Assessing the Impact of Health System Ownership on Fulfilling the Vision of High-Quality Primary Care and Whole Health - TITLE: Assessing the Impact of Health System Ownership on Fulfilling the Vision of High-Quality Primary Care and Whole Health PROJECT SUMMARY The National Academies of Sciences, Engineering, and Medicine’s (NASEM) reports “Implementing High Quality Primary Care'' and “Achieving Whole Health: A New Approach for Veterans and the Nation'' call for coordinated systems level approaches to care.1,2 In response to these calls for action and stresses on primary care from the COVID pandemic and other market forces, primary care practices are increasingly owned by health systems. In Virginia we have documented that between 2018 and 2022 there was an increase from 25% to 43% of practices being owned by a health system with a concurrent decline in clinician ownership.3 These changes could both help (e.g., provide a systems level approach, expanded interprofessional teams, new resources) and/or undermine (e.g., reduce local decision-making authority, replace ambulatory focus with hospital interests, undermine organizational culture) the ability to achieve NASEM’s vision. We propose an explanatory sequential mixed-methods study using multimedia elicitation surveys and focus group interviews to assess the impact of ownership on high-quality primary care and whole health care and to describe contextual factors that may impact care. Building on our ongoing, longitudinal assessment of primary care in Virginia conducted in the Ambulatory Care Outcomes Research Network (ACORN), we will randomly sample 30 primary care practices throughout the state, stratified by practices that in the past 5 years (a) moved from clinician to hospital ownership, (b) stayed clinician owned, or (c) stayed hospital owned. The survey will consist of a brief multimedia presentation, developed in collaboration with the NASEM report authors, of the key elements of high-quality primary care and whole health, immediately followed by Likert scale questions to assess team members’ attitudes, current practice, and confidence in the ability to improve on these elements. The survey will be digitally administered with REDCap software to representatives of each clinical team member type. To develop the multimedia elicitation survey, we will work with the NASEM report authors and committee members to distill and operationalize core elements articulated in the reports, including questions on equity, accessibility, integration, interprofessional teamwork, professional satisfaction and team wellbeing, and community engagement. A practice structural questionnaire will also collect information on practice organization and staffing levels, patient volume and population demographics, payer mix, EHR capabilities, enhanced access options, and participation in innovative payment models. Follow-up group interviews with practice teams will reflect on team survey responses and assess the organizational, practice, and individual level factors influencing high-quality primary care and whole health care. Study findings will be used to further AHRQ’s mission of revitalizing the Nation’s primary care system, promote the NASEM vision of Whole Health in primary care, and develop future interventions to help primary care deliver high-quality and whole health care in diverse ownership settings.
