Team-Based Primary Care Practice Transformation Initiative and Changes in Patient Experience and Recommended Cancer Screening Rates

Abstract

Team-based care has emerged as a promising strategy for primary care practices to provide high-quality care. We examine changes in patient experience of care and recommended cancer screening rates associated with a primary care transformation initiative that established team-based care. Our observational study included 13 academically affiliated primary care practices in the Boston, Massachusetts area that participated in 2 learning collaboratives: the first (2012-2014) aimed to establish team-based primary care, while the second (2014-2016) focused on improving patient safety and cancer screening. We identified 37 comparison practices of similar size and network affiliation. Using a difference-in-differences approach, we compared pre (2013) and post (2015) patient experience and recommended cancer screening rates between intervention and comparison practices. We estimated linear regression models, using inverse probability weighting to balance on observable differences. Massachusetts Health Quality Partners data on patient experience comes from surveys (with communication, integration, knowledge of patient, access, office staff, and willingness to recommend domains), and its data on screening rates for breast, colorectal, and cervical cancers is derived from chart abstraction. Relative to comparison practices, the communication score in intervention practices increased by 1.47 percentage points on a 100-point scale ( P = .02) between pre and post periods. We did not detect immediate improvements in other measures of patient experience of care and recommended cancer screening rates. Communication may be the first dimension of patient experience that improves following establishment of team-based primary care, and changing care processes may require more time or attention in the transition to team-based care. Our findings also suggest a need to better understand the variation in implementation factors that facilitate some practices’ successful transitions to team-based care, and to use teams effectively to improve cancer screening processes.

Primary care practice-based interventions and their effect on participation in population-based cancer screening programs: a systematic narrative review

“…Jones et al (2022) evaluated the effect of audit and feedback and patient reminders on screening rates, finding a positive effect for bowel and cervical; however, no effect for breast. Contrary to the previous practice-facilitated and assessment studies, Nguyen et al (2020) found no effect on bowel, breast, and cervical screening rates when assessing the effect of provider education and financial incentives.…”

“…Multi-component studies outlined circumstances under which interventions were more likely to optimize the role of PHCWs and increase participation in screening programs through the use of two strategies: engaging whole teams in a practice setting and the use of champions (Tables 2 and 3). The 'whole-of-practice approach' contextual factor is defined as empowering an array of practice staff (eg, administrative staff, nurses, managers, and family physicians) to be involved in cancer screening interventions (Ornstein et al, 2010;Atlas et al, 2011;Shaw et al, 2013;Atlas et al, 2014;Harris et al, 2015;Hills et al, 2015;Mader et al, 2016;Wu et al, 2016;Hountz et al, 2017;Weiner et al, 2017;Bakhai et al, 2018;Nguyen et al, 2020;Hussain et al, 2021;Jones et al, 2022). Ornstein et al (2010) concluded that practices that 'meet as a team to plan evidence-based (quality) improvement strategies : : : can achieve much higher levels of screening than typically reported.'…”

Social determinants of health and US cancer screening interventions: A systematic review

“…After removing duplicates, 19,095 studies underwent title and abstract screening, and then 1541 full‐text studies were assessed for eligibility. In total, 699 studies were included, of which 144 were unique intervention studies included in the current analysis (representing 150 articles) 23–172 …”

Strengthening primary health care in rural western India-team based approach

“…The need for addressing NCDs in India through its primary health care network has been perceived since long. [14][15][16] The comprehensive primary health care (CPHC) component of the Ayushman Bharat initiative of the Government of India aims to achieve the same through the 1.5 lakh health and wellness centers (HWCs) across the country. However, there is a dearth of effective models in primary health care in India for addressing NCDs.…”