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Hershberger PJ, Pei Y, Bricker DA, Crawford TN, Shivakumar A, Castle A, Conway K, Medaramitta R, Rechtin M, Wilson JF. Motivational interviewing skills practice enhanced with artificial intelligence: ReadMI. BMC MEDICAL EDUCATION 2024; 24:237. [PMID: 38443862 PMCID: PMC10916112 DOI: 10.1186/s12909-024-05217-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 02/23/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Finding time in the medical curriculum to focus on motivational interviewing (MI) training is a challenge in many medical schools. We developed a software-based training tool, "Real-time Assessment of Dialogue in Motivational Interviewing" (ReadMI), that aims to advance the skill acquisition of medical students as they learn the MI approach. This human-artificial intelligence teaming may help reduce the cognitive load on a training facilitator. METHODS During their Family Medicine clerkship, 125 third-year medical students were scheduled in pairs to participate in a 90-minute MI training session, with each student doing two role-plays as the physician. Intervention group students received both facilitator feedback and ReadMI metrics after their first role-play, while control group students received only facilitator feedback. RESULTS While students in both conditions improved their MI approach from the first to the second role-play, those in the intervention condition used significantly more open-ended questions, fewer closed-ended questions, and had a higher ratio of open to closed questions. CONCLUSION MI skills practice can be gained with a relatively small investment of student time, and artificial intelligence can be utilized both for the measurement of MI skill acquisition and as an instructional aid.
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Affiliation(s)
- Paul J Hershberger
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
| | - Yong Pei
- Department of Computer Science, College of Computing and Software Engineering, Kennesaw State University, Kennesaw, GA, USA
| | - Dean A Bricker
- Department of Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Timothy N Crawford
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
- Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Ashutosh Shivakumar
- Department of Computer Science and Engineering, College of Engineering and Computer Science, Wright State University, Dayton, OH, USA
| | - Angie Castle
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Katharine Conway
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Raveendra Medaramitta
- Department of Computer Science and Engineering, College of Engineering and Computer Science, Wright State University, Dayton, OH, USA
| | - Maria Rechtin
- Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Josephine F Wilson
- Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
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Smith KW, Chang E, Liebling E, Bir A. Meta-Analysis of the Impact of Four Advanced Primary Care Redesign Initiatives on Medicare Expenditures. Med Care Res Rev 2024; 81:49-57. [PMID: 37646166 DOI: 10.1177/10775587231194658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
We conducted a secondary analysis of the evaluations of 22 sites participating in four primary care redesign initiatives funded by the Centers for Medicare and Medicaid Services or the Center for Medicare and Medicaid Innovation. Our objectives were to determine the overall impact of the initiatives on Medicare expenditures and whether specific site-level program features influenced expenditure findings. Averaged over sites, the mean intervention effect was a statistically insignificant US$26 per beneficiary per year. Policy implications from meta-regression results suggest that funders should consider supporting technical assistance efforts and pay for performance incentives to increase savings. There was no evidence that paying for medical home transformation produced savings in total cost of care. We estimate that in future evaluations, data from 35 sites would be needed to detect feature effects of US$300 per beneficiary per year.
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Hovsepian VE, Liu J, Schlak AE, Sadak T, Martsolf G, Bilazarian A, McHugh MD, Poghosyan L. Structural capabilities in primary care practices where nurse practitioners care for persons living with dementia. Int J Older People Nurs 2023; 18:e12556. [PMID: 37431711 PMCID: PMC10569265 DOI: 10.1111/opn.12556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 04/04/2023] [Accepted: 06/04/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Primary care structural capabilities (i.e., electronic health records, care coordination, community integration, and reminder systems) can address the multiple needs of persons living with dementia (PLWD). OBJECTIVES This study describes structural capabilities in primary care practices where nurse practitioners (NPs) provide care to PLWD and compares the presence of structural capabilities in practices with a high and low volume of PLWD. METHODS We conducted a secondary analysis of cross-sectional data from 293 NPs in 259 practices in California. Logistic regression models were used to determine the association between the volume of PLWD and the presence of structural capabilities. RESULTS NPs reported that 96% of practices had electronic health records, 61% had community integration, 55% had reminder systems and 35% had care coordination capabilities. Practices with a high volume of PLWD were less likely to have community integration compared to practices with a low volume of PLWD. CONCLUSION Many PLWD-serving practices do not have the essential infrastructure for providing optimal dementia care. Practice managers should focus on implementing the essential structural capabilities to address the complex needs of PLWD. IMPLICATIONS FOR PRACTICE Clinicians and practice administrations can use the findings of this study to improve the delivery of care in practices that provide care to PLWD.
