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06.08.2018 | Original Research

Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system

verfasst von: Anita D. Misra-Hebert, MD, MPH, Adam Perzynski, PhD, Michael B. Rothberg, MD, MPH, Jaqueline Fox, BSN, RN, Mary Beth Mercer, MPH, Xiaobo Liu, MS, Bo Hu, PhD, David C. Aron, MD, MS, Kurt C. Stange, MD, PhD

Erschienen in: Journal of General Internal Medicine | Ausgabe 11/2018

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Abstract

Background

Successful implementation of new care models within a health system is likely dependent on contextual factors at the individual sites of care.

Objective

To identify practice setting components contributing to uptake of new team-based care models.

Design

Convergent mixed-methods design.

Participants

Employees and patients of primary care practices implementing two team-based models in a large, integrated health system.

Main measures

Field observations of 9 practices and 75 interviews, provider and staff surveys to assess adaptive reserve and burnout, analysis of quality metrics, and patient panel comorbidity scores. The data were collected simultaneously, then merged, thematically analyzed, and interpreted by a multidisciplinary team.

Key results

Based on analysis of observations and interviews, the 9 practices were categorized into 3 groups—high, partial, and low uptake of new team-based models. Uptake was related to (1) practices’ responsiveness to change and (2) flexible workflow as related to team roles. Strength of local leadership and stable staffing mediated practices’ ability to achieve high performance in these two domains. Higher performance on several quality metrics was associated with high uptake practices compared to the lower uptake groups. Mean Adaptive Reserve Measure and Maslach Burnout Inventory scores did not differ significantly between higher and lower uptake practices.

Conclusion

Uptake of new team-based care delivery models is related to practices’ ability to respond to change and to adapt team roles in workflow, influenced by both local leadership and stable staffing. Better performance on quality metrics may identify high uptake practices. Our findings can inform expectations for operational and policy leaders seeking to implement change in primary care practices.

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Titel: Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system
verfasst von: Anita D. Misra-Hebert, MD, MPH
Adam Perzynski, PhD
Michael B. Rothberg, MD, MPH
Jaqueline Fox, BSN, RN
Mary Beth Mercer, MPH
Xiaobo Liu, MS
Bo Hu, PhD
David C. Aron, MD, MS
Kurt C. Stange, MD, PhD
Publikationsdatum: 06.08.2018
Verlag: Springer US
Erschienen in: Journal of General Internal Medicine / Ausgabe 11/2018
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-018-4611-7

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Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system