialization and early results from the application show improved patient outcomes and improved physician productivity.
A Practice Change Model for Quality Improvement in Primary Care Practice
- MedicineJournal of healthcare management / American College of Healthcare Executives
- 2004
A model of practice change is developed using data from a quality improvement intervention that was successful in creating a sustainable practice improvement and depicts the critical elements for understanding and guiding practice change.
Evidence based guidelines or collectively constructed “mindlines?” Ethnographic study of knowledge management in primary care
- MedicineBMJ : British Medical Journal
- 2004
Clinicians rarely accessed and used explicit evidence from research or other sources directly, but relied on “mindlines”—collectively reinforced, internalised, tacit guidelines—to derive individual and collective healthcare decisions.
Organizing care for patients with chronic illness.
- MedicineThe Milbank quarterly
- 1996
The challenge is to organize these components into an integrated system of chronic illness care, which can be done most efficiently and effectively in primary care practice rather than requiring specialized systems of care.
Primary care practice coordination versus physician continuity.
- MedicineFamily medicine
- 2004
While physician continuity was not associated with patient outcomes, primary care practice structure was, and practice coordination should be assessed to identify mechanisms to support improved care.
Integration or pragmatic coalition? An evaluation of nursing teams in primary care
- Medicine
- 2000
Recent findings from an evaluation of integrated nursing teams indicate that this type of organisational change is concerned predominately with structure, professional and organisational issues rather than patient care.
Continuity of Primary Care: To Whom Does It Matter and When?
- MedicineThe Annals of Family Medicine
- 2003
Continuity of physician care is associated with more positive assessments of the visit and appears to be particularly important for more vulnerable patients, who have established a relationship with their physician and whose visit addresses more complex problems.
Interprofessional learning in the trenches: Fostering collective capability
- BusinessJournal of interprofessional care
- 2009
Collective capability is called collective capability the ability of a group of professionals to balance two interdependent levels of organization of practice: what professionals know and what they do collectively over time.