PT  - JOURNAL ARTICLE
AU  - Hysong, Sylvia J
AU  - Amspoker, Amber B
AU  - Hughes, Ashley M
AU  - Lester, Houston F
AU  - Svojse, Erica K
AU  - Khan, Kashif
AU  - Mehta, Praveen
AU  - Petersen, Laura A
TI  - Improving team coordination in primary-care settings via multifaceted team-based feedback: a non-randomised controlled trial study
AID  - 10.3399/BJGPO.2020.0185
DP  - 2021 Apr 01
TA  - BJGP Open
PG  - BJGPO.2020.0185
VI  - 5
IP  - 2
4099  - http://bjgpopen.org/content/5/2/BJGPO.2020.0185.short
4100  - http://bjgpopen.org/content/5/2/BJGPO.2020.0185.full
SO  - BJGP Open2021 Apr 01; 5
AB  - Background Coordination is critical to successful team-based health care. 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 The effectiveness of a multifaceted, A&F-plus-debrief intervention was tested to establish whether it improved coordination in primary care teams compared with controls.Design & setting Case-control trial within US Veterans Health Administration medical centres.Method Thirty-four primary care teams selected from four geographically distinct hospitals were compared with 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 enrolment). Predictors included intervention arm, extent of exposure to intervention, and degree of multiple team membership (MTM).Results Intervention teams did not significantly improve over control teams, even after adjusting for MTM. Follow-up analyses indicated cross-team variability in intervention fidelity; although all intervention teams received feedback reports, not all teams attended all debriefings. Compared with 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 enrolment.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.