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Fraze TK, Beidler LB, Gottlieb LM. A Missed Opportunity? How Health Care Organizations Engage Primary Care Clinicians in Formal Social Care Efforts. Popul Health Manag 2022; 25:509-516. [PMID: 35196116 PMCID: PMC9419929 DOI: 10.1089/pop.2021.0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Health care organizations increasingly recognize the impact of social needs on health outcomes. As organizations develop and scale efforts to address social needs, little is known about the optimal role for clinicians in providing social care. In this study, the authors aimed to understand how health care organizations involve clinicians in formal social care efforts. In 2019, the authors conducted 33 semi-structured interviews with administrators at 29 health care organizations. Interviews focused on the development and implementation of formal social care programs within the health care organization and the role of clinicians within those programs. A few administrators described formal roles for primary care clinicians in organizational efforts to deliver social care. Administrators frequently described programs that were deliberately structured to shield clinicians (eg, clinicians were not expected to review social risk screening results or be involved in addressing social needs). The authors identified 4 ways that administrators felt clinicians could meaningfully engage in social care programs: (1) discuss social risks to strengthen relationships with patients; (2) adjust clinical care follow-up plans based on social risks; (3) modify prescriptions based on social risks; and (4) refer patients to other care team members who can directly assist with social risks. Administrators were hesitant to increase primary care clinicians' responsibilities by tasking them with social care activities. Defining appropriate and scalable roles for clinicians along with adequate support from other care team members may increase the effectiveness of social care programs.
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Affiliation(s)
- Taressa K Fraze
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California, USA.,Healthforce Center, University of California San Francisco, San Francisco, California, USA.,Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Laura B Beidler
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Laura M Gottlieb
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California, USA
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2
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McManus LS, Dominguez-Cancino KA, Stanek MK, Leyva-Moral JM, Bravo-Tare CE, Rivera-Lozada O, Palmieri PA. The Patient-centered Medical Home as an Intervention Strategy for Diabetes Mellitus: A Systematic Review of the Literature. Curr Diabetes Rev 2021; 17:317-331. [PMID: 33231158 DOI: 10.2174/1573399816666201123103835] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/09/2020] [Accepted: 10/16/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Poorly managed diabetes mellitus increases health care expenditures and negatively impacts health outcomes. There are 34 million people living with diabetes in the United States with a direct annual medical cost of $237 billion. The patient-centered medical home (PCMH) was introduced to transform primary care by offering team-based care that is accessible, coordinated, and comprehensive. Although the PCMH is believed to address multiple gaps in delivering care to people living with chronic diseases, the research has not yet reported clear benefits for managing diabetes. OBJECTIVE The study reviews the scientific literature about diabetes mellitus outcomes reported by PCMHs, and understands the impact of team-based care, interdisciplinary communication, and care coordination strategies on the clinical, financial, and health-related outcomes. METHODS The systematic review was performed according to the Cochrane method and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Eight databases were systematically searched for articles. The Oxford Centre for Evidence-based Medicine Levels of evidence and the Critical Appraisal Skills Programme systematic review checklist were used to evaluate the studies. RESULTS The search resulted in 596 articles, of which 24 met all the inclusion criteria. Care management resulted in more screenings and better preventive care. Pharmacy-led interventions and technology were associated with positive clinical outcomes, decreased utilization, and cost savings. Most studies reported decreased emergency room visits and less inpatient admissions. CONCLUSION The quality and strength of the outcomes were largely inconclusive about the overall effectiveness of the PCMH. Defining and comparing concepts across studies was difficult as universal definitions specific to the PCMH were not often applied. More research is needed to unpack the care model of the PCMH to further understand how the individual key components, such as care bundles, contribute to improved outcomes. Further evaluations are needed for team-based care, communication, and care coordination with comparisons to patient, clinical, health, and financial outcomes.
