Primary care practice characteristics associated with team functioning in primary care settings in Canada: A practice-based cross-sectional survey

Team-based care is recognized as a foundational building block of high-performing primary care. The purpose of this study was to identify primary care practice characteristics associated with team functioning and examine whether there is relationship between team composition or size and team functioning. We sought to answer the following research questions: (1) are primary care practice characteristics associated with team functioning; and (2) does team composition or size influence team functioning. This cross-sectional correlational study was conducted in Fraser East, British Columbia, Eastern Ontario Health Unit, Ontario and Central Zone, Nova Scotia in Canada. Data were collected from primary care practices using an organization survey and the Team Climate Inventory (TCI) as a measure team functioning. The independent variables of interest were: physicians’ payment model, internal clinic meetings to discuss clinical issues, care coordination through informal and ad hoc exchange, care coordination through electronic medical records and sharing clinic mission, values and objectives among health professionals. Potentially confounding variables were as follows: team size, composition, and practice panel size. A total of 63 practices were included in these analyses. The overall mean score of team climate was 73 (SD: 10.75) out of 100. Regression analyses showed that care coordination through human interaction and sharing the practice’s mission, values, and objectives among health professionals were positively associated with higher functioning teams. Care coordination through electronic medical records and larger team size were negatively associated with team climate. This study provides baseline data on what practice characteristics are associated with highly functioning teams in Canada.团队照护（Team-based care）被公认为高质量初级保健的核心基石。本研究旨在识别与团队运作效能相关的初级保健诊疗机构特征，并探究团队构成或规模与团队运作效能之间是否存在关联，具体解答以下两项研究问题：（1）初级保健诊疗机构特征是否与团队运作效能相关；（2）团队构成或规模是否会对团队运作效能产生影响。本项横断面相关性研究的开展范围涵盖加拿大不列颠哥伦比亚省弗雷泽东部、安大略省东安大略卫生单位以及新斯科舍省中部地区。研究通过机构调查问卷与团队氛围量表（Team Climate Inventory, TCI）——用于评估团队运作效能——收集来自各初级保健诊疗机构的数据。本研究关注的自变量包括：医师薪酬模式、用于讨论临床议题的诊所内部会议、通过非正式及临时交流开展的照护协调、借助电子病历开展的照护协调，以及医疗专业人员之间共享诊疗机构的使命、价值观与目标。潜在混淆变量如下：团队规模、团队构成，以及诊疗机构服务面板规模。本次分析共纳入63家诊疗机构。团队氛围的总体平均得分为73分（标准差：10.75），满分100分。回归分析结果显示，通过人际互动开展的照护协调，以及医疗专业人员之间共享诊疗机构的使命、价值观与目标，均与更高水平的团队运作效能呈正相关。而借助电子病历开展的照护协调以及更大的团队规模，则与团队氛围呈负相关。本研究为加拿大境内与高绩效团队运作效能相关的诊疗机构特征提供了基线数据。