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Journal of Ambulatory Care Management

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October 2016: Journal of Ambulatory Care Management
Anne M Hirozawa, Maria E Montez-Rath, Elizabeth C Johnson, Stephen A Solnit, Michael J Drennan, Mitchell H Katz, Rani Marx
We compared prospective risk adjustment models for adjusting patient panels at the San Francisco Department of Public Health. We used 4 statistical models (linear regression, two-part model, zero-inflated Poisson, and zero-inflated negative binomial) and 4 subsets of predictor variables (age/gender categories, chronic diagnoses, homelessness, and a loss to follow-up indicator) to predict primary care visit frequency. Predicted visit frequency was then used to calculate patient weights and adjusted panel sizes...
October 2016: Journal of Ambulatory Care Management
Alissa Chen, Lee Revere, Ryan Ramphul
This article evaluates the spatial relationship between primary care provider clinics and walk-in clinics. Using ZIP code level data from Harris County, Texas, the results suggest that primary care physicians and walk-in clinics are similarly located at lower rates in geographic areas with populations of lower socioeconomic status. Although current clinic location choices effectively broaden the gap in primary care access for the lower income population, the growing number of newly insured individuals may make it increasingly attractive for walk-in clinics to locate in geographic areas with populations of lower socioeconomic status and less competition from primary care physicians...
October 2016: Journal of Ambulatory Care Management
Deborah Peikes, Ann S O╩╝Malley, Claire Wilson, Jesse Crosson, Rachel Gaddes, Brenda Natzke, Timothy J Day, DeAnn Cromp, Rosalind Keith, Jasmine Little, James Ralston
Primary care practices are increasingly asked to engage patients in improving care delivery. We report early experiences with Patient and Family Advisory Councils (PFACs) from interviews of patients and practice staff in the Comprehensive Primary Care initiative, and identify ways to improve PFACs. Patients and practice staff report PFACs help practices elicit patient feedback and, in response, improve care delivery. Nonetheless, there are areas for refinement, including recruiting more diverse patients, providing an orientation to members, overcoming reticence of some patients to raise issues, and increasing transparency by sharing progress with PFAC members and patients in the practice more generally...
October 2016: Journal of Ambulatory Care Management
Anna L Christensen, Jonathan D Brown, Lawrence S Wissow, Benjamin Cook
As primary care models increasingly include nonphysician team members, more attention should be paid to patient- and family-centered care (PFCC) among medical assistants (MAs). The aims of this article are to describe parent perceptions of PFCC by MAs and assess associations between MA PFCC and other perceptions of their care experience. To assess PFCC, we administered the CARE (Consultation and Relational Empathy) measure to the parent/guardian of 360 children following a primary care visit. Perceptions of PFCC by MAs were significantly associated with 6 of 7 other measures of patient experience, including PFCC by the physician, treatment by the receptionist, and satisfaction with wait time...
October 2016: Journal of Ambulatory Care Management
Sophie C Miller, Bianca K Frogner, Laura M Saganic, Allison M Cole, Roger Rosenblatt
Over 500 000 Washingtonians gained health insurance under the Affordable Care Act (ACA). As more patients gain insurance, community health centers (CHCs) expect to see an increase in demand for their services. This article studies the CHCs in Washington State to examine how the increase in patients has been impacting their workload and staffing. We found a reported mean increase of 11.7% and 5.4% in new Medicaid and Exchange patients, respectively. Half of the CHCs experienced large or dramatic workload impact from the ACA...
October 2016: Journal of Ambulatory Care Management
(no author information available yet)
No abstract text is available yet for this article.
October 2016: Journal of Ambulatory Care Management
Megan J Hoopes, Heather Angier, Rachel Gold, Steffani R Bailey, Nathalie Huguet, Miguel Marino, Jennifer E DeVoe
Using electronic health record data, we examined longitudinal changes in community health center (CHC) visit rates from 2013 through 2014 in Medicaid expansion versus nonexpansion states. Visits from 219 CHCs in 5 expansion states and 4 nonexpansion states were included. Rates were computed using generalized estimating equation Poisson models. Rates increased in expansion state CHCs for new patient, preventive, and limited-service visits (14%, 41%, and 23%, respectively, P < .01 for all), whereas these rates remained unchanged in nonexpansion states...
October 2016: Journal of Ambulatory Care Management
Mark W Holt
No abstract text is available yet for this article.
July 2016: Journal of Ambulatory Care Management
Kevin Fiscella, Colleen Fogarty, Eduardo Salas
Teams are familiar to sports but relatively new to primary care. In this perspective, we use sports teams to illustrate key principles from team science and extract practical lessons for primary care teams. The most notable lessons include the need for continuous team learning based on presession planning and postsession debriefing, real-world team training focused on identified teamwork needs, and on-site team coaching. Implementation of these principles requires organizational commitment coupled with alignment of continuing medical education and recertification requirements with primary care teamwork competencies...
