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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
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1 to 25 of 32 Research Studies DisplayedQuigley DD, Quereshi N, Hays RD
Reasons primary care practices chose patient experience surveys during patient-centered medical home transformation.
This study’s objective was to identify reasons primary care practices chose to implement a patient experience survey during their patient-centered medical home transformation. The authors conducted interviews with a stratified-random sample of 105 of these practices. Fifty-one practices used a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and 53 administered another patient survey. The three most common reasons to use a survey were given as: (1) to compare performance against other practices, which requires systematically collected data across large numbers of practices (ie, the Consumer Assessment of Healthcare Providers and Systems survey), (2) participation in an external patient-centered medical home program, and (3) survey administration cost. A second patient survey was used to identify quality improvement needs.
AHRQ-funded; HS016980; HS025920.
Citation: Quigley DD, Quereshi N, Hays RD .
Reasons primary care practices chose patient experience surveys during patient-centered medical home transformation.
J Ambul Care Manage 2023 Jan-Mar;46(1):34-44. doi: 10.1097/jac.0000000000000442.
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient-Centered Healthcare, Primary Care, Quality Improvement, Practice Improvement
Quigley DD, Qureshi N, Palimaru A
Content and actionability of recommendations to providers after shadow coaching.
This paper examined the content of the recommendations given to shadow-coached providers aimed at improving provider-patient interactions, to characterize these recommendations, and to examine their actionability. Using CAHPS data, the study’s findings showed that patient experience surveys were effective at identifying where improvement is needed but are not always informative enough to instruct providers on how to modify and improve their interactions with patients. Analyzing the feedback given to coached providers as part of an effective shadow-coaching program provides details about implementation on shadow-coaching feedback.
AHRQ-funded; HS025920.
Citation: Quigley DD, Qureshi N, Palimaru A .
Content and actionability of recommendations to providers after shadow coaching.
Qual Manag Health Care 2022 Oct-Dec;31(4):199-209. doi: 10.1097/qmh.0000000000000354..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Experience, Quality Improvement, Quality of Care, Practice Improvement, Clinician-Patient Communication, Communication
Sweeney SM, Baron A, Hall JD
Effective facilitator strategies for supporting primary care practice change: a mixed methods study.
Investigators conducted a pragmatic qualitative study with patients who had participated in a health-related social needs (HRSN) intervention. They found that patients were likely to have initial skepticism or reservations about the intervention; they identified 4 positive intervention components regarding patient experience; and they found that patients could be left with feelings of appreciation or hope, regardless of whether they connected with HRSN resources.
AHRQ-funded; HS023940.
Citation: Sweeney SM, Baron A, Hall JD .
Effective facilitator strategies for supporting primary care practice change: a mixed methods study.
Ann Fam Med 2022 Sep-Oct;20(5):414-22. doi: 10.1370/afm.2847..
Keywords: Primary Care, Practice Improvement, Quality Improvement, Quality of Care
Pestka DL, Paterson NL, Brummel AR
Barriers and facilitators to implementing pharmacist-provided comprehensive medication management in primary care transformation.
The objective of this study was to identify barriers and facilitators when integrating pharmacist-provided comprehensive medication management (CMM) services into a health system's team-based primary care transformation (PCT) using the Consolidated Framework for Implementation Research. Findings showed that identifying and addressing implementation barriers and facilitators early during PCT rollout was critical to the success of team-based services such as CMM and becoming a learning health system. Further, clinical pharmacists providing CMM represented a valuable interdisciplinary care team member who can help to improve healthcare quality and access to primary care.
AHRQ-funded; HS026379.
Citation: Pestka DL, Paterson NL, Brummel AR .
Barriers and facilitators to implementing pharmacist-provided comprehensive medication management in primary care transformation.
Am J Health Syst Pharm 2022 Jul 22;79(15):1255-65. doi: 10.1093/ajhp/zxac104..
Keywords: Medication, Provider: Pharmacist, Primary Care, Implementation, Practice Improvement
Perry CK, Linder S, Hall J
How type of practice ownership affects participation with quality improvement external facilitation: findings from EvidenceNOW.
