higher retention and potential improvement in patient outcomes. Specific examples of changing roles, delegation of responsibilities, and expanded scopes of work are discussed later in this report as they relate to each segment of the workforce.

Patients and Informal Caregivers

Some models of care introduce new and expanded roles for patients and informal caregivers and integrate those individuals into the care team. An important element of the chronic-care model is engaging patients in their health and providing them with the education and tools to make decisions about their own care and to manage it (Arehart-Treichel, 2006; Unutzer et al., 2001). As more services are delivered in home- and community-based settings, patients and informal caregivers will become even more important to the delivery of care. And, as models of care recognize the contributions needed by these individuals to improve care, more will need to be done to educate and train them in principles of self-management, proper methods of service provision (e.g., wound care and medication administration), and use of new technologies. (See Chapter 6 for more on patients and informal caregivers.)

Interdisciplinary Care

The introduction of interdisciplinary teams into care delivery will pose a number of challenges. Although in the long run the use of such teams has the potential to reduce the use of intensive health services such as hospitalization, these teams are not adequately reimbursed at this time. Furthermore, since team care requires greater effort with respect to primary care and patient monitoring, the introduction of interdisciplinary teams to manage patients may strain the existing capacity of primary care providers even further. An additional challenge is that team training is not a focus of the curriculum for many providers, so that they may be unfamiliar with this practice style (see Chapter 4). Finally, effective teams also require a certain level of respect, comfort, and trust among members, which in some cases may not be present (Boult et al., 2001; Sommers et al., 2000).

Care Coordination

As discussed in Chapter 2, the coordination of care among providers and across settings, especially during transitions, can greatly influence patient outcomes. Older adults often see multiple providers—on average, Medicare beneficiaries are treated by five physicians annually, and beneficia-



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