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Chen MA, Rubinson C, O'Donnell EM, Li J, Bodenheimer T, Casalino LP. High-Performing Teamlets in Primary Care: A Qualitative Comparative Analysis. J Am Board Fam Med 2024; 37:105-111. [PMID: 38092438 DOI: 10.3122/jabfm.2023.230105r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/18/2023] [Accepted: 09/05/2023] [Indexed: 03/13/2024] Open
Abstract
PURPOSE In efforts to improve patient care, collaborative approaches to care have been highlighted. The teamlet model is one such approach, in which a primary care clinician works consistently with the same clinical staff member. The purpose of this study is to identify the characteristics of high-performing primary care teamlets, defined as teamlets with low rates of ambulatory care sensitive emergency department (ACSED) visits and ambulatory care sensitive hospital admissions (ACSAs). METHODS Twenty-six individual qualitative interviews were performed with physicians and their teamlet staff member across 13 teamlets. Potentially important characteristics related to high-performing primary care teamlets were identified, calibrated, and analyzed using qualitative comparative analysis (QCA). RESULTS Key characteristics identified by the QCA that were often present in teamlets with low rates of ACSED visits and, to a lesser extent, ACSAs were staff proactiveness in anticipating physician needs and physician-reported trust in their staff member. CONCLUSION This study suggests that physician trust in their staff and proactiveness of staff in anticipating physician needs are important in promoting high-performing teamlets in primary care. Additional studies are indicated to further explore the relationship between these characteristics and high-performing teamlets, and to identify other characteristics that may be important.
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Affiliation(s)
- Melinda A Chen
- From the Division of Health Policy & Economics, Department of Population Health Sciences, Weill Cornell Medical College (MAC, EMO, LPC), Division of General Internal Medicine, Department of Medicine, University of California, San Diego (MAC), Department of Social Sciences, University of Houston - Downtown (CR), Comparative Health Outcomes, Policy and Economics Institute, Department of Pharmacy, University of Washington (JL), Department of Family Community Medicine, University of California, San Francisco (TB).
| | - Claude Rubinson
- From the Division of Health Policy & Economics, Department of Population Health Sciences, Weill Cornell Medical College (MAC, EMO, LPC), Division of General Internal Medicine, Department of Medicine, University of California, San Diego (MAC), Department of Social Sciences, University of Houston - Downtown (CR), Comparative Health Outcomes, Policy and Economics Institute, Department of Pharmacy, University of Washington (JL), Department of Family Community Medicine, University of California, San Francisco (TB)
| | - Eloise M O'Donnell
- From the Division of Health Policy & Economics, Department of Population Health Sciences, Weill Cornell Medical College (MAC, EMO, LPC), Division of General Internal Medicine, Department of Medicine, University of California, San Diego (MAC), Department of Social Sciences, University of Houston - Downtown (CR), Comparative Health Outcomes, Policy and Economics Institute, Department of Pharmacy, University of Washington (JL), Department of Family Community Medicine, University of California, San Francisco (TB)
| | - Jing Li
- From the Division of Health Policy & Economics, Department of Population Health Sciences, Weill Cornell Medical College (MAC, EMO, LPC), Division of General Internal Medicine, Department of Medicine, University of California, San Diego (MAC), Department of Social Sciences, University of Houston - Downtown (CR), Comparative Health Outcomes, Policy and Economics Institute, Department of Pharmacy, University of Washington (JL), Department of Family Community Medicine, University of California, San Francisco (TB)
| | - Thomas Bodenheimer
- From the Division of Health Policy & Economics, Department of Population Health Sciences, Weill Cornell Medical College (MAC, EMO, LPC), Division of General Internal Medicine, Department of Medicine, University of California, San Diego (MAC), Department of Social Sciences, University of Houston - Downtown (CR), Comparative Health Outcomes, Policy and Economics Institute, Department of Pharmacy, University of Washington (JL), Department of Family Community Medicine, University of California, San Francisco (TB)
| | - Lawrence P Casalino
- From the Division of Health Policy & Economics, Department of Population Health Sciences, Weill Cornell Medical College (MAC, EMO, LPC), Division of General Internal Medicine, Department of Medicine, University of California, San Diego (MAC), Department of Social Sciences, University of Houston - Downtown (CR), Comparative Health Outcomes, Policy and Economics Institute, Department of Pharmacy, University of Washington (JL), Department of Family Community Medicine, University of California, San Francisco (TB)
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Kaplan HC, Goldstein SL, Rubinson C, Daraiseh N, Zhang F, Rodgers IM, Dahale DS, Askenazi DJ, Somers MJG, Zaritsky JJ, Misurac J, Chadha V, Yonekawa KE, Sutherland SM, Weng PL, Walsh KE. Prospective Study of the Multisite Spread of a Medication Safety Intervention: Factors Common to Hospitals With Improved Outcomes. Am J Med Qual 2024; 39:21-32. [PMID: 38127682 DOI: 10.1097/jmq.0000000000000161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Context and implementation approaches can impede the spread of patient safety interventions. The objective of this article is to characterize factors associated with improved outcomes among 9 hospitals implementing a medication safety intervention. Nephrotoxic Injury Negated by Just-in-Time Action (NINJA) is a pharmacist-driven intervention that led to a sustained reduction in nephrotoxic medication-associated acute kidney injury (NTMx-AKI) at 1 hospital. Using qualitative comparative analysis, the team prospectively assessed the association between context and implementation factors and NTMx-AKI reduction during NINJA spread to 9 hospitals. Five hospitals reduced NTMx-AKI. These 5 had either (1) a pharmacist champion and >2 pharmacists working on NINJA (Scon 1.0, Scov 0.8) or (2) a nephrologist-implementing NINJA with minimal competing organizational priorities (Scon 1.0, Scov 0.2). Interviews identified ways NINJA team leaders obtained pharmacist support or successfully implemented without that support. In conclusion, these findings have implications for future spread of NINJA and suggest an approach to study spread of safety interventions more broadly.
