Contextual Factors Affecting the Implementation of Team-Based Primary Care: A Scoping Review

Cross, Dori A.

doi:10.1007/978-3-319-62235-4_5

Cited by 4 publications

(3 citation statements)

References 70 publications

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“…23 , 44 The effectiveness of the care teams, and the quality of care delivered, is impacted by environmental and contextual factors related to implementation, culture of the primary care teams, and perceived team dynamics. 10 , 54 - 56 As we are unable to control for these factors, there may be residual confounding. Lastly, our sample includes academically affiliated primary care practices in the Boston area, which, although a diverse group including hospital-based, community-based and federally qualified health centers, may not be generalizable to other practices.…”

Section: Discussionmentioning

confidence: 99%

Team-Based Primary Care Practice Transformation Initiative and Changes in Patient Experience and Recommended Cancer Screening Rates

Nguyen

Chien

Meyers

et al. 2020

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Team-based care has emerged as a promising strategy for primary care practices to provide high-quality care. We examine changes in patient experience of care and recommended cancer screening rates associated with a primary care transformation initiative that established team-based care. Our observational study included 13 academically affiliated primary care practices in the Boston, Massachusetts area that participated in 2 learning collaboratives: the first (2012-2014) aimed to establish team-based primary care, while the second (2014-2016) focused on improving patient safety and cancer screening. We identified 37 comparison practices of similar size and network affiliation. Using a difference-in-differences approach, we compared pre (2013) and post (2015) patient experience and recommended cancer screening rates between intervention and comparison practices. We estimated linear regression models, using inverse probability weighting to balance on observable differences. Massachusetts Health Quality Partners data on patient experience comes from surveys (with communication, integration, knowledge of patient, access, office staff, and willingness to recommend domains), and its data on screening rates for breast, colorectal, and cervical cancers is derived from chart abstraction. Relative to comparison practices, the communication score in intervention practices increased by 1.47 percentage points on a 100-point scale ( P = .02) between pre and post periods. We did not detect immediate improvements in other measures of patient experience of care and recommended cancer screening rates. Communication may be the first dimension of patient experience that improves following establishment of team-based primary care, and changing care processes may require more time or attention in the transition to team-based care. Our findings also suggest a need to better understand the variation in implementation factors that facilitate some practices’ successful transitions to team-based care, and to use teams effectively to improve cancer screening processes.

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Section: Discussionmentioning

confidence: 99%

Team-Based Primary Care Practice Transformation Initiative and Changes in Patient Experience and Recommended Cancer Screening Rates

Nguyen

Chien

Meyers

et al. 2020

INQUIRY

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“…This means, first, that providers and staff must convey their own commitment to using the portal as a communication tool, including more robust provider or staff training and explicit policies around responsiveness and follow-up [20,29]. Enabling and sustaining this commitment requires health care organizations to support providers in these efforts, for example, by building time for portal encounters into scheduling and productivity considerations, and using EHR features such as shared task queues to facilitate delegation of communications that do not require physician response [51].…”

Section: Principal Findingsmentioning

confidence: 99%

Patient Portal Use, Perceptions of Electronic Health Record Value, and Self-Rated Primary Care Quality Among Older Adults: Cross-sectional Survey

