Team approach keeps breast cancer screening rates high

Dr. Linda Terrell and patient Lesa Huget

A unique approach to caring for patients has resulted in a near‑perfect breast cancer screening rate at Briarwood Medical Group in Ann Arbor. Using a team‑based approach to care means specific staff members work in dedicated care teams with the physicians to provide care for patients’ screening needs and chronic conditions.

“One of the most important things we did a few years ago was to transition to a team‑based approach to care,” says Dr. Linda Terrrell, medical director at Briarwood Medical Group, an outpatient general medicine clinic that is part of Michigan Medicine.

“My medical assistant, nurse, the LPN and case manager work together to manage a panel of patients. It’s not possible for one person to be responsible for ensuring the quality of care for more than a thousand patients.”

As part of the team approach, the medical assistant reviews the schedule with the doctor at the beginning of each day to see which health screenings or tests the patients need. “The assistant queues up those orders and reminds me to discuss it with the patient,” says Dr. Terrell.

The practice has 12,000 patients and 10 physicians. Transitioning to team‑based care first meant getting the buy‑in of all the physicians, nurses and staff in the practice. “It was a big leap of faith,” says Dr. Terrell. Moving to a new approach to care also necessitated physical moves within the practices so doctors’ offices could be near their care teams, rather than the doctors being peripherally located.

“There’s a lot to gain by having consistency of communication and staffing,” she says. “My patients know my nurse and medical assistant are speaking for me. Prior to this team‑based approach, we had a nurse call center and patients might talk to a different nurse each time they called.

“The team approach is also a significant patient satisfier,” continues Dr. Terrell. “My patients know my medical assistant by name and she greets them at each of their visits with me. They know who to connect with and that she represents me. Therefore, it’s very important that team members are strong and committed to excellent patient care.”

The team approach is also valuable in this particular practice because the office serves an older population. Many of Dr. Terrell’s patients are of Medicare age. Therefore, a lot of time is spent managing acute medical issues as well as on chronic disease management, she explains.

Screenings are still a priority at the practice, though. Dr. Terrell uses the Epic‑based electronic medical records to track when patients are due for screenings. “We also pick a focus quality measure of the month that we’re working on at the clinic level to help keep the staff motivated toward pursuing a specific goal,” she says.

One challenge to screening is the recent controversy about the appropriate interval for breast cancer screening, says Dr. Terrell. This can become confusing for patients and often takes some time to explain in detail.

“Regular breast cancer screening may not be right for everyone,” she says. “There are some who don’t care to do the screening, and part of being a PCP is understanding each patient’s values. We review family history, current health status, patient priorities and other risk factors to help determine the intervals that are appropriate for that particular patient.”

Dr. Terrell is a proponent of yearly visits and she believes it’s critical to a rich, long‑term doctor‑patient relationship. “Those visits provide a time and format to explore patients’ beliefs and values, discuss the importance of lifestyle interventions in health and disease, deliver patient education and establish a dialogue surrounding management of their chronic health issues,” she says.