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Jung OS, Kyle MA, McCree P, Nadel HM. Patient-Centered Innovation: Involving Patients in Open Social Innovation. Med Care 2024; 62:314-318. [PMID: 38498871 PMCID: PMC10990018 DOI: 10.1097/mlr.0000000000001987] [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] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Involving patients in the health-care delivery innovation has many benefits. Open social innovation (OSI) presents a fitting lens to examine and advance patient engagement in innovation. OSI offers a participatory approach to innovation, in which diverse groups of participants collaboratively generate ideas and scale solutions on complex social challenges. PURPOSE This study: (1) describes a pilot application of OSI, in which individuals serving on a hospital's patients and family advisory councils (PFACs) were invited to participate in an innovation contest; and (2) explores the extent to which patients' beliefs about their role in innovation relate to their participation in the contest. METHODOLOGY/APPROACH We conducted an innovation contest that invited PFAC members to share ideas that would improve patient experiences and then vote on and select the ideas that they wanted to see move forward. We measured patients' beliefs about their role in innovation in a survey before the contest. RESULTS Twenty individuals submitted 27 ideas. Patients who expressed preference for more involvement in innovation were more likely to participate. CONCLUSIONS Using OSI may help expand patient engagement in innovation, particularly among those who want to be more involved but do not feel authorized to voice ideas in traditional advisory committees. PRACTICAL IMPLICATIONS OSI spurred collaboration among patients, clinicians, quality improvement staff, hospital administrators, and other stakeholders in idea generation, elaboration, and implementation. More experimentation and research are needed to understand how OSI can be leveraged to capture patients' voice and incorporate them in care delivery innovation.
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Affiliation(s)
- Olivia S. Jung
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Michael Anne Kyle
- Department of Health Care Policy, Harvard Medical School, Harvard University, Boston MA
| | - Paula McCree
- Healthcare Transformation Lab, Massachusetts General Hospital, Boston, MA
| | - Hiyam M. Nadel
- Center for Innovations in Care Delivery, Massachusetts General Hospital, Boston, MA
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Meyers D, Miller T, De La Mare J, Gerteis JS, Makulowich G, Weber GH, Zhan C, Genevro J. What AHRQ Learned While Working to Transform Primary Care. Ann Fam Med 2024; 22:161-166. [PMID: 38527822 DOI: 10.1370/afm.3090] [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: 07/11/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 03/27/2024] Open
Abstract
Building on previous efforts to transform primary care, the Agency for Healthcare Research and Quality (AHRQ) launched EvidenceNOW: Advancing Heart Health in 2015. This 3-year initiative provided external quality improvement support to small and medium-size primary care practices to implement evidence-based cardiovascular care. Despite challenges, results from an independent national evaluation demonstrated that the EvidenceNOW model successfully boosted the capacity of primary care practices to improve quality of care, while helping to advance heart health. Reflecting on AHRQ's own learnings as the funder of this work, 3 key lessons emerged: (1) there will always be surprises that will require flexibility and real-time adaptation; (2) primary care transformation is about more than technology; and (3) it takes time and experience to improve care delivery and health outcomes. EvidenceNOW taught us that lasting practice transformation efforts need to be responsive to anticipated and unanticipated changes, relationship-oriented, and not tied to a specific disease or initiative. We believe these lessons argue for a national primary care extension service that provides ongoing support for practice transformation.
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Affiliation(s)
- David Meyers
- Agency for Healthcare Research and Quality, Rockville, Maryland
| | - Therese Miller
- Agency for Healthcare Research and Quality, Rockville, Maryland
| | - Jan De La Mare
- Agency for Healthcare Research and Quality, Rockville, Maryland
| | | | - Gail Makulowich
- Agency for Healthcare Research and Quality, Rockville, Maryland
| | | | - Chunliu Zhan
- Agency for Healthcare Research and Quality, Rockville, Maryland
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Loxterkamp D. What Humans Need. Ann Fam Med 2023; 21:465-467. [PMID: 37748911 PMCID: PMC10519765 DOI: 10.1370/afm.3015] [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: 12/10/2022] [Revised: 04/18/2023] [Accepted: 04/25/2023] [Indexed: 09/27/2023] Open
Abstract
Family medicine is a champion of human-focused health care in the context of lasting relationships. What do humans need-those who seek care and those who offer it? Respect, understanding, and kindness. Without it, more money, more ancillary personnel, more time-saving technology cannot lift us from the profession's doldrums. The author believes that the deep desire to be of help to others can be rekindled in an office culture where the humanity in all of us is honored.
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Mgbako O, Mathu R, Davila MG, Mehta M, Cabrera J, Carnevale C, Zucker J, Gordon P, Olender S. Immediate ART and clinical outcomes in New York City among patients newly diagnosed with HIV. AIDS Care 2023; 35:545-554. [PMID: 35895602 PMCID: PMC9880246 DOI: 10.1080/09540121.2022.2104799] [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] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 07/18/2022] [Indexed: 01/31/2023]
Abstract
Immediate antiretroviral therapy (iART) has been shown to decrease time to viral suppression. Our center underwent significant practice transformation to support iART, including a same-day Open Access (OA) model and enhanced care coordination. We examined whether same-day ART at linkage was associated with favorable proximate and long-term HIV care outcomes. From 2018 to 2019, patients newly diagnosed with HIV, linked to care at our institution, and iART eligible were included. We evaluated the association between iART and time to viral suppression, and between iART and initial/sustained viral suppression and retention in care. We also evaluated the association between use of OA and frequency of care coordination with the same outcomes. Of the 107 patients included, 72 initiated same-day ART at linkage and 35 did not. There was no statistically significant differences in whether patients were ever suppressed, had sustained viral suppression, or were retained in care between those who received same-day ART and those who did not. More care coordination was associated with retention in care (RR 1.21 [1.01-1.5]; p = 0.05). Organizing vital services and ensuring implementation strategies that facilitate iART, while tailoring the approach to the patient's comfort level, is likely optimal for longitudinal HIV care engagement.
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Affiliation(s)
- Ofole Mgbako
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia, University, New York, NY, USA
| | - Rachel Mathu
- NewYork-Presbyterian Hospital-Columbia University Irving Medical Center, New York, NY, USA
| | - Mila Gonzalez Davila
- NewYork-Presbyterian Hospital-Columbia University Irving Medical Center, New York, NY, USA
| | - Monica Mehta
- NewYork-Presbyterian Hospital-Columbia University Irving Medical Center, New York, NY, USA
| | - Joselyn Cabrera
- NewYork-Presbyterian Hospital-Columbia University Irving Medical Center, New York, NY, USA
| | - Caroline Carnevale
- NewYork-Presbyterian Hospital-Columbia University Irving Medical Center, New York, NY, USA
| | - Jason Zucker
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center
| | - Peter Gordon
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center
| | - Susan Olender
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center
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Corrigan MM, Gandhi N, Moore T, Ragucci K, Ross L, Steinkopf M, Vermeulen L, Maine LL. The Bridging Pharmacy Education and Practice Summit: A Unique Convening With Purpose. Am J Pharm Educ 2022; 86:9195. [PMID: 35764415 PMCID: PMC10159478 DOI: 10.5688/ajpe9195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 06/16/2022] [Indexed: 05/06/2023]
Abstract
It is not often that a group of health executives, educators, and professionals gather with the goal of identifying a preferred future for their profession and the patients they serve. It is even more rare when such an assembly results in a clear and actionable plan to follow to achieve that desired future. Nevertheless, the Bridging Pharmacy Education and Practice (BPEP) Summit, an unprecedented collaborative event in June 2022 that involved six sites across the country and more than 300 participants, was just such a convening. In this Commentary we provide a brief overview of this extraordinary summit and the events that led up to it.
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Affiliation(s)
| | - Nidhi Gandhi
- American Association of Colleges of Pharmacy, Arlington, Virginia
| | - Terri Moore
- American Association of Colleges of Pharmacy, Arlington, Virginia
| | - Kelly Ragucci
- American Association of Colleges of Pharmacy, Arlington, Virginia
| | - Libby Ross
- American Association of Colleges of Pharmacy, Arlington, Virginia
| | | | - Lee Vermeulen
- American Association of Colleges of Pharmacy, Arlington, Virginia
| | - Lucinda L Maine
- American Association of Colleges of Pharmacy, Arlington, Virginia
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Pestka DL, Paterson NL, Brummel AR, Norman JA, White KM. Barriers and facilitators to implementing pharmacist-provided comprehensive medication management in primary care transformation. Am J Health Syst Pharm 2022; 79:1255-1265. [PMID: 35390120 PMCID: PMC9305504 DOI: 10.1093/ajhp/zxac104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE How to effectively integrate pharmacists into team-based models of care to maximize the benefit they bring to patients and care teams, especially during times of primary care transformation (PCT), remains unknown. The objective of this study was to identify barriers and facilitators when integrating pharmacist-provided comprehensive medication management (CMM) services into a health system's team-based PCT using the Consolidated Framework for Implementation Research (CFIR). METHODS Semistructured qualitative interviews were carried out with 22 care team members regarding their perceptions of the implementation of CMM in the PCT. Transcripts were coded to identify CMM implementation barriers and facilitators, and resulting codes were mapped to corresponding CFIR domains and constructs. RESULTS Fifteen codes emerged that were labeled as either a barrier or a facilitator to implementing CMM in the PCT. Facilitators were the perception of CMM as an invaluable resource, precharting, tailored appointment lengths, insurance coverage, increased pharmacy presence, enhanced team-based care, location of CMM, and identification of CMM advocates. Barriers included limited clinic leadership involvement, a need for additional resources, CMM pharmacists not always feeling part of the core team, understanding of and training around CMM's role in the PCT, changing mindsets to utilize resources such as CMM more frequently, underutilization of CMM, and CMM scheduling. CONCLUSION Clinical pharmacists providing CMM represent a valuable interdisciplinary care team member who can help improve healthcare quality and access to primary care. Identifying and addressing implementation barriers and facilitators early during PCT rollout is critical to the success of team-based services such as CMM and becoming a learning health system.
