Ensuring that patients, particularly those who are socially disadvantaged, have a meaningful voice in their healthcare while also ensuring they receive high value care, requires new Patient-Centered Outcomes Research (PCOR). Optimizing patients'voice and value in primary care requires transformation of healthcare delivery from care by lone clinicians to care by teams. This career enhancement proposal is designed to provide me with the mentoring, skills, experiences, and partnerships necessary to re-focus my research on this new area of PCOR, i.e. translation of teamwork science into primary care, particularly within federally qualified health centers (FQHCs). I will achieve this aim through stakeholder collaboration, including refining, piloting, and evaluating the Patient-Teamlet Communication (PTC) model. This new model, based on teamlets (teams of clinicians and nursing staff), integrates the science of patient-centered communication with the science of teamwork. The project aim builds on the work of my renowned mentors and consultants and will be accomplished through guided self-study, offsite and onsite training, and application of PCOR methods to piloting of the PTC model within an FQHC. The PTC model enhances patients voice and value by focusing on critical taskwork and teamwork during primary care office visits, including elicitation of patient concerns and preferences and team-based delivery of evidence-based preventive care and other high value processes. The model focuses on the following key office visit processes: pre-visit planning, team huddles and debriefing, team use of clinical decision support systems, full elicitation of patients concerns, and post-visit confirmation of understanding and planning. The proposed project will develop training modules using feasible strategies relevant to FQHCs. My specific educational objectives are: 1) To enhance my skills in direct observation of primary care visits with a focus on tasks and teamwork;2) To acquire teamwork training skills applicable to primary care;3) To enhance my skills relevant to stakeholder and patient engagement;4) To acquire teamwork assessment skills. My specific research aims are: 1)To refine and pilot the PTC model within an FQHC;2) To pilot key PCOR measures relevant to facets of the PTC model;3) To examine key facilitators and barriers to implementation of the PTC model. Achievement of these educational and research aims will provide me with the experiences, skills, partnerships, measures, and preliminary data necessary to launch inquiry into this entirely new area of PCOR. This research offers the promise for transforming care for millions of underserved and socially disadvantaged patients served by FQHCs and for reducing health care disparities.

Public Health Relevance

This project is designed to use PCOR to translate and apply team science to primary care delivery. Specifically, the project will enable Dr. Fiscella to acquir the necessary PCOR skills through mentoring, coursework, and experience to collaboratively refine, pilot, and evaluate the patient-teamlet communication model within federally qualified health centers.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
The Career Enhancement Award (K18)
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Special Emphasis Panel (ZHS1-HSR-A (01))
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Willis, Tamara
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University of Rochester
Family Medicine
Schools of Dentistry
United States
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Fiscella, Kevin; Fogarty, Colleen; Salas, Eduardo (2016) What Can Primary Care Learn From Sports Teams? J Ambul Care Manage 39:279-85
Fiscella, Kevin; Sanders, Mechelle R (2016) Racial and Ethnic Disparities in the Quality of Health Care. Annu Rev Public Health 37:375-94
Phillips, Lindsay; Hendren, Samantha; Humiston, Sharon et al. (2015) Improving breast and colon cancer screening rates: a comparison of letters, automated phone calls, or both. J Am Board Fam Med 28:46-54
Fiscella, Kevin; Geiger, H Jack (2014) Caring for the poor in the 21st century: enabling community health centers for a new era. J Health Care Poor Underserved 25:2044-52
Fiscella, Kevin (2014) Tackling disparities in influenza vaccination in primary care: it takes a team. J Gen Intern Med 29:1579-81
Hendren, Samantha; Fiscella, Kevin (2014) Patient navigation improves the care experience for patients with newly diagnosed cancer. J Clin Oncol 32:3-4