Building Community Health Center Teams: Evaluating the Impact of Team Training

Area of Science:

• Primary Care
• Health Services Research
• Quality Improvement

Background:

• High-performing teams enhance primary care through quality improvement and practice transformation, leading to better patient outcomes.
• Team-based care is especially crucial in medically underserved communities (MUCs).

Purpose of the Study:

• To evaluate the impact of a team-based training program focused on quality improvement and practice transformation.
• The program targeted community health centers (CHCs) serving under-resourced populations in Massachusetts.

Main Methods:

• The Advancing Teams Program (ATP) was implemented over six years (2016-2022) in 47 interdisciplinary teams from CHCs serving MUCs.
• A mixed-methods design included pre-post surveys (Qualis Health Patient-Centered Medical Home Assessment - PCMH-A) and qualitative analysis of improvement projects.
• Participants included 327 administrative staff, clinicians, and trainees.

Main Results:

• CHCs served high proportions of Medicaid and uninsured patients (>65%).
• Significant improvements (p<0.05) were observed in PCMH-A scores for leadership engagement, team-based care, evidence-based practices, patient-centered interactions, access, and care coordination.
• Patient-centered interactions showed the largest improvement (+ 1.04, p=0.001), with ATP linked to enhanced patient decision-making and self-management support. Improved leadership engagement predicted better clinic functioning (β=0.68, p<0.001).
• Qualitative analysis revealed successful improvements in care for behavioral health, diabetes, substance abuse, and social determinants of health.

Conclusions:

• The Advancing Teams Program (ATP) shows promise for developing primary care teams in under-resourced community health centers.
• Further research should focus on evaluating team quality and employing robust methods for measuring improvement project outcomes.