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Affiliation(s)
- Deborah L Pestka
- Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | | | | | | | - Katie M White
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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MacNeil RLM, Hilario H, Gordon SM, Degollado C, Malmrose M, Lepowsky SM. Implementation and analysis of an enhanced screening and testing protocol for prediabetes in a dental school patient population. J Public Health Dent 2022; 82:262-270. [PMID: 35199346 DOI: 10.1111/jphd.12506] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/18/2021] [Accepted: 02/04/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This project aimed to enhance the identification of patients at-risk for prediabetes or diabetes within a dental school patient population by introduction of a modified screening tool and related training of dental residents and students. METHODS The American Diabetes Association Risk Tool (ADART) was modified by addition of three diabetes-linked oral health questions. Of the 1477 dental patients screened, 551 (37.3%) indicated an at-risk status using the modified tool. A subset of 138 patients received follow-up chairside HbA1c blood testing conducted by dental residents and students. Data was analysed to determine a) the influence of the modifications on the tool's discrimination strength and b) change in the tool's predictive value. RESULTS The addition of the 3 oral health questions to the 7-item ADART resulted in a 9.4% increase in identification of patients at-risk for pre-diabetes/diabetes. The predictive value of the tool remained stable. Residents and students successfully incorporated the new screening activities within their assigned clinics. CONCLUSIONS This project demonstrates that screening for risk for prediabetes/diabetes is both prudent and practical in the dental setting. Dental personnel, including trainees, can successfully incorporate enhanced screening methods within their traditional activities. Further, screening tools used in the dental setting might be enhanced by inclusion of certain oral health variables associated with diabetes. These findings add to emerging knowledge on the importance of screening for prediabetes/diabetes in dental settings and have particular relevance and application to institutional practice.
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Affiliation(s)
- Roderick L Monty MacNeil
- Division of General Dentistry, School of Dental Medicine, UConn Health, Farmington, Connecticut, USA
| | - Helena Hilario
- School of Dental Medicine, UConn Health, Farmington, Connecticut, USA
| | - Sharon M Gordon
- College of Dental Medicine, Kansas City University, Joplin, Missouri, USA
| | - Carlos Degollado
- Division of General Dentistry, School of Dental Medicine, UConn Health, Farmington, Connecticut, USA
| | - Michael Malmrose
- Connecticut Department of Energy and Environmental Protection, New Britain, Connecticut, USA
| | - Steven M Lepowsky
- School of Dental Medicine, UConn Health, Farmingtonz, Connecticut, USA
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Garza KB, Abebe E, Bacci JL, Kunda NK, Lor KB, Rickles N, Shankar N, Farrell D. Building Implementation Science Capacity in Academic Pharmacy: Report of the 2020-2021 AACP Research and Graduate Affairs Committee. Am J Pharm Educ 2021; 85:8718. [PMID: 34301581 PMCID: PMC8715976 DOI: 10.5688/ajpe8718] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
EXECUTIVE SUMMARY The 2020-2021 AACP Research and Graduate Affairs Committee (RGAC) continued the work begun by the 2019-2020 RGAC to increase awareness of and capacity for implementation research to advance practice transformation in academic pharmacy. AACP President Anne Lin charged the RGAC with developing resources and programs for training faculty and graduate students in implementation science. The committee was further charged with developing a mechanism to pair pharmacy faculty and implementation experts on practice advancement projects. In its work, the committee focused on generating near-term opportunities for pharmacy practice faculty to pursue projects while developing programs that would support ongoing career development and future implementation practice and research by pharmacy faculty and trainees.
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Affiliation(s)
| | - Ephrem Abebe
- Purdue University, College of Pharmacy, West Lafayette, Indiana
| | - Jennifer L Bacci
- University of Washington, School of Pharmacy, Seattle, Washington
| | - Nitesh K Kunda
- St. John's University, College of Pharmacy and Health Sciences, Queens, New York
| | - Kajua B Lor
- Medical College of Wisconsin, School of Pharmacy, Milwaukee, Wisconsin
| | | | - Nathan Shankar
- University of Oklahoma Health Sciences Center, College of Pharmacy, Oklahoma City, Oklahoma
| | - Dorothy Farrell
- American Association of Colleges of Pharmacy, Arlington, Virginia
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Janke KK, Bloom TJ, Boyce EG, Johnson JL, Kopacek K, O'Sullivan TA, Petrelli HMW, Steeb DR, Ross LJ. A Pathway to Professional Identity Formation: Report of the 2020-2021 AACP Student Affairs Standing Committee. Am J Pharm Educ 2021; 85:8714. [PMID: 34301578 PMCID: PMC8715968 DOI: 10.5688/ajpe8714] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
EXECUTIVE SUMMARY Professional identity formation (PIF) involves internalizing and demonstrating the behavioral norms, standards, and values of a professional community, such that one comes to "think, act and feel" like a member of that community. Professional identity influences how a professional perceives, explains, presents and conducts themselves. This report of the 2020-2021 AACP Student Affairs Standing Committee (SAC) describes the benefits of a strong professional identity, including its importance in advancing practice transformation. Responding to a recommendation from the 2019-2020 SAC, this report presents an illustrative and interpretative schema as an initial step towards describing a pharmacist's identity. However, the profession must further elucidate a universal and distinctive pharmacist identity, in order to better support pharmacists and learners in explaining and presenting the pharmacist's scope of practice and opportunities for practice change. Additionally, the report outlines recommendations for integrating intentional professional identity formation within professional curricula at colleges and schools of pharmacy. Although there is no standardized, single way to facilitate PIF in students, the report explores possibilities for meeting the student support and faculty development needs of an emerging new emphasis on PIF within the Academy.
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Affiliation(s)
- Kristin K Janke
- University of Minnesota, College of Pharmacy, Minneapolis, Minnesota
| | - Timothy J Bloom
- Shenandoah University, Bernard J. Dunn School of Pharmacy, Winchester, Virginia
| | - Eric G Boyce
- University of the Pacific, Thomas J. Long School of Pharmacy, Stockton, California
| | | | - Karen Kopacek
- University of Wisconsin-Madison, School of Pharmacy, Madison, Wisconsin
| | | | | | - David R Steeb
- University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Libby J Ross
- American Association of Colleges of Pharmacy, Arlington, Virginia
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Robinson R, O'Connor SK, Hruza H, Nguyen E, Biddle MA Jr, Jaglowicz A, Wadsworth TG. Establishment of a Framework to Support Multi-Faceted Initiatives for Pharmacy- Practice Transformation: Lessons Learned. Pharmacy (Basel) 2021; 9:153. [PMID: 34564560 DOI: 10.3390/pharmacy9030153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 11/16/2022] Open
Abstract
We describe the first two years of a multifaceted, five-year program to support sustainable pharmacist-provided health services in Alaska. In 2018, the Alaska Pharmacists Association funded the Sustainable Education and Training Model under Pharmacist as Providers (SETMuPP) to train and support pharmacists to navigate the insurance medical billing process for nondispensing healthcare services. The SETMuPP employed a three-pillar implementation approach: (1) training and practice support infrastructure, (2) PharmD curriculum augmentation, and (3) advocacy and legislative support. The first two years have demonstrated the effectiveness of triad partnerships between professional associations, state policy makers, and academic centers to catalyze meaningful practice transformation.
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Lampman MA, Chandrasekaran A, Branda ME, Tumerman MD, Ward P, Staats B, Johnson T, Giblon R, Shah ND, Rushlow DR. Optimizing Huddle Engagement Through Leadership and Problem Solving Within Primary Care: Results from a Cluster-Randomized Trial. J Gen Intern Med 2021; 36:2292-9. [PMID: 33501530 DOI: 10.1007/s11606-020-06487-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Leaders play a crucial role in implementing and sustaining changes in clinical practice, yet there is limited evidence on the strategies to engage them in team problem solving and communication. OBJECTIVE Examine the impact of an intervention focused on facilitating leadership during daily huddles on optimizing team-based care and improving outcomes. DESIGN Cluster-randomized trial using intention-to-treat analysis to measure the effects of the intervention (n = 13 teams) compared with routine practice (n = 16 teams). PARTICIPANTS Twenty-nine primary care clinics affiliated with a large integrated health system in the upper Midwest; representing differing practice types and geographic settings. INTERVENTION Full-day leadership training retreat for team leaders to facilitate of care team huddles. Biweekly coaching calls and two site visits with an assigned coach. MAIN MEASURES Primary outcomes of team development and function were collected, pre- and post-intervention using surveys. Patient satisfaction and quality outcomes were compared pre- and post-intervention as secondary outcomes. Leadership engagement and adherence to the intervention were also assessed. KEY RESULTS A total of 279 pre-intervention and 272 post-intervention surveys were completed. We found no impact on team development (- 0.98, 95% CI (- 3.18, 1.22)), improved team credibility (0.18, 95% CI (0.00, 0.35)), but worse psychological safety (- 0.19, 95% CI (- 0.38, 0.00)). No differences were observed in patient satisfaction; however, results were mixed among quality outcomes. Post hoc analysis within the intervention group showed higher adherence to the intervention was associated with improvement in team coordination (0.47, 95% CI (0.18, 0.76)), credibility (0.28, 95% CI (0.02, 0.53)), team learning (0.42, 95% CI (0.10, 0.74)), and knowledge creation (0.74, 95% CI (0.35, 1.13)) compared to teams that were less engaged. CONCLUSIONS Results of this evaluation showed that leadership training and facilitation were not associated with better team functioning. Additional components to the intervention tested may be necessary to enhance team functioning. TRIAL REGISTRATION Clinicaltrials.gov Identifier NCT03062670. Registration Date: February 23, 2017. URL: https://clinicaltrials.gov/ct2/show/NCT03062670.
