National Healthcare Quality and Disparities Report
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- Adverse Events (1)
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- Surgery (4)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 36 Research Studies DisplayedCohen TN, Anger JT, Kanji FF
A novel approach for engagement in team training in high-technology surgery: the Robotic-Assisted Surgery Olympics.
The purpose of this study was to develop the “Robotic-Assisted Surgery (RAS) Olympics,” a “serious game”-based educational competition to improve the skills required to successfully perform RAS. The pilot study was conducted at an academic medical center in Southern California. Sixteen operating room members participated in the event, reporting that they preferred the RAS Olympics to traditional training, enjoyed the activity, would recommend all staff participate, felt that it was relevant to their work, and believed that they practiced and learned new techniques that would improve their practice. The participants’ confidence in their skills did not change. The researchers concluded that new information was gained about new possibilities for simultaneously engaging and training surgical staff while emphasizing RAS safety and efficiency.
AHRQ-funded; HS026491.
Citation: Cohen TN, Anger JT, Kanji FF .
A novel approach for engagement in team training in high-technology surgery: the Robotic-Assisted Surgery Olympics.
J Patient Saf 2022 Sep 1;18(6):570-77. doi: 10.1097/pts.0000000000001056..
Keywords: Surgery, Training, Education: Continuing Medical Education, Simulation, Teams
Atkinson MK, Benneyan JC, Bambury EA
Evaluating a patient safety learning laboratory to create an interdisciplinary ecosystem for health care innovation.
A patient safety learning laboratory (lab) can be a critical element of nurturing interdisciplinary team innovation across multiple projects and organizations. The purpose of this mixed-methods study was to evaluate a patient safety learning lab to examine the role and activities of a learning ecosystem that support interdisciplinary team innovation. The study found that successful learning ecosystems continuously facilitate alignment between interdisciplinary teams' activities, organizational context, and innovation project objectives. The researchers concluded that Interdisciplinary learning ecosystems have the capacity to facilitate health care improvement and innovation through alignment of team activities, project goals, and organizational contexts.
AHRQ-funded; HS024453.
Citation: Atkinson MK, Benneyan JC, Bambury EA .
Evaluating a patient safety learning laboratory to create an interdisciplinary ecosystem for health care innovation.
Health Care Manage Rev 2022 Jul-Sep;47(3):E50-E61. doi: 10.1097/hmr.0000000000000330..
Keywords: Patient Safety, Teams, Healthcare Delivery
Durojaiye A, Fackler J, McGeorge N
Examining diurnal differences in multidisciplinary care teams at a pediatric trauma center using electronic health record data: social network analysis.
The purpose of this study was to apply social network analysis to electronic health record (EHR) data to explore diurnal differences in the multidisciplinary teams caring for pediatric trauma patients. The researchers created an event log comprised of clinical activity metadata obtained from the EHR. The resulting event log was separated into 6 unique event logs, with content based on clinical activity shift (day shift or night shift) and location of the activities (divided by emergency department (ED), pediatric intensive care unit (PICU), and floor). For each event log, social networks were constructed and community overlap identified. The researchers utilized a comparison with qualitative care team data to compare and validate daytime and nighttime network structures for each care location. Validation was assessed via member-checking interviews with clinicians and qualitatively derived care team data, obtained through semi-structured interviews. The study found that of the 413 clinical encounters taking place within the 1-year study period, 65.9% began during the day shift and 34.1% began during the night shift. Multiple communities were identified in the ED and on the floor during the night shift, while a single community was identified in the ED and on the floor during the day shift, and in the PICU during the night shift. Qualitative data results indicated that the networks were accurate representations of the composition and interactions of the care teams. The researchers concluded that social network analysis was an effective method for utilization on EHR data at a pediatric trauma center to explore, identify, and describe diurnal differences in multidisciplinary care teams.
AHRQ-funded; HS023837.
Citation: Durojaiye A, Fackler J, McGeorge N .
Examining diurnal differences in multidisciplinary care teams at a pediatric trauma center using electronic health record data: social network analysis.
J Med Internet Res 2022 Feb 4;24(2):e30351. doi: 10.2196/30351..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Teams, Healthcare Delivery
Park J, Zhong X, Dong Y
Investigating the cognitive capacity constraints of an ICU care team using a systems engineering approach.