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Affiliation(s)
- Lisa S McManus
- College of Nursing, Walden University, Minneapolis, United States
| | - Karen A Dominguez-Cancino
- Escuela de Enfermería, Universidad Científica del Sur, Lima, Peru
- Evidence-Based Health Care South America: A Joanna Briggs Institute Affiliated Group, Lima, Peru
| | - Michele K Stanek
- Family & Preventive Medicine, School of Medicine, University of South Carolina, Columbia, United States
| | - Juan M Leyva-Moral
- Evidence-Based Health Care South America: A Joanna Briggs Institute Affiliated Group, Lima, Peru
- Department d'Infermeria, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center for Global Nursing, Texas Woman’s University, Houston, United States
| | - Carola E Bravo-Tare
- Evidence-Based Health Care South America: A Joanna Briggs Institute Affiliated Group, Lima, Peru
| | - Oriana Rivera-Lozada
- Evidence-Based Health Care South America: A Joanna Briggs Institute Affiliated Group, Lima, Peru
- Vicerrectorado de Investigación, Universidad Norbert Wiener, Lima, Peru
| | - Patrick A Palmieri
- College of Nursing, Walden University, Minneapolis, United States
- Evidence-Based Health Care South America: A Joanna Briggs Institute Affiliated Group, Lima, Peru
- Center for Global Nursing, Texas Woman’s University, Houston, United States
- Vicerrectorado de Investigación, Universidad Norbert Wiener, Lima, Peru
- College of Graduate Health Studies, A. T. Still University, Kirksville, United States
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Nothelle S, Wolff J, Nkodo A, Litman J, Dunbar L, Boyd C. "It's Tricky": Care Managers' Perspectives on Interacting with Primary Care Clinicians. Popul Health Manag 2020; 24:338-344. [PMID: 32758066 DOI: 10.1089/pop.2020.0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Care management programs that facilitate collaboration between care managers and primary care clinicians are more likely to be successful in improving chronic disease metrics than programs that do not facilitate such collaboration. The authors sought to understand care managers' perspectives on interacting with primary care clinicians. Semi-structured qualitative interviews were conducted with care managers (n = 29) from 3 health systems in and around a large, urban academic center. Interviews were audio recorded, transcribed verbatim, and iteratively analyzed using a grounded theory approach. Care managers worked for health plans (14%), outpatient specialty clinics (31%), hospitals and emergency departments (24%), and primary care offices (14%). Care managers identified the primary care clinician as leading patients' care and as essential to avoiding unnecessary utilization. Care managers described variability in and barriers to interacting with primary care clinicians. When possible, care managers use the electronic medical record to facilitate interaction rather than communicating directly (eg, phone call) with primary care clinicians. The role of the care manager varied across programs, contributing to primary care clinicians' poor understanding of what the care manager could provide. Consequently, primary care clinicians asked the care manager for help with tasks beyond his/her role. Care managers felt inferior to primary care clinicians, a potential result of the traditional medical hierarchy, which also hindered interactions. Although care managers view interactions with the primary care clinician as essential to the health of the patient, communication challenges, variability of the care manager's role, and medical hierarchy limit collaboration.
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Affiliation(s)
- Stephanie Nothelle
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Amelie Nkodo
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jessica Litman
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Linda Dunbar
- Johns Hopkins HealthCare, Baltimore, Maryland, USA
| | - Cynthia Boyd
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Strategies for Delivering Value-Based Care: Do Care Management Practices Improve Hospital Performance? J Healthc Manag 2019; 64:430-444. [PMID: 31725571 DOI: 10.1097/jhm-d-18-00049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
EXECUTIVE SUMMARY Value-based payment has the potential to rein in the volume incentive inherent in fee-for-service payment by holding providers accountable for the quality of patient care they deliver. Success under the new payment structure will depend on how effectively key organizational reforms are embraced by providers in the implementation of quality improvement processes for care delivery. This study examined the relationship between implementation of care management processes (CMPs, the specific tactics that enable the practice of value-based care) and hospital performance under value-based payment. Using the American Hospital Association's Survey of Care Systems and Payment and the Centers for Medicare & Medicaid Services' Hospital Compare, we estimated the relationship between hospital implementation of CMPs and performance as it relates to spending, patient satisfaction, readmission reduction, value-based purchasing, and clinical care outcomes. We found that hospitals increased implementation of CMPs from 2013 to 2014, which has led to modest changes in performance. We concluded that care coordination is associated with greater improvements in hospital performance. However, the long-term effects of resulting changes in care delivery may differ from the short-term effects. Thus, study findings underscore the importance of continued evaluation of care management practice as a strategy for optimizing delivery of high-quality, efficient patient care.
