The association between team-based model of care characteristics and patient outcomes in community health centres: a systematic review

BACKGROUND: Community Health Centres (CHCs) are community-governed organizations often located in communities facing significant challenges with social determinants of health. To date, no review has summarized the evidence on the effects of team-based models of care on patient outcomes. The objective of this systematic review was to synthesize the evidence on the characteristics of interprofessional teams practicing in CHCs and their associations with patient outcomes. METHODS: A systematic review was conducted following the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. In October 2024, an electronic search was performed in five databases and the grey literature using a combination of descriptors and keywords. No restrictions were applied regarding language or year of publication. Screening and data extraction were independently conducted by two reviewers. The included papers focused on interprofessional teams composed of at least three different types of providers (e.g., physician, nurse, and nutritionist) practicing in CHCs and addressing at least one patient outcome (e.g., satisfaction, diabetes management). The risk of bias was assessed by two independent reviewers using the Joanna Briggs Institute checklist. RESULTS: From 6,309 identified papers, 36 papers were included. Most papers focused on team composition (n = 18) and staffing patterns (n = 8). Adjustments to staffing patterns-such as increasing full-time equivalents, expanding team size, and diversifying skill mixes-were associated with improved patient satisfaction and increased number of visits. Adding a chiropractor reduced opioid prescriptions and patient pain, while including a pharmacist improved hepatitis management and patient satisfaction. Inconsistent findings were observed regarding the inclusion of nurse practitioners and physician assistants in interprofessional teams and their impact on the number of patients seen in CHCs. Specialized interprofessional teams addressing diabetes, pain management, and childhood obesity had better health outcomes and care management compared to standard care, highlighting the value of tailored interprofessional collaboration in achieving improved health outcomes for specific populations. CONCLUSIONS: Specific team compositions are associated with improved health outcomes for the populations served by CHCs. Future research is needed to deepen the understanding of the associations between team composition, the type of care provided, and patients' clinical and psychosocial needs.