University of Utah - Care by Design Program

Program Location: 
Salt Lake City, UT
Number of Practices: 
Payer Type: 

Reported Outcomes


In 2003, the University of Utah Health Care Community Clinics (CCs) developed and initiated a series of research-informed, self-funded phases of practice redesign under the name Care by Design (CBD). CBD utilizes organizing principles of appropriate access, care teams (CTs) incorporating the efforts of advanced practice medical assistants, and planned care supported by a robust, augmented electronic medical record.

Care By Design consists of three components--the Care Team Model, Appropriate Access, and Planned Care--which allow community clinic providers to plan each patient's care from before they enter the clinic through postappointment follow-ups.

The Care Team model is a patient-centered collaboration between medical assistants (MAs) and physicians to minimize wait times and engage patients more in their own care. MAs assume a central role in "delivering" the visit, from greeting the patient and taking the medical history to drawing blood and documenting the physician's exam. 

Appropriate Access balances the needs of patients who want same-day appointments with those who have chronic illnesses and must be regularly seen and scheduled in advance. Planned Care uses evidence-based tools in electronic medical records to make each patient's visit more effective.

Fewer ED / Hospital Visits: 

Journal of Healthcare Quality (January 2015) (retrospective study of 118 patients)

  • all-cause 30-day hospital readmission rate decreased from 17.9% to 8.0%
  • mean time to hospital readmission within 180 days was delayed from 95 to 115 days
Improved Health: 

Annals of Family Medicine (May 2013)

  • Improvement across a number of clinical quality measures (see article for detailed results)
Improved Patient/Clinician Satisfaction: 

Annals of Family Medicine (May 2013)

  • Improvement in patient satisfaction: explanation of care, clinician instructions, likely to recommend, overall satisfaction
  • Improvement in clinician satisfaction: time spent working, relationship with patient 
Improved Access: 

Annals of Family Medicine (May 2013)

  • Decrease in wait time at clinic
Cost Savings: 

Annals of Family Medicine (May 2013)

For the composite scores based on team-based care, 2 measures of productivity and cost were statistically significant: 

  • Staff cost, clinician FTE (-0.94)
  • Visits/clinician FTE (-0.70)
Last updated February 2016
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