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Teaming up in primary care: Membership boundaries, interdependence, and coordination
Christine M Everett1, Sharron L Docherty, Elaine Matheson
1At Duke University in Durham, N.C., Christine M. Everett is an associate professor in the Division of PA Studies in the School of Medicine's Department of Family Medicine and Community Health and the Department of Population Health Sciences, and Sharron L. Docherty is a professor in the School of Nursing. Elaine Matheson is advanced practice provider medical director at Duke Primary Care in Durham. Perri A. Morgan is a professor in the Division of PA Studies in the Department of Family Medicine and Community Health and the Department of Population Health. In the Department of Family Medicine and Community Health, Ashley Price is a research program lead, Jacob Christy is a clinical research coordinator, and Lloyd Michener is a professor emeritus. Valerie A. Smith is an associate professor in the Department of Population Health and in the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Health Care System. John B. Anderson, Jr., is an associate professor in the Department of Family Medicine and Community Health and chief medical officer at Duke Primary Care. Anthony Viera is a professor and chair in the Department of Family Medicine and Community Health. George L. Jackson is a professor in the Department of Population Health, Department of Internal Medicine, Department of Family Medicine and Community Health and at ADAPT. The authors disclose that this research was supported by a grant from the National Institutes of Aging (K01AG53378). The grant funding source had no role in the design, conduct, collection, management, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript. The authors have disclosed no other potential conflicts of interest, financial or otherwise. The views expressed in this paper are those of the authors and do not reflect the position or policy of Duke University, Duke Health System, the Department of Veterans Affairs, or the US government.
Primary care providers (PCPs) widely adopt team-based care models, defining membership by tasks performed during patient visits. Enhancing clinician interaction and electronic health records can improve coordination between visits.
Area of Science:
- Health Services Research
- Primary Care Medicine
- Team-Based Care Models
Background:
- Growing demand for quality primary care and value-based payment models necessitate efficient team-based care.
- Successful implementation of primary care teams requires evidence-based recommendations, particularly regarding Physician Assistant (PA) roles.
Purpose of the Study:
- To investigate how primary care providers (PCPs) define team membership boundaries.
- To understand how PCPs coordinate tasks within primary care teams.
Main Methods:
- A mixed-methods study involving 28 PCPs from a primary care network.
- Analysis of survey data using descriptive statistics and interview data using content analysis.
Main Results:
- 96% of PCPs reported participating in team-based care.
- Five distinct team models were identified.
- Coordination mechanisms varied based on whether tasks were performed during or between patient visits.
Conclusions:
- Team-based primary care enhances access to quality care.
- PCPs primarily define team membership based on interdependencies of tasks performed within patient visits.
- Interventions should focus on clarifying team roles, fostering clinician interaction, and optimizing electronic health records for improved coordination.
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