The role of patient care teams in chronic disease management

The role of patient care teams in chronic disease management

2000 | Edward H Wagner
The article by Edward H. Wagner explores the role of patient care teams in managing chronic diseases, emphasizing the importance of teamwork in improving health outcomes and reducing healthcare costs. Wagner argues that successful chronic disease interventions often involve a coordinated multidisciplinary care team, which can include professionals outside a single practice or organization. Key components of effective team care include population-based care, treatment planning, evidence-based clinical management, self-management support, more effective consultations, and sustained follow-up. The article highlights the specific roles of nurse case managers, medical specialists, clinical pharmacists, social workers, and lay health workers in enhancing chronic disease management. Wagner concludes that well-defined and trained team members can significantly improve the quality of care for chronically ill patients, provided that doctors can effectively share care and practices are organized to support these teams.The article by Edward H. Wagner explores the role of patient care teams in managing chronic diseases, emphasizing the importance of teamwork in improving health outcomes and reducing healthcare costs. Wagner argues that successful chronic disease interventions often involve a coordinated multidisciplinary care team, which can include professionals outside a single practice or organization. Key components of effective team care include population-based care, treatment planning, evidence-based clinical management, self-management support, more effective consultations, and sustained follow-up. The article highlights the specific roles of nurse case managers, medical specialists, clinical pharmacists, social workers, and lay health workers in enhancing chronic disease management. Wagner concludes that well-defined and trained team members can significantly improve the quality of care for chronically ill patients, provided that doctors can effectively share care and practices are organized to support these teams.
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