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.

Contents

• PREFACE
• ACKNOWLEDGMENTS
• EXECUTIVE SUMMARY
  • INTRODUCTION
  • METHODS
  • RESULTS
  • DISCUSSION
• INTRODUCTION
• METHODS
  • TOPIC DEVELOPMENT
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • QUALITY ASSESSMENT
  • DATA SYNTHESIS
  • RATING THE BODY OF EVIDENCE
  • PEER REVIEW
• RESULTS
  • LITERATURE FLOW
  • DESCRIPTION OF THE EVIDENCE
  • KEY QUESTION. WHAT ARE THE EFFECTS OF DIFFERENT PRIMARY CARE TEAM STRUCTURES ON CARE?
• SUMMARY OF FINDINGS/CERTAINTY OF EVIDENCE
  • LIMITATIONS
  • RESEARCH GAPS/FUTURE RESEARCH
  • CONCLUSIONS
• REFERENCES
• APPENDIX A. SEARCH STRATEGIES
• APPENDIX B. PEER REVIEWER COMMENTS AND RESPONSES
• APPENDIX C. CITATIONS FOR EXCLUDED PUBLICATIONS
• APPENDIX D. RISK OF BIAS TOOL

Suggested 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. Available at: https://www.hsrd.research.va.gov/publications/esp/reports.cfm.

This report is based on research conducted by the Evidence Synthesis Program (ESP) Center located at the West Los Angeles VA Medical Center, Los Angeles, CA, funded by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (eg, employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.