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Affiliation(s)
| | | | | | - Tatiana Sadak
- University of Washington, Seattle, WA School of Nursing
| | - Grant Martsolf
- School of Nursing, University of Pittsburgh, Pittsburgh, PA
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Casalino LP, Jung HY, Bodenheimer T, Diaz I, Chen MA, Willard-Grace R, Zhang M, Johnson P, Qian Y, O'Donnell EM, Unruh MA. The Association of Teamlets and Teams with Physician Burnout and Patient Outcomes. J Gen Intern Med 2023; 38:1384-1392. [PMID: 36441365 PMCID: PMC10160282 DOI: 10.1007/s11606-022-07894-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 10/26/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Primary care "teamlets" in which a staff member and physician consistently work together might provide a simple, cost-effective way to improve care, with or without insertion within a team. OBJECTIVE To determine the prevalence and performance of teamlets and teams. DESIGN Cross-sectional observational study linking survey responses to Medicare claims. PARTICIPANTS Six hundred eighty-eight general internists and family physicians. INTERVENTIONS Based on survey responses, physicians were assigned to one of four teamlet/team categories (e.g., teamlet/no team) and, in secondary analyses, to one of eight teamlet/team categories that classified teamlets into high, medium, and low collaboration as perceived by the physician (e.g., teamlet perceived-high collaboration/no team). MAIN MEASURES Descriptive: percentage of physicians in teamlet/team categories. OUTCOME MEASURES physician burnout; ambulatory care sensitive emergency department and hospital admissions; Medicare spending. KEY RESULTS 77.4% of physicians practiced in teamlets; 36.7% in teams. Of the four categories, 49.1% practiced in the teamlet/no team category; 28.3% in the teamlet/team category; 8.4% in no teamlet/team; 14.1% in no teamlet/no team. 15.7%, 47.4%, and 14.4% of physicians practiced in perceived high-, medium-, and low-collaboration teamlets. Physicians who practiced neither in a teamlet nor in a team had significantly lower rates of burnout compared to the three teamlet/team categories. There were no consistent, significant differences in outcomes or Medicare spending by teamlet/team or teamlet perceived-collaboration/team categories compared to no teamlet/no team, for Medicare beneficiaries in general or for dual-eligible beneficiaries. CONCLUSIONS Most general internists and family physicians practice in teamlets, and some practice in teams, but neither practicing in a teamlet, in a team, or in the two together was associated with lower physician burnout, better outcomes for patients, or lower Medicare spending. Further study is indicated to investigate whether certain types of teamlet, teams, or teamlets within teams can achieve higher performance.
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Affiliation(s)
- Lawrence P Casalino
- Department of Population Health Sciences, Weill Cornell Medical College, 402 E. 67th St. Room LA 217, New York, NY, 10065-6304, USA.
