Primary Care Practices' Implementation of Patient-Team Partnership: Findings from EvidenceNOW Southwest

Tristen L. Hall; Kyle E. Knierim; Donald E. Nease; Elizabeth W. Staton; Carolina Nkouaga; L. Miriam Dickinson; Robert L. Rhyne; W. Perry Dickinson

doi:10.3122/jabfm.2019.04.180361

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Table 1.

Characteristics and Outcome Scale Scores of 207 Small- and Medium-Sized Primary Care Practices in Colorado and New Mexico That Participated in EvidenceNOW Southwest Cardiovascular Care Improvement Initiative, Gathered using Practice- and Employee-Level Surveys upon Practice Enrollment, December 2015 through November 2017

Characteristics	EvidenceNOW Southwest Initiative (N = 207 Practices) Mean (SD) or %
Practice survey items–patient-team partnership
Patient and family input.	2.3 (1.5)
Patient experience survey.	3.4 (1.6)
Link patients to community resources for self-management.	3.1 (1.3)
Link patients to community resources to address social determinants.	3.1 (1.4)
Provide patients with tools and resources to manage health.	3.5 (1.1)
Patient-team partnership scale (α = 0.82)	51.5 (26.1)
Practice member survey items–patient-team partnership
Good job of assessing patient needs and expectations.	3.1 (0.7)
Data from patients to improve care.	3.0 (0.8)
Data on patient experience when developing new services.	2.9 (0.8)
Ask patients about unmet social needs.	2.6 (1.1)
Link patients with unmet social needs to community resources.	2.6 (1.1)
Practice member patient-team partnership scale (α = 0.81)	71.2 (17.1)
Practice member patient-team partnership scale–clinicians	66.2 (17.6)
Practice member patient-team partnership scale–staff	73.2 (16.6)
Practice member patient-team partnership scale–[role not provided]	66.8 (16.2)
Ownership
Clinician	47.9%
Hospital/academic center	15.6%
Federally Qualified Health Center/rural	36.5%
Practice Size: Number of Providers
Solo	21.0%
2 to 5	60.5%
6 to 10	16.6%
>10	2.0%
Payer mix
Percent Medicaid	27.4 (22.1)
Percent Medicare	18.7 (14.0)
Percent uninsured	11.2 (13.9)
Percent commercial payer	37.6 (25.2)
Accountable care organization membership
Medicaid	27.0%
Medicare	26.1%
Private/commercial	13.7%
Patient registries
Number of registries	2.9 (2.4)
Any registry	67.8%
Use of clinical guidelines
Prevention
Number of guidelines	1.8 (1.4)
No guidelines	16.6%
Management
Number of guidelines	1.7 (1.4)
No guidelines	18.5%
Geographic area
Rural	28.9%
Nonrural	71.1%
Other characteristics
Multispecialty	32.2%
PCMH recognized	44.6%
Medically underserved	45.0%
Practice member characteristics
Role
Clinician (physician or advanced practice provider)	24.1%
Staff	72.7%
Role not provided	3.2%
Years at practice (mean)	5.1 (6.0)
0	18.7%
1 to 2	27.7%
3 to 5	22.9%
6 to 10	16.2%
>10	14.6%
Hours per week	38.9 (8.7)

SD, standard deviation; PCMH, patient-centered medical home.

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Table 2.

Mean Scores for Outcome Scales and Corresponding Survey Items from 1,986 Employees of Small- and Medium-Sized Primary Care Practices in Colorado and New Mexico That Participated in EvidenceNOW Southwest Cardiovascular Care Improvement Initiative, Gathered using Employee Surveys upon Practice Enrollment, December 2015 through November 2017, Stratified by Clinician and Staff Roles

Practice Member Survey Items	Role			Role Comparison
	Clinicians	Staff	[Role not provided]
	n = 478	n = 1444	n = 64
	Mean (SD)			Probability > t
Good job of assessing patient needs and expectations.	3.0 (0.7)	3.2 (0.7)	3.0 (0.5)	.0001^*
Data from patients to improve care.	2.8 (1.0)	3.1 (0.8)	2.8 (0.7)	<.0001^*
Data on patient experience when developing new services.	2.6 (1.0)	3.0 (0.8)	2.6 (0.7)	<.0001^*
Ask patients about unmet social needs.	2.5 (1.0)	2.6 (1.1)	2.4 (1.1)	.0240^*
Link patients with unmet social needs to community resources.	2.3 (1.1)	2.7 (1.2)	2.3 (1.2)	<.0001^*
Member-level patient-team partnership score	66.2 (17.6)	73.2 (16.6)	66.8 (16.2)	<.0001^*

↵* P < .05.
SD, standard deviation.

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Table 3.