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Goldberg DG, Soylu TG, Kitsantas P, Grady VM, Elward K, Nichols LM. Burnout among Primary Care Providers and Staff: Evaluating the Association with Practice Adaptive Reserve and Individual Behaviors. J Gen Intern Med 2021; 36:1222-8. [PMID: 33420562 DOI: 10.1007/s11606-020-06367-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Workplace burnout among healthcare professionals is a critical public health concern. Few studies have examined organizational and individual factors associated with burnout across healthcare professional groups. OBJECTIVE The purpose of this study was to examine the association between practice adaptive reserve (PAR) and individual behavioural response to change and burnout among healthcare professionals in primary care. DESIGN This cross-sectional study used survey data from 154 primary care practices participating in the EvidenceNOW Heart of Virginia Healthcare initiative. PARTICIPANTS We analysed data from 1279 healthcare professionals in Virginia. Our sample included physicians, advanced practice clinicians, clinical support staff and administrative staff. MAIN MEASURES We used the PAR instrument to measure organizational capacity for change and the Change Diagnostic Index© (CDI) to measure individual behavioural response, which achieved a 76% response rate. Logistic regression analysis was used to estimate the effects of PAR and CDI on burnout. KEY RESULTS As organizational capacity for change increased, burnout in healthcare professionals decreased by 51% (OR: 0.49; 95% CI, 0.33, 0.73). As healthcare professionals showed improved response toward change, burnout decreased by 84% (OR: 0.16; 95% CI, 0.11, 0.23). Analysis by healthcare professional type revealed a significant association between high organizational capacity for change, positive response to change and low burnout among administrative staff (OR: 2.92; 95% CI, 1.37, 6.24). Increased hours of work per week was associated with higher odds of burnout (OR: 1.07; 95% CI, 1.05, 1.10) across healthcare professional groups. CONCLUSION As transformation efforts in primary care continue, it is critical to understand the influence of these initiatives on healthcare professionals' well-being. Efforts to reduce burnout among healthcare professionals are needed at both a system and organizational level. Building organizational capacity for change, supporting providers and staff during major change and consideration of individual workload may reduce levels of burnout.
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Schuttner L, Coleman K, Ralston J, Parchman M. The role of organizational learning and resilience for change in building quality improvement capacity in primary care. Health Care Manage Rev 2021; 46:E1-E7. [PMID: 33630509 PMCID: PMC7541444 DOI: 10.1097/hmr.0000000000000281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The extent that organizational learning and resilience for the change process, that is, adaptive reserve (AR), is a component of building practice capacity for continuous quality improvement (QI) is unknown. PURPOSE The aim of the study was to examine the association of AR and development of QI capacity. METHODOLOGY One hundred forty-two primary care practices were evaluated at baseline and 12 months in a randomized trial to improve care quality. Practice AR was measured by staff survey along with a validated QI capacity assessment (QICA). We assessed the association of baseline QICA with baseline AR and both baseline and change in AR with change in QICA from 0 to 12 months. Effect modification by presence of QI infrastructure in parent organizations and trial arm was examined. RESULTS Mean QICA increased from 6.5 to 8.1 (p < .001), and mean AR increased from 71.8 to 73.9 points (p < .001). At baseline, there was a significant association between AR and QICA scores: The QICA averaged 0.34 points higher (95% CI [0.04, 0.64], p = .03) per 10-point difference in AR. There was a significant association between baseline AR and 12-month QICA-which averaged 0.30 points higher (95% CI [0.02, 0.57], p = .04) per 10 points in baseline AR. There was no association between changes in AR and the QICA from 0 to 12 months and no effect modification by trial arm or external QI infrastructure. CONCLUSIONS Baseline AR was positively associated with both baseline and follow-up QI capacity, but there was no association between change in AR and change in the QICA, suggesting AR may be a precondition to growth in QI capacity. PRACTICE IMPLICATIONS Findings suggest that developing AR may be a valuable step prior to undertaking QI-oriented growth, with implications for sequencing of development strategies, including added gain in QI capacity development from building AR prior to engaging in transformation efforts.
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Grady VM, Soylu TG, Goldberg DG, Kitsantas P, Grady JD. A Cross-Sectional Analysis of Primary Care Practice Characteristics and Healthcare Professionals' Behavioral Responses to Change. Inquiry 2021; 58:46958021996518. [PMID: 33645303 PMCID: PMC7923974 DOI: 10.1177/0046958021996518] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The recent decade brought major changes to primary care practices. Previous research on change has focused on change processes, and change implementations rather than studying employee’s feelings, perceptions, and attitudes toward change. The objective of this cross-sectional study was to examine the relationship between healthcare professionals’ behavioral responses to change and practice characteristics. Our study, which builds upon Conner’s theory, addresses an extensive coverage of individual behaviors, feelings, and attitudes toward change. We analyzed survey responses of healthcare professionals (n = 1279) from 154 primary care practices in Virginia. Healthcare professionals included physicians, advanced practice clinicians, clinical support staff, and administrative staff. The Change Diagnostic Index© (CDI) was used to measure behavioral responses in 7 domains: anxiety, frustration, delayed development, rejection of environment, refusal to participate, withdrawal, and global reaction. We used descriptive statistics and multivariate regression analysis. Our findings indicate that professionals had a significantly lower aptitude for change if they work in larger practices (≥16 clinicians) compared to solo practices (P < .05) and at hospital-owned practices compared to independent practices (P < .05). Being part of an accountable care organization was associated with significantly lower anxiety (P < .05). Understanding healthcare professionals’ responses to change can help healthcare leaders design and implement successful change management strategies for future transformation.
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Nguyen AM, Cuthel AM, Rogers ES, Van Devanter N, Pham-Singer H, Shih S, Berry CA, Shelley DR. Attributes of High-Performing Small Practices in a Guideline Implementation: A Multiple-Case Study. J Prim Care Community Health 2020; 11:2150132720984411. [PMID: 33356790 PMCID: PMC7768565 DOI: 10.1177/2150132720984411] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective HealthyHearts NYC was a stepped wedge randomized control trial that tested the effectiveness of practice facilitation on the adoption of cardiovascular disease guidelines in small primary care practices. The objective of this study was to identify was to identify attributes of small practices that signaled they would perform well in a practice facilitation intervention implementation. Methods A mixed methods multiple-case study design was used. Six small practices were selected representing 3 variations in meeting the practice-level benchmark of >70% of hypertensive patients having controlled blood pressure. Inductive and deductive approaches were used to identify themes and assign case ratings. Cross-case rating comparison was used to identify attributes of high performing practices. Results Our first key finding is that the high-performing and improved practices in our study looked and acted similarly during the intervention implementation. The second key finding is that 3 attributes emerged in our analysis of determinants of high performance in small practices: (1) advanced use of the EHR; (2) dedicated resources and commitment to quality improvement; and (3) actively engaged lead clinician and office manager. Conclusions These attributes may be important determinants of high performance, indicating not only a small practice’s capability to engage in an intervention but possibly also its readiness to change. We recommend developing tools to assess readiness to change, specifically for small primary care practices, which may help external agents, like practice facilitators, better translate intervention implementations to context.
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Affiliation(s)
| | | | | | | | - Hang Pham-Singer
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Sarah Shih
- New York City Department of Health and Mental Hygiene, New York, NY, USA
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16
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Qureshi N, Quigley DD, Hays RD. Nationwide Qualitative Study of Practice Leader Perspectives on What It Takes to Transform into a Patient-Centered Medical Home. J Gen Intern Med 2020; 35:3501-3509. [PMID: 32748342 PMCID: PMC7728968 DOI: 10.1007/s11606-020-06052-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/27/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Despite widespread adoption of patient-centered medical home (PCMH), little is known about why practices pursue PCMH and what is needed to undergo transformation. OBJECTIVE Examine reasons practices obtained and maintained PCMH recognition and what resources were needed. DESIGN Qualitative study of practice leader perspectives on PCMH transformation, based on a random sample of primary care practices engaged in PCMH transformation, stratified by US region, practice size, PCMH recognition history, and practice use of Consumer Assessment of Healthcare Providers and Systems (CAHPS®) PCMH survey. PARTICIPANTS 105 practice leaders from 294 sampled practices (36% response rate). APPROACH Content analysis of interviews with practice leaders to identify themes. RESULTS Most practice leaders had local control of PCMH transformation decisions, even if practices adopted quality initiatives under the direction of an organization or network. Financial incentives, being in a statewide effort, and the intrinsic desire to improve care or experiences were the most common reasons practice leaders decided to obtain PCMH recognition and pursue associated care delivery changes. Leadership support and direction were highlighted as essential throughout PCMH transformation. Practice leaders reported needing specialized staff knowledge and significant resources to meet PCMH requirements, including staff knowledgeable about how to implement PCMH changes, track and monitor improvements, and navigate implementation of simultaneous changes, and staff with specific quality improvement (QI) expertise related to evaluating changes and scaling-up programs. CONCLUSION PCMH efforts necessitated support and assistance to frontline, on-site practice leaders leading care delivery changes. Such change efforts should include financial incentives (e.g., direct payment or additional reimbursement), leadership direction and support, and internal or external staff with experience with the PCMH application process, implementation changes, and QI expertise in monitoring process and outcome data. Policies that recognize and meet the needs of on-site practice leaders will better promote primary care practice transformation and move practices further toward their PCMH transformation goals.
