Improving team coordination in primary-care settings via multifaceted team-based feedback: a case–control study

Background Coordination is critical to successful team-based healthcare. Most clinicians, however, are not trained in effective coordination or teamwork. Audit and feedback (A&F) could improve team coordination, if designed with teams in mind.

Aim We tested effectiveness of a multifaceted, A&F-plus-debrief intervention at improving coordination in primary-care teams, compared to controls.

Design & setting Case-control trial within U.S. Veterans Health Administration Medical Centers.

Method We compared 34 primary-care teams selected from four geospaced hospitals to 34 administratively matched control teams. Intervention-arm teams received monthly A&F reports about key coordination behaviours and structured debriefings over 7 months. Control teams were followed exclusively via their clinical records. Outcome measures included a coordination composite and its component indicators (appointments starting on time, timely recall scheduling, emergency department utilisation, and electronic patient portal enrollment). Predictors included intervention arm, extent of exposure to intervention and degree of multiple-team membership.

Results Intervention teams did not significantly improve over control teams, even after adjusting for multiple-team membership. Follow-up analyses indicated cross-team variability in intervention fidelity; although all intervention teams received feedback reports, not all teams attended all debriefings. Compared to their respective baselines, teams with high debriefing exposure improved significantly. Teams with high debriefing exposure improved significantly more than teams with low exposure. Low exposure teams significantly increased patient portal enrollment.

Conclusion Team-based A&F including adequate reflection time can improve coordination; however, the effect is dose dependent. Consistency of debriefing appears more critical than proportion of team members attending a debriefing for ensuring implementation fidelity and effectiveness.