This study uses a large, diverse national sample of primary care teams to examine the impact of different team configurations.
Study Overview
Problem: Although the effectiveness of primary care teams is well documented, the impact of different types of care team configurations on the quality of care is not well understood.
Main Objective: To examine the relationship between the configuration of the primary care team and the stability of the care provided.
Approach: The research team used a large, national dataset from the Veterans Health Administration (VHA) to study the effectiveness of different primary care team configurations. First, the research team convened a panel of experts to select and prioritize a set of primary care performance measures.
The panel reviewed existing performance measures and drew upon evidence-based methodology from organizational psychology normally used for developing performance measurement systems (Productivity Measurement and Enhancement System, or ProMES) to select a curated set of metrics that represented high quality primary care. The panel selected sixteen performance indicators encompassing three fundamental dimensions of primary care: access, patient-health care team partnerships, and technical quality. The research team used a subset of these indicators as the outcomes of the study.
Next, the research team built a dataset with measures of clinical performance, team configuration, and team and role stability for a sample of nearly 6,000 primary care teams from more than 1,000 VHA healthcare centers nationwide. The researchers computed team configurations for each team using network analysis. The researchers then used hierarchical linear models to test the relationship between clinical performance measures and adherence to recommended team configurations, team stability, and the stability of team leadership over time.
Results: In preliminary findings, the research team found that different team characteristics were associated with different quality and access outcomes. In most cases, teams with more full-time equivalent personnel appeared to have better outcomes. In addition, teams with high levels of churn in the nursing role—where the nurse role is always filled, though by different nurses over time—tended to have worse outcomes. The team used these findings to assemble a Primary Care Team-Based Care Toolkit to help primary care teams work more effectively.
Final results and publications from this study are forthcoming and will be posted here.
Primary Care Relevance
This study aims to develop clear guidance on the best primary care team configurations for effectively providing high-quality and patient-centered care.
AHRQ Primary Care Priority Area
Research to improve primary care, including regarding quality, access and affordability, the workforce, care delivery models, financing, digital healthcare, person-centeredness, and health equity.
