Interprofessional training and team function in patient-centred medical home: Findings from a mixed method study of interdisciplinary provider perspectives

ABSTRACT

Transitioning from profession-specific to interprofessional (IP) models of care requires major change. The Veterans Assessment and Improvement Laboratory (VAIL), is an initiative based in the United States that supports and evaluates the Veterans Health Administration’s (VAs) transition of its primary care practices to an IP team based patient-centred medical home (PCMH) care model. We postulated that modifiable primary care practice organizational climate factors impact PCMH implementation. VAIL administered a survey to 322 IP team members in primary care practices in one VA administrative region during early implementation of the PCMH and interviewed 79 representative team members. We used convergent mixed methods to study modifiable organizational climate factors in relationship to IP team functioning. We found that leadership support and job satisfaction were significantly positively associated with team functioning. We saw no association between team functioning and either role readiness or team training. Qualitative interview data confirmed survey findings and explained why the association with IP team training might be absent. In conclusion, our findings demonstrate the importance of leadership support and individual job satisfaction in producing highly functioning PCMH teams. Based on qualitative findings, we hypothesize interprofessional training is important, however, inconsistencies in IP training delivery compromise its potential benefit. Future implementation efforts should improve standardization of training process and train team members together. Interprofessional leadership coordination of interprofessional training is warranted.

KEYWORDS:

• Interdisciplinary teams
• mixed methods research
• Patient-Centered Medical Home
• team functioning
• team training

Acknowledgments

We would like to thank John McElroy for his coordination of the key informant interviews and Jessica Zuchowski PhD, MPH for her involvement in qualitative data coding. We are grateful to Barbara Lawrence PhD for reviewing drafts of the manuscript. Finally, we want to acknowledge and thank all the primary care clinicians and staff in VISN 22 who agreed to participate in our survey and interviews.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Notes

¹ The patient centered medical home is a delivery model that encompasses five functions and attributes including comprehensive care, patient-centeredness, coordinated care, assessible services, and quality and safety. Typically a patient will be assigned to a care team that will provide them continuous coordinated care over time. (Schottenfeld et al., 2016).

Additional information

Funding

This work was undertaken as part of the Veteran Health Administration’s PACT Demonstration Laboratory initiative, supporting and evaluating VA’s transition to a patient-centred medical home. Funding for the PACT Demonstration Laboratory initiative, which includes the VA Assessment and Improvement Laboratory (VAIL) that carried out this project, came from the VA Office of Patient Care Services. Dr Yano’s effort was contributed through a VA HSR&D Senior Research Career Scientist award (Project #05-195). Karleen Giannitrapani’s effort was partially supported by AHRQ grant: 2T32HS000046. The views expressed within are solely those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, AHRQ, or the United States government.