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Affiliation(s)
| | | | - Ron D Hays
- Division of General Internal Medicine & Health Services Research, UCLA, Los Angeles, CA, USA
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17
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Moore GD, Burns AL, Fish H, Gandhi N, Kebodeaux C, Meny LM, Policastri A, Sneed KB, Traynor A, Vosooney A, Bradley-Baker LR. The Report of the 2019-2020 Professional Affairs Standing Committee: Pharmacist Integration with Primary Care Practices. Am J Pharm Educ 2020; 84:ajpe8199. [PMID: 33149338 PMCID: PMC7596612 DOI: 10.5688/ajpe8199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The 2019-2020 Professional Affairs Committee was charged to (1) Describe the leadership role of schools of pharmacy in advancing interprofessional practice, with an emphasis on physician-pharmacist collaborative relationships; (2) Establish an inventory of resources that can support school efforts to grow collaborative partnerships between pharmacists and physicians; (3) Determine gaps that exist in the resources required to support schools in efforts to facilitate expansion of interprofessional partnerships; and (4) Define strategies and draft an action plan for AACP's role in facilitating member school efforts to accelerate the development of interprofessional practices within their geography of influence. This report provides information on the committee's process to address the committee charges as well as background and resources pertaining to the charges, describes the rationale for and the results from the focus groups conducted at the 2020 AACP Interim Meeting, communicates the results of an initial inventory of models that integrate pharmacists with primary care practices, and provides an overview on issues to continue the work to integrate pharmacists with primary care practices. The committee offered several revisions to current association policy statements and provided a proposed policy statement and several recommendations to AACP pertaining to the committee charges.
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Affiliation(s)
- Gina D Moore
- University of Colorado, Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, Colorado
| | - Anne L Burns
- American Pharmacists Association, Washington, District of Columbia
| | - Hannah Fish
- National Community Pharmacists Association, Alexandria, Virginia
| | - Nidhi Gandhi
- American Association of Colleges of Pharmacy, Arlington, Virginia
| | - Clark Kebodeaux
- University of Kentucky, College of Pharmacy, Lexington, Kentucky
| | - Lisa M Meny
- Ferris State University, College of Pharmacy, Grand Rapids, Michigan
| | - Anne Policastri
- American Society of Health-System Pharmacists, Bethesda, Maryland
| | - Kevin B Sneed
- University of South Florida, College of Pharmacy, Tampa, Florida
| | - Andy Traynor
- Concordia University of Wisconsin, School of Pharmacy, Mequon, Wisconsin
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18
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Welch BE, Arif SA, Bloom TJ, Isaacs AN, Janke KK, Johnson JL, Moseley LE, Ross LJ. Report of the 2019-2020 AACP Student Affairs Standing Committee. Am J Pharm Educ 2020; 84:ajpe8198. [PMID: 33149337 PMCID: PMC7596594 DOI: 10.5688/ajpe8198] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The 2019-2020 Student Affairs Standing Committee addressed charges related to professional identity formation (PIF) in order to set direction and propose action steps consistent with Priority #3.4 of the AACP Strategic Plan, which states "Academic-practice partnerships and pharmacist-involved practice models that lead to the progress of Interprofessional Practice (IPP) are evident and promoted at all colleges and schools of pharmacy." To this end, the committee was charged to 1) outline key elements of PIF, 2) explore the relationship between formal curricular learning activities and co- or extra-curricular activities in supporting PIF, 3) determine the degree to which there is evidence that strong PIF is embedded in student pharmacists' educational experience, and 4) define strategies and draft an action plan for AACP's role in advancing efforts of schools to establish strong PIF in pharmacy graduates. This report describes work of the committee in exploring PIF and provides resources and background information relative to the charges. The committee offers several suggestions and recommendations for both immediate and long-term action by AACP and members to achieve goals related to integrating PIF into pharmacy education. The committee proposes a policy statement relative to the committee charges. Furthermore, the report calls upon the profession to develop a unified identity and incorporate support for PIF into pharmacy education, training, and practice.
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Affiliation(s)
- Beth E Welch
- Western New England University, College of Pharmacy and Health Sciences, Springfield, Massachusetts
| | - Sally A Arif
- Midwestern University, Chicago College of Pharmacy, Downers Grove, Illinois
| | - Timothy J Bloom
- Shenandoah University Bernard J. Dunn School of Pharmacy, Winchester, Virginia
| | - Alex N Isaacs
- Purdue University College of Pharmacy, West Lafayette, Indiana
| | - Kristin K Janke
- University of Minnesota College of Pharmacy, Minneapolis, Minnesota
| | | | | | - Libby J Ross
- American Association of Colleges of Pharmacy, Arlington, Virginia
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19
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Adewale V, Brown J, Shield R, Goldman R, Frazzano AA, Khan U, Wheeler E, Kunkel ML, Borkan J. PCMH in a College Setting: A Brown Primary Care Transformation Initiative. R I Med J (2013) 2020; 103:73-77. [PMID: 33003685] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
While the PCMH is the primary care model of choice for many healthcare systems, it is a relatively new area for college communities. The college health setting provides an important and challenging primary care platform because of developmental milestones that young adults face at this time of their lives. The Brown Primary Care Transformation Initiative (BPCTI) facilitated PCMH practice transformation efforts within a university center from 2013-2015. A mixed methods evaluative approach was used for baseline and follow-up periods as part of a broader transformation initiative that included interviews, surveys, focus groups, and observations. The college health practice was engaged in a number of other transformation activities concurrently. Results suggest that these multiple efforts, of which BPCTI's facilitation was one, together had a positive effect in this college health setting. This intervention provides a unique window into strengths and challenges for a college health practice as it seeks to transform its provision of primary care.
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Affiliation(s)
- Victoria Adewale
- Resident Physician, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Joanna Brown
- Clinical Associate Professor of Family Medicine, Alpert Medical School of Brown University, Providence, RI
| | - Renee Shield
- Professor of Health Services, Policy & Practice (Clinical), Alpert Medical School of Brown University, Providence, RI
| | - Roberta Goldman
- Clinical Professor of Family Medicine, Alpert Medical School of Brown University, Providence, RI
| | - Arthur A Frazzano
- Clinical Associate Professor Emeritus of Family Medicine, Alpert Medical School of Brown University, Providence, RI
| | - Unab Khan
- Associate Professor and Chair, Department of Family Medicine, The Aga Khan University, Pakistan
| | | | | | - Jeffrey Borkan
- Chair & Professor, Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI
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20
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Chair GK, Bacci JL, Chui MA, Farley J, Gannett PM, Holstad SG, Livet M, Farrell D. Implementation Science to Advance Practice and Curricular Transformation: Report of the 2019-2020 AACP Research and Graduate Affairs Committee. Am J Pharm Educ 2020; 84:ajpe848204. [PMID: 33149346 PMCID: PMC7596610 DOI: 10.5688/ajpe848204] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The 2019-2020 AACP Research and Graduate Affairs Committee (RGAC) was charged with articulating the case for and evaluating the state of implementation science in academic pharmacy, given the potential for implementation science to act as a driver of practice and curricular transformation. Based on the current state of pharmacy research in this area, the RGAC was further charged with outlining a plan to raise the profile of implementation science with pharmacy leadership and defining strategies for AACP to facilitate schools in applying its methods to their practice and education missions. For this work, the RGAC considered implementation science to be the scientific study of methods and strategies to promote adoption of evidence-based practices and interventions into real world settings and routine practice, to improve the quality and effectiveness of services. The RGAC identified three components of an effective strategy for AACP to assist schools in applying implementation science in practice and education: 1) raising awareness of implementation science as an opportunity for academic pharmacy, 2) connecting pharmacy researchers with the larger implementation science community, and 3) developing pharmacy researchers in the competencies and methods associated with implementation science. Specific recommendations for this strategy were informed by searches of the literature and funding landscape related to implementation science and pharmacy. The RGAC also identified stakeholder groups that AACP could target in a campaign to raise awareness of implementation science and connectivity to the existing research community in this space, including academic leadership, faculty with expertise in relevant research methodologies (eg, the Social and Administrative Science (SAS) section of AACP), and the academic pharmacy community as a whole.
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Affiliation(s)
- Grace Kuo Chair
- Oregon State University College of Pharmacy, Corvallis, Oregon
| | - Jennifer L Bacci
- University of Washington School of Pharmacy, Seattle, Washington
| | - Michelle A Chui
- University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin
| | - Joel Farley
- University of Minnesota College of Pharmacy, Minneapolis, Minnesota
| | - Peter M Gannett
- Nova Southeastern University College of Pharmacy, Fort Lauderdale, Florida
| | | | - Melanie Livet
- University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Dorothy Farrell
- American Association of Colleges of Pharmacy, Arlington, Virginia
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21
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Robinson R, Liday C, Burde A, Pettinger T, Paul A, Nguyen E, Holmes J, Penner M, Jaglowicz A, Spann N, Boyle J, Biddle M, Buffat B, Cleveland K, Powell B, Owens C. Practice Transformation Driven through Academic Partnerships. Pharmacy (Basel) 2020; 8:E120. [PMID: 32674322 DOI: 10.3390/pharmacy8030120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022] Open
Abstract
Evidence-based interventions have been shown to improve the quality of patient care, reduce costs, and improve overall health outcomes; however, adopting new published research and knowledge into practice has historically been slow, and requires an active, systematic approach to engage clinicians and healthcare administrators in the required change. Pharmacists have been identified as important agents of change and can enhance care delivery in primary care settings through evidence-based interventions. Utilizing the Consolidated Framework for Implementation Research (CFIR) we identify, assess, and share barriers and facilitators to program development, as well as growth and expansion efforts across five discrete, university-subsidized, embedded-pharmacy practices in primary care. We identified two overarching modifiable factors that influence current and future practice delivery and highlight the role of academia as an incubator for practice change and implementation: Data collection and information sharing. Conceptual frameworks such as CFIR help establish a common vernacular that can be used to facilitate systematic practice site implementation and dissemination of information required to support practice transformation.
