Patient Function as a Health Indicator of Team-Based Primary Care: A Study of Why, What, and How for Health Leaders

Abstract

Background: Team-based care is core to primary care transformation initiatives aimed at strengthening primary care as the foundation of health systems to improve patient and provider experience, reduce healthcare costs, and improve health outcomes for patients. To assess impacts, performance measurement should include health indicators of patient health outcomes. Efforts to measure patient function, a biopsychosocial model of functioning and disability health, in primary care have been largely unsuccessful. This research aims to explore the concept of patient function as a health indicator of team-based primary care and how it can be practically measured to inform quality improvement. Methods and Results: The research was conducted through 3 concurrent phases. In phase 1, a qualitative study explored patients’ and primary care teams’ understanding of patient function and perspectives on the utility of function as a health indicator. The findings suggest patients and teams understand the concept of function, perceive value in function as a health indicator, and measurement and reporting of function should reflect the complex nature of primary care. In phase 2, a Delphi study was employed to identify patient function health indicators for use in in primary care. These findings suggest that identifying patient function health indicators in primary care is complex and all domains of function are important. Five valid and reliable measures of function were deemed to be appropriate and feasible health indicators in primary care, of which the SF-12 ranked the highest. In the third phase, 3 frameworks were described from the quality improvement and implementation science literature that health leaders could use to implement patient function health indicators to inform quality improvement for primary care teams. A quasi-fictitious case scenario was used to demonstrate how the frameworks could be practically used to develop theory-informed implementation strategies. Conclusion: Patient function health indicators are important to patients and primary care teams. There are valid patient-reported measures of function that can be used as health indicators in primary care. Healthcare leaders can use quality improvement and implementation science theory to inform effective strategies to implement patient function health indicators with primary care teams to drive quality improvement.