This study used systems engineering to investigate the association between the operational conditions and the quantity of medication orders in an intensive care unit (ICU). The dataset used was 4822 unique patients admitted to the ICU at the Mayo Clinic between February 2016 and March 2018. Findings were that when the ICU was more than 50% occupied (> 18 patients), the number of medication orders per patient hour was significantly reduced. The reduction was even more pronounced when there was a higher presence of severely ill patients requiring a mechanical ventilator, which might be encountered in an ICU treating COVID-19 patients. These factors impact the ICU critical care team’s cognitive function and results in changes in the production of medication orders.
AHRQ-funded; HS026609.
Citation: Park J, Zhong X, Dong Y .
Investigating the cognitive capacity constraints of an ICU care team using a systems engineering approach.
BMC Anesthesiol 2022 Jan 4;22(1):10. doi: 10.1186/s12871-021-01548-7..
Keywords: Intensive Care Unit (ICU), Teams
Hoonakker PLT, Hose BZ, Carayon P
Scenario-based evaluation of team health information technology to support pediatric trauma care transitions.
This study’s objective was to examine if the Teamwork Transition Technology (T(3)) supports teams and team cognition. Using a scenario-based mock-up methodology with 36 clinicians and staff from the different units and departments who are involved in pediatric trauma to examine T(3), results showed that most participants agreed that the technology helped to achieve the goals set out in the design phase. Respondents thought that T(3) organized and presented information in a different way that was helpful to them. The authors concluded that the results of their evaluation showed that participants agreed that T(3) does support them in their work and increases their situation awareness.
AHRQ-funded; HS023837.
Citation: Hoonakker PLT, Hose BZ, Carayon P .
Scenario-based evaluation of team health information technology to support pediatric trauma care transitions.
Appl Clin Inform 2022 Jan;13(1):218-29. doi: 10.1055/s-0042-1742368.
AHRQ-funded; HS023837..
AHRQ-funded; HS023837..
Keywords: Children/Adolescents, Transitions of Care, Health Information Technology (HIT), Teams, Trauma
McAlearney AS, Hefner JL, MacEwan SR
Care Team perspectives about an inpatient portal: benefits and challenges of patients' portal use during hospitalization.
This study’s goal was to get care team member’s point of view on the benefits and challenges of inpatient portal implementation and use. Brief in-person interviews with 433 care team members across a six-hospital health system were held to explore opinions about patients’ use. The Inpatient Portal Evaluation Framework was used to characterize benefits and challenges of portal use that care team members reported affected patients, themselves, and the collaborative work of those care teams with their patients.
AHRQ-funded; HS024379; HS024091; HS024767.
Citation: McAlearney AS, Hefner JL, MacEwan SR .
Care Team perspectives about an inpatient portal: benefits and challenges of patients' portal use during hospitalization.
Med Care Res Rev 2021 Oct;78(5):537-47. doi: 10.1177/1077558720925296..
Keywords: Teams, Health Information Technology (HIT), Inpatient Care
Atkinson MK, Singer SJ
Managing organizational constraints in innovation teams: a qualitative study across four health systems.
This study examined how interdisciplinary teams are affected by and manage external constraints over the lifecycle of their innovation project. The authors used a multimethod qualitative approach consisting of over 3 years of participant observation data to analyze how four interdisciplinary teams across different health system experienced and managed constraints as they pursued process innovations. Their findings point to several practical implications concerning innovation processes in healthcare: 1) how conditions in the organizational context, or constraints, can impede team progress at different stages of innovation; and 2) the collective efforts, or tactics, teams use to manage or work around those constraints to further progress on their innovations.
AHRQ-funded; HS024453.
Citation: Atkinson MK, Singer SJ .
Managing organizational constraints in innovation teams: a qualitative study across four health systems.
Med Care Res Rev 2021 Oct;78(5):521-36. doi: 10.1177/1077558720925993..
Keywords: Learning Health Systems, Health Systems, Teams
Sosa T, Sitterding M, Dewan M
Optimizing situation awareness to reduce emergency transfers in hospitalized children.
