An Implementation Science Perspective on the Effectiveness of Primary Care Teams

Lori Damiano Merkel, Thomas Jefferson University

Abstract

Background: Primary care teams (PCT) are an evidence-based intervention that can reduce unnecessary, redundant, and expensive acute service encounters (ASE). Implementation science (IS) has been identified as an approach that improves the successful installation of evidence-based practice (EBP) in health care settings. Purpose: To evaluate the effectiveness of PCTs at reducing ASEs in a medically complex, chronically ill population and to evaluate the success of this EBP implementation at the conclusion of Program Year 3 using an IS framework while also descriptively exploring the degree of practice transformation that has occurred. Methods: Aim 1: A retrospective, longitudinal evaluation of PCT effectiveness using a multi-level, linear mixed model to quantify change in service outcome over time. Aim 2: A mixed methods study to assess the implementation of this initiative. Two different dimensions of fidelity were developed to assess implementation success and interviews, informed by the Consolidated Framework for Implementation Research, explored influential facilitators and barriers. Aim 3: A variety of techniques were used to search for indications that practice transformation may have occurred, including trend analysis, relationship testing, and two interview questions. Results: Aim 1: Model estimation showed that the interaction between team interventions and time decreased utilization growth in this cohort by 2.1%. In fact, team interventions slowed ASE growth between program year one vs three by nearly half. Aim 2: Implementation was variable across practices and suboptimal implementation was evident. Common barriers expressed included not enough PCT for the patient need and role confusion/lack of clarity. Common facilitators were good working relationships and high accessibility. Aim 3: Optimistic directional trends evident locally and nationally, but only one correlation between utilization differential and fidelity had a significant, weak, positive linear relationship. Conclusions: Primary care teams are beginning to bend the patient utilization curve. Different facilitators and barriers cited by differing staff roles, along w fidelity inconsistencies suggest suboptimal implementation. While this may mire EBP installation, IS strategies can be deployed to improve integration and performance.

Subject Area

Health care management

Recommended Citation

Merkel, Lori Damiano, "An Implementation Science Perspective on the Effectiveness of Primary Care Teams" (2020). ETD Collection for Thomas Jefferson University. AAI28152809.
https://jdc.jefferson.edu/dissertations/AAI28152809

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