This study examined how practice ownership influences participation in external facilitation using data from EvidenceNOW. The authors collected data from practices on practice characteristics and ownership type via surveys and from facilitators on the number of hours, encounters, and months each practice had with a facilitator via facilitation logs. Semi-structured interviewers with EvidenceNOW leadership (n = 12) and facilitators (n = 51) were conducted, and facilitators (n = 64) were observed for patterns of facilitation. In the fully adjusted model, differences by ownership were non-significant. Federally Qualified Health Centers (FQHCs) however, had significantly less participation in facilitation than clinician-owned practices for the measures number of encounters and number of months with encounters.
AHRQ-funded; HS023940.
Citation: Perry CK, Linder S, Hall J .
How type of practice ownership affects participation with quality improvement external facilitation: findings from EvidenceNOW.
J Gen Intern Med 2022 Mar;37(4):793-801. doi: 10.1007/s11606-021-07204-7..
Keywords: Quality Improvement, Quality of Care, Primary Care, Practice Improvement
Pestka DL, White KM, DeRoche KK
'Trying to fly the plane while we were building it'. applying a learning health systems approach to evaluate early-stage barriers and facilitators to implementing primary care transformation: a qualitative study.
This study’s objective was to examine the use of a learning health system (LHS) in primary care transformation (PCT) by utilizing the Consolidated Framework for Implementation Research (CFIR) to categorize implementation lessons. A large integrated health delivery system in Minnesota began implementation of a population management PCT in two of its 40 primary care clinics in May 2019. Semistructured qualitative interviews were conducted and observational field notes were taken. Inductive coding of the data was performed, and resultant codes were mapped to the CFIR. Seventeen codes emerged to describe care team members from the two clinics to adopt PCT occurring in each of the five CFIR domains (intervention characteristics, outer setting, inner setting, characteristics of individuals and process), with most codes occurring in the ‘inner setting’ domain.
AHRQ-funded; HS026379.
Citation: Pestka DL, White KM, DeRoche KK .
'Trying to fly the plane while we were building it'. applying a learning health systems approach to evaluate early-stage barriers and facilitators to implementing primary care transformation: a qualitative study.
BMJ Open 2022 Jan 3;12(1):e053209. doi: 10.1136/bmjopen-2021-053209..
Keywords: Learning Health Systems, Health Systems, Primary Care, Practice Improvement
Hemler JR, Edwards ST, Valenzuela S
The effects of major disruptions on practice participation in facilitation during a primary care quality improvement initiative.
This study explored the relationship between disruptions in primary care practices and practice participation in facilitated quality improvement (QI). Using data from EvidenceNOW, findings showed that disruptions are prevalent in primary care, but practices can continue participating in QI interventions, particularly when supported by a facilitator.
AHRQ-funded; HS023940.
Citation: Hemler JR, Edwards ST, Valenzuela S .
The effects of major disruptions on practice participation in facilitation during a primary care quality improvement initiative.
J Am Board Fam Med 2022 Jan-Feb;35(1):124-39. doi: 10.3122/jabfm.2022.01.210205..
Keywords: Primary Care, Practice Improvement, Quality Improvement, Quality of Care, Workforce
Quigley DD, Qureshi N, Slaughter ME
Provider and coach perspectives on implementing shadow coaching to improve provider-patient interactions.
Healthcare organizations want to improve patient care experiences. Some use 'shadow coaching' to improve interactions between providers and patients. In this study, the investigators aimed to characterize lessons and barriers to implementing shadow coaching as a mechanism to improve interactions with patients and change organizational culture. The investigators concluded that regular messaging by leadership about the priority and purpose of shadow coaching was essential for both physician engagement and its mature implementation across the organization.
AHRQ-funded; HS025920.
Citation: Quigley DD, Qureshi N, Slaughter ME .
Provider and coach perspectives on implementing shadow coaching to improve provider-patient interactions.
J Eval Clin Pract 2021 Dec;27(6):1381-89. doi: 10.1111/jep.13575..
Keywords: Clinician-Patient Communication, Patient Experience, Practice Improvement
Linzer M, Neprash H, Brown R
Where trust flourishes: perceptions of clinicians who trust their organizations and are trusted by their patients.