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Implementing Comprehensive Primary Care Referral Tracking in a Patient-Centered Medical Home. J Nurs Care Qual 2018; 33:255-262. [PMID: 29790864 DOI: 10.1097/ncq.0000000000000283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Patient-Centered Medical Home care model emphasizes efficient, coordinated care distributed among interdisciplinary team members. One key function to care coordination is referral/test tracking. This study evaluated the referral practices in a nurse-managed Patient-Centered Medical Home primary care clinic. The major findings corroborate the need for a well-organized referral-tracking system that is centralized and contains safety nets to reduce the number of delayed or missed referrals.
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Holtrop JS, Ruland S, Diaz S, Morrato EH, Jones E. Using Social Network Analysis to Examine the Effect of Care Management Structure on Chronic Disease Management Communication Within Primary Care. J Gen Intern Med 2018; 33:612-620. [PMID: 29313225 PMCID: PMC5910335 DOI: 10.1007/s11606-017-4247-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 07/19/2017] [Accepted: 11/17/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Care management and care managers are becoming increasingly prevalent in primary care medical practice as a means of improving population health and reducing unnecessary care. Care managers are often involved in chronic disease management and associated transitional care. In this study, we examined the communication regarding chronic disease care within 24 primary care practices in Michigan and Colorado. We sought to answer the following questions: Do care managers play a key role in chronic disease management in the practice? Does the prominence of the care manager's connectivity within the practice's communication network vary by the type of care management structure implemented? METHODS Individual written surveys were given to all practice members in the participating practices. Survey questions assessed demographics as well as practice culture, quality improvement, care management activities, and communication regarding chronic disease care. Using social network analysis and other statistical methods, we analyzed the communication dynamics related to chronic disease care for each practice. RESULTS The structure of chronic disease communication varies greatly from practice to practice. Care managers who were embedded in the practice or co-located were more likely to be in the core of the communication network than were off-site care managers. These care managers also had higher in-degree centrality, indicating that they acted as a hub for communication with team members in many other roles. DISCUSSION Social network analysis provided a useful means of examining chronic disease communication in practice, and highlighted the central role of care managers in this communication when their role structure supported such communication. Structuring care managers as embedded team members within the practice has important implications for their role in chronic disease communication within primary care.
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Affiliation(s)
- Jodi Summers Holtrop
- Department of Family Medicine, School of Medicine , University of Colorado Denver, Aurora, CO, USA.
