Commentary on “Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system.”

Employing mixed methods to assess implementation of evidence-based practices can be resource intensive and complex but also fruitful.  Misra-Hebert and colleagues’ recent manuscript, “Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system,” highlights the benefits of this approach. They employ a convergent mixed methods design—using quantitative administrative data (i.e., quality measures), surveys, observational data, and interviews—to reveal insights about practice-setting characteristics and adoption of team-based models in primary care. These insights hold value for policymakers, clinicians, and researchers alike, as the shift to team-based care is a key component of the patient-centered medical home and high-quality primary care.

Often overlooked in the rush to re-shape primary care is the nuance and complexity of transitioning to a new style of delivery. Although the importance of clinical champions is commonly emphasized, the authors highlight other critical elements, particularly flexibility in defining workflows and roles, positive perceptions about change, strong leadership, and stable staffing. The potential linkages between these elements with high-functioning team-based care and the subsequent associated improvements in care quality make this manuscript a must-read for those interested in realizing the potential of primary care in an evolving value-based care environment.

The authors’ findings point to additional exciting research questions.  For example, how might the identified implementation facilitators inform strategies for organizations to adopt team-based primary care models? Perhaps more generally, the Misra-Hebert et al. study highlights organizational capacity elements that contribute to the complexity of implementing evidence-based practice patterns in primary care.  This is an area likely to experience continued disruption and attention from policy makers—a point illustrated by a quote from one of the physicians interviewed in the study: “…the way I see it, you’ve got to be on the move… things are rapidly evolving in health care and you’ve got to remain nimble.”

Read the full abstract.