Impact of Primary Care Team Configuration on Access and Quality of Care.

Abstract

Background: 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.

Objective: This paper examines the associations between variations in team staffing configurations on primary care access and clinical quality.

Design: 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.

Participants: 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.

Main measures: 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.

Key results: 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.

Conclusions: 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.