Investigators sought to determine perceived characteristics of clinics by clinicians who trust their organizations and whose patients have trust in them. Baseline data was obtained from the Healthy Work Place trial and included 165 clinicians with 1,132 patients. They found that high clinician-high patient trust occurred when clinicians perceived their organizational cultures to have (1) an emphasis on quality, (2) an emphasis on communication and information, (3) cohesiveness among clinicians, and (4) values alignment between clinicians and leaders.
AHRQ-funded; HS018160.
Citation: Linzer M, Neprash H, Brown R .
Where trust flourishes: perceptions of clinicians who trust their organizations and are trusted by their patients.
Ann Fam Med 2021 Nov-Dec;19(6):521-26. doi: 10.1370/afm.2732..
Keywords: Practice Improvement, Quality Improvement, Quality of Care
Khodyakov D, Buttorff C, Xenakis L
Alignment between objective and subjective assessments of health system performance: findings from a mixed-methods study.
This study was a survey of health system executives to examine whether their performance assessments match objective performance assessments and qualitatively explore ways to achieve high performance. Interviews were conducted with 138 C-suite executives of 24 health systems in California, Minnesota, Washington, and Wisconsin between 2017 and 2019. The interviews were focused on executives’ perceptions of their own health system’s performance and factors they perceived generally contributed to high performance. The authors grouped health systems based on objective performance levels used in sampling and compared the ratings to executives’ subjective performance assessments. There was poor agreement between objective and subjective performance assessments. Executives whose views were inconsistent with objective assessments did not cite clinical care quality as their basis for their assessment but focused instead on market competition, financial performance, and high customer satisfaction and loyalty. Executives who cited clinical quality metrics had subjective ratings consistent with objective ratings.
AHRQ-funded; HS024067.
Citation: Khodyakov D, Buttorff C, Xenakis L .
Alignment between objective and subjective assessments of health system performance: findings from a mixed-methods study.
J Healthc Manag 2021 Sep-Oct;66(5):380-94. doi: 10.1097/jhm-d-20-00249..
Keywords: Health Systems, Quality of Care, Practice Improvement, Provider Performance
Ye J, Zhang R, Bannon JE
Identifying practice facilitation delays and barriers in primary care quality improvement.
Practice facilitation is an effective approach to implementing quality improvement (QI) interventions in practice-based research networks (PBRNs). Regular facilitator-practice interactions are necessary for successful facilitation and missed engagements may hinder the process of practice improvement. This study employed a mixed-methods approach to characterize the dynamics of practice facilitation and examine facilitation delays and barriers, as well as their association with the achievement of QI program goals in a PBRN initiative.
AHRQ-funded; HS023921.
Citation: Ye J, Zhang R, Bannon JE .
Identifying practice facilitation delays and barriers in primary care quality improvement.
J Am Board Fam Med 2020 Sep-Oct;33(5):655-64. doi: 10.3122/jabfm.2020.05.200058..
Keywords: Practice Improvement, Primary Care, Quality Improvement, Quality of Care
Quigley DD, Slaughter M, Qureshi N
Practices and changes associated with patient-centered medical home transformation.
Knowing which patient-centered medical home (PCMH) care delivery changes and quality improvement (QI) practices further PCMH implementation is essential. In this study, the investigators used the 2008-2017 National Committee of Quality Assurance (NCQA) PCMH directory of 15,188 primary care practices that received Level 1, 2, or 3 NCQA PCMH recognition to: 1.) construct a stratified national sample of 105 practices engaged in PCMH transformation and 2.) examine their QI practices and PCMH changes associated with PCMH transformation.
AHRQ-funded; HS016980; HS025920.
Citation: Quigley DD, Slaughter M, Qureshi N .
Practices and changes associated with patient-centered medical home transformation.
Am J Manag Care 2021 Sep;27(9):386-93. doi: 10.37765/ajmc.2021.88740..
Keywords: Patient-Centered Healthcare, Primary Care, Practice Improvement, Healthcare Delivery, Quality Improvement, Quality of Care
Quigley DD, Qureshi N, AlMasarweh L
Using CAHPS patient experience data for patient-centered medical home transformation.
The purpose of this study was to examine how primary care practices used the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and its patient-centered medical home (PCMH) items during their PCMH transition. The investigators concluded that CAHPS surveys were considered actionable for PCMH transformation and used in standardizing and coordinating care. The CAHPS PCMH items were considered integral to the continuous QI needed for moving beyond formal PCMH recognition and maximizing transformation.