July 2016: Journal of Ambulatory Care Management
Staci A Young, Laila S Azam, John R Meurer, Renee S Hill, Chen Cui
PURPOSE: To elicit the perspective of patients with type 2 diabetes, specific to communication with providers and health care teams. METHODS: We conducted 21 focus groups with 115 adults in Midwestern primary care, endocrinology, and bariatric surgery clinics. Facilitators analyzed the transcripts using an iterative coding method. RESULTS: The themes of encouragement and motivation, relationship building, compassion, and communication preferences highlighted effective strategies consistent with the core components of patient-centered care...
July 2016: Journal of Ambulatory Care Management
Deborah Gurewich, Linda Cabral, Laura Sefton
Case studies of 8 primary care medical homes participating in a Massachusetts-based initiative were conducted to understand the approaches they used to operationalize medical home standards and associated barriers. All sites received their National Committee on Quality Assurance recognition as medical homes, yet varied considerably in how components were implemented. Despite this variation, they faced similar challenges to implementing and sustaining medical home standards. Variations and challenges strongly emerged in 4 areas: team-based care, scheduling and online access, identifying and managing high-risk patients, and organizing follow-up care...
July 2016: Journal of Ambulatory Care Management
Sharanya Murty, Charles E Begley, Luisa Franzini, J Michael Swint
The objective of the study was to examine the relationship between physician/safety net availability and health insurance coverage and preventable hospitalizations (PHs) in nonelderly adults in an urban area. Preventable conditions (PHs) were identified for nonelderly adults in Harris County using the Texas Health Care Information Collection hospital database. Multivariable logistic regression models examined the association of health insurance and patient proximity to physicians and safety net clinics with the risk of a PH...
July 2016: Journal of Ambulatory Care Management
Dorothy Hung, Sukyung Chung, Meghan Martinez, Ming Tai-Seale
This study examined relationships between organizational culture and patient-centered outcomes in primary care. Generalized least squares regression was used to analyze patient access, care continuity, and reported experiences of care among 357 physicians in 41 primary care departments. Compared with a "Group-oriented" culture, a "Rational" culture type was associated with longer appointment wait times, and both "Hierarchical" and "Developmental" culture types were associated with less care continuity, but better patient experiences with care...
July 2016: Journal of Ambulatory Care Management
Eric A Miller, Sandra L Decker, Jennifer D Parker
Previous research has found differences in characteristics of beneficiaries enrolled in Medicare fee-for-service versus Medicare Advantage (MA), but there has been limited research using more recent MA enrollment data. We used 1997-2005 National Health Interview Survey data linked to 2000-2009 Medicare enrollment data to compare characteristics of Medicare beneficiaries before their initial enrollment into Medicare fee-for-service or MA at age 65 and whether the characteristics of beneficiaries changed from 2006 to 2009 compared with 2000 to 2005...
July 2016: Journal of Ambulatory Care Management
Mark J Klarich, Ronald W Rea, Tarun Mohan Lal, Angel L Garcia, Fay L Steffens
Demand for ambulatory care visits is projected to increase 22% between 2008 and 2025. Given this growth, ambulatory care managers need to proactively plan for efficient use of scarce resources (ie, space, equipment, and staff). One important component of ambulatory care space (the number of examination rooms) is dependent on multiple factors, including variation in demand, hours of operation, scheduling, and staff. The authors (1) outline common data collection methods, (2) highlight analysis and reporting considerations for examination room utilization, and (3) provide a strategic framework for short- and long-term decision making for facility design or renovation...
July 2016: Journal of Ambulatory Care Management
Larry R Hearld, Kristine R Hearld, Henna Budhwani
Poor transitions in care represent opportunities for improvement. The purpose of this study was to examine whether early follow-up by patients discharged from a hospital varied as a function of patient-centered medical home (PCMH) capacity. The PCMH capacity was not significantly associated with early follow-up; however, higher levels of capacity were associated with early follow-up among patients with more chronic conditions. Policy makers and practitioners should consider how the PCMH may be targeted to maximize its potential to improve transitions in care for these patients and ways it may be modified to improve transitions for other types of patients...
July 2016: Journal of Ambulatory Care Management
Natabhona M Mabachi, Maribel Cifuentes, Juliana Barnard, Angela G Brega, Karen Albright, Barry D Weiss, Cindy Brach, David West
The Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit was developed to help primary care practices assess and make changes to improve communication with and support for patients. Twelve diverse primary care practices implemented assigned tools over a 6-month period. Qualitative results revealed challenges practices experienced during implementation, including competing demands, bureaucratic hurdles, technological challenges, limited quality improvement experience, and limited leadership support...
July 2016: Journal of Ambulatory Care Management
Jessica L Navratil-Strawn, Kevin Hawkins, Stephen K Hartley, Timothy S Wells, Ronald J Ozminkowski, Richard J Migliori, Charlotte S Yeh
Propensity to succeed modeling was used to identify characteristics associated with higher utilization of a telephone triage program and adherence to nurse recommendations among callers. Characteristics significantly associated with calling the telephone triage service and engaging in triage services were being female and having an elevated health risk score. Callers most likely to adhere to nurse recommendations were younger than 85 years of age, had called on a weekday, and had received a recommendation to seek care at an emergency department or a doctor's office visit...
July 2016: Journal of Ambulatory Care Management
(no author information available yet)
No abstract text is available yet for this article.
July 2016: Journal of Ambulatory Care Management
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