Interventions to improve care team situation awareness (SA) are associated with reduced rates of unrecognized clinical deterioration in hospitalized children. By addressing themes from recent safety events and emerging corruptors to SA in their system, the investigators aimed to decrease emergency transfers (ETs) to the ICU by 50% over 10 months. The investigators concluded that an innovative, proactive, and reliable process to predict, prevent, and respond to clinical deterioration was associated with a nearly 70% reduction in ETs.
AHRQ-funded; HS026975.
Citation: Sosa T, Sitterding M, Dewan M .
Optimizing situation awareness to reduce emergency transfers in hospitalized children.
Pediatrics 2021 Oct;148(4). doi: 10.1542/peds.2020-034603..
Keywords: Children/Adolescents, Emergency Department, Teams
Mathis MR, Yule S, Wu X
The impact of team familiarity on intra and postoperative cardiac surgical outcomes.
The authors hypothesized that familiarity among cardiac surgery team members may be an important contributor to better outcomes and thus serve as a target for enhancing outcomes. They found that high team familiarity was associated with reduced cardiopulmonary bypass duration for medium-risk and high-risk patients. Increasing team familiarity was not significantly associated with the odds of major morbidity and mortality. They concluded that team familiarity, which was predictive of improved intraoperative efficiency without compromising major postoperative outcomes, may serve as a novel quality improvement target in the setting of cardiac surgery.
AHRQ-funded; HS026003.
Citation: Mathis MR, Yule S, Wu X .
The impact of team familiarity on intra and postoperative cardiac surgical outcomes.
Surgery 2021 Oct;170(4):1031-38. doi: 10.1016/j.surg.2021.05.020..
Keywords: Teams, Surgery, Heart Disease and Health, Cardiovascular Conditions, Outcomes
McGuier EA, Kolko DJ, Klem M
Team functioning and implementation of innovations in healthcare and human service settings: a systematic review protocol.
Implementation of evidence-based practices and other innovations in these settings requires teams to work together to change processes and behaviors. Accordingly, team functioning may be a key determinant of implementation outcomes. This systematic review identified and summarized empirical research examining associations between team functioning and implementation outcomes in healthcare and human service settings.
AHRQ-funded; HS026862.
Citation: McGuier EA, Kolko DJ, Klem M .
Team functioning and implementation of innovations in healthcare and human service settings: a systematic review protocol.
Syst Rev 2021 Jun 26;10(1):189. doi: 10.1186/s13643-021-01747-w..
Keywords: Teams, Implementation, Evidence-Based Practice
Manges KA, Wallace AS, Groves PS
Ready to go home? Assessment of shared mental models of the patient and discharging team regarding readiness for hospital discharge.
A critical task of the inpatient interprofessional team is readying patients for discharge. Assessment of shared mental model (SMM) convergence can determine how much team members agree about patient discharge readiness and how their mental models align with the patient's self-assessment. The objective of this study was to determine the convergence of interprofessional team SMMs of hospital discharge readiness and identify factors associated with these assessments.
AHRQ-funded; HS026116.
Citation: Manges KA, Wallace AS, Groves PS .
Ready to go home? Assessment of shared mental models of the patient and discharging team regarding readiness for hospital discharge.
J Hosp Med 2021 Jun;16(6):326-32. doi: 10.12788/jhm.3464..
Keywords: Hospital Discharge, Teams, Care Management, Shared Decision Making, Hospitals
Hollingsworth JM, Yu X, Yan PL
Provider care team segregation and operative mortality following coronary artery bypass grafting.
The purpose of this study was to examine whether provider care team segregation within hospitals contributes to the higher mortality rate of Black patients following coronary artery bypass grafting compared to their White counterparts. Using national Medicare data, findings showed that Black patients who undergo coronary artery bypass grafting at a hospital with a higher level of provider care team segregation die more frequently after surgery than Black patients treated at a hospital with a lower level.
AHRQ-funded; HS026908.
Citation: Hollingsworth JM, Yu X, Yan PL .
Provider care team segregation and operative mortality following coronary artery bypass grafting.
Circ Cardiovasc Qual Outcomes 2021 May;14(5):e007778. doi: 10.1161/circoutcomes.120.007778..
