Date of Completion

Spring 4-30-2022

Document Type

Open Access Capstone

Degree Name

Doctor of Nursing Practice (DNP)

Faculty Advisor

Priscilla Gazarian, PhD, RN

Site Advisor

Derek Clevidence, MD, PhD

Abstract

Background: To assure high quality, safe, affordable, and accessible health care, organizations are embarking on quality improvement initiatives to work toward the triple aim of patient satisfaction, improving the health of populations, and reducing the cost of care.

Description of the Problem: Primary care is the backbone of the health care system, but it is a challenging environment with high rates of clinician burnout. Clinician burnout undermines the ability of organizations to meet the triple aim. Innovative new care delivery models are needed that can meet the triple aim while also mitigating burnout.

Available Knowledge: A PRISMA review of the literature examined care delivery models which improve quality of care. The most promising strategy identified was the advanced team-based model of care.

Specific Aims: The specific aim of this project was to implement an innovative, team-based model of primary care. The primary objectives were to describe patient satisfaction with the care model, to maintain patient experience, and to reduce provider burnout while maintaining or improving productivity.

Context: The project was implemented in a small family practice clinic in a semi-rural community in Wisconsin. The practice is within one of nine regions of one of the largest health systems in the United States.

Intervention: An advanced team-based model of care was implemented, which involved nurses taking on a broader set of clinical care tasks as care-team coordinators, to achieve a fuller scope of practice, with staffing model change from 1 NP:1 MA: 0.75RN to 1 NP:1 MA: 1.75 RN.

Results: In the first three months of a team-based care implementation, patient experience as measured by Press Ganey surveys was either maintained or improved. Patient acceptance of the model on a brief post-encounter survey showed significant improvement in patient perception of the visit when a care-team coordinator was involved in the visit. Provider burnout was measured with “work after clinic” hours and chart closure time, surrogate measures for burnout, with both factors decreasing in the three months post-implementation. Productivity was measured using work RVUs per contact hour and panel risk adjusted score, both of which showed increases in the first 3 months of implementation.

Discussion: The design of this project included a comparison group to evaluate measures with and without care team coordinator involvement which established statistically significant improvements with patient overall satisfaction with care. While previous team-based care studies have demonstrated improvement in patient satisfaction, provider burnout, and revenue potential in months or years after implementation, this work suggests that benefits may occur much sooner. Immediate return on investment may help remove barriers to implementation.

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