Improving Primary Care with Team-Based Strategies
Michael Parchman, M.D., M.P.H.
University of Washington, Schools of Medicine and Public Health
“Highly functioning clinical teams can really make a difference in managing patients with chronic conditions. With funding from AHRQ, I have been able to develop evidence about improving the management of chronic disease and translate this knowledge to primary care.”
Family physician and health services researcher Michael Parchman, M.D., M.P.H., has dedicated his career to improving care for patients with chronic conditions such as diabetes and heart disease. With funding from AHRQ, Dr. Parchman, a professor at the University of Washington’s Schools of Medicine and Public Health in Seattle, has helped primary care clinical teams improve care for patients with chronic conditions by promoting adoption of team-based strategies.
With a 2002 career development award from AHRQ, Dr. Parchman started investigating the quality of care delivered to patients with diabetes in the primary care setting. Dr. Parchman, who is also a senior investigator at Kaiser Permanente Washington Health Research Institute, hypothesized that two attributes of primary care, continuity and coordination, were critical in providing high quality care for patients with chronic conditions, especially for those who were routinely interacting with numerous healthcare providers. The Centers for Disease Control and Prevention estimates that 6 in 10 adults in the U.S. have a chronic condition.
Following his 2006 study published in Annals of Family Medicine that analyzed the quality of care among patients with diabetes, Dr. Parchman realized that primary care physicians face a multitude of tasks with high levels of competing demands. If they could learn to function better within a team, streamlined, higher quality care would result. Dr. Parchman turned to team-based strategies to improve existing quality-of-care models for patients with chronic disease. His strategies included creating a unified clinical team through practice facilitation, seeking support from experts for implementation of research findings, and forming collaborations to share best practices.
Dr. Parchman put these team-based approaches into practice in 2015 through his Healthy Hearts Northwest coalition that was funded through AHRQ’s EvidenceNOW heart health initiative. Dr. Parchman’s research team provided external support for 209 small and medium primary care practices to build their quality improvement capacity and improve performance on heart health indicators. The team used AHRQ’s training resources on practice facilitation and the Institute for Healthcare Improvement model for improvement. The project, which was detailed in a 2019 study published in Annals of Family Medicine, demonstrated that team-based approaches can accelerate adoption of new medical evidence into clinical practices to benefit patients more quickly.
In 2015, Dr. Parchman also began work on a second AHRQ-funded project that used team-based strategies to improve care delivery—in this case, management of patients with chronic pain on long-term opioids. His team created and implemented the Six Building Blocks Program for Opioid Management, a systems-based approach to help primary care providers and teams manage patients who have chronic pain and are taking opioid therapy. According to Dr. Parchman, “Team-based approaches to opioid management have shown great promise for success, but have not been commonly used in opioid medication management.” His Six Building Blocks program was established to address that gap.
As part of this project, Dr. Parchman’s team worked with 20 rural primary care clinics to improve opioid prescribing for patients with chronic non-cancer pain over a 15-month period. They found a significant decrease in opioid prescribing after one year and improvements in the quality of work life for both providers and staff in these clinics. Dr. Parchman reports that this AHRQ work formed the foundation of continued efforts to provide technical assistance to primary care practices under a contract with the State of Washington.
Dr. Parchman is a Fellow, American Academy of Family Physicians; Diplomate, American Board of Family Medicine; and a member of AcademyHealth, the North American Primary Care Research Group, and the Washington State Medical Association. Dr. Parchman previously served as AHRQ’s Senior Advisor for Primary Care in the Center for Primary Care, Prevention and Clinical Partnerships from 2011-2012.
Principal Investigator: Michael Parchman, M.D., M.P.H.
Institution: University of Washington
Grantee Since: 2002
Type of Grant: Various
Consistent with its mission, AHRQ provides a broad range of extramural research grants and contracts, research training, conference grants, and intramural research activities. AHRQ is committed to fostering the next generation of health services researchers who can focus on some of the most important challenges facing our Nation's health care system.
To learn more about AHRQ's Research Education and Training Programs, please visit https://www.ahrq.gov/training.