Impact of Team Configuration and Team Stability on Primary Care Quality

项目摘要 背景：本研究的目的是直接解决特殊利益通知NOT-HS-16-011， 初级保健创新研究，通过检查团队配置，团队稳定性和角色的影响 在初级保健团队环境中的临床表现的稳定性。以病人为中心的联合原则 医疗之家（PCMH）建议采用以团队为基础的初级保健方法，以确保患者获得高质量的 由始终如一的医疗保健专业人员团队提供优质、协调良好的护理。然而，现实世界 联合原则的实施往往严重偏离原则的主张。虽然 关于什么使团队有效的科学是有据可查的，但对具体的影响却知之甚少。 配置可能会影响团队有效提供护理的能力。这项研究利用了一个独特的数据源 来自退伍军人健康管理局（VHA），其中包含最大，最多样化的国家样本之一， 初级保健团队，通过社会网络分析的透镜检查团队配置因素。 具体目标：（1）选择一套明确的、可衡量的、负责任的初级保健绩效指标， 根据其对初级保健的总体贡献和价值，确定优先次序。(2)确定团队的影响力 配置对目标1中测量的初级保健临床性能的影响。(3)确定团队的影响力 稳定性和特定作用稳定性对临床性能的影响，如目标1所述。 方法：在目标1中，我们将召集一个10人专家小组，代表相关的主要利益相关者群体， 包括初级保健团队成员、管理人员、科学家和患者。从现有来源提取 临床性能指标，该小组将选择和优先考虑一组有针对性的初级保健性能 这些措施将被用作目标2和3的主要成果。该过程将通过使用关键字 生产力衡量和提高系统（ProMES），一个全面的，证据， 基于工业/组织心理学的方法，用于开发和实施绩效 测量系统 目标2和3将包括对1200个国家中约7,700个初级保健小组的样本进行数据库审查。 VHA在美国各地的医疗机构。我们将链接来自VHA（团队）的多个数据源 报告、HR Smart、VHA企业数据仓库），以创建具有临床指标的数据集 性能、团队配置、团队稳定性、角色稳定性以及对推荐团队的遵守情况 我们的示例中所有团队的配置。团队配置变量将通过社交网络计算 分析.将进行分层线性模型，以检验以下假设： 分数更有可能在团队中观察到（a）更接近推荐团队 配置（B）随时间推移更稳定，以及（c）其临床管理者角色随时间推移更稳定。

PROJECT SUMMARY Background: The purpose of this study is to directly address Special Interest Notification NOT-HS-16-011, Innovative Research in Primary Care, by examining the impact of team configuration, team stability, and role stability on clinical performance in primary care team settings. The Joint Principles of the Patient Centered Medical Home (PCMH) recommend a team-based approach to primary care to ensure that patients receive high- quality, well-coordinated care from a consistent team of health-care professionals. However, real-world implementation of the Joint Principles often deviates significantly from the Principles' propositions. Though the science of what makes teams effective is well documented, far less is known about the impact specific configurations may have on teams' ability to deliver care effectively. This study leverages a unique data source from the Veterans Health Administration (VHA) containing one of the largest, most diverse national samples of primary care teams to examine team configuration factors through the lens of social network analysis. Specific Aims: (1) Select a targeted set of clear, measurable, accountable, primary care performance metrics, prioritized according to their overall contribution and value to primary care. (2) Determine the impact of team configuration on primary care clinical performance as measured in Aim 1. (3) Determine the impact of team stability and specific role stability on clinical performance as measured in Aim 1. Methods: In Aim 1 we will convene a 10-member expert panel representing relevant key stakeholder groups, including primary care team members, administrators, scientists, and patients. Drawing from existing sources of clinical performance metrics, the panel will select and prioritize a targeted set of primary care performance measures, which will be used as the primary outcomes in Aims 2 and 3. The process will be facilitated using key elements of the Productivity Measurement and Enhancement System (ProMES), a comprehensive, evidence- based methodology from industrial/organizational psychology for developing and implementing performance measurement systems. Aims 2 and 3 will consist of a database review of a sample of approximately 7,700 primary care teams from 1200 VHA healthcare locations throughout the United States. We will link multiple data sources from VHA (Team Assignments Report, HR Smart, VHA Corporate Data Warehouse) to create a dataset with measures of clinical performance, team configuration, team stability, role stability, and adherence to recommended team configurations for all teams in our sample. Team configuration variables will be computed via social network analysis. Hierarchical linear models will be conducted to test the hypotheses that higher clinical performance scores are more likely to be observed in teams (a) who adhere more closely to recommended team configurations (b) that are more stable over time, and (c) whose clinical manager role is more stable over time.