TY - JOUR
KW - Aged
KW - Cohort Studies
KW - Delivery of Health Care
KW - Female
KW - Humans
KW - implementation science
KW - Leadership
KW - Longitudinal Studies
KW - Male
KW - Middle Aged
KW - Mortality/trends
KW - Patient Care Team/organization & administration
KW - Patient-Centered Care/methods/organization & administration
KW - Retrospective Studies
KW - United States
KW - United States Department of Veterans Affairs
AU - F. M. Wu
AU - L. V. Rubenstein
AU - J. Yoon
A1 - 
AB - BACKGROUND: New models of patient-centered primary care such as the patient-centered medical home (PCMH) depend on high levels of interdisciplinary primary care team functioning to achieve improved outcomes. A few studies have qualitatively assessed barriers and facilitators to optimal team functioning; however, we know of no prior study that assesses PCMH team functioning in relationship to patient health outcomes. PURPOSE: The aim of the study was to assess the relationships between primary care team functioning, patients' use of acute care, and mortality. METHODOLOGY/APPROACH: Retrospective longitudinal cohort analysis of patient outcomes measured at two time points (2012 and 2013) after PCMH implementation began in Veterans Health Administration practices. Multilevel models examined practice-level measures of team functioning in relationship to patient outcomes (all-cause and ambulatory care-sensitive condition-related hospitalizations, emergency department visits, and mortality). We controlled for practice-level factors likely to affect team functioning, including leadership support, provider and staff burnout, and staffing sufficiency, as well as for individual patient characteristics. We also tested the model among a subgroup of vulnerable patients (homeless, mentally ill, or with dementia). RESULTS: In adjusted analyses, higher team functioning was associated with lower mortality (OR = 0.92, p = .04) among all patients and with fewer all-cause admissions (incidence rate ratio [IRR] = 0.90, p < 0.01), ambulatory care-sensitive condition-related admissions (IRR = 0.91, p = .04), and emergency department visits (IRR = 0.91, p = .03) in the vulnerable patient subgroup. CONCLUSION: These early findings give support for the importance of team functioning within PCMH models for achieving improved patient outcomes. PRACTICE IMPLICATIONS: A focus on team functioning is important especially in the early implementation of team-based primary care models.
AD - Frances M. Wu, PhD, is Statistical Consultant, Information Support for Care Transformation, Kaiser Permanente, Oakland, California. E-mail: Frances.M.Wu@kp.org. Lisa V. Rubenstein, MD, MSPH, is Professor of Medicine, VA Greater Los Angeles, and UCLA Senior Scientist, RAND, VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, North Hills, California. Jean Yoon, PhD, MHS, is Health Economist, Health Economics Resource Center, VA Palo Alto, Menlo Park, California.
BT - Health care management review
C5 - Medical Home
CP - 3
CY - United States
DO - 10.1097/HMR.0000000000000196
IS - 3
JF - Health care management review
M1 - Journal Article
N2 - BACKGROUND: New models of patient-centered primary care such as the patient-centered medical home (PCMH) depend on high levels of interdisciplinary primary care team functioning to achieve improved outcomes. A few studies have qualitatively assessed barriers and facilitators to optimal team functioning; however, we know of no prior study that assesses PCMH team functioning in relationship to patient health outcomes. PURPOSE: The aim of the study was to assess the relationships between primary care team functioning, patients' use of acute care, and mortality. METHODOLOGY/APPROACH: Retrospective longitudinal cohort analysis of patient outcomes measured at two time points (2012 and 2013) after PCMH implementation began in Veterans Health Administration practices. Multilevel models examined practice-level measures of team functioning in relationship to patient outcomes (all-cause and ambulatory care-sensitive condition-related hospitalizations, emergency department visits, and mortality). We controlled for practice-level factors likely to affect team functioning, including leadership support, provider and staff burnout, and staffing sufficiency, as well as for individual patient characteristics. We also tested the model among a subgroup of vulnerable patients (homeless, mentally ill, or with dementia). RESULTS: In adjusted analyses, higher team functioning was associated with lower mortality (OR = 0.92, p = .04) among all patients and with fewer all-cause admissions (incidence rate ratio [IRR] = 0.90, p < 0.01), ambulatory care-sensitive condition-related admissions (IRR = 0.91, p = .04), and emergency department visits (IRR = 0.91, p = .03) in the vulnerable patient subgroup. CONCLUSION: These early findings give support for the importance of team functioning within PCMH models for achieving improved patient outcomes. PRACTICE IMPLICATIONS: A focus on team functioning is important especially in the early implementation of team-based primary care models.
PP - United States
PY - 2018
SN - 1550-5030; 0361-6274
SP - 238
EP - 248
EP - 
T1 - Team functioning as a predictor of patient outcomes in early medical home implementation
T2 - Health care management review
TI - Team functioning as a predictor of patient outcomes in early medical home implementation
U1 - Medical Home
U2 - 29533272
U3 - 10.1097/HMR.0000000000000196
VL - 43
VO - 1550-5030; 0361-6274
Y1 - 2018
Y2 - Jul/Sep
ER -