AHRQ-funded; HS016980; HS025920.
Citation: Quigley DD, Qureshi N, AlMasarweh L .
Using CAHPS patient experience data for patient-centered medical home transformation.
Am J Manag Care 2021 Sep;27(9):e322-e29. doi: 10.37765/ajmc.2021.88745..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Experience, Patient-Centered Healthcare, Primary Care, Practice Improvement, Healthcare Delivery, Quality Improvement, Quality of Care
Berry CA, Nguyen AM, Cuthel AM
Measuring implementation strategy fidelity in HealthyHearts NYC: a complex intervention using practice facilitation in primary care.
This study measured implementation strategy fidelity for the HealthyHearts NYC intervention program, an AHRQ-funded program that uses practice facilitation (PF) to improve adoption of cardiovascular disease evidence-based guidelines in primary care practices. Data from 257 practices measured fidelity using 4 categories: frequency, duration, content, and coverage. Almost all (94.2%) of practices received at least the 13 PF visits with an average 26.3 hours spent at each site by facilitators. Most practices (95.7%) completed all Task List items, and 71.2% were educated on all Chronic Care Models, with the majority (65.8%) receiving full coverage.
AHRQ-funded; HS023922.
Citation: Berry CA, Nguyen AM, Cuthel AM .
Measuring implementation strategy fidelity in HealthyHearts NYC: a complex intervention using practice facilitation in primary care.
Am J Med Qual 2021 Jul-Aug;36(4):270-76. doi: 10.1177/1062860620959450..
Keywords: Implementation, Heart Disease and Health, Cardiovascular Conditions, Primary Care, Practice Improvement, Quality Improvement, Quality of Care, Evidence-Based Practice, Patient-Centered Outcomes Research, Primary Care: Models of Care
Fagnan LJ, Ramsey K, Kline T
Place matters: closing the gap on rural primary care quality improvement capacity-the Healthy Hearts Northwest study.
This study compared rural independent and health system primary care practices with urban practices to external practice facilitation support in terms of recruitment, readiness, engagement, retention, and change in quality improvement (QI) capacity and quality metric performing. The Healthy Hearts Northwest quality improvement initiative consisting of 135 small or medium-sized primary care practices were used. The practices were stratified by geography, rural or urban, and by ownership. Changes in 3 clinical quality measures (CQMs): appropriate aspirin use, blood pressure (BP) control, and tobacco use screening, were measured at baseline in 2015 and follow-up in 2017. Rural practices were more likely to enroll than urban practices. Rural independent practices had the lowest QI capacity at baseline, making the largest gain in establishing a regular QI process. They made the greatest improvement in meeting the BP control CQM and the smoking cessation metric, from 72.3% to 86.7%.
AHRQ-funded; HS023908; HS023921.
Citation: Fagnan LJ, Ramsey K, Kline T .
Place matters: closing the gap on rural primary care quality improvement capacity-the Healthy Hearts Northwest study.
J Am Board Fam Med 2021 Jul-Aug;34(4):753-61. doi: 10.3122/jabfm.2021.04.210011..
Keywords: Rural Health, Primary Care, Primary Care: Models of Care, Practice Improvement, Quality Improvement, Quality of Care, Heart Disease and Health, Cardiovascular Conditions
Walunas TL, Ye J, Bannon J
Does coaching matter? Examining the impact of specific practice facilitation strategies on implementation of quality improvement interventions in the Healthy Hearts in the Heartland study.
Practice facilitation is a multicomponent implementation strategy used to improve the capacity for practices to address care quality and implementation gaps. In this study, the investigators sought to assess whether practice facilitators use of coaching strategies aimed at improving self-sufficiency were associated with improved implementation of quality improvement (QI) interventions in the Healthy Hearts in the Heartland Study.
AHRQ-funded; HS023921.
Citation: Walunas TL, Ye J, Bannon J .
Does coaching matter? Examining the impact of specific practice facilitation strategies on implementation of quality improvement interventions in the Healthy Hearts in the Heartland study.
Implement Sci 2021 Mar 31;16(1):33. doi: 10.1186/s13012-021-01100-8..
