A Review and Synthesis of TBPCC Evaluation in Canada: Looking beyond the Quadruple Aim
Bibliographic record
Abstract
Abstract Background: The objectives of this article are: 1. To synthesize peer-reviewed evidence on the outcomes of team-based primary and community care (TBPCC) in Canada on Patient and Provider Experience, Population Health, and Health Care Costs (Quadruple Aim); 2. To introduce the TBPCC Evaluation Framework; and 3. To extend the critical interpretive synthesis to include the additional four domains from the TBPCC Evaluation Framework (i.e., Relationship Centred Care, Care Process and Quality, Team Function and TBC Foundations). Methods: We conducted a review of the following databases: Medline (OVID and PubMed), CINAHL, Embase, SportDiscus, and PsycINFO as well as an advanced search with Google Scholar (Title only) with the words “Canada AND primary AND team”. Review concepts included: population (patients), intervention (team-based primary health care), comparator (usual care, single practitioner delivery mode), outcome (patient and provider experience, population health, and health care costs), time (2000-present), and type (randomized controlled trials, controlled trials, quasi-experimental designs, and implementation studies/evaluations). We excluded reviews, opinion papers, laboratory-based studies, and studies based outside of Canada. Results: Forty-five publications met our inclusion criteria with the majority of these (34) from Central Canada. Results were initially mapped to the domains of the Quadruple Aim, with 51% (23/45) aligning. The additional domains from the TBPCC Evaluation Framework (Team Function, Relationship Centred Care, Care Process and Quality and Team-Based Care Foundations) and the Team-Based Care (TBC) Adoption Model were integrated into the synthesis. 100% of the included articles reported outcomes that aligned with the TBPCC Evaluation Framework. Conclusion: Across Canada, the value of relationships, shared understanding, communication, and coordination across teams are highlighted as is the potential of TBC to result in improvements in patient and provider experience, team function, and the quality of care. By encouraging a focus on formative as well as summative evaluation, the TBPCC Evaluation Framework provides a comprehensive approach to assessing the evidence needed to support actionable improvements for TBPCC in Canada. Trial Registration: To identify peer-reviewed literature, we followed standard review methodology and reporting guidelines as established by PRISMA. We registered our review on PROSPERO (2018 CRD42018091086).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.077 | 0.281 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.012 | 0.007 |
| Bibliometrics | 0.034 | 0.050 |
| Science and technology studies | 0.004 | 0.005 |
| Scholarly communication | 0.013 | 0.005 |
| Open science | 0.005 | 0.005 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".