| | - Sandra Ruland
- Department of Family Medicine, School of Medicine , University of Colorado Denver, Aurora, CO, USA
| | - Stephanie Diaz
- Department of Family Medicine, School of Medicine , University of Colorado Denver, Aurora, CO, USA
| | - Elaine H Morrato
- Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | - Eric Jones
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
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Gabutti I, Mascia D, Cicchetti A. Exploring "patient-centered" hospitals: a systematic review to understand change. BMC Health Serv Res 2017; 17:364. [PMID: 28532463 PMCID: PMC5439229 DOI: 10.1186/s12913-017-2306-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/11/2017] [Indexed: 11/23/2022] Open
Abstract
Background The healthcare scenario in developed countries is changing deeply: patients, who are frequently affected by multi-pathological chronic conditions, have risen their expectations. Simultaneously, there exist dramatic financial pressures which require healthcare organizations to provide more and better services with equal (or decreasing) resources. In response to these challenges, hospitals are facing radical transformations by bridging, redesigning and engaging their organization and staff. Methods This study has the ambitious aim to shed light and clearly label the trends of change hospitals are enhancing in developed economies, in order to fully understand the presence of common trends and which organizational models and features are inspiring the most innovative organizations. The purpose is to make stock of what is known in the field of hospital organization about how hospitals are changing, as well as of how such change may be implemented effectively through managerial tools. To do so the methodology adopted integrates a systematic literature review to a wider engaged research approach. Results Evidence suggests that the three main pillars of change of the system are given by the progressive patient care model, the patient-centered approach and the lean approach. However, there emerge a number of gaps in what is known about how to exploit drivers of change and their effects. Conclusions This study confirms that efforts in literature are concentrated in analyzing circumscribed experiences in the implementation of new models and approaches, failing therefore to extend the analysis at the organizational and inter-organizational level in order to legitimately draw consequences to be generalized. There seem to be a number of “gaps” in what is known about how to exploit drivers of change and their effects, suggesting that the research approach privileged till now fails in providing a clear guidance to policy makers and to organizations’ management on how to concretely and effectively implement new organizational models. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2306-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Irene Gabutti
- Department of management, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy.
| | - Daniele Mascia
- Department of Management, University of Bologna, Bologna, Italy
| | - Americo Cicchetti
- Department of management, Università Cattolica del Sacro Cuore, Rome, 00168, RM, Italy
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A comparison of care management delivery models on the trajectories of medical costs among patients with chronic diseases: 4-year follow-up results. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2016. [DOI: 10.1007/s10742-016-0160-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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9
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Holtrop JS, Potworowski G, Fitzpatrick L, Kowalk A, Green LA. Effect of care management program structure on implementation: a normalization process theory analysis. BMC Health Serv Res 2016; 16:386. [PMID: 27527614 PMCID: PMC4986276 DOI: 10.1186/s12913-016-1613-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 07/30/2016] [Indexed: 01/16/2023] Open
Abstract
Background Care management in primary care can be effective in helping patients with chronic disease improve their health status, however, primary care practices are often challenged with implementation. Further, there are different ways to structure care management that may make implementation more or less successful. Normalization process theory (NPT) provides a means of understanding how a new complex intervention can become routine (normalized) in practice. In this study, we used NPT to understand how care management structure affected how well care management became routine in practice. Methods Data collection involved semi-structured interviews and observations conducted at 25 practices in five physician organizations in Michigan, USA. Practices were selected to reflect variation in physician organizations, type of care management program, and degree of normalization. Data were transcribed, qualitatively coded and analyzed, initially using an editing approach and then a template approach with NPT as a guiding framework. Results Seventy interviews and 25 observations were completed. Two key structures for care management organization emerged: practice-based care management where the care managers were embedded in the practice as part of the practice team; and centralized care management where the care managers worked independently of the practice work flow and was located outside the practice. There were differences in normalization of care management across practices. Practice-based care management was generally better normalized as compared to centralized care management. Differences in normalization were well explained by the NPT, and in particular the collective action construct. When care managers had multiple and flexible opportunities for communication (interactional workability), had the requisite knowledge, skills, and personal characteristics (skill set workability), and the organizational support and resources (contextual integration), a trusting professional relationship (relational integration) developed between practice providers and staff and the care manager. When any of these elements were missing, care management implementation appeared to be affected negatively. Conclusions Although care management can introduce many new changes into delivery of clinical practice, implementing it successfully as a new complex intervention is possible. NPT can be helpful in explaining differences in implementing a new care management program with a view to addressing them during implementation planning. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1613-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jodi Summers Holtrop
- Department of Family Medicine, University of Colorado Denver School of Medicine, 12631 E. 17th Avenue, Mail stop F-496, Aurora, CO, 80045, USA.
