While team-based approaches to primary care transformation provide benefit to patients with chronic illness by reducing acute care utilization, it may lead to higher use among healthier patients.
The implementation of healthcare teams has gained recognition as a tool for improving both healthcare quality and value in the healthcare system. Previous research has shown that introducing teams in hospital settings has led to reductions in mortality and length of stay, and care provided by geriatric teams has improved elderly patients’ functional status, mental health, and independence.
Despite this research, several gaps remain, with more understanding needed in identifying how academic medical practices use team-based care, how team-based care affects safety-net practices, and which patients benefit most from these interventions. Taking aim at these gaps, a new study has found that team-based approaches to primary care transformation provide benefit to patients with chronic illness by reducing acute care utilization.
However, the study also found that team-based approaches may lead to higher use among healthier patients.
The study researchers focused on the Academic Innovations Collaborative (AIC) launched by Harvard Medical School in 2012 as a multiyear, multisite care learning collaborative aimed at establishing team-based care at its affiliated primary care practices.
The researchers identified 18 AIC practices and 76 other academically affiliated primary care practices as a comparison group. Using data from 2011 to 2015, the study included 83,953 patients accounting for 138,113 patient-years in the AIC practices and 238,455 patients accounting for 401,573 patient-years across the comparison practices.
“The AIC initiative was inspired by the need to control increasing healthcare costs through more efficient care delivery and aimed to improve care through team-based management of chronic illness,” explained the researchers. “Before the AIC, practice-level care delivery was largely decentralized because most of the included practices had not established patient care teams, and participation in multisite collaborative initiatives was limited.”
Required team activities included daily 15-minute huddles and the implementation of population management systems. Team members were also required to attend thrice-yearly 1.5-day learning sessions and regular webinars to connect with other practices and collaborate on strategies for improving quality care.
In the full sample, there was a 7.4% increase in outpatient visits for patients in intervention practices compared with those in the comparison practices. According to the researchers, this may be attributed to improved care planning and treatment that could have encouraged patients to make more frequent primary care appointments.
Narrowing in on the chronically ill, the researchers observed that there was a 19.6% reduction in hospitalizations, a 25.2% reduction in emergency department visits, and a 36.7% reduction in ambulatory care-sensitive emergency department visits. While not statistically significant, there was a decrease in the total cost of care among the patient population.
In contrast, among patients with less than 2 comorbidities, there were increases in outpatient visits (9.2%), hospitalizations (36.2%), and ambulatory care-sensitive hospitalizations (50.6%). “The increases in hospitalization were primarily driven by a larger reduction among comparison practices rather than an actual increase in intervention practices,” the researchers noted.
Meyers D, Chien A, Nguyen K, et al. Association of team-based primary care with health care utilization and costs among chronically ill patients [published online November 26, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.5118.