Practicing Teamwork – Revere Clinic is All About Collaboration and Communication

By Seth Daniel

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Dr. Megan Littlefield, medical director of the Revere Family Health Center on Broadway, informs Revere resident Daniel Diaz about a new physician-led group concentrating on diabetes.

When Revere’s Daniel Diaz used to manage a Walgreen’s store a few years back, he said he had zero success until he instilled a team attitude into all of the staff members.


It was in that coordination and teamwork that Diaz got the store running like a well-oiled machine.


Ironically, it’s in the spirit of that same idea of coordination at the Revere Family Health Center that Diaz turned his life around and took charge of his newly diagnosed diabetes. Through a team effort of doctors, nutritionists, patient representatives and even group meetings, Diaz is in complete control of his weight and his diabetes.


“They taught me everything,” he said. “The major thing they taught me was about my eating habits. I changed all my eating habits. I used to like fried dough and taking three plates of food at a buffet and eating a bunch of candy. I changed all of that. Halloween is over for me. Within three months, I had control of my health. They also educated me on how to watch my numbers and determine how much medication to take. If I didn’t care about myself and hadn’t come to Dr. Littlefield when I began feeling bad, I probably wouldn’t be here.”


The Revere clinic at the corner of Broadway and Fernwood Avenue has been transforming the way it cares for patients for the last six years – instituting coordinated care and other innovations, all for which they have recently won several accolades and become a statewide model.


Such patient-centered models and global payment plans have been in the news lately with Gov. Deval Patrick’s proposed change to the state’s health care system. However, the Revere clinic has for some time been on the cusp of much of what the governor is proposing.


Recently, they received a Level 3 designation for their “patient-centered medical home” program – the highest designation available – and they are also one of only 46 PILOT programs statewide to venture into this model.


But awards aside, it’s that coordinated effort that is helping with patient satisfaction for those like Diaz, and also possibly lowering health care costs.


“It’s funny that other industries (like Walgreen’s) have realized this so much earlier than the medical field, where we’re just now getting that concept together,” said Dr. Megan Littlefield, the new director of the Revere clinic, which is run by the Cambridge Health Alliance (CHA).


She continued, “In order to make a patient feel this well taken care of – like Daniel does – it can’t just be the primary care doctor,” she said. “It really has to be a team effort. In our current payment system, it’s impossible to provide comprehensive support without a team approach.”


Littlefield said that the clinic realized about six years ago that a change had to happen in the way that they cared for their patients – that the system was broken – and new ideas had to be injected.


So, they began the long journey.


“We realized in this area we have patients with so many health needs, not single health needs but complex health needs in the context of complicated lives,” said Littlefield. “You can’t just treat a person for 15 minutes in the office because it’s only a sliver of their health care needs. You have to treat the entire person…The majority of their lives are out in the community. You have to cast a wide net in order to improve their lives.


“Really, what it came down to for our doctors was that this was why we all went into medicine and primary care – because this is good medicine and it’s finding a way to practice it,” she continued.


Some of those ways have included having a special patient coordinator who speeds up the appointment process – making sure that an entire team is assigned to the patient and that appointments are carried out.


“If we have someone who is diagnosed with an abnormal mammogram, for instance, we do more than give them the news and numbers,” said Littlefield. “We have a care supervisor who calls the patient and helps get the appointments set up and who follows up with them to make sure they get the care they need so that they don’t end up falling through the cracks.”


Additionally, they have also instituted home visits for patients who are very sick with chronic or terminal diseases.


Another approach has been to have group doctor visits, in which patients with similar diagnoses can meet in a group setting with a doctor and other members of the care team.


This approach has been most successful with diabetes care and well child visits.


“If a patient wants to come in and see their doctor about their diabetes, they can, but we also have diabetes groups that are run by a primary care doctor and has a group of people with diabetes and they can spend an hour and a half with the doctor and a nutritionist. This isn’t for every patient, but it’s been effective,” she said.


The Revere clinic has also expanded its hours, allowed questions to doctors via secure e-mail and permitted patients access to their records and care plans.


Most of all, the team concept has been the greatest change. So, instead of one physician speaking down to a patient, they have made sure there is a team of providers teaching patients.


“We want patients to be really engaged in their health,” said Littlefield. “That’s really a different way of practicing medicine. It has been very paternalistic…This is a way to empower the patient to make the health decisions they need to make.”


That’s something that Diaz is grateful for, he said.


Not only has he learned that he has diabetes, but also he has learned how to deal with it on his own with the help of a health care team.


“They pointed me in the direction where I was eating healthier and was watching my health,” he said. “I’m getting back to my normal weight and I feel really good now. Now, I know how to keep an eye on everything.”



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