Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system.
Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system.
复制标题
实施基于团队的初级保健模式：大型综合医疗保健系统中的混合方法比较案例研究。
DOI：
10.1007/s11606-018-4611-7
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发表时间：
2018
影响因子：
5.7
通讯作者：
Stange,KurtC
中科院分区：
文献类型：
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作者：
Misra-Hebert,AnitaD;Perzynski,Adam;Rothberg,MichaelB;Fox,Jaqueline;Mercer,MaryBeth;Liu,Xiaobo;Hu,Bo;Aron,DavidC;Stange,KurtC
背景在卫生系统内成功实施新的护理模式可能取决于各个护理站点的环境因素。目的识别有助于采用新的基于团队的护理模式的实践设置组件。设计融合混合方法设计。综合卫生系统。主要措施实地观察9个做法和75个访谈，供应商和工作人员的调查，以评估适应性储备和倦怠，分析质量指标，和病人面板comormalence分数。同时收集的数据，然后合并，主题分析，并解释了一个多学科的team.Key resultsBased上的观察和访谈分析，9种做法被分为3组高，部分，和低吸收新的团队为基础的模型。吸收与（1）实践对变化的响应能力和（2）与团队角色相关的灵活工作流程有关。地方领导的力量和稳定的工作人员构成了在这两个领域实现高绩效的能力。与较低吸收组相比，在几个质量指标上的较高表现与高吸收实践相关。平均适应性储备措施和Maslach倦怠库存分数没有显着差异较高和较低的摄取practices.ConclusionUptake的新的团队为基础的医疗服务模式是有关的做法的能力，以应对变化，并适应团队的角色，在工作流程中，当地的领导和稳定的人员配置的影响。在质量指标上的更好表现可能会发现高吸收实践。我们的研究结果可以为寻求实施初级保健实践变革的业务和政策领导者提供信息。
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 groups—high, 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.