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Dartmouth College

DH Ambulatory Nursing Presents - How the Pandemic can Help us Drive the Implementation of Team-Based Care at DH-H

Dartmouth College via Independent


Dartmouth Health Continuing Education for Professionals Home, DH Ambulatory Nursing Presents - How the Pandemic can Help us Drive the Implementation of Team-Based Care at DH-H, 6/18/2021 8:00:00 AM - 6/18/2024 9:00:00 AM, It is said frequently: “I spend too much time on the phone” or “I’m glued to my computer all day.” Triage will always be a critical, complex, and needed component of ambulatory care nursing. However, in the future we must implement models of care that fully utilize the training and expertise of our nurses to meet the growing demand for management of chronic health conditions. There is strong and extensive evidence that implementing team-based care in ambulatory care improves outcomes. This presentation will review and discuss key attributes of effective team-based care, highlight clinics in the DH-H system already utilizing this approach, and end with a discussion on growth opportunities as a result of the COVID-19 pandemic.

Justin B. Montgomery, MSN, APRN

About our Presenter:
Justin B. Montgomery, MSN, APRN, has been a Nurse-Practitioner for over 11-years and a nurse for 22-years. Justin recently led a team that created a Team-Based Care model for managing hypertension in a primary care clinic. He is completing his Doctorate of Nursing Practice through The Johns Hopkins School of Nursing in May 2021. Justin’s scholarly project utilized a nursing clinical practice guideline to guide ambulatory care nurses in augmenting and enhancing hypertension care for primary care patients. He has also presented at over 100 conferences on a variety of topics specifically for nursing.

Learning Outcome(s)
At the conclusion of this learning activity, (at least 75% of) participants will self-report that they are able to identify three elements that are critical to the success of team based care.

The activity director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content have reported NO financial interest or relationship* with various companies. There were no individuals in a position to control the content that refused to disclose.

*A “financial interest or relationship" refers to an equity position, receipt of royalties, consultantship, funding by a research grant, receiving honoraria for educational services elsewhere, or to any other relationship to a company that provides sufficient reason for disclosure, in keeping with the spirit of the stated policy.

Bibliographic Sources
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• American Nurses Association [ANA]. (2016). Promoting Patient-Centered Team-Based Health Care. Retrieved April 6, 2021 from: New title (

• Bodenheimer, T. The future of primary care: transforming practice. New England Journal of Medicine, 2008;359(20):2086-9.

• Bureau of Health Workforce Health Resources and Services Administration (HRSA), 2021. Designated Health Professional Shortage Areas Statistics. Link to Article

• Centers for Disease Control and Prevention (CDC), 2021.  About Chronic Disease. Link to Article

• Community Preventive Services Task Force, (2015). Team-Based Care to Improve Blood Pressure Control. Retrieved April 1, 2021 From: Team-Based Care to Improve Blood Pressure Control (

• Cooper, L. & Hernandez, A. (2015) Assessing the Quality and Comparative Effectiveness of Team-Based Care for Heart Failure.  Heart Failure Clinics.  Volume 11, Issue 3, Pages 499-506

• Institute of Medicine.  (2021). The future of nursing 2020-2030: charting a path to achieve health equity. Link to Article

• Loudin B, Gainer L, Mayor M, et al. Elevating the role of the medical/clinical assistant: maximizing team-based care in the patient-centered medical home. Seattle, WA: MacColl Center for Health Care Innovation at the Group Health Institute and Qualis Health; August 2011.

• Mitchell, P., Wynia, M., Golden, R., McNellis, B., Okun, S., Webb, C. E., Kohorn, I. V. (2012). Core Principles & Values of Effective Team-based Health Care. Discussion Paper, Institute of Medicine, Washington, DC. Retrieved on September 18, 2015, from Link to Site

• Society for Cardiovascular Angiography & Interventions (2021, January 13). New Data confirms alarming trend: COVID-19 fears are causing American to avoid Doctor’s office and delay routine care. [Press release]. Retrieved from Link to Site

• The Community Guide; (2016). Diabetes Management: Team-Based Care for Patients with Type 2 Diabetes. Retrieved April 2, 2021 Link to Article

• World Health Organization, (2002). Innovative care for chronic conditions: building blocks for action. WHO Library Cataloging.


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