| | - Hye-Young Jung
- Department of Population Health Sciences, Weill Cornell Medical College, 402 E. 67th St. Room LA 217, New York, NY, 10065-6304, USA
| | | | - Ivan Diaz
- Department of Population Health Sciences, Weill Cornell Medical College, 402 E. 67th St. Room LA 217, New York, NY, 10065-6304, USA
| | | | | | - Manyao Zhang
- Department of Population Health Sciences, Weill Cornell Medical College, 402 E. 67th St. Room LA 217, New York, NY, 10065-6304, USA
| | - Phyllis Johnson
- Department of Population Health Sciences, Weill Cornell Medical College, 402 E. 67th St. Room LA 217, New York, NY, 10065-6304, USA
| | | | - Eloise M O'Donnell
- Department of Population Health Sciences, Weill Cornell Medical College, 402 E. 67th St. Room LA 217, New York, NY, 10065-6304, USA
| | - Mark A Unruh
- Department of Population Health Sciences, Weill Cornell Medical College, 402 E. 67th St. Room LA 217, New York, NY, 10065-6304, USA
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Kim SJ, Martin M, Caskey R, Weiler A, Van Voorhees B, Glassgow AE. The Effect of Neighborhood Disorganization on Care Engagement Among Children With Chronic Conditions Living in a Large Urban City. FAMILY & COMMUNITY HEALTH 2023; 46:112-122. [PMID: 36799944 PMCID: PMC9930887 DOI: 10.1097/fch.0000000000000356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Neighborhood context plays an important role in producing and reproducing current patterns of health disparity. In particular, neighborhood disorganization affects how people engage in health care. We examined the effect of living in highly disorganized neighborhoods on care engagement, using data from the Coordinated Healthcare for Complex Kids (CHECK) program, which is a care delivery model for children with chronic conditions on Medicaid in Chicago. We retrieved demographic data from the US Census Bureau and crime data from the Chicago Police Department to estimate neighborhood-level social disorganization for the CHECK enrollees. A total of 6458 children enrolled in the CHECK between 2014 and 2017 were included in the analysis. Families living in the most disorganized neighborhoods, compared with areas with lower levels of disorganization, were less likely to engage in CHECK. Black families were less likely than Hispanic families to be engaged in the CHECK program. We discuss potential mechanisms through which disorganization affects care engagement. Understanding neighborhood context, including social disorganization, is key to developing more effective comprehensive care models.
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Affiliation(s)
- Sage J. Kim
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago (Dr Kim and Ms Weiler); and Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago (Drs Martin, Caskey, Van Voorhees, and Glassgow)
| | - Molly Martin
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago (Dr Kim and Ms Weiler); and Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago (Drs Martin, Caskey, Van Voorhees, and Glassgow)
| | - Rachel Caskey
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago (Dr Kim and Ms Weiler); and Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago (Drs Martin, Caskey, Van Voorhees, and Glassgow)
| | - Amanda Weiler
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago (Dr Kim and Ms Weiler); and Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago (Drs Martin, Caskey, Van Voorhees, and Glassgow)
| | - Benjamin Van Voorhees
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago (Dr Kim and Ms Weiler); and Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago (Drs Martin, Caskey, Van Voorhees, and Glassgow)
| | - Anne Elizabeth Glassgow
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago (Dr Kim and Ms Weiler); and Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago (Drs Martin, Caskey, Van Voorhees, and Glassgow)
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Bilazarian A, McHugh J, Schlak AE, Liu J, Poghosyan L. Primary Care Practice Structural Capabilities and Emergency Department Utilization Among High-Need High-Cost Patients. J Gen Intern Med 2023; 38:74-80. [PMID: 35941491 PMCID: PMC9849605 DOI: 10.1007/s11606-022-07706-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 06/16/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND US primary care practices are actively identifying strategies to improve outcomes and reduce costs among high-need high-cost (HNHC) patients. HNHC patients are adults with high health care utilization who suffer from multiple chronic medical and behavioral health conditions such as depression or substance abuse. HNHC patients with behavioral health conditions face heightened challenges accessing timely primary care and managing their conditions, which is reflected by their high rates of emergency department (ED) utilization and preventable spending. Structural capabilities (i.e., care coordination, chronic disease registries, shared communication systems, and after-hours care) are key attributes of primary care practices which can enhance access and quality of chronic care delivery. OBJECTIVE The purpose of this study was to analyze the association between structural capabilities and ED utilization among HNHC patients with behavioral health conditions. DESIGN AND MEASURES We merged cross-sectional survey data on structural capabilities from 240 primary care practices in Arizona and Washington linked with Medicare claims data on 70,182 HNHC patients from 2019. KEY RESULTS Using multivariable Poisson models, we found shared communication systems were associated with lower rates of all-cause and preventable ED utilization among HNHC patients with alcohol use (all-cause: aRR 0.72, 95% CI: 0.62, 0.84; preventable: aRR 0.5, 95% CI: 0.40, 0.64) and HNHC patients with substance use disorders (all-cause: aRR 0.76, 95% CI: 0.68, 0.85; preventable: aRR 0.61, 95% CI: 0.52, 0.71). Care coordination was also associated with decreased rates of ED utilization among the overall HNHC population and those with alcohol use, but not among HNHC patients with depression or substance use disorders. CONCLUSION Shared communication systems and care coordination have the potential to increase the effectiveness of primary care delivery for specific HNHC patients.
