Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

Health Services Research & Development

Go to the ORD website
Go to the QUERI website

What are the Effects of Different Team-based Primary Care Structures on the Quadruple Aim of Care? A Rapid Review

Click for list of published reports
Click for topic nomination form
Click for list of reports in progress

Subscribe to the
ESP Report RSS feed RSS feed icon
What are the Effects of Different Team-based Primary Care Structures on the Quadruple Aim of Care? A Rapid Review

Prepared by:
Evidence Synthesis Program (ESP) Center
West Los Angeles VA Medical Center
Los Angeles, CA
Paul G. Shekelle, MD, PhD, Director

Recommended citation:
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.

Download PDF: Complete Report, Executive Summary, Report, Appendices


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.

Key Question

What are the effects of different primary care team structures on care?

Questions about the HSR&D website? Email the Web Team.

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.