Improving team coordination in primary-care settings via multifaceted team-based feedback: a non-randomised controlled trial study

Sylvia J Hysong; Amber B Amspoker; Ashley M Hughes; Houston F Lester; Erica K Svojse; Kashif Khan; Praveen Mehta; Laura A Petersen

doi:10.3399/BJGPO.2020.0185

Improving team coordination in primary-care settings via multifaceted team-based feedback: a non-randomised controlled trial study

BJGP Open. 2021 Apr 26;5(2):BJGPO.2020.0185. doi: 10.3399/BJGPO.2020.0185. Print 2021 Apr.

Authors

Sylvia J Hysong^{1

2}, Amber B Amspoker^{3

2}, Ashley M Hughes⁴, Houston F Lester^{3

2

5}, Erica K Svojse³, Kashif Khan⁶, Praveen Mehta⁷, Laura A Petersen^{3

2}

Affiliations

¹ Center of Innovations in Quality Effectiveness and Safety, Michael E DeBakey VA Medical Center, Houston, Texas, USA hysong@bcm.edu.
² Department of Medicine - Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA.
³ Center of Innovations in Quality Effectiveness and Safety, Michael E DeBakey VA Medical Center, Houston, Texas, USA.
⁴ Department of Biomedical and Health Information Sciences, University of Illinois Chicago, Chicago, Illinois, USA.
⁵ Department of Management, University of Mississippi, Oxford, Mississippi, USA.
⁶ Richmond VA Community-Based Outpatient Clinic, Richmond, Texas, USA.
⁷ VA Great Lakes Health Care System, Westchester, Illinois, USA.

Abstract

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.

Keywords: audit and feedback; debriefs; embedded partnership research; learning health system; primary health care; quality of health care; team coordination.