Keywords: Practice Improvement, Quality Improvement, Quality of Care, Implementation, Heart Disease and Health, Cardiovascular Conditions
Solberg LI, Kuzel A, Parchman ML
A taxonomy for external support for practice transformation.
There is no commonly accepted comprehensive framework for describing the practical specifics of external support for practice change. In this study, the researchers’goal was to develop a taxonomy that could be used by both external groups or researchers and health care leaders. The leaders of 8 grants from Agency for Research and Quality for the EvidenceNOW study of improving cardiovascular preventive services in over 1500 primary care practices nationwide worked collaboratively over 18 months to develop descriptions of key domains that might comprehensively characterize any external support intervention.
AHRQ-funded; HS023940.
Citation: Solberg LI, Kuzel A, Parchman ML .
A taxonomy for external support for practice transformation.
J Am Board Fam Med 2021 Jan-Feb;34(1):32-39. doi: 10.3122/jabfm.2021.01.200225..
Keywords: Primary Care, Healthcare Delivery, Cardiovascular Conditions, Evidence-Based Practice, Prevention, Quality Improvement, Practice Improvement, Quality of Care
Varley AL, Kripalani S, Spain T
Understanding factors influencing quality improvement capacity among ambulatory care practices across the MidSouth region: an exploratory qualitative study.
Success in choosing and implementing quality metrics, necessary in a value-based care model, depends on quality improvement (QI) capacity-the shared knowledge, understanding, and commitment to continuous improvement. In this study, the investigators set out to explore factors influencing QI capacity among ambulatory care practices in the MidSouth Practice Transformation Network. Their findings provide insight into factors influencing the adoption and implementation of QI metrics across a diverse group of ambulatory care practices.
AHRQ-funded; HS013852.
Citation: Varley AL, Kripalani S, Spain T .
Understanding factors influencing quality improvement capacity among ambulatory care practices across the MidSouth region: an exploratory qualitative study.
Qual Manag Health Care 2020 Jul/Sep;29(3):136-41. doi: 10.1097/qmh.0000000000000255..
Keywords: Quality Improvement, Quality of Care, Ambulatory Care and Surgery, Practice Improvement
Sweeney SM, Hemler JR, Baron AN
Dedicated workforce required to support large-scale practice improvement.
Facilitation is an effective approach for helping practices implement sustainable evidence-based practice improvements. Few studies examine the facilitation infrastructure and support needed for large-scale dissemination and implementation initiatives. In this paper, the authors discuss a project by the Agency for Health care Research and Quality in which it funded 7 Cooperatives, each of which worked with over 200 primary care practices to rapidly disseminate and implement improvements in cardiovascular preventive care.
AHRQ-funded; HS023940.
Citation: Sweeney SM, Hemler JR, Baron AN .
Dedicated workforce required to support large-scale practice improvement.
J Am Board Fam Med 2020 Mar-Apr;33(2):230-39. doi: 10.3122/jabfm.2020.02.190261..
Keywords: Practice Improvement, Primary Care, Cardiovascular Conditions, Healthcare Delivery, Quality Improvement, Quality of Care, Prevention, Implementation, Evidence-Based Practice
Kaufman A, Dickinson WP, Fagnan LJ
The role of health extension in practice transformation and community health improvement: lessons from 5 case studies.
The states of New Mexico, Oklahoma, Oregon, Colorado, and Washington stand out in stretching the boundaries of health extension; their stories reveal lessons learned regarding the successes and challenges. All states saw the need for long-term, sustained fundraising beyond grants in an environment expecting a short-term return on investment, and they were challenged operating in a shifting health system landscape where the creativity and personal relationships built with small primary care practices was hindered when these practices were purchased by larger health delivery systems.
AHRQ-funded; HS020890; HS020972; HS23904; HS023908.
Citation: Kaufman A, Dickinson WP, Fagnan LJ .
The role of health extension in practice transformation and community health improvement: lessons from 5 case studies.
Ann Fam Med 2019 Aug 12;17(Suppl 1):S67-s72. doi: 10.1370/afm.2409..
Keywords: Community-Based Practice, Health Services Research (HSR), Healthcare Delivery, Organizational Change, Primary Care, Social Determinants of Health, Practice Improvement
Wagner EH, LeRoy L, Schaefer J
How do innovative primary care practices achieve the quadruple aim?
