Nurse practitioner-led multidisciplinary teams to improve chronic illness care: the unique strengths of nurse practitioners applied to shared medical appointments/group visits

J Am Acad Nurse Pract. 2009 Mar;21(3):167-72. doi: 10.1111/j.1745-7599.2008.00379.x.


Purpose: To describe the roles of nurse practitioners (NPs) in a novel model of healthcare delivery for patients with chronic disease: shared medical appointments (SMAs)/group visits based on the chronic care model (CCM). To map the specific skills of NPs to the six elements of the CCM: self-management, decision support, delivery system design, clinical information systems, community resources, and organizational support.

Data sources: Case studies of three disease-specific multidisciplinary SMAs (diabetes, heart failure, and hypertension) in which NPs played a leadership role.

Conclusions: NPs have multiple roles in development, implementation, and sustainability of SMAs as quality improvement interventions. Although the specific skills of NPs map out all six elements of the CCM, in our context, they had the greatest role in self-management, decision support, and delivery system design.

Implications for practice: With the increasing numbers of patients with chronic illnesses, healthcare systems are increasingly challenged to provide necessary care and empower patients to participate in that care. NPs can play a key role in helping to meet these challenges.

MeSH terms

  • Chronic Disease / nursing*
  • Clinical Competence*
  • Diabetes Mellitus / nursing
  • Disease Management
  • Heart Failure / nursing
  • Humans
  • Hypertension / nursing
  • Interdisciplinary Communication*
  • Leadership*
  • Nurse Practitioners / organization & administration*
  • Nurse's Role
  • Nursing Assessment / methods*
  • Nursing, Team / organization & administration*
  • Outcome and Process Assessment, Health Care
  • Quality Assurance, Health Care
  • United States