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22
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Krist AH, DeVoe JE, Cheng A, Ehrlich T, Jones SM. Redesigning Primary Care to Address the COVID-19 Pandemic in the Midst of the Pandemic. Ann Fam Med 2020; 18:349-354. [PMID: 32661037 PMCID: PMC7358035 DOI: 10.1370/afm.2557] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 11/09/2022] Open
Abstract
During a pandemic, primary care is the first line of defense. It is able to reinforce public health messages, help patients manage at home, and identify those in need of hospital care. In response to the COVID-19 pandemic, primary care scrambled to rapidly transform itself and protect clinicians, staff, and patients while remaining connected to patients. Using the established public health framework for addressing a pandemic, we describe the actions primary care needs to take in a pandemic. Recommended actions are based on observed experiences of the authors' primary care practices and networks. Early in the COVID-19 pandemic, tasks focused on promoting physical distancing and encouraging patients with suspected illness or exposure to self-quarantine. Testing was not available and contract tracing was not possible. As the pandemic spread, in-person care was converted to virtual care using telehealth. Practices remained connected to patients using registries to reach out to those at risk for infection, with uncontrolled chronic conditions, or were socially vulnerable. Practices managed most patients with suspected COVID-19 at home. As the pandemic decelerates, practices are now preparing to address the direct and indirect consequences-complications from COVID-19 infections, missed treatment for acute problems, inadequate prevention, uncontrolled chronic disease, mental illness, and greater social needs. Throughout, practices bore tremendous financial burden, laying off staff or even closing at a time when most needed. Primary care must learn from this experience and be ready for the next pandemic. Policymakers and payers cannot fail primary care during their next time of need.
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Affiliation(s)
- Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia .,Inova Health System, Fairfax, Virginia.,Fairfax Family Practice Residency, Fairfax, Virginia
| | - Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Anthony Cheng
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Thomas Ehrlich
- Inova Health System, Fairfax, Virginia.,Fairfax Family Practice Residency, Fairfax, Virginia
| | - Samuel M Jones
- Inova Health System, Fairfax, Virginia.,Fairfax Family Practice Residency, Fairfax, Virginia
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23
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Motley E. Building a Thriving Lifestyle Medicine Practice Within a Primary Care Clinic: A Model for Aspiring Lifestyle Medicine Practitioners. Am J Lifestyle Med 2020; 14:133-136. [PMID: 32231477 DOI: 10.1177/1559827620904868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The field of Lifestyle Medicine (LM) is growing rapidly as individuals and communities seek real solutions to the hardship of chronic disease. Providers across various medical specialties and allied health professions are gaining certification in this field, and yet are struggling with implementation. Time constraints, concern about reimbursement, and lack of clinical experience in counseling patients are often cited as obstacles. This article will address these issues and demonstrate how LM can be successfully practiced in a standard primary care setting. Active participation in the local community is essential. Office visits must be prepared for efficiently, and encounters should focus on teaching simple concepts to patients. At-home learning activities can then be used to build on these concepts. Referral to health coaches and outside programs are helpful options as well. Equipping providers with practice tools to promote lifestyle change will improve satisfaction for patients and providers alike and is an important step toward advancing the field of LM.
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Affiliation(s)
- Elizabeth Motley
- Prisma Health-Upstate, University of South Carolina School of Medicine Greenville, Greenville, South Carolina
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24
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Adler RN, Ferguson WJ, Antar H, Steinkrauss M, Bjoern B, Konar V, Flanagan J, Polakoff DF. Transformation Support Provided Remotely to a National Cohort of Optometry Practices. Ann Fam Med 2019; 17:S33-S39. [PMID: 31405874 PMCID: PMC6827673 DOI: 10.1370/afm.2423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/23/2019] [Accepted: 02/27/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We describe the results of a practice transformation project conducted within a national cohort of optometry practices participating in the Southern New England Practice Transformation Network. METHODS Participants were 2,997 optometrists in 1,706 practices in 50 states. The multicomponent intervention entailed curriculum dissemination through a preexisting network of optometrists supported by specialized staff and resources, and data collection through a web portal providing real-time feedback. Outcomes included practices reporting data, urgent optometry visits for target conditions, and projected cost savings achieved by reducing emergency department (ED) use through increased provision of urgent care for conditions amenable to management in optometry practices. RESULTS Over 13 months, 69.9% of practices reported data for a mean of 6.7 months. Beginning with the fourth month, the number of urgent optometry visits increased steadily. Among reporting practices, the total cost savings were estimated at $152 million (176,703 ED visits avoided at an average cost differential of $860 per visit). Monthly projected cost savings per optometrist were substantially greater in rural vs urban practices ($10,800 vs $7,870; P <.001). CONCLUSIONS Technical assistance to promote practice transformation can be provided remotely and at scale at low per-practice cost. Through the provision of timely, easily accessed ambulatory care, optometrists can improve the patient experience and reduce ED use, thereby reducing costs. The cost savings opportunities are immense because of the large volume and high expense of ED visits for ocular conditions that might otherwise be managed in ambulatory optometry practices.
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Affiliation(s)
- Ronald N Adler
- Department of Family Medicine and Community Health, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Warren J Ferguson
- Department of Family Medicine and Community Health, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Hussein Antar
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Michael Steinkrauss
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Brian Bjoern
- Department of Family Medicine and Community Health, UMass Memorial Medical Center, Worcester, Massachusetts.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Valerie Konar
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jay Flanagan
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - David F Polakoff
- Department of Family Medicine and Community Health, UMass Memorial Medical Center, Worcester, Massachusetts.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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25
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Rogers ES, Cuthel AM, Berry CA, Kaplan SA, Shelley DR. Clinician Perspectives on the Benefits of Practice Facilitation for Small Primary Care Practices. Ann Fam Med 2019; 17:S17-S23. [PMID: 31405872 PMCID: PMC6827665 DOI: 10.1370/afm.2427] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 05/20/2019] [Accepted: 05/28/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Small independent primary care practices (SIPs) often lack the resources to implement system changes. HealthyHearts NYC, funded through the EvidenceNOW initiative of the Agency for Healthcare Research and Quality, studied the effectiveness of practice facilitation to improve cardiovascular disease- related care in 257 SIPs. We sought to understand SIP clinicians' perspectives on the benefits of practice facilitation. METHODS We conducted in-depth interviews with 19 SIP clinicians enrolled in HealthyHearts NYC. Interviews were transcribed and coded using deductive and inductive approaches. To understand whether the perceived benefits of practice facilitation differ based on the availability of internal staff for quality improvement (QI), we compared themes pertaining to benefits between practices with 3 or fewer office staff vs more than 3 office staff. RESULTS Clinicians perceived 2 main benefits of practice facilitation. First, facilitators served as a connection to the external health care environment for SIPs, often through teaching and information sharing. Second, facilitators provided electronic health record (EHR)/data expertise, often by teaching functionality and completing technical assistance and tasks. SIPs with more than 3 office staff felt that facilitators provided benefits primarily through teaching, whereas SIPs with 3 or fewer staff felt that facilitators also provided hands-on support. At the intersections of these benefits, there emerged 3 central practice facilitation benefits: (1) creating awareness of quality gaps, (2) connecting practices to information, resources, and strategies, and (3) optimizing the EHR for QI goals. CONCLUSIONS SIP clinicians perceived practice facilitation to be an important resource for connecting their practice to the external health care environment and resources, and helping their practice build QI capacity through teaching, hands-on support, and EHR-driven solutions.
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Affiliation(s)
- Erin S Rogers
- New York University School of Medicine, Department of Population Health, New York, New York .,VA NY Harbor Healthcare System, New York, New York
| | - Allison M Cuthel
- New York University School of Medicine, Department of Population Health, New York, New York
| | - Carolyn A Berry
- New York University School of Medicine, Department of Population Health, New York, New York
| | - Sue A Kaplan
- New York University School of Medicine, Department of Population Health, New York, New York
| | - Donna R Shelley
- New York University School of Medicine, Department of Population Health, New York, New York
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26
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Letourneau LM, Ritzo J, Shonk R, Eichler M, Sy S. Supporting Physicians and Practice Teams in Efforts to Address the Opioid Epidemic. Ann Fam Med 2019; 17:S77-S81. [PMID: 31405881 PMCID: PMC6827670 DOI: 10.1370/afm.2408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/31/2018] [Revised: 01/09/2019] [Accepted: 01/31/2019] [Indexed: 11/09/2022] Open
Abstract
Primary care physicians and practice teams increasingly recognize the need to take a role in addressing the growing epidemic of opioid use disorder (OUD) and opioid-related drug overdose deaths, but face considerable challenges in doing so. Through its work supporting practice transformation efforts, sharing innovations, and connecting key sectors within communities, the Network for Regional Healthcare Improvement and several of its member regional health improvement collaboratives have identified innovative ways to support physicians and practice teams in transforming practice in ways that address a spectrum of issues related to opioid use. These strategies include efforts to prevent, identify, and treat opioid addiction, including reducing inappropriate prescribing; improving opioid prescribing safety; compassionately tapering chronic and/or high-dose opioid regimens; appropriately screening for and identifying OUD; initiating treatment with evidence-based medications for OUD within practice settings; and prescribing life-saving naloxone to reverse opioid overdose. By outlining specific initiatives and practice transformation efforts that several regional health improvement collaboratives across the country have implemented to support clinicians and their teams, this article offers examples of how clinicians can get support from collaboratives in their region to implement practice improvement efforts to advance this critically important work.
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Affiliation(s)
| | - Jolie Ritzo
- Network for Regional Healthcare Improvement, South Portland, Maine
| | | | - Mark Eichler
- Mountain-Pacific Quality Health, Casper, Wyoming
| | - Stevi Sy
- Mountain-Pacific Quality Health, Casper, Wyoming
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27
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Khanna N, Gritzer L, Klyushnenkova E, Montgomery R, Dark M, Shah S, Shaya F. Practice Transformation Analytics Dashboard for Clinician Engagement. Ann Fam Med 2019; 17:S73-S76. [PMID: 31405880 PMCID: PMC6827660 DOI: 10.1370/afm.2382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/21/2018] [Accepted: 01/31/2019] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Practice transformation in primary care is a movement toward data-driven redesign of care, patient-centered care delivery, and practitioner activation. A critical requirement for achieving practice transformation is availability of tools to engage practices. METHODS A total of 48 practices with 109 practice sites participate in the Garden Practice Transformation Network in Maryland (GPTN-Maryland) to work together toward practice transformation and readiness for the Quality Payment Program implemented by the Centers for Medicare & Medicaid Services. Practice-specific data are collected in GPTN-Maryland by practices themselves and by practice transformation coaches, and are provided by the Centers for Medicare & Medicaid Services. These data are overwhelming to practices when presented piecemeal or together, a barrier to practices taking action to ensure progress on the transformation spectrum. The GPTN-Maryland team therefore created a practice transformation analytics dashboard as a tool to present data that are actionable in care redesign. RESULTS When practices reviewed their data provided by the Centers for Medicare & Medicaid Services using the dashboard, they were often seeing, for the first time, cost data on their patients, trends in their key performance indicator data, and their practice transformation phase. Overall, 72% of practices found the dashboard engaging, and 48% found the data as presented to be actionable. CONCLUSIONS The practice transformation analytics dashboard encourages practices to advance in practice transformation and improvement of patient care delivery. This tool engaged practices in discussions about data, care redesign, and costs of care, and about how to develop sustainable change within their practices. Research is needed to study the impact of the dashboard on costs and quality of care delivery.
