Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Sep-Oct;19(5):411-418.
doi: 10.1370/afm.2714.

Primary Care 2.0: A Prospective Evaluation of a Novel Model of Advanced Team Care With Expanded Medical Assistant Support

Jonathan G Shaw  1 , Marcy Winget  2 , Cati Brown-Johnson  2 , Timothy Seay-Morrison  3 , Donn W Garvert  2 , Marcie Levine  2 , Nadia Safaeinili  2 , Megan R Mahoney  2
Affiliations

Primary Care 2.0: A Prospective Evaluation of a Novel Model of Advanced Team Care With Expanded Medical Assistant Support

Jonathan G Shaw et al. Ann Fam Med. 2021 Sep-Oct.

Abstract

Purpose: Assess effectiveness of Primary Care 2.0: a team-based model that incorporates increased medical assistant (MA) to primary care physician (PCP) ratio, integration of advanced practice clinicians, expanded MA roles, and extended the interprofessional team.

Methods: Prospective, quasi-experimental evaluation of staff/clinician team development and wellness survey data, comparing Primary Care 2.0 to conventional clinics within our academic health care system. We surveyed before the model launch and every 6-9 months up to 24 months post implementation. Secondary outcomes (cost, quality metrics, patient satisfaction) were assessed via routinely collected operational data.

Results: Team development significantly increased in the Primary Care 2.0 clinic, sustained across all 3 post implementation time points (+12.2, +8.5, + 10.1 respectively, vs baseline, on the 100-point Team Development Measure) relative to the comparison clinics. Among wellness domains, only "control of work" approached significant gains (+0.5 on a 5-point Likert scale, P = .05), but was not sustained. Burnout did not have statistically significant relative changes; the Primary Care 2.0 site showed a temporal trend of improvement at 9 and 15 months. Reversal of this trend at 2 years corresponded to contextual changes, specifically, reduced MA to PCP staffing ratio. Adjusted models confirmed an inverse relationship between team development and burnout (P <.0001). Secondary outcomes generally remained stable between intervention and comparison clinics with suggestion of labor cost savings.

Conclusions: The Primary Care 2.0 model of enhanced team-based primary care demonstrates team development is a plausible key to protect against burnout, but is not sufficient alone. The results reinforce that transformation to team-based care cannot be a 1-time effort and institutional commitment is integral.

Keywords: burnout; healthcare team; healthcare workforce; organizational innovation; primary care team.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Average Team Development Measure scores at each survey time point. MA = medical assistant; Pre = pre implementation. Notes: Range bars indicate 95% CIs. The dashed line indicates change in MA to clinician ratio from 2:1 to 1.5:1 at 16 months post implementation.
Figure 2.
Figure 2.
Average employee wellness scores, at each survey time point, adjusted for repeated measures. MA = medical assistant; Pre = pre-implementation. Notes: Range bars indicate 95% CIs. The dashed line indicates change in MA to clinician ratio from 2:1 to 1.5:1 at 16 months post implementation.
Figure 2.
Figure 2.
Average employee wellness scores, at each survey time point, adjusted for repeated measures. MA = medical assistant; Pre = pre-implementation. Notes: Range bars indicate 95% CIs. The dashed line indicates change in MA to clinician ratio from 2:1 to 1.5:1 at 16 months post implementation.
Figure 2.
Figure 2.
Average employee wellness scores, at each survey time point, adjusted for repeated measures. MA = medical assistant; Pre = pre-implementation. Notes: Range bars indicate 95% CIs. The dashed line indicates change in MA to clinician ratio from 2:1 to 1.5:1 at 16 months post implementation.
Figure 2.
Figure 2.
Average employee wellness scores, at each survey time point, adjusted for repeated measures. MA = medical assistant; Pre = pre-implementation. Notes: Range bars indicate 95% CIs. The dashed line indicates change in MA to clinician ratio from 2:1 to 1.5:1 at 16 months post implementation.
See this image and copyright information in PMC

References

    1. Jackson GL, Williams JW Jr.. Does PCMH “work”?—the need to use implementation science to make sense of conflicting results. JAMA Intern Med. 2015; 175(8): 1369-1370. 10.1001/jamainternmed.2015.2067 - DOI - PubMed
    1. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014; 12(6): 573-576. 10.1370/afm.1713 - DOI - PMC - PubMed
    1. Sinsky CA, Willard-Grace R, Schutzbank AM, Sinsky TA, Margolius D, Bodenheimer T. In search of joy in practice: a report of 23 high-functioning primary care practices. Ann Fam Med. 2013; 11(3): 272-278. 10.1370/afm.1531 - DOI - PMC - PubMed
    1. Hamidi MS, Bohman B, Sandborg C, et al. . Estimating institutional physician turnover attributable to self-reported burnout and associated financial burden: a case study. BMC Health Serv Res. 2018; 18(1): 851. 10.1186/s12913-018-3663-z - DOI - PMC - PubMed
    1. Han S, Shanafelt TD, Sinsky CA, et al. . Estimating the attributable cost of physician burnout in the United States. Ann Intern Med. 2019; 170(11): 784-790. 10.7326/M18-1422 - DOI - PubMed

Publication types