Enabling System Functionalities of Primary Care Practices for Team Dynamics in Transformation to Team-Based Care: A Qualitative Comparative Analysis (QCA).
Enabling System Functionalities of Primary Care Practices for Team Dynamics in Transformation to Team-Based Care: A Qualitative Comparative Analysis (QCA).
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DOI：
10.3390/healthcare11142018
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发表时间：
2023-07-13
期刊：
影响因子：
2.8
通讯作者：
Singer, Sara J.
中科院分区：
文献类型：
--
作者：
Liu, Lingrui;Chien, Alyna T.;Singer, Sara J.
以团队为基础的初级保健已被证明是转变初级保健以实现全人保健、增强卫生公平和减少提供者职业倦怠的重要举措。已经探索了更好地实施以团队为基础的护理的组织方法，但缺乏对系统职能作用的透彻了解。我们的目标是确定初级保健实践中最能实现有效团队合作的系统功能组合。我们使用一种新的方法，定性比较分析(QCA)，在哈佛大学学术创新合作(AIC)的19个初级保健实践中确定了跨病例模式，AIC是一个通过建立团队和实施基于团队的护理来转变初级保健实践的倡议。QCA调查结果表明，具有强大团队活力的初级保健实践在三个操作保健流程功能方面表现出优势，包括异常测试结果的管理、高优先级患者的癌症筛查和药物管理、护理过渡以及健康信息技术(HIT)功能。仅有HIT功能不足以实现预期结果。初级保健实践中的系统功能，支持医生及其团队识别需要立即反应和护理的紧急和复杂急性疾病患者，并克服机构内和机构间合作的障碍，对于维持强有力的以团队为基础的初级保健可能是必不可少的。
Team-based primary care has been shown to be an important initiative for transforming primary care to achieve whole-person care, enhance health equity, and reduce provider burnout. Organizational approaches have been explored to better implement team-based care but a thorough understanding of the role of system functions is lacking. We aimed to identify the combinations of system functionalities in primary care practices that most enable effective teamwork. We used a novel method, qualitative comparative analysis (QCA), to identify cross-case patterns in 19 primary care practices in the Harvard Academic Innovations Collaborative (AIC), an initiative for transforming primary care practices by establishing teams and implementing team-based care. QCA findings identified that primary care practices with strong team dynamics exhibited strengths in three operational care process functionalities, including management of abnormal test results, cancer screening and medication management for high-priority patients, care transitions, and in health information technology (HIT) functionality. HIT functionality alone was not sufficient to achieve the desired outcomes. System functionalities in a primary care practice that support physicians and their teams in identifying patients with urgent and complex acute illnesses requiring immediate response and care and overcoming barriers to collaboration within and across institutional settings, may be essential for sustaining strong team-based primary care.
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影响因子：
2.2
作者：
Blumenthal, Karen J.;Chien, Alyna T.;Singer, Sara J.
通讯作者：
Singer, Sara J.
影响因子：
2.8
作者：
Geese, Franziska;Schmitt, Kai-Uwe
通讯作者：
Schmitt, Kai-Uwe
影响因子：
5.5
作者：
Selby K;Bartlett-Esquilant G;Cornuz J
通讯作者：
Cornuz J
影响因子：
3.4
作者：
Dy, SM;Garg, P;Wu, AW
通讯作者：
Wu, AW
影响因子：
168.9
作者：
Hersch, Jolyn;Barratt, Alexandra;McCaffery, Kirsten
通讯作者：
McCaffery, Kirsten