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Affiliation(s)
- Heather C Kaplan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Stuart L Goldstein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Claude Rubinson
- Department of Social Sciences, University of Houston-Downtown, Houston, TX
| | - Nancy Daraiseh
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Fang Zhang
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | | | - Devesh S Dahale
- Operational Effectiveness Department, Southeast Health, Dothan, AL
| | - David J Askenazi
- Division of Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | | | | | - Jason Misurac
- Department of Pediatrics, University of Iowa, Stead Family Children's Hospital, Iowa City, IA
| | - Vimal Chadha
- Division of Nephrology, Children's Mercy Hospital, Kansas City, MO
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Karyn E Yonekawa
- Division of Nephrology, Seattle Children's Hospital, Seattle, WA
| | - Scott M Sutherland
- Division of Nephrology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
- Division of Nephrology, Lucille Packard Stanford Children's Hospital, Palo Alto, CA
| | - Patricia L Weng
- Division of Nephrology, Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, CA
| | - Kathleen E Walsh
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA
- Department of General Pediatrics, Harvard Medical School, Boston, MA
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Holtrop JS, Connelly L, Gomes R, Fitzpatrick L, Rubinson C, Dolor RJ, Gritz RM, Luo Z, Jortberg B, Nederveld A. Models for Delivering Weight Management in Primary Care: Qualitative Results from the MOST Obesity Study. J Am Board Fam Med 2023; 36:603-615. [PMID: 37385720 DOI: 10.3122/jabfm.2022.220315r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/16/2022] [Accepted: 04/03/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Obesity is a leading cause of morbidity and mortality in the United States (US). Primary care medical practices can educate patients about the health effects of obesity and help patients with obesity lose and manage their weight. However, implementation of weight management in primary care is challenging. We sought to examine how practices that implement weight management services do so feasibly. METHODS Multiple methods including site visits, observations, interviews, and document reviews were utilized to identify and learn from primary care practices located across the US. A qualitative multidimensional classification of empirical cases was performed to identify unique delivery features that were feasible to implement in primary care. RESULTS Across 21 practices, 4 delivery models were identified: group, integrated into standard primary care, hiring an "other" professional, and using a specific program. Model characteristics included who delivered the weight management services, whether delivered to an individual or group, the types of approaches used, and how the care was reimbursed or paid. Most practices integrated weight management services and primary care delivery, although some created specific carve-out programs. CONCLUSION This study identified 4 models that may serve to overcome challenges in delivering weight management services in primary care. Based on practice characteristics, preferences, and resources, primary care practices can identify a model for successfully implementing weight management services that best fits their context and needs. It is time for primary care to truly address obesity care as the health issue it is and make it a standard of care for all patients with obesity.