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Affiliation(s)
- Ani Bilazarian
- School of Nursing, Columbia University, New York, NY, USA.
| | - John McHugh
- School of Nursing, Columbia University, New York, NY, USA
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Jianfang Liu
- School of Nursing, Columbia University, New York, NY, USA
| | - Lusine Poghosyan
- School of Nursing, Columbia University, New York, NY, USA
- Mailman School of Public Health, Columbia University, New York, NY, USA
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Renshaw S, Kenawy D, Azap R, Gupta A, Poulose B, Collins C. Impact of insurance type in postoperative emergency department utilization and clinical outcomes following ventral hernia repair (VHR). Surg Endosc 2022; 36:9416-9423. [PMID: 35585286 DOI: 10.1007/s00464-022-09287-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 04/18/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Access to care and barriers to achieving health equity remain persistent and prevailing issues in the USA, particularly for low socioeconomic (L-SES) populations. Previous studies have shown that public insurance (a surrogate marker for L-SES) is an independent predictor of emergent hernia repair. However, the impact of insurance type on postoperative healthcare utilization, including emergency department (ED) care, following ventral hernia repair (VHR) remains unknown. METHODS The 2013-2020 Abdominal Core Health Quality Collaborative (ACHQC) database was used to identify patients aged 18-64 undergoing ventral hernia repair (VHR) who had private or Medicaid insurance. Patients with no health insurance were also included. Using insurance type, the cohort was divided into three groups: private, public (Medicaid), and uninsured (self-pay). Multivariate logistic regression analyses were used to assess the impact of insurance type on emergency department (ED) utilization, postoperative complications, and readmission. RESULTS A total of 17,036 patients undergoing VHR were included in the study, out of which 13,980 (85.8%) had private insurance, 2,451 (8.4%) had public, and 605 (5.8%) were uninsured. Following adjustment for demographics (age, gender, race), comorbidities (hypertension, diabetes, smoking), and clinical characteristics (emergent procedure, ASA class, surgical approach), public insurance was associated with 1.7 times greater odds of returning to the emergency department (ED) within 30 days of surgery compared to private insurance (95% CI 1.4, 2.0; p = 0.01). Public insurance or being uninsured was also associated with increased odds of experiencing any postoperative complications compared to those who were privately insured (public: OR 1.3, p < 0.01; self-pay: OR 1.67, p < 0.01). CONCLUSION Our study demonstrates that public and self-pay insurance are associated with increased emergency department (ED) utilization and worse postoperative outcomes compared to those with private insurance. In an effort to promote health equity, healthcare providers need to assess how parameters beyond physical presentation may impact a patient's health.
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Affiliation(s)
- Savannah Renshaw
- Center for Abdominal Core Health, Department of Surgery, Ohio State University Wexner Medical Center, 181 Taylor Avenue, 11th Floor, Suite 1102A, Columbus, OH, 43203, USA
| | - Dahlia Kenawy
- Center for Abdominal Core Health, Department of Surgery, Ohio State University Wexner Medical Center, 181 Taylor Avenue, 11th Floor, Suite 1102A, Columbus, OH, 43203, USA
| | - Rosevine Azap
- College of Medicine, Ohio State University Wexner Medical Center, 181 Taylor Avenue, 11th Floor, Suite 1102A, Columbus, OH, 43203, USA
| | - Anand Gupta
- Center for Abdominal Core Health, Department of Surgery, Ohio State University Wexner Medical Center, 181 Taylor Avenue, 11th Floor, Suite 1102A, Columbus, OH, 43203, USA
| | - Benjamin Poulose
- Center for Abdominal Core Health, Department of Surgery, Ohio State University Wexner Medical Center, 181 Taylor Avenue, 11th Floor, Suite 1102A, Columbus, OH, 43203, USA
| | - Courtney Collins
- Center for Abdominal Core Health, Department of Surgery, Ohio State University Wexner Medical Center, 181 Taylor Avenue, 11th Floor, Suite 1102A, Columbus, OH, 43203, USA.
