Patient-Centered Team-Based Care Model

PCTBC Model - Full

Community Community Community Triple Aim of Health Care Team Parent Organization Hallmarks of Practice Engaged Patient Core Principles Workforce Diversity

Full Model

This is a relationship model where all parts interconnect. The central focus of the model is an engaged patient.  The model relies on leadership and connectivity between:  (1) three core elements (team, interprofessional diverse workforce, and parent organization); (2) three influencing factors (core principles, hallmarks of practice, and the Triple Aim of Health Care™); and (3) durable linkages between health systems and communities.

The model expresses that the whole is greater than any individual element.  It responds to an expressed need by our funders to conceptualize a Wisconsin-centric model for patient-centered team-based care. The model, based on literature and evidence, was tempered by the wisdom of our diverse collaborators during its development and external review.

The model was originally developed to address two highly prevalent conditions: hypertension and diabetes. As the model evolved, collaborating partners concurred that a flexible and adaptable model was needed for application in a wide array of settings to address specific conditions and diseases, including prevention initiatives. The collaborating partners recommended that the model depict antecedent conditions necessary for successful team development. The proposed model incorporates these recommendations. It also emphasizes the importance of interprofessional approaches needed by teams and parent organizations.

To learn more about the individual components of the model, click on the words contained in the model shown above.