Keywords: Surgery, Heart Disease and Health, Cardiovascular Conditions, Mortality, Teams, Healthcare Delivery, Racial and Ethnic Minorities
Kuo YF, Agrawal P, Chou LN
Assessing association between team structure and health outcome and cost by social network analysis.
Researchers sought to assess the impact of team structure composition and degree of collaboration among various providers on process and outcomes of primary care. Their findings showed that highly connected primary care practices with high collaborative care and less top-down MD-centered authority have lower odds of hospitalization, fewer emergency room admissions, and lower total spending. They concluded that these findings likely reflect better communication and more coordinated care of older patients.
AHRQ-funded; HS020642.
Citation: Kuo YF, Agrawal P, Chou LN .
Assessing association between team structure and health outcome and cost by social network analysis.
J Am Geriatr Soc 2021 Apr;69(4):946-54. doi: 10.1111/jgs.16962..
Keywords: Elderly, Teams, Healthcare Delivery, Primary Care, Primary Care: Models of Care, Care Coordination
Baloh J, Zhu X, Ward MM
What influences sustainment and nonsustainment of facilitation activities in implementation? Analysis of organizational factors in hospitals implementing TeamSTEPPS.
This study looked at the influences on sustainment of internal facilitation activities. For two years the authors followed 10 small rural hospitals implementing TeamSTEPPS, a patient safety program. Factors the authors examined were the influence of senior management support (SMS), middle management support (MMS), facilitator team time availability (TIME), and team continuity (CONTINUITY). Five hospitals sustained facilitation activities and they found that the combination of SMS, MMS, and CONTINUITY was a sufficient condition for sustainment. The five other hospitals that did not sustain facilitation activities either lacked MMS or lacked both TIME and CONTINUITY. They also discussed the implications for research and practice.
AHRQ-funded; HS024112; HS018396.
Citation: Baloh J, Zhu X, Ward MM .
What influences sustainment and nonsustainment of facilitation activities in implementation? Analysis of organizational factors in hospitals implementing TeamSTEPPS.
Med Care Res Rev 2021 Apr;78(2):146-56. doi: 10.1177/1077558719848267..
Keywords: TeamSTEPPS, Teams, Implementation, Hospitals, Patient Safety, Rural Health, Organizational Change
Rosenman ED, Misisco A, Olenick J
Does team leader gender matter? A Bayesian reconciliation of leadership and patient care during trauma resuscitations.
This study assessed and compared team leadership and patient care in trauma resuscitations led by male and female physicians. A secondary analysis of data from a larger randomized controlled trial using video recordings of resuscitations at a Level 1 trauma center from April 2016 to December 2017 was conducted. A total of 60 participants and 120 video observations were included in the analysis. There was a weak positive effect for female leaders for both patient care and team leadership. Gender-based advantages to team leadership and clinical care were not conclusive with the exception of rejecting a strong male advantage to team leadership.
AHRQ-funded; HS022458.
Citation: Rosenman ED, Misisco A, Olenick J .
Does team leader gender matter? A Bayesian reconciliation of leadership and patient care during trauma resuscitations.
J Am Coll Emerg Physicians Open 2021 Feb;2(1):e12348. doi: 10.1002/emp2.12348..
Keywords: Teams, Trauma, Critical Care, Provider: Physician, Provider
Kuo YF, Lin YL, D Jupiter, et al.
How to identify team-based primary care in the United States using Medicare data.
The authors assessed whether analyses using different sets of Medicare data can produce results similar to those from analyses using 100% data from an entire state in identifying primary care teams through social network analysis. They found that, depending on specific study purposes, researchers could use either 100% data from Medicare beneficiaries in randomly selected primary care services areas or data from a 20% national sample of Medicare beneficiaries to study team-based primary care in the United States.
AHRQ-funded; HS020642.
Citation: Kuo YF, Lin YL, D Jupiter, et al..
How to identify team-based primary care in the United States using Medicare data.
Med Care 2021 Feb;59(2):118-22. doi: 10.1097/mlr.0000000000001478.