Cross¹,

Levin²,

Raj³

2021

J Med Internet Res

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Background Older adults are increasingly accessing information and communicating using patient-facing portals available through their providers’ electronic health record (EHR). Most theories of technology acceptance and use suggest that patients’ overall satisfaction with care should be independent of their chosen level of portal engagement. However, achieving expected benefits of portal use depends on demonstrated support from providers to meet these expectations. This is especially true among older adults, who may require more guidance. However, little is known about whether misalignment of expectations around technology-facilitated care is associated with lower perceptions of care quality. Objective The aims of this study were to analyze whether older adults’ assessment of primary care quality differs across levels of patient portal engagement and whether perceptions of how well their provider uses the EHR to support care moderates this relationship. Methods We conducted a cross-sectional survey analysis of 158 older adults over the age of 65 (average age 71.4 years) across Michigan using a 13-measure composite of self-assessed health care quality. Portal use was categorized as none, moderate (use of 1-3 functionalities), or extensive (use of 4-7 functionalities). EHR value perception was measured by asking respondents how they felt their doctor’s EHR use improved the patient–provider relationship. Results Moderate portal users, compared to those who were extensive users, had lower estimated care quality (–0.214 on 4-point scale; P=.03). Differences between extensive portal users and nonportal users were not significant. Quality perception was only particularly low among moderate portal users with low EHR value perception; those with high EHR value perception rated quality similarly to other portal user groups. Conclusions Older adults who are moderate portal users are the least satisfied with their care, and the most sensitive to perceptions of how well their provider uses the EHR to support the relationship. Encouraging portal use without compromising perceptions of quality requires thinking beyond patient-focused education. Achieving value from use of patient-facing technologies with older adults is contingent upon matched organizational investments that support technology-enabled care delivery. Providers and staff need policies and practices that demonstrate technology adeptness. Older adults may need more tailored signaling and accommodation for technology to be maximally impactful.

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“…This allowed for staff and trainees alike to learn without further burdening already busy schedules. Notably, our organization implemented electronic medical record (EMR) adoption (Cerner PowerChart [ 18 ]) at the same time as we pursued our initial PCMH recognition, a practice which is pivotal in adapting team-based primary care[ 19 ]; we partnered closely with our information technology staff to create documentation and workflow plans that would support PCMH recognition as efficiently as possible by leveraging EMR functions such as auto-texts and order sets.…”

Section: Methodsmentioning

confidence: 99%

Healthcare workforce transformation: implementing patient-centered medical home standards in an academic medical center

et al. 2021

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Background Large scale implementation of new strategies and healthcare delivery standards in academic medical centers (AMCs) requires training of healthcare workforce at different stages of their medical career. The patient-centered medical home (PCMH) model for healthcare delivery involves adoption by all members of the healthcare workforce, including seasoned professionals and trainees. Though widely known, the PCMH model has been implemented sporadically at large AMCs and methods to implement the model across healthcare workforce have not been well-documented. Methods To meet all PCMH standards and achieve sustainable level 3 recognition, the authors implemented in 2014–2015 a multi-pronged approach that capitalized on existing educational infrastructure among faculty, residents, and medical students. Within 18 months, the authors applied new interdisciplinary practices and policies, redesigned residency training in continuity practices and extensively modified medical school curricula. Results These innovative transformational education efforts addressed the six PCMH standards for faculty, residents, and undergraduate medical students. Faculty played a major role as system change agents and facilitators of learning. Residents learned to better understand patients’ cultural needs, identify ‘at-risk’ patients, ensure continuity of care, and assess and improve quality of care. Medical students were exposed to PCMH core standards throughout their training via simulations, training in the community and with patients, and evaluation tasks. By implementing these changes across the healthcare workforce, the AMC achieved PCMH status in a short time, changed practice culture and improved care for patients and the community. Since then, the AMC has been able to maintain PCMH recognition annually with minimal effort. Conclusions Successful strategies that capitalize on existing strengths in infrastructure complemented by innovative educational offerings and inter-professional partnerships can be adapted by other organizations pursuing similar transformation efforts. This widespread transformation across the healthcare workforce facilitate a deep-rooted change that enabled our academic medical center to sustain PCMH recognition.

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Contextual Factors Affecting the Implementation of Team-Based Primary Care: A Scoping Review

Cited by 4 publications

References 70 publications

Team-Based Primary Care Practice Transformation Initiative and Changes in Patient Experience and Recommended Cancer Screening Rates

Team-Based Primary Care Practice Transformation Initiative and Changes in Patient Experience and Recommended Cancer Screening Rates

Patient Portal Use, Perceptions of Electronic Health Record Value, and Self-Rated Primary Care Quality Among Older Adults: Cross-sectional Survey

Healthcare workforce transformation: implementing patient-centered medical home standards in an academic medical center

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