Utilization Outcomes of a Pilot Primary Care Team Redesign

Abstract

Objectives:To evaluate the effect of a team-based primary care redesign on primary care, emergency department (ED) and urgent care (UC) utilization, and new patient access to primary care.Study Design:A retrospective pre–post difference-in-differences analysis of utilization outcomes for patients on a redesigned primary care team compared to a standard primary care group.Methods:Within a patient-centered medical home, a pilot team was developed comprising 2 colocated “teamlets” of 1 physician, 1 nurse practitioner (NP), 1 registered nurse (RN), and 2 licensed practical nurses (LPNs). The redesigned team utilized physician–NP comanagement, expanded roles for RNs and LPNs, and dedicated provider time for telephone and e-mail medicine. We compared changes in number of office, ED, and UC visits during the implementation year for patients on the redesigned team compared to patients receiving the standard of care in the same clinic. Proportion of new patient visits was also compared between the pilot and the control groups.Results:There were no differences between the redesign group and control group in per-patient mean change in office visits (Δ = −0.04 visits vs Δ = −0.07; P = .98), ED visits (Δ = 0.00 vs Δ = 0.01; P = .25), or UC visits (Δ = 0.00 vs Δ = 0.05; P = .08). Proportion of new patient visits was higher in the pilot group during the intervention year compared to the control group (6.6% vs 3.9%; P < .0001).Conclusions:The redesign did not significantly impact ED, UC, or primary care utilization within 1 year of follow-up. It did improve access for new patients.

Provider Perspectives of Medication Complexity in Home Health Care: A Qualitative Secondary Data Analysis

“…Unfortunately, many of the gaps in care identified in this study are precisely those which the 2007 patient-centered medical home (PCMH) model was designed to address. The model was proposed to improve care coordination by placing a PCP who knows the patient well at the head of the health care team (Almalki et al, 2018;David, Saynisch, Luster, Smith-McLallen, & Chawla, 2018;Landrey et al, 2018;Wells et al, 2018). However, our findings echo those from other papers that indicate this kind of long-term relationship in primary care is becoming increasingly rare as hospital-based practices rotate providers through primary care clinics, or structure care such that the patient sees whichever provider is available at the time of their visit.…”

A framework of the institutional policies and practice environments of nurse practitioner primary care models

“…Building off Burns and Wholey’s system classification of organizations (Burns & Wholey, 1993) and previous nursing administration literature that examined inpatient nursing care models (Dubois et al, 2012; Meyer & O’Brien-Pallas, 2010; Tiedeman & Lookinland, 2004), we define an NP primary care model as the organizational procedures and practice patterns related to the utilization of NPs in a primary care practice. Existing literature has documented a number of actual and theoretical NP primary care models (e.g., the collaborative approach, independent, and comanagement), but there is little consistency in the use of these descriptors, and their similarities and differences remain poorly defined (Callahan et al, 2006; Landrey et al, 2018; Norful et al, 2018). To support the ability of primary care NPs to reduce the primary care shortages, greater standardization of how health care organizations implement and utilize resources within different NP primary care models is needed.…”