Abstract
BACKGROUND: High-performing teams anchored by quality improvement and practice transformation skills strengthen primary care by improving patient outcomes. Effective team-based care may be particularly valuable in medically underserved communities (MUCs). OBJECTIVE: To evaluate the impact of a team-based training program that focused on quality improvement and practice transformation skills in community health centers (CHC) serving under-resourced communities across the Commonwealth of Massachusetts. DESIGN: The Advancing Teams Program was delivered to CHC teams over 6 years (2016-2022). The evaluation used a mixed methods design to assess the program's impact. PARTICIPANTS: Forty-seven interdisciplinary teams from CHCs serving MUCs in Massachusetts. The 327 individual participants included administrative staff, clinicians, and trainees. APPROACH: Evaluative data included participating CHC team and clinic demographics, pre-post evaluation of participants' perceptions of practice transformation using the Qualis Health Patient-Centered Medical Home Assessment (PCMH-A), and qualitative analysis of team improvement projects to identify themes related to project aims, practice transformation skills, and patient outcomes. KEY RESULTS: CHCs participating in the ATP program served under-resourced communities, with > 65% serving high levels of Medicaid and uninsured patients. Pre-post PCMH-A analysis indicated significant improvements (p < 0.05) in team members' perceptions of leadership engagement, team-based care, evidence-based practices, patient-centered interactions, access, and care coordination. The largest improvement was seen in patient-centered interactions (+ 1.04, p = 0.001), with ATP participation strongly associated with improved perceptions of encouraging patients to expand their role in decision-making, health-related behavior change, and self-management. Positive change in perceived leadership engagement predicted greater improvement in clinic functioning (β = 0.68, p < 0.001). Qualitative analysis showed that ATP teams successfully improved care in areas such as behavioral health, diabetes, substance abuse, and social determinants of health. CONCLUSIONS: ATP is a promising approach to building primary care teams within under-resourced CHCs. Additional research should include evaluation of team quality and robust approaches to measuring improvement projects.