Hysong Sylvia J, Arredondo Kelley, Lester Houston F, SoRelle Richard, Pham Trang, Oswald Frederick L, Woodard LeChauncy, Petersen Laura A, Hamer Joshua, Hughes Ashley M
Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA.
J Gen Intern Med. 2025 Mar 6. doi: 10.1007/s11606-025-09456-z.
Team-based primary care has become the norm within many large healthcare systems; however, limited guidance exists on how to optimally staff primary care teams in relationship to healthcare.
This paper examines the associations between variations in team staffing configurations on primary care access and clinical quality.
Observational study linking national Veterans Health Administration (VHA) data from February 2020 on primary care team staffing configurations to data on access to and quality of care the teams delivered.
We examined data from 22,390 primary care personnel assigned to 7050 teams from 1050 VA Medical Centers and Community-Based Outpatient Clinics across the USA.
We used data from VHA's Corporate Data Warehouse. We assessed team-based measures of overall adherence to VHA's national guidelines for front-line clinical team staffing based on achievement of recommended staffing configurations in terms of quantity of staff and diversity of professional roles. To measure staffing sufficiency, we integrated total number of team members (team size) with their full-time equivalents (FTEs). To measure role diversity, we assessed deviation from guidelines using network analysis of staffing data. As outcomes, we used three measures of patient access to primary care and four measures of clinical quality that were prioritized by a prior expert panel. We analyzed associations between predictors and outcomes using random intercept multilevel models, with teams nested within healthcare facility.
Variation in team size and FTE reflected lack of adherence to VHA guidelines rather than normal variation. Overall adherence to VHA guidelines was unrelated to access or quality of care delivered. In most cases, teams with higher FTEs exhibited better outcomes. Increased role diversity was associated with decreased secure messaging communication ratios. Teams with more members exhibited improved 2-day post-hospital discharge contact, but reduced access through third next available appointments.
Primary care teams require a minimum amount of FTE staff capacity to deliver high quality and access to healthcare. Future work should examine how these associations vary by specific job role to further optimize staffing configurations.
基于团队的初级保健已成为许多大型医疗系统的常态；然而，关于如何根据医疗保健情况优化初级保健团队的人员配备，相关指导却很有限。
本文研究了团队人员配备结构的差异与初级保健可及性和临床质量之间的关联。
观察性研究，将2020年2月来自美国退伍军人健康管理局（VHA）的关于初级保健团队人员配备结构的全国性数据与这些团队提供的医疗服务可及性和质量数据相联系。
我们研究了来自美国各地1050家退伍军人事务部医疗中心和社区门诊诊所的7050个团队的22390名初级保健人员的数据。
我们使用了退伍军人健康管理局企业数据仓库的数据。我们基于在人员数量和专业角色多样性方面达到推荐的人员配备结构，评估了基于团队的对退伍军人健康管理局一线临床团队人员配备国家指南的总体遵循情况。为了衡量人员配备充足性，我们将团队成员总数（团队规模）与其全职等效人员（FTE）相结合。为了衡量角色多样性，我们使用人员配备数据的网络分析评估与指南的偏差。作为结果，我们使用了三项患者获得初级保健的测量指标和四项临床质量测量指标，这些指标是由先前的专家小组确定优先级的。我们使用随机截距多级模型分析预测因素与结果之间的关联，团队嵌套在医疗机构内。
团队规模和全职等效人员的差异反映了对退伍军人健康管理局指南的不遵循，而非正常差异。对退伍军人健康管理局指南的总体遵循情况与所提供的医疗服务可及性或质量无关。在大多数情况下，全职等效人员较多的团队表现出更好的结果。角色多样性增加与安全消息通信比率降低相关。成员较多的团队在出院后2天的联系方面有所改善，但通过第三次可预约就诊的可及性降低。
初级保健团队需要最低数量的全职等效人员能力来提供高质量的医疗服务并确保可及性。未来的工作应研究这些关联如何因具体工作角色而异，以进一步优化人员配备结构。