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Keywords: Teams, Primary Care: Models of Care, Primary Care, Medicare, Health Services Research (HSR), Healthcare Delivery
Hung DY, Truong QA, Liang SY
Implementing lean quality improvement in primary care: impact on efficiency in performing common clinical tasks.
Investigators examined 3-year impacts of Lean implementation on the amount of time taken for physicians to complete common clinical tasks. They found that Lean redesigns led to improvements in timely completion of 3 out of 4 common clinical tasks, thus supporting the use of Lean techniques to engage teams in routine aspects of patient care. They recommended more research to understand the mechanisms by which Lean promotes quality improvement and effectiveness of care team workflows.
AHRQ-funded; HS024529.
Citation: Hung DY, Truong QA, Liang SY .
Implementing lean quality improvement in primary care: impact on efficiency in performing common clinical tasks.
J Gen Intern Med 2021 Feb;36(2):274-79. doi: 10.1007/s11606-020-06317-9..
Keywords: Primary Care, Quality Improvement, Quality of Care, Primary Care: Models of Care, Primary Care, Implementation, Workflow, Teams, Healthcare Delivery
Wang G, Wignall J, Kinard D
An implementation model for managing cloud-based longitudinal care plans for children with medical complexity.
In this study, the investigators aimed to iteratively refine an implementation model for managing cloud-based longitudinal care plans (LCPs) for children with medical complexity (CMC). They conducted iterative 1-on-1 design sessions with CMC caregivers (ie, parents/legal guardians) and providers between August 2017 and March 2019. The investigators concluded that utilizing the management strategies, described in the article, when implementing cloud-based LCPs had the potential to improve team-based care across settings.
AHRQ-funded; HS024299.
Citation: Wang G, Wignall J, Kinard D .
An implementation model for managing cloud-based longitudinal care plans for children with medical complexity.
J Am Med Inform Assoc 2021 Jan 15;28(1):23-32. doi: 10.1093/jamia/ocaa207..
Keywords: Children/Adolescents, Implementation, Chronic Conditions, Care Management, Care Coordination, Health Information Exchange (HIE), Health Information Technology (HIT), Teams
Pestka DL, Paterson NL, Benedict KA
Delivering care to high-cost high-need patients: lessons learned in the development of a complex care primary care team.
As part of a population health-focused primary care transformation, in 2019 a health system in Minnesota developed a primary care team to exclusively care for high-cost high-need patients. Through its development and implementation, the team has discovered several key lessons in delivering care to complex patients. In this paper, the authors discuss lessons learned from their research.
AHRQ-funded; HS026379.
Citation: Pestka DL, Paterson NL, Benedict KA .
Delivering care to high-cost high-need patients: lessons learned in the development of a complex care primary care team.
J Prim Care Community Health 2021 Jan-Dec;12:21501327211023888. doi: 10.1177/21501327211023888..
Keywords: Primary Care, Primary Care: Models of Care, Healthcare Delivery, Teams, Communication, Implementation
Miller-Rosales C, Rodriguez HP
Interdisciplinary primary care team expertise and diabetes care management.
Researchers examined whether care team role expertise is associated with patients' experiences of chronic care for type 2 diabetes and whether the relationship is stronger for small community health center (CHC) sites. Results of surveys conducted with adults with diabetes that assessed nonphysician team roles involved in managing their chronic care were integrated with clinical and administrative data from 14 CHCs. They found that patients with access to care team expertise in self-management support, including diabetes educators, nutritionists, community health workers, and other general staff report better experiences of chronic care. They concluded that these team roles may reduce barriers to patient self-management and improve patients' overall experiences of chronic care, particularly in small CHC sites.
Citation: Miller-Rosales C, Rodriguez HP .
Interdisciplinary primary care team expertise and diabetes care management.
J Am Board Fam Med 2021 Jan-Feb;34(1):151-61. doi: 10.3122/jabfm.2021.01.200187..
Keywords: Primary Care, Diabetes, Teams, Care Management, Community-Based Practice
Rodriguez HP, Friedberg MW, Vargas-Bustamante A
The impact of integrating medical assistants and community health workers on diabetes care management in community health centers.
