Background
Team composition and primary care performance
Team stability and quality of care
Objectives and hypotheses
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Hypothesis 1: Teams that adhere more closely to the recommended team configurations relative to teams who deviate more egregiously.
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Hypothesis 2: Teams that are more stable over time relative to teams who are less stable
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Hypothesis 3: Teams whose clinical manager is more stable over time relative to teams whose clinical manager are less stable
Methods
Design
Setting: Veterans Affairs medical center primary care clinics
Aim 1: Identifying and prioritizing primary care measures
Methodology overview
Participants: design team subject matter experts
Procedure
Data Analysis
Aim 2: Identify the relationships between team characteristics, team/role stability, and clinical performance
Overview: social network analysis as an approach to studying team configuration
Data sources
Measures
Role | Time point in study observation period | n of within role separations in obs. period | n of time points role filled | Staffing sufficiency | Role continuity | |||||
---|---|---|---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | 6 | |||||
PCP | a | a | a | 0 | 0 | b | 1 | 4.00 | .67 | 0.83 |
Care manager | c | c | c | c | c | c | 0 | 6.00 | 1.00 | 1.00 |
Clinical associate | d | e | e | e | f | f | 2 | 6.00 | 1.00 | 0.67 |
Clerical associate | g | g | 0 | 0 | 0 | 0 | 0 | 2.00 | .33 | 1.00 |
n of roles | 4 | 4 | 3 | 2 | 2 | 3 | ||||
Calculating team stability: | ||||||||||
A. n of separations during the observation period: (i.e., total number of people who left their role, whether or not they were replaced by a new team member) | 4 | |||||||||
B. Average n of roles during the observation period | 3 | |||||||||
Coefficient of team stability (1 − (A/B)) | − .33 |