Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Creating and Sustaining Care Teams in Primary Care: Perspectives From Innovative Patient-Centered Medical Homes

Howard, Jenna, PhD; Miller, William L., MD, MA; Willard-Grace, Rachel, MPH; Burger, Elizabeth Stewart, PhD, MBA; Kelleher, Kelly J., MD, PhD; Nutting, Paul A., MD, MSPH; Hahn, Karissa A., MPH; Crabtree, Benjamin F., PhD

doi: 10.1097/QMH.0000000000000176
Quality Management in Primary Care

Objective: To learn from the experiences of innovative primary care practices that have successfully developed care teams.

Research Design: A 2½-day working conference was convened with representatives from 10 innovative primary care practices, content experts, and researchers to discuss experiences of developing care teams. Qualitative data included observation notes, transcripts of conference sessions and interviews, and narrative summaries of innovations. Case summaries of practices and an analysis matrix were created to identify common themes.

Participants: Ten practices known nationally for innovations in team-based care participated in the conference represented by 1 to 2 practice members.

Results: Two domains emerged related to creating effective teams and funding them. Participants emphasized the importance of making practice values explicit and involving everyone in the change process, standardizing routine processes, and mitigating resistance. They also highlighted that team-based care adds comprehensiveness, not necessarily productivity. They, thus, highlighted the need for a long-term financial vision, including resourcefulness and alternate funding.

Conclusions: Team-based care is possible and valuable in primary care. It is difficult to develop and sustain, however, and requires dedicated time and resources. The challenges these highly motivated practices described raise the question of feasibility for more average practices in the current funding environment.

Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey (Drs Howard and Crabtree); Lehigh Valley Health Network, One City Center, Allentown, Pennsylvania (Dr Miller); Department of Family Community Medicine, University of California San Francisco (Ms Willard-Grace); Sunflower Foundation: Health Care for Kansans, Topeka (Dr Stewart Burger); The Research Institute at Nationwide Children's Hospital, Columbus, Ohio (Dr Kelleher); and Department of Family Medicine, University of Colorado Health Sciences Center, Aurora (Dr Nutting).

Correspondence: Jenna Howard, PhD, Department of Family Medicine and Community Health, Institute for Health, Healthcare Policy and Aging Research, Rutgers Robert Wood Johnson Medical School, 112 Paterson St, Rm 339, New Brunswick, NJ 08901 (


This research was funded by the Agency for Healthcare Research and Quality.

No authors have any conflicts of interest to report.

© 2018Wolters Kluwer Health | Lippincott Williams & Wilkins