The primary care workforce is facing
imminent clinician shortages and increased demand. With the
implementation of the Affordable Care Act (ACA), Federally
Qualified Health Centers (FQHCs) are expected to play a major role
in addressing the large numbers of people who become eligible for
health insurance as well as continue in their role as safety net
providers. Thus, understanding new models of service delivery and
improving efficiency within FQHCs is of national policy import. The
proposed data collection supports the goal of developing a more
efficient FQHC service delivery model through studying outcomes
associated with a "delegate model," which is designed to improve
provider and team efficiency, and the spread of this model
throughout a large FQHC. Recent models of practice transformation
have documented the use of an Organized Team Model that distributes
responsibility for patient care among an interdisciplinary team,
thereby allowing physicians to manage a larger panel size while
practicing high quality care. The delegate model requires that all
team members perform at the top of their skill level, and that
tasks currently performed by clinicians are delegated to
non-clinician team members in a safe and effective manner.
Researchers at the University of California, San Francisco have
estimated that delegation may allow physicians to increase their
panel size by shifting tasks to non-physician team members. More
specifically, if portions of preventive and chronic care services
are delegated to non-physicians, primary care practices can meet
recommended quality and care guidelines while maintaining panel
sizes with a limited primary care physician workforce. This study
will examine the real-world implementation of such a model in order
to build evidence of whether such delegation can achieve the
predicted increases in panel sizes. AHRQ is working with John Snow,
Inc. (JSI) and its partner, Penobscot Community Health Center
(PCHC), to evaluate the effectiveness and spread of a delegate
model in 5 of PCHC's 15 primary care service sites. The model will
be spread from an initial pilot physician-medical assistant team to
other clinics, as well as to other teams within each clinic. PCHC
is an FQHC located in Bangor, Maine that serves northeastern Maine.
Currently, PCHC's primary care providers (PCPs, which include
medical doctors, osteopaths, nurse practitioners, and physician
assistants) each work with a Medical Assistant (MA). Under the
delegate model, a pair of PCPs will be assigned an "administrative"
MA to enhance their team. This position will enable shifting of
responsibilities among the team, with the intent of relieving the
PCPs of administrative tasks and incorporating new tasks that will
enhance team efficiency. Examples of tasks that an administrative
MA may take on include standardized prescription renewals, schedule
management, in-box management, scribing, pre-visit planning with
pre-appointment laboratory tests, and identification of patients
for ancillary referrals (e.g., behavioral health and case
management). This study has the following goals: 1) To evaluate the
spread and effectiveness of the delegate model in five of PCHC's
primary care sites; 2) To evaluate the influence of the delegate
model on provider satisfaction, team functioning, and patient
satisfaction; 3) To assess the contextual factors influencing the
above outcomes; and 4) To disseminate findings.
US Code:
42
USC 299 Name of Law: Healthcare and Quality Act of 1999
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.
Form 2 Key Informant Interview Guide (Phone Calls)
Supporting Statement Part B (05.29.14).doc
Key Informant Interview Guide (Phone Calls)