Team-based care may be more effective than traditional practice management in primary care
Researchers compared quality of care, acute care use, and program investment costs of team-based care and traditional practices.
Patients who receive primary care in integrated team-based care practices have a higher quality of care, lower rates of acute care use, and lower actual payments, according to data published in JAMA.
Brenda Reiss Brennan, PhD, of Intermountain Healthcare in Salt Lake City, Utah, and colleagues conducted a retrospective cohort study to measure the patient outcomes, health care use, and costs of team-based care practices in primary care compared with traditional practice management.
The researchers included 113,452 unique patients (mean age: 56.1; 58.9% women) that accounted for 163,226 person-years of exposure from 27 team-based care practices and 75 traditional practices.
Patients who were treated in team-based care practices had higher rates of active depression screening compared with patients treated at traditional practices (46.1% vs 24.1%). Patients treated at team-based care practices also had higher rates of adherence to a diabetes care bundle (24.6% vs 19.5%) and documentation of self-care plans (48.4% vs 8.7%). There was a lower proportion of patients with controlled hypertension in the team-based care group (85.0% vs 97.7%), and there were no significant differences in the documentation of advanced directives (9.6% vs 9.9%).
“The study suggests the value of coordinated team relationships within a delivery system emphasizing the integration of physical and mental health care,” the study authors wrote. “To our knowledge, this study has observed the largest cohort of patients, physicians, or clinics involved in team-based care and longitudinally evaluated to date. It highlights the challenge of transforming physician practice over time to function as a team and manage the complexities of population health.”
The rates of health care use were lower for patients treated at team-based care practices compared with those treated at traditional practices for emergency department visits (18.1 vs 23.5 per 100 person-years), hospital admissions (9.5 vs 10.6 per 100 person-years), ambulatory care visits (3.3 vs 4.3 per 100 person-years), and primary care physician encounters (232.8 vs 250.4 per 100 person-years).
The researchers also measured the payments made to the delivery system, and found that the payments were lower among patients treated at team-based care practices ($3,400.62 vs $3,515.71).
“Transforming practice culture presents continuous operational challenges of monitoring and rewarding collaboration among teams and across systems of care,” the authors concluded. “The cost of implementing TBC is an ongoing investment in which outcomes that provide value to the delivery system may need to be realized over time and if supported by value-based or accountable care organization reimbursement structures could represent decreased health care expenses.”
- Reiss-Brennan B, Brunisholz KD, Dredge C, et al. Association of integrated team-based care with health care quality, utilization, and cost. JAMA. 2016;316(8):826-834. doi: 10.1001/jama.2016.11232.