Relationship among team dynamics, care coordination and perception of safety culture in primary care

Blumenthal, Karen; Chien, Alyna T.; Singer, Sara J.

doi:10.1093/fampra/cmy029

Cited by 12 publications

(24 citation statements)

References 22 publications

(32 reference statements)

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“…22 The transition to teambased care in AIC practices was associated with greater career satisfaction and perceptions of patient safety for physicians, nurse practitioners, physician assistants and medical assistants. [22][23][24][25][26][27] Following the establishment of team-based care, healthier patients in AIC practices had more annual outpatient visits, while chronically ill patients experienced significant reductions in hospitalizations and emergency department visits. 28 Studies have also examined the diagnostic evaluation processes of patients presenting to AIC practices with high-risk symptoms for breast and colorectal cancer.…”

Section: Description Of Initiativementioning

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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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: Description Of Initiativementioning

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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“…To date, examinations of the AIC have demonstrated that transitions to team-based care involved changing practice configurations (ie, who worked with whom) and composition (ie, ratios of certain types of personnel to physicians) more than it changed the overall size of practices (ie, total number of staff within practices). [12][13][14][15][16][17] They have also shown that better team dynamics (eg, team members' ability to understand each other's roles) were associated with greater satisfaction with clinical work among primary care clinicians and with more positive perceptions regarding patient safety among all staff. Qualitative studies have illustrated how the establishment of primary care teams can provide important scaffolding for residents when they feel stressed and inadequate during continuity clinic and with greater job satisfaction among medical assistants despite a higher workload.…”

Section: Interventionmentioning

confidence: 99%

“…Qualitative studies have illustrated how the establishment of primary care teams can provide important scaffolding for residents when they feel stressed and inadequate during continuity clinic and with greater job satisfaction among medical assistants despite a higher workload. [12][13][14][15][16][17]…”

Section: Interventionmentioning

confidence: 99%

Association of Team-Based Primary Care With Health Care Utilization and Costs Among Chronically Ill Patients

et al. 2019

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IMPORTANCE Empirical study findings to date are mixed on the association between team-based primary care initiatives and health care use and costs for Medicaid and commercially insured patients, especially those with multiple chronic conditions. OBJECTIVE To evaluate the association of establishing team-based primary care with patient health care use and costs. DESIGN, SETTING, AND PARTICIPANTS We used difference-indifferences to compare preutilization and postutilization rates between intervention and comparison practices with inverse probability weighting to balance observable differences. We fit a linear model using generalized estimating equations to adjust for clustering at 18 academically affiliated primary care practices in the Boston, Massachusetts, area between 2011 and 2015. The study included 83 953 patients accounting for 138 113 patient-years across 18 intervention practices and 238 455 patients accounting for 401 573 patient-years across 76 comparison practices. Data were analyzed between April and August 2018. EXPOSURES Practices participated in a 4-year learning collaborative that created and supported team-based primary care. MAIN OUTCOMES AND MEASURES Outpatient visits, hospitalizations, emergency department visits, ambulatory care-sensitive hospitalizations, ambulatory care-sensitive emergency department visits, and total costs of care. RESULTS Of 322 408 participants, 176 259 (54.7%) were female; 64 030 (19.9%) were younger than 18 years and 258 378 (80.1%) were age 19 to 64 years. Intervention practices had fewer participants, with 2 or more chronic conditions (n = 51 155 [37.0%] vs n = 186 954 [46.6%]), more participants younger than 18 years (n = 337 931 [27.5%] vs n = 74 691 [18.6%]), higher Medicaid enrollment (n = 39 541 [28.6%] vs n = 81 417 [20.3%]), and similar sex distributions (75 023 women [54.4%] vs 220 097 women [54.8%]); however, after inverse probability weighting, observable patient characteristics were well balanced. Intervention practices had higher utilization in the preperiod. Patients in intervention practices experienced a 7.4% increase in annual outpatient visits relative to baseline (95% CI, 3.5%-11.3%; P < .001) after adjusting for patient age, sex, comorbidity, zip code level sociodemographic characteristics, clinician characteristics, and plan fixed effects. In a subsample of patients with 2 or more chronic conditions, there was a statistically significant 18.6% reduction in hospitalizations (95% CI, 1.5%-33.0%; P = .03), 25.2% reduction in emergency department visits (95% CI, 6.6%-44.0%; P = .007), and a 36.7% reduction in ambulatory care-sensitive emergency department visits (95% CI, 9.2%-64.0%; P = .009). Among patients with less than 2 comorbidities, there was an increase in outpatient visits (9.

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“…Engajar profissionais nas ações de segurança do paciente mantém relação estatisticamente significativa com a cultura de segurança positiva e a redução de erros (18) . Importante destacar que a dinâmica da equipe influencia a coordenação do cuidado e as percepções da segurança do paciente, o que sugere que tornar a assistência mais segura implica prestar mais atenção em como se dá o trabalho colaborativo entre os profissionais de saúde ante a necessidade de coordenação do cuidado (19) .…”

Section: Discussionunclassified

Patient safety culture in Primary Health Care

Bohrer¹,

Vasconcelos²,

Bezerra³

et al. 2021

Rev Rene

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Objective: to evaluate the patient safety culture in a primary care health unit. Methods: cross-sectional study conducted with 51 professionals linked to Primary Health Care. Data were collected using the self-administered instrument Medical Office Survey on Patient Safety Culture, translated, adapted and validated for use in Brazil. Descriptive statistical analysis was performed. Nurses, physicians, Community Health Agents, among other professionals participated. Results: the dimensions of the patient safety culture in Primary Health Care indicated opportunities for improvement or weaknesses in the service. The general assessment of patient safety and the global assessment of the quality of care provided in Primary Health Care were appointed as good or fair. Conclusion: the safety culture in Primary Care did not identify strong dimensions; there were problems with equipment, performance and availability of test results and exchange of information with imaging centers/laboratories in the care network.

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Relationship among team dynamics, care coordination and perception of safety culture in primary care

Abstract: Our findings suggest there is a relationship between team dynamics, care coordination and perceptions of patient safety in a primary care setting. To make patients safer, we may need to pay more attention to how primary care providers work together to coordinate care.

Cited by 12 publications

References 22 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

Association of Team-Based Primary Care With Health Care Utilization and Costs Among Chronically Ill Patients

Patient safety culture in Primary Health Care

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