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首页> 外文期刊>Journal of general internal medicine >Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system
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Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system

机译：实施基于团队的初级保健模型：混合方法在大型综合医疗系统中的比较案例研究

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BackgroundSuccessful implementation of new care models within a health system is likely dependent on contextual factors at the individual sites of care.ObjectiveTo identify practice setting components contributing to uptake of new team-based care models.DesignConvergent mixed-methods design.ParticipantsEmployees and patients of primary care practices implementing two team-based models in a large, integrated health system.Main measuresField observations of 9 practices and 75 interviews, provider and staff surveys to assess adaptive reserve and burnout, analysis of quality metrics, and patient panel comorbidity scores. The data were collected simultaneously, then merged, thematically analyzed, and interpreted by a multidisciplinary team.Key resultsBased on analysis of observations and interviews, the 9 practices were categorized into 3 groupshigh, partial, and low uptake of new team-based models. Uptake was related to (1) practices' responsiveness to change and (2) flexible workflow as related to team roles. Strength of local leadership and stable staffing mediated practices' ability to achieve high performance in these two domains. Higher performance on several quality metrics was associated with high uptake practices compared to the lower uptake groups. Mean Adaptive Reserve Measure and Maslach Burnout Inventory scores did not differ significantly between higher and lower uptake practices.ConclusionUptake of new team-based care delivery models is related to practices' ability to respond to change and to adapt team roles in workflow, influenced by both local leadership and stable staffing. Better performance on quality metrics may identify high uptake practices. Our findings can inform expectations for operational and policy leaders seeking to implement change in primary care practices.
机译：背景技术在卫生系统中的新护理模型的实施可能依赖于个人护理场所的背景因素.Objectiveto确定练习设定组件有助于吸收新的基于团队的护理模型.DesignConvergent的混合方法设计.ParticipantsEm单位和患者在大型综合健康系统中实施两支基于团队的模型的护理措施。衡量标准的措施，有9种实践和75个访谈，提供商和工作人员调查，以评估适应性储备和倦怠，质量指标分析和患者面板合并症分数。同时收集数据，然后通过多学科团队合并，专门分析和解释，并由多学科团队进行解释。在观察和访谈的分析上，将9种实践分为3个GroupShigh，部分和低摄取新的团队的模型。摄取与（1）练习对变更的响应和（2）与团队角色相关的灵活工作流程相关。当地领导力的力量和稳定的人员配置介导的实践在这两个领域中实现高性能的能力。与较低的摄取组相比，几种质量指标的性能更高的性能与高摄取实践相关。平均自适应储备措施和Maslach倦怠库存分数在上升和降低的摄取实践之间没有显着差异。基于新团队的护理送货方式的组件与实践有关的响应变更以及适应工作流中的团队角色的能力，受到影响地方领导和稳定的人员配置。质量指标的更好性能可能识别高摄取实践。我们的调查结果可以了解寻求实施初级保健实践变更的业务和政策领导人的期望。

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