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Affiliation(s)
- Niharika Khanna
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Lauren Gritzer
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Elena Klyushnenkova
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Michael Dark
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Savyasachi Shah
- University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Fadia Shaya
- University of Maryland School of Pharmacy, Baltimore, Maryland
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Phillips RL, Cohen DJ, Kaufman A, Dickinson WP, Cykert S. Facilitating Practice Transformation in Frontline Health Care. Ann Fam Med 2019; 17:S2-S5. [PMID: 31405869 PMCID: PMC6827672 DOI: 10.1370/afm.2439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 06/18/2019] [Accepted: 07/01/2019] [Indexed: 01/13/2023] Open
Affiliation(s)
- Robert L Phillips
- Center for Professionalism & Value in Health Care, Lexington, Kentucky
| | - Deborah J Cohen
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Arthur Kaufman
- Office for Community Health, University of New Mexico, Albuquerque, New Mexico
| | - W Perry Dickinson
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Samuel Cykert
- Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.,Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
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Abraham MR, McGann P. Contribution of the Transforming Clinical Practice Initiative in Advancing the Movement to Value-Based Care. Ann Fam Med 2019; 17:S6-S8. [PMID: 31405870 PMCID: PMC6827664 DOI: 10.1370/afm.2425] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 04/16/2019] [Indexed: 11/09/2022] Open
Affiliation(s)
- Meena R Abraham
- Centers for Medicare & Medicaid Services, Baltimore, Maryland
| | - Paul McGann
- Centers for Medicare & Medicaid Services, Baltimore, Maryland
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Willgerodt MA, Abu-Rish Blakeney E, Summerside N, Vogel MT, Liner DA, Zierler B. Impact of leadership development workshops in facilitating team-based practice transformation. J Interprof Care 2019; 34:76-86. [PMID: 31039647 DOI: 10.1080/13561820.2019.1604496] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The development of interprofessional collaborative practice (IPCP) environments requires a systematic, multi-pronged approach. Despite recognition of the need for IPCP, interventions that support its development are not well described in the literature. Leadership training is necessary for individuals and teams to build IPCP-supportive environments. This study describes the impact of a longitudinal series of leadership development workshops to strengthen IPCP and facilitate practice transformation. Semi-structured interviews were conducted with 16 healthcare professionals who described ways in which the workshops influenced the team-based practice transformation. Thematic analysis indicated that the workshops were instrumental in providing structure and opportunity for participants to learn skills, expand perspectives, and change behavior to improve team outcomes. Findings highlight the importance of supporting individual and team development over time and suggest that intentional, targeted coaching focused on relationship building and meeting the evolving needs of the team is critical to the implementation and sustainment of practice change.
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Affiliation(s)
| | | | | | - Mia T Vogel
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Debra A Liner
- School of Nursing, Department of Biobehavioral Nursing and Health Informatics
| | - Brenda Zierler
- School of Nursing, University of Washington, Seattle, WA, USA
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31
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Castro MG, Dicks M, Fallin-Bennett K, Hustedde C, Sacks D, Hunter LJ, Elder W. Teach students, Empower patients, Act collaboratively and Meet health goals: an early interprofessional clinical experience in transformed care. Adv Med Educ Pract 2019; 10:47-53. [PMID: 30787645 PMCID: PMC6368122 DOI: 10.2147/amep.s175413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE Transformation of care teaching is often didactic and conceptual instead of practical and operational. Clinical environments, slow to transform, limit student exposure to key experiences that characterize transformed care. We describe the design and implementation of TEAM Clinic (Teach students, Empower patients, Act collaboratively, Meet health goals) - an early clinical learning experience to address this gap. METHODS The TEAM Clinic curriculum was based on a review of existing curricula and best practice recommendations for the transformation of care. Three key elements were selected as the focus for a low-volume, high-service clinic: patient centeredness, interprofessional collaboration and team-based care. Learners and medically and socially complex patients were recruited for voluntary participation and completed anonymous surveys about the experience during and afterward. RESULTS Nine first-year medical students, two first-year social work students and one pharmacy resident were integrated into the interprofessional team. Students were assigned roles adapted to their level and skill set; deliberate interprofessional pairing was assigned to broaden perspectives on scope and role of team members. Upon completion of this two-semester experience, 11 of the 12 learners returned surveys; all rated the experience as positive (strongly agree or agree) on the Authentic Clinical Interprofessional Experience - Evaluation of Interprofessional Site tool. Patient surveys indicated satisfaction with multiple aspects of the visit. CONCLUSION TEAM Clinic provided a practical example of transformation of care teaching in a not-yet-transformed environment. Logistical barriers included space, schedule and staffing. Facilitators included alignment with the goals of core curricula and faculty. Limitations included that this description of these curricula and this pilot come early in our longitudinal development of TEAM Clinic, constraining our ability to measure behavioral changes around interprofessional education, teamwork or patient centeredness. Next steps would examine the trajectory to these outcomes in the preclinical student group.
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Affiliation(s)
- Maria Gabriela Castro
- Department of Family and Community Medicine, University of Kentucky, Lexington, KY, USA,
| | - Melanie Dicks
- College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Keisa Fallin-Bennett
- Department of Family and Community Medicine, University of Kentucky, Lexington, KY, USA,
| | - Carol Hustedde
- Department of Family and Community Medicine, University of Kentucky, Lexington, KY, USA,
| | - David Sacks
- Department of Family and Community Medicine, University of Kentucky, Lexington, KY, USA,
| | | | - William Elder
- Department of Family and Community Medicine, University of Kentucky, Lexington, KY, USA,
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32
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Pyles P, Pelland K, Crowningshield V, Jenkins B, Capizzo L. Helping Ambulatory Practices Succeed: Reflections from Practice Transformation Facilitators. R I Med J (2013) 2018; 101:24-27. [PMID: 30509002] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Healthcare reform efforts implemented to optimize primary and specialty care delivery require practices to undertake considerable transformation. To support change efforts, many private insurers and federal and state health-reform efforts provide practices and clinicians with access to practice-transformation facilitators. Healthcentric Advisors provides practice-transformation support and technical assistance to practices in Rhode Island and across New England. From this work we know that strategies and approaches to support transformation and achievement of program recognitions differ by practice characteristics, resource access, and patient panels. Understanding practice attitudes and beliefs about change, recognizing that change occurs on a spectrum, acknowledging that program recognition is only the beginning, and aligning quality-improvement initiatives, are domains that support success regardless of practice type. However, working with a facilitator who engages your entire care team to integrate a culture of quality improvement and process ownership, has the greatest impact on overall transformation.
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Affiliation(s)
- Putney Pyles
- Senior Program Coordinator, Healthcentric Advisors, Providence, RI
| | | | | | - Brenda Jenkins
- Senior Program Administrator / HIT Consultant, Healthcentric Advisors, Providence, RI
| | - Lauren Capizzo
- Director, Practice Transformation, Healthcentric Advisors, Providence, RI
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Felizzola J, Wolfrum SG, Sol C, Zea MC, Nieves-Lugo K, Del Río-González AM, Pinho V, Funk D, Weeks K. Development and Implementation of an HIV Health Care Practice Transformation Model for Latinos. AIDS Educ Prev 2018; 30:502-515. [PMID: 30966766 DOI: 10.1521/aeap.2018.30.6.502] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A Latino Community Health Center in Washington, D.C. implemented and evaluated a practice transformative model to optimize human resources and improve quality health outcomes in HIV service delivery for Latino patients. We conducted a qualitative formative assessment through interviews and focus groups with clinic staff and patients living with HIV/AIDS in order to inform implementation. The formative assessment identified specific training and practice facilitation needs and provided valuable insight for choosing evaluation metrics. Incorporating staff input fostered staff engagement in laying the foundation of the transformation and helped build a sense of ownership of the transformative process. Through the formative assessment process we gained insight into the organization's HIV practice and improved our ability to align practice transformation goals with evaluation metrics to better measure changes resulting from the model implementation. The formative assessment process also highlighted challenges in conducting health systems research with Latino communities in the U.S.
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Affiliation(s)
- Jesus Felizzola
- Department of Psychology, The George Washington University, Washington, D.C
| | | | | | - Maria Cecilia Zea
- Department of Psychology, The George Washington University, Washington, D.C
| | - Karen Nieves-Lugo
- Department of Psychology, The George Washington University, Washington, D.C
| | | | - Veronica Pinho
- Department of Psychology, The George Washington University, Washington, D.C
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34
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Brown-Johnson CG, Chan GK, Winget M, Shaw JG, Patton K, Hussain R, Olayiwola JN, Chang SI, Mahoney M. Primary Care 2.0: Design of a Transformational Team-Based Practice Model to Meet the Quadruple Aim. Am J Med Qual 2018; 34:339-347. [PMID: 30409021 DOI: 10.1177/1062860618802365] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A new transformational model of primary care is needed to address patient care complexity and provider burnout. An 18-month design effort (2015-2016) included the following: (1) Needs Finding, (2) Integrated Facility Design, (3) Design Process Assessment, and (4) Development of Evaluation. Initial outcome metrics were assessed. The design team successfully applied Integrated Facility Design to primary care transformation design; qualitative survey results suggest that design consensus was facilitated by team-building activities. Initial implementation of Quadruple Aim-related outcome metrics showed positive trends. Redesign processes may benefit from emphasis on team building to facilitate consensus and increased patient involvement to incorporate patient voices successfully.
