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Impact of team configuration and team stability on primary care quality

机译：团队配置和团队稳定对初级保健品质的影响

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The science of effective teams is well documented; far less is known, however, about how specific team configurations may impact primary care team effectiveness. Further, teams experiencing frequent personnel changes (perhaps as a consequence of poor implementation) may have difficulty delivering effective, continuous, well-coordinated care. This study aims to examine the extent to which primary care clinics in the Veterans Health Administration have implemented team configurations consistent with recommendations based on the Patient-Centered Medical Home model and the extent to which adherence to said recommendations, team stability, and role stability impact healthcare quality. Specifically, we expect to find better clinical outcomes in teams that adhere to recommended team configurations, teams whose membership and configuration are more stable over time, and teams whose clinical manager role is more stable over time. We will employ a combination of social network analysis and multilevel modeling to conduct a database review of variables extracted from the Veterans Health Administration's Team Assignments Report (TAR) (one of the largest, most diverse existing national samples of primary care teams (nteams?7000)), as well as other employee and clinical data sources. To ensure the examination of appropriate clinical outcomes, we will enlist a team of subject matter experts to select a concise set of clear, prioritized primary care performance metrics. We will accomplish this using the Productivity Measurement and Enhancement System, an evidence-based methodology for developing and implementing performance measurement. We are unaware of other studies of healthcare teams that consider team size, composition, and configuration longitudinally or with sample sizes of this magnitude. Results from this study can inform primary care team implementation policy and practice in both private- and public-sector clinics, such that teams are configured optimally, with adequate staffing, and the right mix of roles within the team. Not applicable-this study does not involve interventions on human participants.
机译：有效球队的科学有很好的记录;然而，关于特定的团队配置如何影响初级保健团队有效性，较小是众所周知的。此外，经常常见的人员变更的团队（也许是由于差的实施方式）可能难以提供有效，连续，协调的护理。本研究旨在审查退伍军人健康管理局的初级保健诊所的程度已经实施了与基于患者为中心的医疗家庭模式的建议一致的团队配置，以及遵守所述建议，团队稳定和角色稳定性影响的程度医疗质量。具体而言，我们希望在遵守推荐的团队配置的团队中找到更好的临床结果，其成员和配置随着时间的推移更稳定，以及临床经理角色随着时间的推移更稳定的团队。我们将采用社交网络分析和多级建模的组合，并对退伍军人健康管理团队分配报告（TAR）提取的变量数据库审查（TAR）（最大，最多样化的主要保健团队的国家样本之一（NTEAMS？7000 ））以及其他员工和临床数据来源。为确保检查适当的临床结果，我们将招募一个主题专家团队，选择一套明确的明确优先考虑的初级护理绩效指标。我们将使用生产力测量和增强系统，这是一种基于证据的方法，用于开发和实施性能测量。我们不知道对医疗保健团队的其他研究，考虑团队规模，构图和配置纵向或具有这种幅度的样本尺寸。本研究的结果可以通知初级保健团队实施政策和私人和公共部门诊所的实践，使团队能够最佳地配置，具有足够的人员配置，以及团队内部的角色的正确组合。不适用 - 本研究不涉及人类参与者的干预措施。

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