BACKGROUND: @entity1 panel management and community-based care management may be viable strategies for community health centers to improve the quality of @entity6 care for vulnerable @entity1 populations. The objective of our study was to clarify implementation processes and experiences of integrating office-based @entity910 ( @entity910 ) panel management and @entity497 ( @entity497 ) community-based management into routine care for @entity6 @entity1 . METHODS: Mixed methods study with interviews and surveys of clinicians and staff participating in a study comparing the effectiveness of @entity910 and @entity497 health coaching for improving @entity6 care. @entity1 included 24 key informants in five role categories and 249 clinicians and staff survey respondents from 14 participating practices. We conducted thematic analyses of key informant interview transcripts to clarify implementation processes and describe barriers to integrating the new roles into practice. We surveyed clinicians and staff to assess differences in practice culture among intervention and control groups. We triangulated findings to identify concordant and disparate results across data sources. RESULTS: Implementation processes and experiences varied considerably among the practices implementing @entity497 and @entity910 team-based approaches, resulting in differences in the organization of health coaching and self-management support activities. Importantly, @entity497 and @entity910 responsibilities converged over time to focus on health coaching of @entity6 @entity1 . @entity910 health coaches experienced difficulty in allocating dedicated time due to other @entity910 responsibilities that often crowded out time for @entity6 @entity1 health coaching. Time constraints also limited the personal introduction of @entity1 to health coaches by clinicians. @entity1 highlighted the importance of a supportive team climate and proactive leadership as important enablers for MAs and CHWs to implement their health coaching responsibilities and also promoted professional growth. CONCLUSION: Implementation of team-based strategies to improve @entity6 care for vulnerable populations was diverse, however all practices converged in their foci on health coaching roles of CHWs and MAs. Our study suggests that a flexible approach to implementing health coaching is more important than fidelity to rigid models that do not allow for variable allocation of responsibilities across team members. Clinicians play an instrumental role in supporting health coaches to grow into their new @entity1 care responsibilities.

Comparing the implementation of team approaches for improving XXXX care in community health centers.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient', 'Patient', 'Participants'] @entity497 :: ('MESH:D003147', 'Disease') :: ['community health worker', 'CHW'] @entity910 :: ('MESH:D004409', 'Disease') :: ['MA', 'medical assistant'] @entity6 :: ('MESH:D003920', 'Disease') :: ['diabetic', 'diabetes']
@entity6 :: (MESH:D003920,Disease) :: ['diabetes']