Univariable Associations between Patient-Team Partnership Outcome Scale Scores and Characteristics of Practices Participating in EvidenceNOW Southwest Cardiovascular Care Improvement Initiative

Characteristics	Patient-Team Partnership Outcome Scale Scores
	Practice-Level Scores			Member-Level Scores
	Coef.	SE (95% CI)	Probability > t	Coef.	SE (95% CI)	Probability > t
Ownership
Clinician	(ref)	(ref)	(ref)	(ref)	(ref)	(ref)
Hospital or academic center	1.64	4.88	.7367	−3.72	2.01	.0649^*
Federally Qualified Health Center or rural health clinic	20.84	3.70	<.0001^*	6.62	1.55	<.0001^*
Practice size: number of clinicians
Solo provider	(ref)	(ref)	(ref)	(ref)	(ref)	(ref)
2 to 5	0.88	4.69	.8508	1.31	2.15	.5412
6 to 10	9.58	6.01	.1129	2.54	2.55	.3204
>10	11.34	13.58	.4047	−1.58	6.02	.7933
Accountable Care Organization member
Medicaid	13.55	3.97	.0008^*	5.10	1.59	.0014^*
Medicare	12.81	4.03	.0017^*	1.84	1.61	.2548
Private/commercial	18.28	5.16	.0005^*	5.21	1.94	.0073^*
Other Accountable Care Organization	−11.77	13.19	.3733	2.65	4.86	.5860
Use of patient registries
Number of registries	5.02	0.68	<.0001^*	2.01	0.28	<.0001^*
Any registry	24.55	3.53	<.0001^*	8.10	1.58	<.0001^*
Use of clinical guidelines (%)
Cardiovascular disease prevention
Number of guidelines	7.26	1.23	<.0001^*	2.31	0.48	<.0001^*
No guidelines	−9.42	4.93	.0575^*	−6.92	1.95	.0004^*
Manage patients with cardiovascular disease risk
Number of guidelines	7.76	1.21	<.0001^*	2.46	0.48	<.0001^*
No guidelines	−16.26	4.56	.0005^*	−9.34	1.85	<.0001^*
Geographic area
Rural	8.08	4.00	.0446^*	0.35	1.77	.8417
Nonrural	(ref)	(ref)	(ref)	(ref)	(ref)	(ref)
Other practice characteristics
Multispecialty	13.10	3.77	.0006^*	1.45	1.59	.3625
PCMH recognized	11.50	3.58	.0015^*	3.99	1.51	.0082^*
Medically underserved	21.13	3.35	<.0001^*	6.83	1.45	<.0001^*
Practice member characteristics	[n/a]	[n/a]	[n/a]
Role
Clinician				(ref)	(ref)	(ref)
Staff				6.53	0.85	<.0001^*
Role not provided				1.99	2.87	.4885
Years at practice				−0.19	0.07	.0059^*
Hours per week				0.03	0.05	.4536

↵* P < .10. ref, reference; n/a, not applicable.

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Table 4.

Final Multivariate Regression Models of Patient-Team Partnership Outcome Scale Scores and Characteristics of Practices Participating in EvidenceNOW Southwest Cardiovascular Care Improvement Initiative

	Coefficient (SE)	Probability > t
Practice-level patient-team partnership scale
Intercept	23.46 (3.02)	<.0001^*
Any registry	15.72 (3.44)	<.0001^*
Designated underserved	15.49 (3.03)	<.0001^*
Multispecialty practice	6.87 (3.18)	.0320^*
Number of guidelines for cardiovascular disease management	4.55 (1.17)	.0001^*
Member-level patient-team partnership scale
Intercept	57.37 (1.54)	<.0001^*
Role
Clinician	(ref)	(ref)
Staff	6.31 (0.85)	<.0001^*
Role not provided	−0.82 (6.22)	.8952
Designated underserved	5.44 (1.33)	<.0001^*
Any registry	5.19 (1.60)	.0012^*
Number of guidelines for cardiovascular disease management	1.46 (0.49)	.0030^*
Years at practice	−0.14 (0.07)	.0378^*

↵* P < .05.
SD, standard deviation; PCMH, patient-centered medical home; SE, standard error.

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Appendix.

Patient-Team Partnership Outcome Scales, Corresponding Practice Survey and Practice Member Survey Questions and Response Options

Scale	Survey Questions	Response Options
Practice-level patient-team partnership scale	- A system has been implemented for including patient and family input in ongoing improvement activities (such as patient advisory groups or patients or family members on quality improvement teams).	1–Not at all
	- A patient experience survey is used regularly (monthly or quarterly) to monitor practice performance.	2
	- Patients and families are actively linked with community resources to assist with their self-management goals.	3
	- Our practice has the capacity to link patients to community resources to address social determinants of health (such as housing, food security, transportation, legal assistance, help with paying bills, personal safety).	4
	- Patients and families are provided with tools and resources to help them engage in the management of their health between visits.	5–Completely
Member-level patient-team partnership scale	- Our practice does a good job of assessing patient needs and expectations.	1–Strongly disagree 2–Disagree 3–Neutral 4–Agree 5–Strongly agree
	- Our practice uses data from patients to improve care.
	- Our practice uses data on patient expectations and/or experience when developing new services.
	- How often does your practice currently ask patients about unmet social needs that can affect their health, such as housing, food security, childcare, transportation, legal assistance, or help with paying bills?	1–Never 2–Rarely 3–Sometimes 4–Always
	- At this moment, how confident are you in your practice's ability to link patients with unmet social needs to resources in the community?	1–Not at all confident 2–Somewhat not confident 3–Somewhat confident 4–Very confident