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To What Extent Are ACO and PCMH Models Advancing the Triple Aim Objective? Implications and Considerations for Primary Care Medical Practices. J Ambul Care Manage 2022; 45:254-265. [PMID: 36006384 DOI: 10.1097/jac.0000000000000434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Accountable care organizations (ACOs) and patient-centered medical homes (PCMHs) have emerged to advance the health care system by achieving the Triple Aim of improving population health, reducing costs, and enhancing the patient experience. This review examines evidence regarding the relationship between these innovative care models and care outcomes, costs, and patient experiences. The 28 articles summarized in this review show that ACO and PCMH models play an important role in achieving the Triple Aim, when compared with conventional care models. However, there can be drawbacks associated with model implementation. The long-term success of these models still merits further investigation.
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Bodenheimer T. Revitalizing Primary Care, Part 2: Hopes for the Future. Ann Fam Med 2022; 20:469-478. [PMID: 36228059 PMCID: PMC9512544 DOI: 10.1370/afm.2859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 05/16/2022] [Accepted: 05/27/2022] [Indexed: 11/09/2022] Open
Abstract
Part 1 of this essay argued that the root causes of primary care's problems lie in (1) the low percent of national health expenditures dedicated to primary care and (2) overly large patient panels that clinicians without a team are unable to manage, leading to widespread burnout and poor patient access. Part 2 explores policies and practice changes that could solve or mitigate these primary care problems.Initiatives attempting to improve primary care are discussed. Diffuse multi-component initiatives-patient-centered medical homes (PCMHs), accountable care organizations (ACOs), and Comprehensive Primary Care Plus (CPC+)-have had limited success in addressing primary care's core problems. More focused initiatives-care management, open access, and telehealth-offer more promise.To truly revitalize primary care, 2 fundamental changes are needed: (1) a substantially greater percent of health expenditures dedicated to primary care, and (2) the building of powerful teams that add capacity to care for large panels while reducing burnout.Part 2 of the essay reviews 3 approaches to increasing primary care spending: state-level legislation, eliminating Medicare's disparity between primary care and procedural specialty reimbursement, and efforts by health systems. The final section of Part 2 addresses the building of powerful core and interprofessional teams.
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Affiliation(s)
- Thomas Bodenheimer
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
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Reynolds JC, Damiano PC, Herndon JB. Patient centered dental home: Building a framework for dental quality measurement and improvement. J Public Health Dent 2021; 82:445-452. [PMID: 34704254 DOI: 10.1111/jphd.12482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/18/2021] [Accepted: 10/12/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This article presents results of the second phase of a project to develop a patient-centered dental home (PCDH) model. Aims of PCDH model development include broadening the scope of prior dental home definitions to include populations across the lifespan, developing a quality measurement framework to facilitate quality assessment and improvement, and promoting opportunities for medical-dental integration through alignment with existing PCMH models. This phase determined the components, or conceptual subdivisions, associated with a previously developed PCDH definition and characteristics. METHODS We used a modified Delphi process to obtain structured feedback and gain consensus among the project national advisory committee (NAC). The process included a web-based survey that asked NAC members to rank the importance of each potential component on a scale of 1-9. Criteria for consensus on component inclusion/exclusion combined a median rating and measure of disagreement. Respondents were also encouraged to provide open-ended feedback regarding rationale for component ratings and additional suggested components. RESULTS A total of 47 out of 51 members completed the survey. All 34 components met the quantitative criteria for inclusion in the PCDH model. Changes were made to components based on open-ended feedback. CONCLUSIONS This project phase further developed a PCDH measurement framework that aims to guide practice transformation, quality measurement and improvement in dental care delivery, as well as integration between medicine and dentistry. Using a Delphi approach with a broad group of stakeholders ensured that components had face validity and were conceptually aligned with the PCDH definition and characteristics.
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Affiliation(s)
- Julie C Reynolds
- College of Dentistry, University of Iowa, Iowa City, Iowa, USA.,Public Policy Center, University of Iowa, Iowa City, Iowa, USA
| | - Peter C Damiano
- College of Dentistry, University of Iowa, Iowa City, Iowa, USA.,Public Policy Center, University of Iowa, Iowa City, Iowa, USA
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Budhwar N, Gollop S. Can You Hear Me Now? Refining the PCMH Model and an Overlooked Disability Affecting Seniors. Ann Fam Med 2020; 18:482-483. [PMID: 33168673 PMCID: PMC7708279 DOI: 10.1370/afm.2611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/01/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Nitin Budhwar
- Chief of Geriatric Medicine, Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
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