Department of Population Health Sciences, Weill Cornell Medical College, 402 E. 67th St. Room LA 217, New York, NY, 10065-6304, USA.
University of California, San Francisco, USA.
J Gen Intern Med. 2023 May;38(6):1384-1392. doi: 10.1007/s11606-022-07894-7. Epub 2022 Nov 28.
Primary care "teamlets" in which a staff member and physician consistently work together might provide a simple, cost-effective way to improve care, with or without insertion within a team.
To determine the prevalence and performance of teamlets and teams.
Cross-sectional observational study linking survey responses to Medicare claims.
Six hundred eighty-eight general internists and family physicians.
Based on survey responses, physicians were assigned to one of four teamlet/team categories (e.g., teamlet/no team) and, in secondary analyses, to one of eight teamlet/team categories that classified teamlets into high, medium, and low collaboration as perceived by the physician (e.g., teamlet perceived-high collaboration/no team).
Descriptive: percentage of physicians in teamlet/team categories.
physician burnout; ambulatory care sensitive emergency department and hospital admissions; Medicare spending.
77.4% of physicians practiced in teamlets; 36.7% in teams. Of the four categories, 49.1% practiced in the teamlet/no team category; 28.3% in the teamlet/team category; 8.4% in no teamlet/team; 14.1% in no teamlet/no team. 15.7%, 47.4%, and 14.4% of physicians practiced in perceived high-, medium-, and low-collaboration teamlets. Physicians who practiced neither in a teamlet nor in a team had significantly lower rates of burnout compared to the three teamlet/team categories. There were no consistent, significant differences in outcomes or Medicare spending by teamlet/team or teamlet perceived-collaboration/team categories compared to no teamlet/no team, for Medicare beneficiaries in general or for dual-eligible beneficiaries.
Most general internists and family physicians practice in teamlets, and some practice in teams, but neither practicing in a teamlet, in a team, or in the two together was associated with lower physician burnout, better outcomes for patients, or lower Medicare spending. Further study is indicated to investigate whether certain types of teamlet, teams, or teamlets within teams can achieve higher performance.
由一名员工和一名医生组成的初级保健“团队”可能是一种简单、具有成本效益的改善护理的方法，无论是否嵌入团队中。
确定团队的流行程度和表现。
将调查回复与医疗保险索赔联系起来的横断面观察性研究。
688 名普通内科医生和家庭医生。
根据调查回复，医生被分配到四个团队类别之一（例如，团队/无团队），在二次分析中，根据医生感知的团队合作程度（例如，团队感知高合作/无团队），将团队分为高、中、低合作的八个团队类别之一。
描述性：团队/团队类别的医生百分比。
77.4%的医生在团队中工作；36.7%的医生在团队中工作。在这四个类别中，49.1%的医生在团队/无团队类别中工作；28.3%的医生在团队类别中工作；8.4%的医生在无团队/无团队类别中工作；14.1%的医生在无团队/无团队类别中工作。15.7%、47.4%和 14.4%的医生在感知高、中、低合作团队中工作。与三个团队/团队类别相比，既不在团队中工作也不在团队中工作的医生的倦怠率明显较低。与无团队/无团队相比，团队/团队或团队感知合作/团队类别对一般医疗保险受益人和双重合格受益人在结果或医疗保险支出方面没有一致的显著差异。
大多数普通内科医生和家庭医生在团队中工作，一些医生在团队中工作，但既不在团队中工作，也不在团队中工作，与医生倦怠程度较低、患者预后较好或医疗保险支出较低无关。需要进一步研究以调查某些类型的团队、团队或团队内的团队是否可以实现更高的绩效。
