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Journal of Ambulatory Care Management

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https://www.readbyqxmd.com/read/27893520/impact-of-a-patient-centered-medical-home-pilot-on-utilization-quality-and-costs-and-variation-in-medical-homeness
#1
Signe Peterson Flieger
This study evaluated the impact of a patient-centered medical home (PCMH) pilot on utilization, costs, and quality and assessed variation in PCMH components. Data included the New Hampshire Comprehensive Healthcare Information System and Medical Home Index (MHI) scores for 9 pilot sites. A quasi-experimental, difference-in-difference model with propensity score-matched comparison group was employed. MHI scores were collected in late 2011. There were no statistically significant findings for utilization, cost, or quality in the expected direction...
November 23, 2016: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27893519/effects-of-hospital-systems-on-medical-home-transformation-in-primary-care-residency-training-practices
#2
Kyle Knierim, Tristen Hall, Douglas Fernald, Thomas J Staff, Emilie Buscaj, Jessica Cornett Allen, Mary Onysko, W Perry Dickinson
Most primary care residency training practices have close financial and administrative relationships with teaching hospitals and health systems. Many residency practices have begun integrating the core principles of the patient-centered medical home (PCMH) into clinical workflows and educational experiences. Little is known about how the relationships with hospitals and health systems affect these transformation efforts. Data from the Colorado Residency PCMH Project were analyzed. Results show that teaching hospitals and health systems have significant opportunities to influence residency practices' transformation, particularly in the areas of supporting team-based care, value-based payment reforms, and health information technology...
November 23, 2016: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27893518/patient-centered-medical-home-implementation-and-burnout-among-va-primary-care-employees
#3
Joseph A Simonetti, Philip W Sylling, Karin Nelson, Leslie Taylor, David C Mohr, Idamay Curtis, Gordon Schectman, Stephan D Fihn, Christian D Helfrich
Burnout is widespread throughout primary care and is associated with negative consequences for providers and patients. The relationship between the patient-centered medical home model and burnout remains unclear. Using survey data from 8135 and 7510 VA primary care employees in 2012 and 2013, respectively, we assessed whether clinic-level medical home implementation was independently associated with burnout prevalence and estimated whether burnout changed among this workforce from 2012 to 2013. Adjusting for differences in respondent and clinic characteristics, we found that burnout was common among primary care employees, increased by 3...
November 23, 2016: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27893517/ready-for-change-the-role-of-physician-and-staff-engagement-burnout-and-workplace-attributes
#4
Dorothy Hung, Po-Han Chen
We examined factors associated with change readiness among 343 primary care physicians and 590 nonphysician staff undergoing "Lean"-based process improvements. Baseline levels of engagement were associated with greater readiness for change across all measured domains. Job-related burnout correlated with greater need for change, but lower self-efficacy and perceived support, whereas a personal sense of accomplishment was associated with higher efficacy to implement changes. At a department level, teamwork, participation in decision making, and change history were associated with higher engagement and lower burnout among physicians and staff; conversely, a busy or stressful department correlated with lower engagement and higher burnout...
November 23, 2016: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27893516/caregiver-expectations-and-satisfaction-of-urgent-care-in-a-pediatric-emergency-department
#5
Greg P Marconi, Phung K Pham, Alan L Nager
Health care delivery expectations that may affect patient and caregiver satisfaction are not clearly understood. This study examined caregiver expectations and satisfaction with urgent care in a pediatric emergency department. Of 201 caregivers surveyed, we found that caregivers have specific expectations regarding clinical care of their child in terms of radiographic imaging, blood testing, antibiotics, pain management, and subspecialty consultation. Caregivers were generally less dissatisfied with the actual care provided than the urgent care physicians expected...
November 23, 2016: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27893515/use-of-federally-qualified-health-centers-and-potentially-preventable-hospital-utilization-among-older-medicare-medicaid-enrollees
#6
Brad Wright, Andrew J Potter, Amal N Trivedi
Using Medicare claims data from 2007 to 2010, we sought to determine whether dual eligibles 65 years and older who utilize federally qualified health centers (FQHCs) have lower rates of ambulatory care-sensitive hospitalizations and emergency department visits compared with nonusers. We found that FQHC use is associated with increased ambulatory care-sensitive hospitalization rates for whites and other races, but a decrease among blacks. Depending on race, FQHC use is associated with an increase of 24 to 43 ambulatory care-sensitive emergency department visits per thousand persons annually...
November 23, 2016: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27902555/primary-care-nurse-practitioner-practice-characteristics-barriers-and-opportunities-for-interprofessional-teamwork
#7
Lusine Poghosyan, Allison A Norful, Grant R Martsolf
Developing team-based care models and expanding nurse practitioner (NP) workforce in primary care are recommended by policy makers to meet demand. Little is known how to promote interprofessional teamwork. Using a mixed-methods design, we analyzed qualitative interview and quantitative survey data from primary care NPs to explore practice characteristics important for teamwork. The Interprofessional Teamwork for Health and Social Care Framework guided the study. We identified NP-physician and NP-administration relationships; organizational support and governance; time and space for teamwork; and regulations and economic impact as important...
January 2017: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27902554/access-to-care-and-satisfaction-among-health-center-patients-with-chronic-conditions
#8
Leiyu Shi, De-Chih Lee, Geraldine Pierre Haile, Hailun Liang, Michelle Chung, Alek Sripipatana
This study examined access to care and satisfaction among health center patients with chronic conditions. Data for this study were obtained from the 2009 Health Center Patient Survey. Dependent variables of interest included 5 measures of access to and satisfaction with care, whereas the main independent variable was number of chronic conditions. Results of bivariate analysis and multiple logistic regressions showed that patients with chronic conditions had significantly higher odds of reporting access barriers than those without chronic conditions...