The purpose of this study was to compare the impact of implementing team-based diabetes care management involving community health workers (CHWs) vs. medical assistants (MA) in community health centers (CHCs) on diabetes care processes, intermediate outcomes, and patients' experiences of chronic care. The investigators found that diabetes care improved in CHCs integrating CHWs and MAs onto primary care teams, but the improvements were no different than improvements observed among matched control group patients.
AHRQ-funded; HS02012001.
Citation: Rodriguez HP, Friedberg MW, Vargas-Bustamante A .
The impact of integrating medical assistants and community health workers on diabetes care management in community health centers.
BMC Health Serv Res 2018 Nov 20;18(1):875. doi: 10.1186/s12913-018-3710-9..
Keywords: Community-Based Practice, Diabetes, Healthcare Delivery, Teams
Misra-Hebert AD, Perzynski A, Rothberg MB
Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system.
This mixed-methods comparative case study examined the implementation of team-based primary care models in a large integrated health system. Field observations of 9 practices were conducted along with 75 interviews and provider and staff surveys. The 9 practices were categorized into 3 groups: high, partial, and low update of the new models. Ability of the practices to implement the new team-based model depended on their ability to adapt to change and to adapt team roles in workflow.
AHRQ-funded; HS024128.
Citation: Misra-Hebert AD, Perzynski A, Rothberg MB .
Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system.
J Gen Intern Med 2018 Nov;33(11):1928-36. doi: 10.1007/s11606-018-4611-7..
Keywords: Case Study, Health Systems, Patient-Centered Healthcare, Primary Care, Primary Care: Models of Care, Teams
Murray DJ, Boyle WA, Beyatte MB
Decision-making skills improve with critical care training: using simulation to measure progress.
Health care professionals are expected to acquire decision-making skills during their training, but few methods are available to assess progress in acquiring these essential skills. The purpose of this study was to determine whether a simulation methodology could be used to assess whether decision-making skills improve during critical care training. The investigators indicate that their findings provide evidence to support the validity of a simulation-based method to assess progress in decision-making skills.
AHRQ-funded; HS022265.
Citation: Murray DJ, Boyle WA, Beyatte MB .
Decision-making skills improve with critical care training: using simulation to measure progress.
J Crit Care 2018 Oct;47:133-38. doi: 10.1016/j.jcrc.2018.06.021..
Keywords: Critical Care, Education: Continuing Medical Education, Shared Decision Making, Simulation, Teams, Training
Bordley J, Sakata KK, Bierman J
Use of a novel, electronic health record-centered, interprofessional ICU rounding simulation to understand latent safety issues.
The electronic health record is a primary source of information for all professional groups participating in ICU rounds. However, it is unclear how team dynamics impacts identification and verbalization of viewed data. Therefore, the investigators created an ICU rounding simulation to assess how the interprofessional team recognized and reported data and its impact on decision-making.
AHRQ-funded; HS023793.
Citation: Bordley J, Sakata KK, Bierman J .
Use of a novel, electronic health record-centered, interprofessional ICU rounding simulation to understand latent safety issues.
Crit Care Med 2018 Oct;46(10):1570-76. doi: 10.1097/ccm.0000000000003302..
Keywords: Shared Decision Making, Electronic Health Records (EHRs), Intensive Care Unit (ICU), Patient Safety, Teams
Meyers D, LeRoy L, Bailit M
AHRQ Author: Meyers D, Zhan C
Workforce configurations to provide high-quality, comprehensive primary care: a mixed-method exploration of staffing for four types of primary care practices.
The aim of this study was to explore the team configurations and associated costs required to deliver high-quality, comprehensive primary care. The study estimates provided health care decision-makers with needed guideposts for considering primary care staffing and financing and informed broader discussions on primary care innovations and the necessary resources to provide high-quality, comprehensive primary care in the USA.
AHRQ-authored; AHRQ-funded; 290201000004I; 29032009T.
Citation: Meyers D, LeRoy L, Bailit M .
Workforce configurations to provide high-quality, comprehensive primary care: a mixed-method exploration of staffing for four types of primary care practices.
J Gen Intern Med 2018 Oct;33(10):1774-79. doi: 10.1007/s11606-018-4530-7..
Keywords: Healthcare Delivery, Quality of Care, Primary Care, Workforce, Teams