| | - Georges Potworowski
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, Albany, NY, USA
| | - Laurie Fitzpatrick
- Department of Family Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | | | - Lee A Green
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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10
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Luo Z, Chen Q, Annis AM, Piatt G, Green LA, Tao M, Holtrop JS. A Comparison of Health Plan- and Provider-Delivered Chronic Care Management Models on Patient Clinical Outcomes. J Gen Intern Med 2016; 31:762-70. [PMID: 26951287 PMCID: PMC4907946 DOI: 10.1007/s11606-016-3617-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 08/31/2015] [Accepted: 02/01/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The real world implementation of chronic care management model varies greatly. One aspect of this variation is the delivery mode. Two contrasting strategies include provider-delivered care management (PDCM) and health plan-delivered care management (HPDCM). OBJECTIVE We aimed to compare the effectiveness of PDCM vs. HPDCM on improving clinical outcomes for patients with chronic diseases. DESIGN We used a quasi-experimental two-group pre-post design using the difference-in-differences method. PATIENTS Commercially insured patients, with any of the five chronic diseases-congestive heart failure, chronic obstructive pulmonary disease, coronary heart disease, diabetes, or asthma, who were outreached to and engaged in either PDCM or HPDCM were included in the study. MAIN MEASURES Outreached patients were those who received an attempted or actual contact for enrollment in care management; and engaged patients were those who had one or more care management sessions/encounters with a care manager. Effectiveness measures included blood pressure, low density lipoprotein (LDL), weight loss, and hemoglobin A1c (for diabetic patients only). Primary endpoints were evaluated in the first year of follow-up. KEY RESULTS A total of 4,000 patients were clustered in 165 practices (31 in PDCM and 134 in HPDCM). The PDCM approach demonstrated a statistically significant improvement in the proportion of outreached patients whose LDL was under control: the proportion of patients with LDL < 100 mg/dL increased by 3 % for the PDCM group (95 % CI: 1 % to 6 %) and 1 % for the HPDCM group (95 % CI: -2 % to 5 %). However, the 2 % difference in these improvements was not statistically significant (95 % CI: -2 % to 6 %). The HPDCM approach showed 3 % [95 % CI: 2 % to 6 %] improvement in overall diabetes care among outreached patients and significant reduction in obesity rates compared to PDCM (4 %, 95 % CI: 0.3 % to 8 %). CONCLUSIONS Both care management delivery modes may be viable options for improving care for patients with chronic diseases. In this commercially insured population, neither PDCM nor HPDCM resulted in substantial improvement in patients' clinical indicators in the first year. Different care management strategies within the provider-delivered programs need further investigation.
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Affiliation(s)
- Zhehui Luo
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA.
| | - Qiaoling Chen
- Department of Research and Evaluation, Kaiser Permanente Sourthen California, Pasadena, CA, USA
| | - Ann M Annis
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Gretchen Piatt
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Lee A Green
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Min Tao
- Clinical Epidemiology and Biostatistics, Blue Cross Blue Shield of Michigan, Detroit, MI, USA
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Holtrop JS, Potworowski G, Fitzpatrick L, Kowalk A, Green LA. Understanding effective care management implementation in primary care: a macrocognition perspective analysis. Implement Sci 2015; 10:122. [PMID: 26292670 PMCID: PMC4545994 DOI: 10.1186/s13012-015-0316-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 08/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Care management in primary care can be effective in helping patients with chronic disease improve their health status. Primary care practices, however, are often challenged with its implementation. Incorporating care management involves more than a simple physical process redesign to existing clinical care routines. It involves changes to who is working with patients, and consequently such things as who is making decisions, who is sharing patient information, and how. Studying the range of such changes in "knowledge work" during implementation requires a perspective and tools designed to do so. We used the macrocognition perspective, which is designed to understand how individuals think in dynamic, messy real-world environments such as care management implementation. To do so, we used cognitive task analysis to understand implementation in terms of such thinking as decision making, knowledge, and communication. METHODS Data collection involved semi-structured interviews and observations at baseline and at approximately 9 months into implementation at five practices in one physician-owned administratively connected group of practices in the state of Michigan, USA. Practices were intervention participants in a larger trial of chronic care model implementation. Data were transcribed, qualitatively coded and analyzed, initially using an editing approach and then a template approach with macrocognition as a guiding framework. RESULTS Seventy-four interviews and five observations were completed. There were differences in implementation success across the practices, and these differences in implementation success were well explained by macrocognition. Practices that used more macrocognition functions and used them more often were also more successful in care management implementation. CONCLUSIONS Although care management can introduce many new changes into the delivery of primary care clinical practice, implementing it successfully as a new complex intervention is possible. Macrocognition is a useful perspective for illuminating the elements that facilitate new complex interventions with a view to addressing them during implementation planning.