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Affiliation(s)
- Jodi Summers Holtrop
- From the Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO (JSH, LC, BJ, AN); ACCORDS, University of Colorado School of Medicine, Aurora, CO (RG, RMG); Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids MI (LF); Department of Social Sciences, University of Houston-Downtown, Houston, TX (CR); Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, NC (RJD); Division of Healthcare Policy and Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (RMG); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI (ZL)
| | - Lauri Connelly
- From the Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO (JSH, LC, BJ, AN); ACCORDS, University of Colorado School of Medicine, Aurora, CO (RG, RMG); Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids MI (LF); Department of Social Sciences, University of Houston-Downtown, Houston, TX (CR); Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, NC (RJD); Division of Healthcare Policy and Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (RMG); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI (ZL)
| | - Rebekah Gomes
- From the Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO (JSH, LC, BJ, AN); ACCORDS, University of Colorado School of Medicine, Aurora, CO (RG, RMG); Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids MI (LF); Department of Social Sciences, University of Houston-Downtown, Houston, TX (CR); Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, NC (RJD); Division of Healthcare Policy and Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (RMG); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI (ZL)
| | - Laurie Fitzpatrick
- From the Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO (JSH, LC, BJ, AN); ACCORDS, University of Colorado School of Medicine, Aurora, CO (RG, RMG); Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids MI (LF); Department of Social Sciences, University of Houston-Downtown, Houston, TX (CR); Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, NC (RJD); Division of Healthcare Policy and Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (RMG); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI (ZL)
| | - Claude Rubinson
- From the Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO (JSH, LC, BJ, AN); ACCORDS, University of Colorado School of Medicine, Aurora, CO (RG, RMG); Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids MI (LF); Department of Social Sciences, University of Houston-Downtown, Houston, TX (CR); Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, NC (RJD); Division of Healthcare Policy and Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (RMG); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI (ZL)
| | - Rowena J Dolor
- From the Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO (JSH, LC, BJ, AN); ACCORDS, University of Colorado School of Medicine, Aurora, CO (RG, RMG); Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids MI (LF); Department of Social Sciences, University of Houston-Downtown, Houston, TX (CR); Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, NC (RJD); Division of Healthcare Policy and Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (RMG); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI (ZL)
| | - R Mark Gritz
- From the Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO (JSH, LC, BJ, AN); ACCORDS, University of Colorado School of Medicine, Aurora, CO (RG, RMG); Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids MI (LF); Department of Social Sciences, University of Houston-Downtown, Houston, TX (CR); Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, NC (RJD); Division of Healthcare Policy and Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (RMG); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI (ZL)
| | - Zhehui Luo
- From the Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO (JSH, LC, BJ, AN); ACCORDS, University of Colorado School of Medicine, Aurora, CO (RG, RMG); Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids MI (LF); Department of Social Sciences, University of Houston-Downtown, Houston, TX (CR); Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, NC (RJD); Division of Healthcare Policy and Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (RMG); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI (ZL)
| | - Bonnie Jortberg
- From the Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO (JSH, LC, BJ, AN); ACCORDS, University of Colorado School of Medicine, Aurora, CO (RG, RMG); Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids MI (LF); Department of Social Sciences, University of Houston-Downtown, Houston, TX (CR); Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, NC (RJD); Division of Healthcare Policy and Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (RMG); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI (ZL)
| | - Andrea Nederveld
- From the Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO (JSH, LC, BJ, AN); ACCORDS, University of Colorado School of Medicine, Aurora, CO (RG, RMG); Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids MI (LF); Department of Social Sciences, University of Houston-Downtown, Houston, TX (CR); Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, NC (RJD); Division of Healthcare Policy and Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (RMG); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI (ZL)
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Holtrop JS, Gurfinkel D, Nederveld A, Phimphasone-Brady P, Hosokawa P, Rubinson C, Waxmonsky JA, Kwan BM. Methods for capturing and analyzing adaptations: implications for implementation research. Implement Sci 2022; 17:51. [PMID: 35906602 PMCID: PMC9335955 DOI: 10.1186/s13012-022-01218-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/22/2022] [Indexed: 11/19/2022] Open
Abstract
Background Interventions are often adapted; some adaptations may provoke more favorable outcomes, whereas some may not. A better understanding of the adaptations and their intended goals may elucidate which adaptations produce better outcomes. Improved methods are needed to better capture and characterize the impact of intervention adaptations. Methods We used multiple data collection and analytic methods to characterize adaptations made by practices participating in a hybrid effectiveness-implementation study of a complex, multicomponent diabetes intervention. Data collection methods to identify adaptations included interviews, observations, and facilitator sessions resulting in transcripts, templated notes, and field notes. Adaptations gleaned from these sources were reduced and combined; then, their components were cataloged according to the framework for reporting adaptations and modifications to evidence-based interventions (FRAME). Analytic methods to characterize adaptations included a co-occurrence table, statistically based k-means clustering, and a taxonomic analysis. Results We found that (1) different data collection methods elicited more overall adaptations, (2) multiple data collection methods provided understanding of the components of and reasons for adaptation, and (3) analytic methods revealed ways that adaptation components cluster together in unique patterns producing adaptation “types.” These types may be useful for understanding how the “who, what, how, and why” of adaptations may fit together and for analyzing with outcome data to determine if the adaptations produce more favorable outcomes rather than by adaptation components individually. Conclusion Adaptations were prevalent and discoverable through different methods. Enhancing methods to describe adaptations may better illuminate what works in providing improved intervention fit within context. Trial registration This trial is registered on clinicaltrials.gov under Trial number NCT03590041, posted July 18, 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01218-3.
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Affiliation(s)
- Jodi Summers Holtrop
- Department of Family Medicine, University of Colorado, Aurora, CO, 80045, USA. .,Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Aurora, CO, USA.
| | - Dennis Gurfinkel
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Aurora, CO, USA
| | - Andrea Nederveld
- Department of Family Medicine, University of Colorado, Aurora, CO, 80045, USA
| | | | - Patrick Hosokawa
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Aurora, CO, USA
| | | | | | - Bethany M Kwan
- Department of Family Medicine, University of Colorado, Aurora, CO, 80045, USA.,Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Aurora, CO, USA.,Department of Emergency Medicine, University of Colorado, Aurora, CO, USA
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