Primary Care 2.0: A Prospective Evaluation of a Novel Model of Advanced Team Care With Expanded Medical Assistant Support

Article Figures & Data

Table 1.

Description of Clinics Included in Primary Care 2.0 Evaluation

	Setting^{^a}	PCP Types	PCP cFTEs^{^b}	Annual Visits^{^b}
Implementation clinic
Primary Care 2.0 site	Community-based faculty practice	FM, IM	6 (2.0 of which were APC)	13,500
Comparison clinics
Site A	Hospital-based faculty practice	FM	8	17,000
Site B	Hospital-based faculty practice	IM	8	17,000
Site C	Community-based faculty practice	FM, IM	5	10,800
Site D	Community-based faculty practice	FM, IM	3.5	11,700

APC = advanced practice clinician (ie, nurse practitioner or physician assistant); cFTE = clinical full-time equivalent; FM = family medicine; IM = internal medicine; PCP = primary care physician.
↵a All clinics are in a single county and serve primarily private- and Medicare-insured populations.
↵b Values are approximate, based on fiscal year 2018.

Table 2.

Surveys Completed^{^a} at Each Time Point, by Clinic Group and Survey (N = 188)

↵a Response rates (%) are based on number of eligible individuals at each time point, which varies by number of employees at each site, at each time point. The implementation clinic had approximately 25 total staff/clinicians throughout and the 4 comparison clinics ranged from 22 to 40 staff/clinicians at each.

Table 3.

Difference-in-Difference Analysis^{^a} of Team Development and Wellness Scores by Time Point

Survey Time Point (Post Implementation)	Team Development DnD, Score (P Value) [95% CI]	Wellness Domain DnD, Score (P Value) [95% CI]
Survey Time Point (Post Implementation)	Team Development DnD, Score (P Value) [95% CI]	Burnout^{^b}	Sense of Control	Fulfillment	Meaning
9 months	12.2 (<.001)^{^c}	–0.2 (.48)	0.5 (.05)^{^c}	0.2 (.41)	0.1 (.35)
	[6.4 to 18.0]	[–0.7 to 0.3]	[<0.1 to 1.0]	[–0.3 to 0.6]	[–0.2 to 0.4]
15 months	8.5 (.006)^{^c}	–0.3 (.26)	0.2 (.41)	0.3 (.23)	0.2 (.29)
	[2.5 to 14.6]	[–0.9 to 0.2]	[–0.3 to 0.7]	[–0.2 to 0.7]	[–0.1 to 0.5]
24 months	10.1 (.001)^{^c}	0.1 (.79)	0.1 (.79)	–0.2 (.51)	–0.1 (.71)
	[4.1 to 16.1]	[–0.5 to 0.6]	[–0.5 to 0.6]	[–0.6 to 0.3]	[–0.4 to 0.3]

DnD = difference-in-difference; pre = pre implementation; post = post implementation.
↵a Difference-in-difference calculation = Implementation clinic (post – pre) – Comparison clinics (post – pre); results shown are from linear mixed-models, configured to account for correlation over individuals and time, with the interaction terms of “intervention × time” providing estimate of the difference-in-difference effect of the intervention at each time point (referenced to baseline).
↵b Lower score indicates less burnout.
↵c P value ≤.05

Table 4.

Quality Metrics Pre/Post Implementation of Primary Care 2.0

	Average of 3 HEDIS Quality Indicators^{^a} by Clinic, During Intervention
	October 2016^{^b} (Early Implementation), %	October 2017^{^c} (1 year Post), %	October 2018^{^d}(2 years Post), %
Implementation clinic	93	93	92
Comparison clinics	84	93	90

ACE = angiotensin converting enzyme inhibitors; ARB = angiotensin-receptor blockers; HEDIS = Healthcare Effectiveness Data and Information Set.
↵a Results shown are simple averages (unweighted) of 3 standard HEDIS indicators: 2 diabetes metrics (hemoglobin A_1c testing, nephropathy screening rates) and 1 medication monitoring metric of ACE/ARB laboratory monitoring.
↵b Patient denominator for implementation clinic: n = 232 (diabetes metrics) and n = 364 (ACE/ARB metric); Denominator for comparison clinics: n = 1,952 (diabetes metrics) and n = 4,192 (monitoring metric).
↵c Patient denominator for implementation clinic: n = 342 (diabetes metrics) and n = 570 (ACE/ARB metric); Denominator for comparison clinics: n = 1,909 (diabetes metrics) and n = 4,297 (ACE/ARB metric).
↵d Patient denominator for implementation clinic: n = 427 (diabetes metrics) and n = 663 (ACE/ARB metric); Denominator for comparison clinics: n = 2,390 (diabetes metrics) and n = 5,149 (ACE/ARB metric).

Table 5.

Patient Experience Pre/Post Implementation of Primary Care 2.0

	Percentage of Patients Giving Highest Score (Top Box) for Likelihood-to-Recommend in the Press Ganey Survey, by Clinic
	October 2016 (Early Implementation)	October 2017 (1 Year Post)	October 2018 (2 Year Post)
Implementation clinic
Top Box Responses, %	82	77	82
Total respondents, No.	56	44	38
Comparison clinics
Top Box Responses, %	84	81	85
Total respondents, No.	339	254	232