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Affiliation(s)
- Jodi Summers Holtrop
- Department of Family Medicine, University of Colorado Denver School of Medicine, 12631 E 17th Avenue, Mail Stop F496, Room 3505 Academic Office 1, Aurora, CO, 80045, USA.
| | - Georges Potworowski
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, Albany, NY, USA
| | - Laurie Fitzpatrick
- Department of Family Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | | | - Lee A Green
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
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Liyanage H, Correa A, Liaw ST, Kuziemsky C, Terry AL, de Lusignan S. Does Informatics Enable or Inhibit the Delivery of Patient-centred, Coordinated, and Quality-assured Care: a Delphi Study. A Contribution of the IMIA Primary Health Care Informatics Working Group. Yearb Med Inform 2015; 10:22-9. [PMID: 26123905 DOI: 10.15265/iy-2015-017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Primary care delivers patient-centred and coordinated care, which should be quality-assured. Much of family practice now routinely uses computerised medical record (CMR) systems, these systems being linked at varying levels to laboratories and other care providers. CMR systems have the potential to support care. OBJECTIVE To achieve a consensus among an international panel of health care professionals and informatics experts about the role of informatics in the delivery of patient-centred, coordinated, and quality-assured care. METHOD The consensus building exercise involved 20 individuals, five general practitioners and 15 informatics academics, members of the International Medical Informatics Association Primary Care Informatics Working Group. A thematic analysis of the literature was carried out according to the defined themes. RESULTS The first round of the analysis developed 27 statements on how the CMR, or any other information system, including paper-based medical records, supports care delivery. Round 2 aimed at achieving a consensus about the statements of round one. Round 3 stated that there was an agreement on informatics principles and structures that should be put in place. However, there was a disagreement about the processes involved in the implementation, and about the clinical interaction with the systems after the implementation. CONCLUSIONS The panel had a strong agreement about the core concepts and structures that should be put in place to support high quality care. However, this agreement evaporated over statements related to implementation. These findings reflect literature and personal experiences: whilst there is consensus about how informatics structures and processes support good quality care, implementation is difficult.
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Affiliation(s)
| | | | | | | | | | - S de Lusignan
- Simon de Lusignan, Department of Health Care Management & Policy, University of Surrey, GUILDFORD, Surrey GU2 7XH, UK, E-mail:
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Newton WP, Lefebvre A. Is a strategy focused on super-utilizers equal to the task of health care system transformation? No. Ann Fam Med 2015; 13:8-9. [PMID: 25583885 PMCID: PMC4291258 DOI: 10.1370/afm.1747] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Warren Polk Newton
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina North Carolina Area Health Education Centers, University of North Carolina, Chapel Hill, North Carolina
| | - Ann Lefebvre
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina North Carolina Area Health Education Centers, University of North Carolina, Chapel Hill, North Carolina
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