Evidence Synthesis Program (ESP) Center
West Los Angeles VA Medical Center
Los Angeles, CA
Paul G. Shekelle, MD, PhD, Director
Shekelle PG, Begashaw M. What are the Effects of Different Team-Based Primary Care Structures on the Quadruple Aim of Care?: A Rapid Review. Los Angeles: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #05-226; 2021.
Team-based primary care has become a predominant model to provide accessible, high-quality care, and meet the quadruple aims of improving patient experience, population health, the work life of the health care workforce, and reduce costs. VA re-organized primary care delivery via the Patient Aligned Care Teams, which is based on the medical home model. Within the primary care team are smaller units, what Bodenheimer and Liang term "the central subunit" of the team, which has been called the teamlet. The smallest composition of the teamlet is the clinician and medical assistant. Bodenheimer and Liang proposed the teamlet consist of a clinician and 2 health coaches. Other compositions have been proposed. In VA, the teamlet has been defined as a primary care provider (either a physician, a physician's assistant, or a nurse practitioner), a registered nurse (RN), a licensed practical nurse (LPN), and a clerk or medical support assistant. Thus, the model aims to provide 3.0 full-time equivalent (FTE) staff for each PCP FTE, and each teamlet is expected to provide primary care for approximately 1200 Veterans. As VA continually seeks to improve the quality, cost, access, and wellbeing of the health care workforce, the question arises whether other compositions of the teamlet or the larger team might produce improvements in any of these domains. Thus, the Office of Primary Care requested this Rapid Review regarding team composition and outcomes.
What are the effects of different primary care team structures on care?