Project Overview: The FCT-AIMs grant has set out to uncover the program theory for team-based primary care (TBPC). Program Theory has been described well by Davidoff et al. Interventions that are developed and tested are generally required to stipulate the rationale and theory by which the intervention components lead to the proposed outcomes. This process ensures an accurate and comprehensive evaluation framework can be developed and used in the assessment process. While this is the norm for many interventions being evaluated for research purposes, this is not always the case for interventions that are recommended for roll out in health systems. This can happen for many reasons, one of which is that policy-recommended interventions are often faced with the challenge of combining many pieces of research evidence together to deliver care on a larger scale in more complex systems.
This is the case for TBPC, the typical Patient’s Medical Home model of TBPC is perhaps the most synonymous with what is being rolled out in NL. The overall model appears to be based on evidence of different types of TBPC that can lead to a variety of outcomes. However, the overall model lacks a robust program theory that describes the intervention components and activities in sufficient detail for replication and how they lead to improved outcomes within the quintuple aim. This can severely hamper implementation and resulting potential for improvement on outcomes. The first step to building a Program Theory is to map the literature of models of TBPC to identify any documented intervention rationales and produce a logic model. The second step is to document the empirical evidence of the theoretical relationships within the logic model to further validate it for widespread use or modifications.
My first project: to map the literature and build a program theory for TBPC.
Progress Update: The design for the systematic review proved difficult as defining the intervention of TBPC is not straightforward and lacks defining features that can be easily screened for in library databases. Other systematic and scoping reviews of TBPC to date have faced the same issues and are not sufficiently robust to capture all relevant literature. Rather, they tend to only “scratch the surface” without providing “actionable evidence”. To this end, our team decided that a “state of science” scoping review was required to provide actionable recommendations to move the evidence base forward in the right directions. This will be the most comprehensive scoping review on this topic to date. In order to capture all relevant literature, it has a sensitive search which retrieved 45,000 citations and we are working on ways to secure resources to complete the first of its kind TBPC scoping review. While this is underway, we are working on screening and synthesizing data from a subset of the articles identified in this search to provide a snapshot of what this type of scoping review will produce. We plan to share this at PRIFor 2026.
Below I have a slide that discusses my progress to date and a short audio recording of myself describing these reviews further.
Progress Slide with accompanying audio file below
Next Progress Update: My next progress update will be in early July
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