Putting population-based care into practice: real option or rhetoric?

Efforts to improve care have focused on population-based approaches, though little practical information exists about implementation.

This report reviews relevant literature on teamwork in the context of a time-series evaluation of a demonstration project to reorganize care of a single panel of patients in a managed care setting. The proportion of the study panel achieving recommended levels for breast and colon cancer screening, warfarin control, and diabetic eye care was compared with the surrounding practice panels and the managed care population as a whole. Using unconditional logistic regression, we compared changes within populations between March 1993 and March 1995, and the rate of change between populations during the same period.

A model of team care was successfully implemented. Colon (occult blood in the stool) and breast (mammography) screening increased more rapidly in the study population than in the surrounding practices or plan as a whole (P < 0.05 for all comparisons). There was no significant improvement in warfarin control or diabetic eye examinations, though absolute increases occurred.

This work shows that a team approach to population-based care is a real option. Such an approach, however, will not generalize to other settings or all conditions, and its implementation involves some major challenges.