Sohn Young-Jin, Schmitt Hannah L, Pollack Amie A, Sullivan Erin E, Hunt Lindsay S, Norman Chenelle, Azzara Jennifer, Mir Julita, Weed Louise Keogh, Frank Amanda, Phillips Russell S
Center for Primary Care, Harvard Medical School, Boston, MA, USA.
Suffolk University, Boston, MA, USA.
J Gen Intern Med. 2025 Apr 21. doi: 10.1007/s11606-025-09523-5.
High-performing teams anchored by quality improvement and practice transformation skills strengthen primary care by improving patient outcomes. Effective team-based care may be particularly valuable in medically underserved communities (MUCs).
To evaluate the impact of a team-based training program that focused on quality improvement and practice transformation skills in community health centers (CHC) serving under-resourced communities across the Commonwealth of Massachusetts.
The Advancing Teams Program was delivered to CHC teams over 6 years (2016-2022). The evaluation used a mixed methods design to assess the program's impact.
Forty-seven interdisciplinary teams from CHCs serving MUCs in Massachusetts. The 327 individual participants included administrative staff, clinicians, and trainees.
Evaluative data included participating CHC team and clinic demographics, pre-post evaluation of participants' perceptions of practice transformation using the Qualis Health Patient-Centered Medical Home Assessment (PCMH-A), and qualitative analysis of team improvement projects to identify themes related to project aims, practice transformation skills, and patient outcomes.
CHCs participating in the ATP program served under-resourced communities, with > 65% serving high levels of Medicaid and uninsured patients. Pre-post PCMH-A analysis indicated significant improvements (p < 0.05) in team members' perceptions of leadership engagement, team-based care, evidence-based practices, patient-centered interactions, access, and care coordination. The largest improvement was seen in patient-centered interactions (+ 1.04, p = 0.001), with ATP participation strongly associated with improved perceptions of encouraging patients to expand their role in decision-making, health-related behavior change, and self-management. Positive change in perceived leadership engagement predicted greater improvement in clinic functioning (β = 0.68, p < 0.001). Qualitative analysis showed that ATP teams successfully improved care in areas such as behavioral health, diabetes, substance abuse, and social determinants of health.
ATP is a promising approach to building primary care teams within under-resourced CHCs. Additional research should include evaluation of team quality and robust approaches to measuring improvement projects.
以质量改进和实践转型技能为核心的高效团队通过改善患者结局来加强初级保健。有效的基于团队的护理在医疗服务不足的社区（MUCs）可能特别有价值。
评估一项基于团队的培训项目在马萨诸塞州联邦各地为资源不足社区服务的社区卫生中心（CHC）中，对质量改进和实践转型技能的影响。
推进团队项目在6年（2016 - 2022年）内交付给CHC团队。该评估采用混合方法设计来评估该项目的影响。
来自马萨诸塞州为MUCs服务的CHC的47个跨学科团队。327名个体参与者包括行政人员、临床医生和实习生。
评估数据包括参与项目的CHC团队和诊所的人口统计学数据、使用Qualis Health以患者为中心的医疗之家评估（PCMH - A）对参与者对实践转型的认知进行前后评估，以及对团队改进项目进行定性分析，以确定与项目目标、实践转型技能和患者结局相关的主题。
参与ATP项目的CHC为资源不足的社区服务，超过65%的CHC服务于大量医疗补助和未参保患者。PCMH - A前后分析表明，团队成员对领导参与、基于团队的护理、循证实践、以患者为中心的互动、可及性和护理协调的认知有显著改善（p < 0.05）。以患者为中心的互动改善最大（+1.04，p = 0.001），参与ATP与对鼓励患者在决策、健康相关行为改变和自我管理中扩大作用的认知改善密切相关。领导参与认知的积极变化预示着诊所功能有更大改善（β = 0.68，p < 0.001）。定性分析表明，ATP团队在行为健康、糖尿病、药物滥用和健康的社会决定因素等领域成功改善了护理。
ATP是在资源不足的CHC中建立初级保健团队的一种有前景的方法。进一步的研究应包括对团队质量的评估以及衡量改进项目的有力方法。
