• Introduction
• Improving Care for the Chronically Ill
  • Improving Care of the Chronically Ill
  • Team Care Recognizes and Embraces Complexity
  • Team Care is Cost-Effective Care
  • Making Team Care the Standard of Care
• History of Commitment to Team Care
• Team Care Models
• Model 1: Care Transitions
  Improving Transitions Across Sites of Geriatric Care
  • Model 1: Care Transitions
    Improving Transitions Across Sites of Geriatric Care
  • The Four Pillars of Care Transitions
  • Illustration: Care Transitions Model
  • Measuring the Success of Care Transitions
  • Moving the Model from Two Sites to 100
  • A Transition Coach Makes Recovery from Surgery Faster, Easier
• Model 2: Care Management Plus
  Using Technology to Improve Outpatient Care for Older Adults
  • Model 2: Care Management Plus
    Using Technology to Improve Outpatient Care for Older Adults
  • Description of the Model: Care Management Plus
  • Illustration: Care Management Plus Model
  • Measuring the Success of Care Management Plus
  • The National Search for Quality Health Care Finds Care Management Plus
  • Tracking Care Over Time Helps Avoid Serious Disability
• Model 3: Senior Health & Wellness Clinic
  Managing Care of Older Patients in the Clinic by Fostering Team Care
  • Model 3: Senior Health & Wellness Clinic
    Managing Care of Older Patients in the Clinic by Fostering Team Care
  • Senior Health and Wellness Center: Total Care Under One Roof
  • Team Care Approach at Senior Health and Wellness Center
  • Measuring the Success of Senior Health and Wellness Clinic
  • Illustration: Senior Health and Wellness Clinic
  • Customizing Team Care to Work Locally
  • From Clinic Volunteer to Clinic Patient, But Always a Member of the Team
• Model 4: Virtual Integrated Practice
  Implementing Team Care Across Practices and Virtually
  • Model 4: Virtual Integrated Practice
    Implementing Team Care Across Practices and Virtually
  • Virtual Integrated Practice: The Community Response
  • Measuring the Success of Virtual Integrated Practice
  • Illustration: Virtual Integrated Practice Model
  • Building Community Capacity
  • VIP: A Seamless System of Resources
• Senior Resource Team
  Important Role Foundations Play in Taking Risk
• Looking Toward the Future of Team Care

Featured Initiative:

Virtual Integrated Practice Model

Implementing Team Care Across Practices and Virtually

As an outstanding educational site within the Foundation's Geriatric Interdisciplinary Team Training program, Rush University Medical Center successfully integrated concepts of interdisciplinary team training into the curricula of the disciplines involved in geriatric care, including medicine, nursing, and social work. In 2000, the Foundation awarded Rush a five-year grant of $1,833,284 to extend its work on interdisciplinary team care into the realm of clinical practice with the Virtual Integrated Practice team care model. The project is led by Steven K. Rothschild, MD, Associate Professor of Family Medicine and Director of the Section of Community Medicine, Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois.

Steven K. Rothschild, MD
Principal Investigator,
Virtual Integrated Practice
Rush University In the United States, the majority of primary care offices are solo fee-for-service practices of four or fewer physicians.²⁵ Unlike larger practices and clinics, these small practices rarely have the capability to offer the kind of multidisciplinary team care that has been shown to improve outcomes for older adult patients with complex care needs. Ideally, interdisciplinary teams include social workers, nurse practitioners, pharmacists, physical and occupational therapists, clinical nutritionists, and others to provide critically needed and well coordinated patient care services. Small practices often lack the financial resources and space to support and accommodate these additional clinicians. Practices in rural settings have particular difficulty offering interdisciplinary team care.

"We developed a team care model that brings primary care physicians together with providers in other disciplines at other sites to a virtual table to interact around the care of patients with chronic diseases and disability," says Dr. Rothschild, Principal Investigator. The model, called Virtual Integrated Practice (VIP), utilizes redesign of office systems, structured communications tools, and relationship building to coordinate patient care among team members who do not share office facilities. "Each member of our research team brings stellar academic credentials and practical bedside experience in their respective clinical disciplines. The result is a robust care model that is informed by theory and clinical practice."
Steven K. Rothschild, MD
Principal Investigator,
Virtual Integrated Practice

The VIP model was developed by an interdisciplinary team of researchers and clinicians. David Lindeman, MSW, PhD, an internationally recognized gerontologist, was Co-Principal Investigator. Dr. Lindeman, then Director of the Mather Institute on Aging, Evanston, IL, brought insight from two decades of work on the care of persons with Alzheimer's disease. Lois A. Halsted, PhD, RN, then the Associate Dean of the Rush College of Nursing and currently Vice-Provost and Vice President for University Affairs at Rush, provided nursing input into the project.

Drs. Lindeman and Halstead continue to work on the VIP team, along with a dietician (Kathy Keim, PhD, RD), a social worker/gerontologist (Robyn Golden, LCSW), and two additional nurse-researchers (Ann Minnick, PhD, RN and Cathy Catrambone PhD, RN). A gerontologist, Stan Lapidos, has served as Project Manager for VIP and Rush's prior GITT initiative.

Rush was an outstanding educational site in the Hartford Foundation's previous Geriatric Interdisciplinary Team Training (GITT) initiative. It has developed its capacity to train future health professionals to work together and deliver care to older people using an interdisciplinary approach.
Next: Virtual Integrated Practice: The Community Response ›
25- Wassenaar JD, Thran SL. Physician socioeconmic statistics. Chicago, AMA Press, Center for Health Policy Research. 2003.