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Affiliation(s)
| | - Garrett K Chan
- 1 Stanford University School of Medicine, Stanford, CA.,2 Stanford Health Care, Stanford, CA
| | - Marcy Winget
- 1 Stanford University School of Medicine, Stanford, CA
| | | | - Kendra Patton
- 1 Stanford University School of Medicine, Stanford, CA.,2 Stanford Health Care, Stanford, CA
| | | | - J Nwando Olayiwola
- 4 University of California San Francisco (UCSF), San Francisco, CA.,5 RubiconMD, New York, NY
| | | | - Megan Mahoney
- 1 Stanford University School of Medicine, Stanford, CA.,2 Stanford Health Care, Stanford, CA
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English AF, Dickinson LM, Zittleman L, Nease DE, Herrick A, Westfall JM, Simpson MJ, Fernald DH, Rhyne RL, Dickinson WP. A Community Engagement Method to Design Patient Engagement Materials for Cardiovascular Health. Ann Fam Med 2018; 16:S58-S64. [PMID: 29632227 PMCID: PMC5891315 DOI: 10.1370/afm.2173] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE EvidenceNOW Southwest is a cluster-randomized trial evaluating the differential impact on cardiovascular disease (CVD) care of engaging patients and communities in practice transformation in addition to standard practice facilitation support. The trial included development of locally tailored CVD patient engagement materials through Boot Camp Translation (BCT), a community engagement process that occurred before practice recruitment but after cluster randomization. METHODS We introduce a cluster randomization method performed before recruitment of small to medium-size primary care practices in Colorado and New Mexico, which allowed for balanced study arms while minimizing contamination. Engagement materials for the enhanced study arm were developed by means of BCT, which included community members, practice members, and public health professionals from (1) metropolitan Denver, (2) rural northeast Colorado, (3) Albuquerque, and (4) rural southeast New Mexico. Outcome measures were messages and materials from BCTs and population characteristics of study arms after using geographic-based covariate constrained randomization. RESULTS The 4 BCTs' messages and materials developed by the BCT groups uniquely reflected each community and ranged from family or spiritual values to early prevention or adding relevance to CVD risk. The geographic-based covariate of a cluster randomization method constrained randomization-assigned regions to study arms, allowing BCTs to precede practice recruitment, reduce contamination, and balance populations. CONCLUSIONS Cluster-randomized trials with community-based interventions present study design and implementation challenges. The BCTs elicited unique contextual messages and materials, suggesting that interventions designed to help primary care practices decrease CVD risk may not be one size fits all.
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Affiliation(s)
- Aimee F English
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - L Miriam Dickinson
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Linda Zittleman
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Donald E Nease
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Alisha Herrick
- Department of Family Medicine, University of New Mexico, Albuquerque, New Mexico
| | - John M Westfall
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Matthew J Simpson
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Douglas H Fernald
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Robert L Rhyne
- Department of Family Medicine, University of New Mexico, Albuquerque, New Mexico
| | - W Perry Dickinson
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
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Durvasula R, Kelly J, Schleyer A, Anawalt BD, Somani S, Dellit TH. Standardized Review and Approval Process for High-Cost Medication Use Promotes Value-Based Care in a Large Academic Medical System. Am Health Drug Benefits 2018; 11:65-73. [PMID: 29915640 PMCID: PMC5973244] [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] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 10/14/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND As healthcare costs rise and reimbursements decrease, healthcare organization leadership and clinical providers must collaborate to provide high-value healthcare. Medications are a key driver of the increasing cost of healthcare, largely as a result of the proliferation of expensive specialty drugs, including biologic agents. Such medications contribute significantly to the inpatient diagnosis-related group payment system, often with minimal or unproved benefit over less-expensive therapies. OBJECTIVE To describe a systematic review process to reduce non-evidence-based inpatient use of high-cost medications across a large multihospital academic health system. METHODS We created a Pharmacy & Therapeutics subcommittee consisting of clinicians, pharmacists, and an ethics representative. This committee developed a standardized process for a timely review (<48 hours) and approval of high-cost medications based on their clinical effectiveness, safety, and appropriateness. The engagement of clinical experts in the development of the consensus-based guidelines for the use of specific medications facilitated the clinicians' acceptance of the review process. RESULTS Over a 2-year period, a total of 85 patient-specific requests underwent formal review. All reviews were conducted within 48 hours. This review process has reduced the non-evidence-based use of specialty medications and has resulted in a pharmacy savings of $491,000 in fiscal year 2016, with almost 80% of the savings occurring in the last 2 quarters, because our process has matured. CONCLUSION The creation of a collaborative review process to ensure consistent, evidence-based utilization of high-cost medications provides value-based care, while minimizing unnecessary practice variation and reducing the cost of inpatient care.
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Affiliation(s)
- Raghu Durvasula
- Associate Professor of Medicine, Division of Nephrology, University of Washington Medical Center, Seattle
| | - Janet Kelly
- Assistant Director of Pharmacy Services, University of Washington Medical Center
| | - Anneliese Schleyer
- Associate Professor of Medicine, Harborview Medical Center, University of Washington
| | - Bradley D Anawalt
- Professor of Medicine, Division of General Internal Medicine, Department of Medicine, University of Washington
| | - Shabir Somani
- Chief Pharmacy Officer and Assistant Dean, University of Washington School of Pharmacy
| | - Timothy H Dellit
- Professor of Medicine, Harborview Medical Center, University of Washington School of Medicine
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Mendel P, Chen EK, Green HD, Armstrong C, Timbie JW, Kress AM, Friedberg MW, Kahn KL. Pathways to Medical Home Recognition: A Qualitative Comparative Analysis of the PCMH Transformation Process. Health Serv Res 2017; 53:2523-2546. [PMID: 29243823 DOI: 10.1111/1475-6773.12803] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To understand the process of practice transformation by identifying pathways for attaining patient-centered medical home (PCMH) recognition. DATA SOURCES/STUDY SETTING The CMS Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration was designed to help FQHCs achieve NCQA Level 3 PCMH recognition and improve patient outcomes. We used a stratified random sample of 20 (out of 503) participating sites for this analysis. STUDY DESIGN We developed a conceptual model of structural, cultural, and implementation factors affecting PCMH transformation based on literature and initial qualitative interview themes. We then used conventional cross-case analysis, followed by qualitative comparative analysis (QCA), a cross-case method based on Boolean logic algorithms, to systematically identify pathways (i.e., combinations of factors) associated with attaining-or not attaining-Level 3 recognition. DATA COLLECTION METHODS Site-level indicators were derived from semistructured interviews with site leaders at two points in time (mid- and late-implementation) and administrative data collected prior to and during the demonstration period. PRINCIPAL FINDINGS The QCA results identified five distinct pathways to attaining PCMH recognition and four distinct pathways to not attaining recognition by the end of the demonstration. Across these pathways, one condition (change leader capacity) was common to all pathways for attaining recognition, and another (previous improvement or recognition experience) was absent in all pathways for not attaining recognition. In general, sites could compensate for deficiencies in one factor with capacity in others, but they needed a threshold of strengths in cultural and implementation factors to attain PCMH recognition. CONCLUSIONS Future efforts at primary care transformation should take into account multiple pathways sites may pursue. Sites should be assessed on key cultural and implementation factors, in addition to structural components, in order to differentiate interventions and technical assistance.
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Affiliation(s)
| | | | | | | | | | - Amii M Kress
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mark W Friedberg
- RAND Corporation, Boston, MA.,Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Katherine L Kahn
- RAND Corporation, Santa Monica, CA.,David Geffen School of Medicine at UCLA, Los Angeles, CA
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Anglin G, Tu HA, Liao K, Sessums L, Taylor EF. Strengthening Multipayer Collaboration: Lessons From the Comprehensive Primary Care Initiative. Milbank Q 2017; 95:602-633. [PMID: 28895218 DOI: 10.1111/1468-0009.12280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Policy Points: Collaboration across payers to align financial incentives, quality measurement, and data feedback to support practice transformation is critical, but challenging due to competitive market dynamics and competing institutional priorities. The Centers for Medicare & Medicaid Services or other entities convening multipayer initiatives can build trust with other participants by clearly outlining each participant's role and the parameters of collaboration at the outset of the initiative. Multipayer collaboration can be improved if participating payers employ neutral, proactive meeting facilitators; develop formal decision-making processes; seek input on decisions from practice representatives; and champion the initiative within their organizations. CONTEXT With increasing frequency, public and private payers are joining forces to align goals and resources for primary care transformation. However, sustaining engagement and achieving coordination among payers can be challenging. The Comprehensive Primary Care (CPC) initiative is one of the largest multipayer initiatives ever tested. Drawing on the experience of the CPC initiative, this paper examines the factors that influence the effectiveness of multipayer collaboration. METHODS This paper draws largely on semistructured interviews with CPC-participating payers and payer conveners that facilitated CPC discussions and on observation of payer meetings. We coded and analyzed these qualitative data to describe collaborative dynamics and outcomes and assess the factors influencing them. FINDINGS We found that several factors appeared to increase the likelihood of successful payer collaboration: contracting with effective, neutral payer conveners; leveraging the support of payer champions, and seeking input on decisions from practice representatives. The presence of these factors helped some CPC regions overcome significant initial barriers to achieve common goals. We also found that leadership from the Centers for Medicare & Medicaid Services (CMS) was key to achieving broad payer engagement in CPC, but CMS's dual role as initiative convener and participating payer at times made collaboration challenging. CMS was able to build trust with other payers by clarifying which parts of CPC could be adapted to regional contexts, deferring to other payers for these decisions, and increasing opportunities for payers to meet with CMS representatives. CONCLUSIONS CPC demonstrates that when certain facilitating factors are present, payers can overcome competitive market dynamics and competing institutional priorities to align financial incentives, quality measurement, and data feedback to support practice transformation. Lessons from this large-scale, multipayer initiative may be helpful for other multipayer efforts getting under way.
