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Virtual Integrated Practice Model:

Virtual Integrated Practice: The Community Response

Rather than hiring additional staff, the VIP concept calls for primary care physicians to identify practitioners in nearby health care settings or community organizations and develop working relationships among them. Teams are built among providers in the community who are seeing the same patients and addressing the same issues around aging and chronic disease management, but who don't otherwise interact with one another. Communication among these team members occurs primarily though e-mail, voicemail, and Internet-based medical informatics systems to facilitate efficient teamwork.

Jack Olsen, MD, examines patient Carmen ZuZula in SeniorCare at Rush University Medical Center. Technology allows Dr. Olsen to communicate his findings with members of the health care team. The VIP process begins with convening and training the virtual team members. The team members discuss clinical issues that they can work on together. For example, the physician may identify diabetes education as an area that he or she lacks the resources to comprehensively provide.

The pharmacist may offer to give medication instruction and a dietician may offer to provide nutrition education. The team also develops population-based goals for patients with target conditions. For example, a team may decide to increase the number of diabetic patients with controlled blood pressure or reduce the number of patients who are nonadherent with their medication.

The team can also utilize a toolkit of activities that were devised by the Rush team to facilitate the team process. The toolkits provide guidance on four improvement strategies: planned communications, process standardization, patient self-management, and group activities. Planned communication involves team members being explicit with each other in advance about what information they want and how they want to receive it. Process standardization means that the team determines each provider's role and responsibility in delivering care that adheres to evidence-based practice guidelines. Patients themselves are integral members of the team and must be armed with knowledge about their illness and empowered to alter their own behavior to improve outcomes. Group activities involve bringing together small groups of patients with a common diagnosis or health problem to receive direct care or education at the same time.

While the members of the virtual team—nutritionist, social worker, pharmacist, physician, and others—are not employed in the same location, for the patient the experience is one of coordinated team care.
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