TY - JOUR
AU - A. M. Annis
AU - M. Harris
AU - H. M. Kim
AU - A. M. Rosland
AU - S. L. Krein
A1 - 
AB - OBJECTIVES: Team-based care models, including the patient-centered medical home (PCMH), are increasingly promoted to improve the delivery of primary care. However, evaluation measures are often reported at a clinic or primary care provider (PCP) level, creating challenges in describing and analyzing the use and impact of non-PCP clinician team members. Thus, we aimed to measure clinician-specific care delivery trends and determine whether trends were responsive to systemwide PCMH implementation. STUDY DESIGN: Interrupted time-series analysis of 57 million primary care encounters among 5 million veterans at 764 Veterans Health Administration primary care clinics from 2009 to 2013. METHODS: Retrospective data identified patient encounters attributable to 12 types of clinicians, yielding an encounters-by-clinician metric. Negative binomial regression modeled the monthly clinic-level rates of encounters for each type of clinician, before and during PCMH implementation. RESULTS: Over 5 years, the percentage of encounters by non-PCP clinicians increased from 29% to 35%. Monthly encounter rates for nurses and social workers significantly increased by 0.5% and 1.3%, respectively, after the introduction of PCMH, whereas PCP encounter rates significantly decreased over time. Encounter trends for pharmacists, nutritionists, and behavioral health clinicians did not significantly change. CONCLUSIONS: This study demonstrated the feasibility of capturing care delivered by a full complement of team members using routinely collected data. Findings suggest that the proportions of care delivered by non-PCP clinicians were sensitive to a change in care delivery model. As team-based care models expand, availability and use of metrics that account for care by all team members are critical for inferring clinician-related effects on outcomes.
AD - Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2800 Plymouth Rd, NCRC Bldg 16, 3rd Fl, Ann Arbor, MI 48109. Email: ann.annis@va.gov.
BT - The American Journal of Managed Care
C5 - Medical Home
CP - 7
CY - United States
IS - 7
JF - The American Journal of Managed Care
M1 - Journal Article
N2 - OBJECTIVES: Team-based care models, including the patient-centered medical home (PCMH), are increasingly promoted to improve the delivery of primary care. However, evaluation measures are often reported at a clinic or primary care provider (PCP) level, creating challenges in describing and analyzing the use and impact of non-PCP clinician team members. Thus, we aimed to measure clinician-specific care delivery trends and determine whether trends were responsive to systemwide PCMH implementation. STUDY DESIGN: Interrupted time-series analysis of 57 million primary care encounters among 5 million veterans at 764 Veterans Health Administration primary care clinics from 2009 to 2013. METHODS: Retrospective data identified patient encounters attributable to 12 types of clinicians, yielding an encounters-by-clinician metric. Negative binomial regression modeled the monthly clinic-level rates of encounters for each type of clinician, before and during PCMH implementation. RESULTS: Over 5 years, the percentage of encounters by non-PCP clinicians increased from 29% to 35%. Monthly encounter rates for nurses and social workers significantly increased by 0.5% and 1.3%, respectively, after the introduction of PCMH, whereas PCP encounter rates significantly decreased over time. Encounter trends for pharmacists, nutritionists, and behavioral health clinicians did not significantly change. CONCLUSIONS: This study demonstrated the feasibility of capturing care delivered by a full complement of team members using routinely collected data. Findings suggest that the proportions of care delivered by non-PCP clinicians were sensitive to a change in care delivery model. As team-based care models expand, availability and use of metrics that account for care by all team members are critical for inferring clinician-related effects on outcomes.
PP - United States
PY - 2018
SN - 1936-2692; 1088-0224
SP - e222
EP - e229
EP - 
T1 - Trends in primary care encounters across professional roles in PCMH
T2 - The American Journal of Managed Care
TI - Trends in primary care encounters across professional roles in PCMH
U1 - Medical Home
U2 - 30020758
VL - 24
VO - 1936-2692; 1088-0224
Y1 - 2018
Y2 - Jul 1
ER -