title: Building high functioning clinical teams through quality improvement initiatives.
abstract: BACKGROUND
  Team-based care has consistently been associated with improved clinical outcomes. However, strategies for promoting and sustaining a team-based approach in family medicine practice are more elusive.
  
  
  METHODS
  We conducted a longitudinal time series cohort study of 30 primary care providers in seven practices to assess the sequential addition of three different chronic disease management feedback reports over 24 months, culminating in a team-based quality improvement intervention linked to feedback, assessing clinical performance and self-reported effectiveness.
  
  
  RESULTS
  The proportion of patients at their low density lipoprotein target (<100 mg/dL) improved over the 24-month study period (P<0.001) but the rate of clinical improvement was more modest when feedback data were only presented at an individual and at a team level. When feedback reports were linked to a team-based quality improvement intervention, the results were more robust and were sustained for 12 months following the intervention cycle. Surveyed clinicians reported that the individual and team reports impacted both on their own practice approach and on team functioning.
  
  
  CONCLUSIONS
  These findings suggest a strategic role for clinical performance feedback linked to team initiated quality improvement initiatives for improving both clinical outcomes and clinical team-based care.
authors.affiliation: Chief, Primary Care, Providence VA Medical Center, Providence, RI, USA. thomas.o'toole@va.gov
authors.forename: Thomas P
authors.initials: TP
authors.lastname: O'Toole
authors.forename: Richard
authors.initials: R
authors.lastname: Cabral
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Blumen
authors.forename: Dawna A
authors.initials: DA
authors.lastname: Blake
mesh_terms: D001291:Attitude of Health Personnel; D002908:Chronic Disease; D006801:Humans; D008137:Longitudinal Studies; D010348:Patient Care Team / Q000592:standards* / Q000639:trends; D018802:Patient-Centered Care / Q000592:standards* / Q000639:trends; D011320:Primary Health Care / Q000592:standards* / Q000639:trends; D058996:Quality Improvement / Q000458:organization & administration* / Q000592:standards; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data