Utilization Outcomes of a Pilot Primary Care Team Redesign

Abstract

Objectives To evaluate the effect of a team-based primary care redesign on primary care, emergency department (ED) and urgent care (UC) utilization, and new patient access to primary care. Study Design A retrospective pre-post difference-in-differences analysis of utilization outcomes for patients on a redesigned primary care team compared to a standard primary care group. Methods Within a patient-centered medical home, a pilot team was developed comprising 2 colocated "teamlets" of 1 physician, 1 nurse practitioner (NP), 1 registered nurse (RN), and 2 licensed practical nurses (LPNs). The redesigned team utilized physician-NP comanagement, expanded roles for RNs and LPNs, and dedicated provider time for telephone and e-mail medicine. We compared changes in number of office, ED, and UC visits during the implementation year for patients on the redesigned team compared to patients receiving the standard of care in the same clinic. Proportion of new patient visits was also compared between the pilot and the control groups. Results There were no differences between the redesign group and control group in per-patient mean change in office visits (Δ = -0.04 visits vs Δ = -0.07; P = .98), ED visits (Δ = 0.00 vs Δ = 0.01; P = .25), or UC visits (Δ = 0.00 vs Δ = 0.05; P = .08). Proportion of new patient visits was higher in the pilot group during the intervention year compared to the control group (6.6% vs 3.9%; P < .0001). Conclusions The redesign did not significantly impact ED, UC, or primary care utilization within 1 year of follow-up. It did improve access for new patients.