January 2017: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27902553/perspectives-and-uses-of-the-electronic-health-record-among-us-pediatricians-a-national-survey
#9
Julie W Doberne, Travis Redd, Daniel Lattin, Thomas R Yackel, Carl O Eriksson, Vishnu Mohan, Jeffrey A Gold, Joan S Ash, Michael F Chiang
Little is known about how existing electronic health records (EHRs) influence the practice of pediatric medicine. A total of 808 pediatricians participated in a survey about workflows using the EHR. The EHR was the most commonly used source of initial patient information. Seventy-two percent reported requiring between 2 and 10 minutes to complete an initial review of the EHR. Several moderately severe information barriers were reported regarding the display of information in the EHR. Pediatricians acquire information about new patients from EHRs more often than any other source...
January 2017: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27902552/factors-associated-with-electronic-health-record-use-among-nurse-practitioners-in-the-united-states
#10
Emily B Jones
Widespread use of electronic health records (EHRs) among all provider types is foundational to delivery system transformation. Three in 4 nurse practitioners used EHRs in 2012 (76.0%), and 60.3% of nonusers planned to adopt within 18 months. Practice setting, younger age, and colocation with physicians were associated with EHR use. In hospitals and in settings without on-site physicians, EHR use lagged in rural areas. Implementation assistance should be targeted to nonadopters, particularly those who never or infrequently work alongside physicians and those in rural hospitals...
January 2017: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27902551/do-years-of-experience-with-electronic-health-records-matter-for-productivity-in-community-health-centers
#11
Bianca K Frogner, Xiaoli Wu, Leighton Ku, Patricia Pittman, Leah E Masselink
This study investigated how years of experience with an electronic health record (EHR) related to productivity in community health centers (CHCs). Using data from the 2012 Uniform Data System, we regressed average annual medical visits, weighted for service intensity, as a function of full-time equivalent medical staff controlling for CHC size and location. Physician productivity significantly improved. Although the productivity of all other staff types was not significantly different by years of EHR experience, the trends showed lower productivity among nurses and other medical staff in CHCs with fewer years of EHR experience versus more years of experience...
January 2017: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27902550/-salt-in-the-wound-safety-net-clinician-perspectives-on-performance-feedback-derived-from-ehr-data
#12
Arwen E Bunce, Rachel Gold, James V Davis, MaryBeth Mercer, Victoria Jaworski, Celine Hollombe, Christine Nelson
Electronic health record (EHR) data can be extracted for calculating performance feedback, but users' perceptions of such feedback impact its effectiveness. Through qualitative analyses, we identified perspectives on barriers and facilitators to the perceived legitimacy of EHR-based performance feedback, in 11 community health centers (CHCs). Providers said such measures rarely accounted for CHC patients' complex lives or for providers' decisions as informed by this complexity, which diminished the measures' perceived validity...
January 2017: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27902549/integration-of-medical-scribes-in-the-primary-care-setting-improving-satisfaction
#13
Brian H Imdieke, Marc L Martel
There are little published data on the use of medical scribes in the primary care setting. We assessed the feasibility of incorporating medical scribes in our ambulatory clinic to support provider documentation in the electronic medical record. In our convenience sampling of patient, provider, and staff perceptions of scribes, we found that patients were comfortable having scribes in the clinic. Overall indicators of patient satisfaction were slightly decreased. Providers found scribe support to be valuable and overall clinician documentation time was reduced by more than 50% using scribes...
January 2017: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27902548/leveraging-electronic-health-record-implementation-to-facilitate-clinical-and-operational-quality-improvement-in-an-ambulatory-surgical-clinic
#14
Joseph L Bobadilla, Cathy S Roe, Patricia Estes, Jennifer Lackey, Carol L Steltenkamp
The implementation of electronic health records is a challenging, complex process requiring significant resources. The temptation is to convert a paper process into electronic format. This strategy fosters a familiar product to the users but is fraught with pitfalls. We chose to utilize the opportunity of the implementation of an enterprise-wide ambulatory electronic health record to foster an overreaching clinical and operational improvement project in a multispecialty surgical ambulatory clinic practice. We interrogated every aspect of the practice: clinic design, scheduling, physical space, staffing, and clinical and operational workflows...
January 2017: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27902547/ambulatory-electronic-health-records-must-be-more-interoperable-to-support-optimal-practice
#15
Alan E Zuckerman
No abstract text is available yet for this article.
January 2017: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27902546/toward-electronic-health-record-optimization-learning-from-the-user-experience
#16
Jeffrey M Weinfeld, Ranit Mishori
No abstract text is available yet for this article.
January 2017: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27902545/from-the-editor
#17
(no author information available yet)
No abstract text is available yet for this article.
January 2017: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27580314/the-2008-erice-statement-toward-a-more-humanistic-oncology-erratum
#18
(no author information available yet)
No abstract text is available yet for this article.
October 2016: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27576054/multivariate-risk-adjustment-of-primary-care-patient-panels-in-a-public-health-setting-a-comparison-of-statistical-models
#19
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
https://www.readbyqxmd.com/read/27576053/assessing-the-proximity-relationship-of-walk-in-clinics-and-primary-care-physicians
#20
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
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