The Patient-Centered Medical Home (PCMH) defines excellent primary care but there is little empiric evidence that helps practices, payers, or policy makers understand how high-performing practices have improved outcomes. This paper reports findings from 38 high-performing practices. The authors describe how these practices execute 8 functions that collectively meet patient needs.
AHRQ-authored.
Citation: Wagner EH, LeRoy L, Schaefer J .
How do innovative primary care practices achieve the quadruple aim?
J Ambul Care Manage 2018 Oct/Dec;41(4):288-97. doi: 10.1097/jac.0000000000000249..
Keywords: Primary Care, Patient-Centered Healthcare, Practice Improvement, Organizational Change, Patient-Centered Outcomes Research
Ono SS, Crabtree BF, Hemler JR
Taking innovation to scale in primary care practices: the functions of health care extension.
Health care extension is an approach to providing external support to primary care practices with the aim of diffusing innovation. EvidenceNOW was launched to rapidly disseminate and implement evidence-based guidelines for cardiovascular preventive care in the primary care setting. This article describes how cooperatives varied in their approaches to extension and provides early empirical evidence that health care extension is a feasible and potentially useful approach for providing quality improvement.
AHRQ-funded; HS023940.
Citation: Ono SS, Crabtree BF, Hemler JR .
Taking innovation to scale in primary care practices: the functions of health care extension.
Health Aff 2018 Feb;37(2):222-30. doi: 10.1377/hlthaff.2017.1100.
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Keywords: Primary Care, Implementation, Cardiovascular Conditions, Evidence-Based Practice, Healthcare Delivery, Practice Improvement, Quality Improvement, Quality of Care, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Prevention
Hoff T, Scott S
The strategic nature of individual change behavior: how physicians and their staff implement medical home care.
The purpose of this study was to gain insight into patient-centered medical home (PCMH) implementation at the workplace level by understanding better how primary care physicians and staff perceive, experience, and use certain types of PCMH work for adapting to new demands. The investigators indicated that the findings showed that particular forms of PCMH work not only advanced patient care in favorable ways but also enhanced individual and organizational capacity for adapting to this innovative model and its demands.
AHRQ-funded; HS020931.
Citation: Hoff T, Scott S .
The strategic nature of individual change behavior: how physicians and their staff implement medical home care.
Health Care Manage Rev 2017 Jul/Sep;42(3):226-36. doi: 10.1097/hmr.0000000000000109..
Keywords: Patient-Centered Healthcare, Primary Care, Organizational Change, Practice Improvement, Implementation
Quigley DD, Predmore ZS, Chen AY
Implementation and sequencing of practice transformation in urban practices with underserved patients.
Researchers conducted interviews at 14 primary care practices undergoing patient-centered medical home (PCMH) transformation in a large urban federally qualified health center in California and used grounded theory to identify common themes and patterns. They concluded that full PCMH transformation took time and effort and relied on a sequential approach, with an early focus on foundational changes that included use of a robust quality improvement strategy.
AHRQ-funded; HS000029.
Citation: Quigley DD, Predmore ZS, Chen AY .
Implementation and sequencing of practice transformation in urban practices with underserved patients.
Qual Manag Health Care 2017 Jan/Mar;26(1):7-14. doi: 10.1097/qmh.0000000000000118.
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Keywords: Patient-Centered Healthcare, Urban Health, Vulnerable Populations, Practice Improvement, Organizational Change, Quality Improvement, Quality of Care, Primary Care, Healthcare Delivery, Implementation, Teams
Rodriguez HP, Chen X, Martinez AE
Availability of primary care team members can improve teamwork and readiness for change.
Researchers conducted a survey of adult primary care providers and staff in California safety net practices to assess primary care team structure (team size, team member availability, and access to interdisciplinary expertise), teamwork, and readiness for change. Greater team member availability was associated with greater readiness for change, but the relationship was stronger for staff than for primary care providers.
AHRQ-funded; HS020120.
Citation: Rodriguez HP, Chen X, Martinez AE .
Availability of primary care team members can improve teamwork and readiness for change.
Health Care Manage Rev 2016 Oct-Dec;41(4):286-95. doi: 10.1097/hmr.0000000000000082.
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Keywords: Primary Care, Teams, Patient-Centered Healthcare, Organizational Change, Practice Improvement