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Affiliation(s)
| | - H A Tu
- Mathematica Policy Research, Inc
| | - Kristie Liao
- John F. Kennedy School of Government, Harvard University
| | - Laura Sessums
- Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services
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Di Guglielmo MD, Greenspan JS, Abatemarco DJ. Pediatrician preferences, local resources, and economic factors influence referral to a subspecialty access clinic. Prim Health Care Res Dev 2016; 17:628-635. [PMID: 27185320 PMCID: PMC5065399 DOI: 10.1017/s1463423616000165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Pediatric patients seek timely access to subspecialty care within a complex delivery system while facing barriers: distance, economics, and clinician shortages. Aim We examined stakeholder perceptions about solutions to the access challenge. We engaged over 300 referring primary care pediatricians in the evaluation of Access Clinics at an academic children's hospital. METHODS Using an anonymous online survey, we asked pediatricians about their and their patients' experiences and analyzed factors that may influence referrals. Findings Referring pediatricians reported satisfaction; they provided feedback about their patients' experiences, physician communication, and referral influences. Distance from the Access Clinic does not correlate with differences in referral volume; living in areas with higher child populations and higher median income is associated with more referrals. Referring pediatricians have strong opinions about referrals, are attuned to patient experiences, and desire bi-directional communication. Multiple factors influence referral to and acceptance of Access Clinics, but external influences have less impact than expected.
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Affiliation(s)
- Matthew D. Di Guglielmo
- Clinical Assistant Professor of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Jay S. Greenspan
- Professor of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
- Department of Pediatrics, Nemours/Alfred I., duPont Hospital for Children, Wilmington, DE, USA
| | - Diane J. Abatemarco
- Associate Professor of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
- Department of Pediatrics, Nemours/Alfred I., duPont Hospital for Children, Wilmington, DE, USA
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Abstract
BACKGROUND Patient and family engagement (PFE) is vital to the spirit of the medical home. This article reflects the efforts of an expert consensus panel, the Patient and Family Engagement Workgroup, as part of the Society of General Internal Medicine's 2013 Research Conference. OBJECTIVE To review extant literature on PFE in pediatric and adult medicine and quality improvement, highlight emerging best practices and models, suggest questions for future research, and provide references to tools and resources to facilitate implementation of PFE strategies. METHODS We conducted a narrative review of relevant articles published from 2000 to 2015. Additional information was retrieved from personal contact with experts and recommended sources from workgroup members. RESULTS Despite the theoretical importance of PFE and policy recommendations that PFE occurs at all levels across the health care system, evidence of effectiveness is limited, particularly for quality improvement. There is some evidence that PFE is effective, mostly related to engagement in the care of individual patients, but the evidence is mixed and few studies have assessed the effect of PFE on health outcomes. Measurement issues and the lack of a single comprehensive conceptual model pose challenges to progress in this field. Recommendations for future research and a list of practical tools and resources to facilitate PFE are provided. CONCLUSIONS Although PFE appeals to patients, families, providers, and policy-makers, research is needed to assess outcomes beyond satisfaction, address implementation barriers, and support engagement in practice redesign and quality improvement. Partnering with patients and families has great potential to support high-quality health care and optimize outcomes.
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Affiliation(s)
- Crystal W. Cené
- Division of General Internal Medicine, University of North Carolina at Chapel Hill School of Medicine
| | | | | | - Beverly Baker
- National Center for Family Professional Partnerships, Family Voices, Inc
| | - Renee Davis
- Drexel University School of Public Health/College of Medicine, Philadelphia PA
| | - Renee Turchi
- Division of General Pediatrics, St. Christopher’s Hospital for Children, Philadelphia, PA
- Drexel University School of Public Health/College of Medicine, Philadelphia PA
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Petersen DM, Zickafoose J, Hossain M, Ireys H. Physician Perspectives on Medical Home Recognition for Practice Transformation for Children. Acad Pediatr 2016; 16:373-80. [PMID: 26706123 DOI: 10.1016/j.acap.2015.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 12/07/2015] [Accepted: 12/11/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine child-serving physicians' perspectives on motivations for and support for practices in seeking patient-centered medical home (PCMH) recognition, changes in practice infrastructure, and care processes before and after recognition, and perceived benefits and challenges of functioning as a PCMH for the children they serve, especially children with special health care needs. METHODS Semistructured interviews with 20 pediatricians and family physicians at practices that achieved National Committee for Quality Assurance level 3 PCMH recognition before 2011. We coded notes and identified themes using an iterative process and pattern recognition analysis. RESULTS Physicians reported being motivated to seek PCMH recognition by a combination of altruistic and practical goals. Most said recognition acknowledged existing practice characteristics, but encouraged ongoing, and in some cases substantial, transformation. Although many physicians said recognition helped practices improve financial arrangements with payers and participate in quality initiatives, most physicians could not assess the specific benefits of recognition on patients' use of services or health outcomes. Challenges for practices in providing care for children included managing additional physician responsibilities, communicating with other providers and health systems, and building sustainable care coordination procedures. CONCLUSIONS PCMH recognition can be valuable to practices as a public acknowledgement to payers and patients that certain processes are in place, and can also catalyze new and continued transformation. Programs and policies seeking to transform primary care for children should leverage physicians' motivations and find mechanisms to build practices' capacity for care management systems and linkages with the medical neighborhood.
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Affiliation(s)
- Dana M Petersen
- Mathematica Policy Research, Health Research Division, Oakland, Calif.
| | - Joseph Zickafoose
- Mathematica Policy Research, Health Research Division, Ann Arbor, Mich
| | - Mynti Hossain
- Mathematica Policy Research, Health Research Division, Ann Arbor, Mich
| | - Henry Ireys
- Mathematica Policy Research, Health Research Division, Washington DC
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Goldman RE, Parker DR, Brown J, Walker J, Eaton CB, Borkan JM. Recommendations for a mixed methods approach to evaluating the patient-centered medical home. Ann Fam Med 2015; 13:168-75. [PMID: 25755039 PMCID: PMC4369592 DOI: 10.1370/afm.1765] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE There is a strong push in the United States to evaluate whether the patient-centered medical home (PCMH) model produces desired results. The explanatory and contextually based questions of how and why PCMH succeeds in different practice settings are often neglected. We report the development of a comprehensive, mixed qualitative-quantitative evaluation set for researchers, policy makers, and clinician groups. METHODS To develop an evaluation set, the Brown Primary Care Transformation Initiative convened a multidisciplinary group of PCMH experts, reviewed the PCMH literature and evaluation strategies, developed key domains for evaluation, and selected or created methods and measures for inclusion. RESULTS The measures and methods in the evaluation set (survey instruments, PCMH meta-measures, patient outcomes, quality measures, qualitative interviews, participant observation, and process evaluation) are meant to be used together. PCMH evaluation must be sufficiently comprehensive to assess and explain both the context of transformation in different primary care practices and the experiences of diverse stakeholders. In addition to commonly assessed patient outcomes, quality, and cost, it is critical to include PCMH components integral to practice culture transformation: patient and family centeredness, authentic patient activation, mutual trust among practice employees and patients, and transparency, joy, and collaboration in delivering and receiving care in a changing environment. CONCLUSIONS This evaluation set offers a comprehensive methodology to enable understanding of how PCMH transformation occurs in different practice settings. This approach can foster insights about how transformation affects critical outcomes to achieve meaningful, patient-centered, high-quality, and cost-effective sustainable change among diverse primary care practices.
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Affiliation(s)
- Roberta E Goldman
- Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Donna R Parker
- Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Joanna Brown
- Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Judith Walker
- Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Charles B Eaton
- Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jeffrey M Borkan
- Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Lynch K, Kendall M, Shanks K, Haque A, Jones E, Wanis MG, Furukawa M, Mostashari F. The Health IT Regional Extension Center Program: evolution and lessons for health care transformation. Health Serv Res 2013; 49:421-37. [PMID: 24359032 DOI: 10.1111/1475-6773.12140] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Assess the Regional Extension Center (REC) program's progress toward its goal of supporting over 100,000 providers in small, rural, and underserved practices to achieve meaningful use (MU) of an electronic health record (EHR). DATA SOURCES/STUDY SETTING Data collected January 2010 through June 2013 via monitoring and evaluation of the 4-year REC program. STUDY DESIGN Descriptive study of 62 REC programs. DATA COLLECTION/EXTRACTION METHODS Primary data collected from RECs were merged with nine other datasets, and descriptive statistics of progress by practice setting and penetration of targeted providers were calculated. PRINCIPAL FINDINGS RECs recruited almost 134,000 primary care providers (PCPs), or 44 percent of the nation's PCPs; 86 percent of these were using an EHR with advanced functionality and almost half (48 percent) have demonstrated MU. Eighty-three percent of Federally Qualified Health Centers and 78 percent of the nation's Critical Access Hospitals were participating with an REC. CONCLUSIONS RECs have made substantial progress in assisting PCPs with adoption and MU of EHRs. This infrastructure supports small practices, community health centers, and rural and public hospitals to use technology for care delivery transformation and improvement.
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Affiliation(s)
- Kimberly Lynch
- Office of the National Coordinator for Health IT, U.S. Department of Health and Human Services, Washington, DC
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Gill JM, Bagley B. Practice transformation? Opportunities and costs for primary care practices. Ann Fam Med 2013; 11:202-5. [PMID: 23690317 PMCID: PMC3659134 DOI: 10.1370/afm.1534] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 03/26/2013] [Accepted: 03/26/2013] [Indexed: 11/09/2022] Open
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