Environmental scan of measures of team-based primary care: The current state and preliminary gaps

Background: A growing body of literature acknowledges that primary care settings that use team-based approaches are likely to have higher patient satisfaction as well as improved health outcomes. Comprehensive and coordinated team-based care is a facet of many models of primary care transformation, including the patient-centered medical home. Thus, robust measures of team-based care appropriate for the primary care setting and suitable for research, quality improvement, and/or evaluation are of utmost importance in order to improve patient outcomes through better team functioning. Existing measurement tools often focus on settings other than primary care, rarely evaluate patient experience, and often are atheoretical or lack adequate psychometric testing. The aims of this study are to identify existing measures of team-based care and related measures that can be adapted for that setting, understand the domains of team-based care the measures address within a newly-developed conceptual model, and identify preliminary gaps for future development. Methodology: To identify measures of team-based care we explored several sources, including: measure databases (e.g., NQF, Nat'l Quality Measures Clearinghouse, HHS Measure Inventory, NIH GEM database), Measures Application Partnership, and CAHPS. We also sought input from experts in team care, examined reviews of team care measures, and completed a review of the peer-reviewed and grey literature on both teamwork and team-based primary care. Results: The following are preliminary results based on the measures that have been identified to date. Over one hundred different measures of teamwork and team-based care have been identified. The majority of measures identified are surveys or observational checklists and related tools. The measures or tools have measured attributes of teamwork from individuals, teams or even patients' perspectives. Among the most common domains or attributes of teamwork and team-based primary care identified include: communication, coordination, collaboration, respect, use of all team member's expertise, conflict management, group cohesion or shared identity, shared workload, and role responsibility and understanding. The environmental scan will be completed in July 2013; the full results will be presented at the meeting. Conclusions/Discussion: As health care delivery continues to evolve toward patient-centered medical homes and other models of team-based care, having measures to understand, evaluate and improve upon team-based care will be instrumental to future progress. Many existing measures of team functioning may require adaptation, and/or demonstration of adequate psychometric properties, for use in the primary care setting.