Display options
Cite
Helfrich CD, Dolan ED, Fihn SD, et al. Association of medical home team-based care functions and perceived improvements in patient-centered care at VHA primary care clinics. Healthc (Amst). 2014;2(4):238-44doi: 10.1016/j.hjdsi.2014.09.008.
Helfrich, C. D., Dolan, E. D., Fihn, S. D., Rodriguez, H. P., Meredith, L. S., Rosland, A. M., Lempa, M., Wakefield, B. J., Joos, S., Lawler, L. H., Harvey, H. B., Stark, R., Schectman, G., & Nelson, K. M. (2014). Association of medical home team-based care functions and perceived improvements in patient-centered care at VHA primary care clinics. Healthcare (Amsterdam, Netherlands), 2(4), 238-44. https://doi.org/10.1016/j.hjdsi.2014.09.008
Helfrich, Christian D, et al. "Association of medical home team-based care functions and perceived improvements in patient-centered care at VHA primary care clinics." Healthcare (Amsterdam, Netherlands) vol. 2,4 (2014): 238-44. doi: https://doi.org/10.1016/j.hjdsi.2014.09.008
Helfrich CD, Dolan ED, Fihn SD, Rodriguez HP, Meredith LS, Rosland AM, Lempa M, Wakefield BJ, Joos S, Lawler LH, Harvey HB, Stark R, Schectman G, Nelson KM. Association of medical home team-based care functions and perceived improvements in patient-centered care at VHA primary care clinics. Healthc (Amst). 2014 Dec;2(4):238-44. doi: 10.1016/j.hjdsi.2014.09.008. Epub 2014 Nov 06. PMID: 26250630.
Copy Download .nbib Format: NLM
Share it on

Healthc (Amst). 2014 Dec;2(4):238-44. doi: 10.1016/j.hjdsi.2014.09.008. Epub 2014 Nov 06.

Association of medical home team-based care functions and perceived improvements in patient-centered care at VHA primary care clinics.

Healthcare (Amsterdam, Netherlands)

Christian D Helfrich, Emily D Dolan, Stephan D Fihn, Hector P Rodriguez, Lisa S Meredith, Ann-Marie Rosland, Michele Lempa, Bonnie J Wakefield, Sandra Joos, Lauren H Lawler, Henry B Harvey, Richard Stark, Gordon Schectman, Karin M Nelson

Affiliations

  1. VA Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs, Seattle, WA, USA; Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA. Electronic address: [email protected].
  2. VA Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs, Seattle, WA, USA.
  3. Office of Analytics and Business Intelligence, US Department of Veterans Affairs, Seattle, WA, USA.
  4. Division of Health Policy and Management, School of Public Health, University of California, Berkeley, CA, USA.
  5. RAND Corporation, Santa Monica, CA, USA; Veterans Health Administration Health Services Research & Development Center of Excellence, VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA.
  6. VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA; University of Michigan Medical School, Department of Internal Medicine, USA.
  7. Philadelphia VA Medical Center, US Department of Veterans Affairs, Philadelphia, PA, USA.
  8. VA Iowa City Health Services Research & Development Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City, IA, USA.
  9. Portland VA Medical Center, VISN 20 PACT Demonstration Laboratory, US Department of Veterans Affairs, Portland, OR, USA.
  10. Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA.
  11. VA Office of Clinical Operations, Washington, DC, USA.
  12. VA Office of Patient Care Services, Washington, DC, USA.

PMID: 26250630 DOI: 10.1016/j.hjdsi.2014.09.008

Abstract

INTRODUCTION: Team-based care is central to the patient-centered medical home (PCMH), but most PCMH evaluations measure team structure exclusively. We assessed team-based care in terms of team structure, process and effectiveness, and the association with improvements in teams׳ abilities to deliver patient-centered care.

MATERIAL AND METHODS: We fielded a cross-sectional survey among 913 VA primary care clinics implementing a PCMH model in 2012. The dependent variable was clinic-level respondent-reported improvements in delivery of patient-centered care. Independent variables included three sets of measures: (1) team structure, (2) team process, and (3) team effectiveness. We adjusted for clinic workload and patient comorbidity.

RESULTS: 4819 surveys were returned (25% estimated response rate). The highest ratings were for team structure (median of 89% of respondents being assigned to a teamlet, i.e., a PCP working with the same clinical associate, nurse care manager and clerk) and lowest for team process (median of 10% of respondents reporting the lowest level of stress/chaos). In multivariable regression, perceived improvements in patient-centered care were most strongly associated with participatory decision making (β=32, P<0.0001) and history of change in the clinic (β=18, P=0008) (both team processes). A stressful/chaotic clinic environment was associated with higher barriers to patient centered care (β=0.16-0.34, P=<0.0001), and lower improvements in patient-centered care (β=-0.19, P=0.001).

CONCLUSIONS: Team process and effectiveness measures, often omitted from PCMH evaluations, had stronger associations with perceived improvements in patient-centered care than team structure measures.

IMPLICATIONS: Team process and effectiveness measures may facilitate synthesis of evaluation findings and help identify positive outlier clinics.

Published by Elsevier Inc.

Keywords: Evaluation; Patient care team; Patient-centered care; Patient-centered medical home (PCMH); Team-based care

Publication Types