Improving Team Dynamics Can Improve Patient Care

Christal M. Clemens; Michael E. Johansen

doi:10.1370/afm.2735

The Annals of Family Medicine encourages readers to develop a learning community to improve health care and health through enhanced primary care. Participate by conducting a journal club. We encourage diverse participants to think critically about important issues affecting primary care and act on those discussions.¹

HOW IT WORKS

In each issue, the Annals selects an article and provides discussion tips and questions. Post a summary of your conversation in our online discussion. (Open the article, click on the eLetters tab, and submit a comment.) Discussion questions and information are online at: https://www.AnnFamMed.org/content/AJC.

CURRENT SELECTION

Shaw JG, Winget M, Brown-Johnson C, et al. Primary Care 2.0: a prospective evaluation of a novel model of advanced team care with expanded medical assistant support. Ann Fam Med. 2021; 19(5):411-418.

Discussion Tips

Team-based care in the primary care setting has been studied most robustly in relation to patient centered medical homes (PCMH).² This article studied outcomes associated with a team-based model, Primary Care 2.0, which focused on improving team development and enlarging the interprofessional team. The goal of this study was to test team dynamics and burnout among the teams.

Discussion Questions

What question is asked by the authors and why does it matter?
How does this study advance beyond previous research and clinical practice on this topic?
How strong is the study design for answering the question?
- ∘ What is a difference-in-difference analysis?
- ∘ What are strengths and weaknesses of this study design?
- ∘ What validation has the burnout inventory used been subject to?
- ∘ What are the limitations to this study design?
To what degree can the findings be accounted for by:
- ∘ How the main outcome variables were measured?
- ∘ How the comparison clinics were chosen?
- ∘ Model design and/or confounders?
- ∘ How many surveys were completed by the implementation and comparison clinics? Who filled the surveys out?
- ∘ Missing data?
- ∘ Chance?
What are the main study findings?
How comparable is the study to team dynamics in your practice? What is your judgment about the transportability of the findings?
- ∘ What is the scope of practice for medical assistants (MAs) and advanced practice providers (APPs) in your practice setting?
- ∘ Based on the study findings, how important is the MA/primary care physician ratio?
What contextual factors are important for interpreting the findings? How generalizable are the study findings?
How might this study change your practice? Education? Research?
Who are the constituencies for the findings, and how might they be engaged in interpreting or using the findings?
What are the next steps in interpreting or applying the findings?
What researchable questions remain?

References

1.↵
1. Stange KC,
2. Miller WL,
3. McLellan LA, et al.
Annals Journal Club: It’s time to get RADICAL. Ann Fam Med. 2006; 4(3): 196-197. https://AnnFamMed.org/content/4/3/196
OpenUrl FREE Full Text
2.↵
1. Sinaiko AD,
2. Landrum MB,
3. Meyers DJ, et al.
Synthesis of research on patient-centered medical homes brings systematic differences into relief. Health Aff (Millwood). 2017; 36(3): 500-508. doi: 10.1377/hlthaff.2016.1235
OpenUrl Abstract/FREE Full Text