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Primary Care Transformation

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https://www.readbyqxmd.com/read/28192568/early-performance-in-medicaid-accountable-care-organizations-a-comparison-of-oregon-and-colorado
#1
K John McConnell, Stephanie Renfro, Benjamin K S Chan, Thomas H A Meath, Aaron Mendelson, Deborah Cohen, Jeanette Waxmonsky, Dennis McCarty, Neal Wallace, Richard C Lindrooth
Importance: Several state Medicaid reforms are under way, but the relative performance of different approaches is unclear. Objective: To compare the performance of Oregon's and Colorado's Medicaid Accountable Care Organization (ACO) models. Design, Setting, and Participants: Oregon initiated its Medicaid transformation in 2012, supported by a $1.9 billion investment from the federal government, moving most Medicaid enrollees into 16 Coordinated Care Organizations, which managed care within a global budget...
February 13, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28187747/using-the-consolidated-framework-for-implementation-research-cfir-to-produce-actionable-findings-a-rapid-cycle-evaluation-approach-to-improving-implementation
#2
Rosalind E Keith, Jesse C Crosson, Ann S O'Malley, DeAnn Cromp, Erin Fries Taylor
BACKGROUND: Much research does not address the practical needs of stakeholders responsible for introducing health care delivery interventions into organizations working to achieve better outcomes. In this article, we present an approach to using the Consolidated Framework for Implementation Research (CFIR) to guide systematic research that supports rapid-cycle evaluation of the implementation of health care delivery interventions and produces actionable evaluation findings intended to improve implementation in a timely manner...
February 10, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28186016/collaborators-and-communication-channels-in-eight-patient-centered-medical-homes
#3
Dian A Chase, David A Dorr, Deborah J Cohen, Joan S Ash
BACKGROUND: The patient-centered medical home (PCMH) concept requires collaboration among clinicians both within the medical home clinic, and outside the clinic. As we redesign health information technology (HIT) to support transformation to the PCMH, we need to better understand these collaboration patterns. This study provides quantitative data describing these collaborations in order to facilitate the design of systems to allow for more efficient collaboration. APPROACH: Eighty-four clinicians in eight clinics identified their two most recent significant collaborators - one each within the clinic and in the medical neighborhood...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28186015/community-paramedicine-initiative-transforming-paramedicine-in-british-columbia
#4
Colton Calderone, Michelle Brittain, Daniel Sirivar, Nancy Kotani
British Columbia's health care system is facing challenges related to rural access to care and an ever increasing demand for services. These variables are compounded by the anticipated needs of an aging population that can expect to live several of their golden years with a chronic illness. The introduction of community paramedicine in BC allows for a care delivery model that expands the role of qualified paramedics to include the delivery of prevention, health promotion and primary care services in the community...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28169976/the-impact-of-alternative-payment-in-chronically-ill-and-older-patients-in-the-patient-centered-medical-home
#5
Claudia A Salzberg, Asaf Bitton, Stuart R Lipsitz, Cal Franz, Shimon Shaykevich, Lisa P Newmark, Japneet Kwatra, David W Bates
BACKGROUND: Patient-centered medical home (PCMH) has gained prominence as a promising model to encourage improved primary care delivery. There is a paucity of studies that evaluate the impact of payment models in the PCMH. OBJECTIVES: We sought to examine whether coupling coordinated, team-based care transformation plan with a novel reimbursement model affects outcomes related to expenditures and utilization. RESEARCH DESIGN: Interrupted time-series model with a difference-in-differences approach to assess differences between intervention and control groups, across time periods attributable to PCMH transformation and/or payment change...
February 6, 2017: Medical Care
https://www.readbyqxmd.com/read/28166113/using-a-mixed-methods-approach-to-examine-practice-characteristics-associated-with-implementation-of-an-adult-immunization-intervention-using-the-4-pillars-practice-transformation-program
#6
Mary Hawk, Mary Patricia Nowalk, Krissy K Moehling, Valory Pavlik, Jonathan M Raviotta, Anthony E Brown, Richard K Zimmerman, Edmund M Ricci
Adult immunization rates are consistently suboptimal, exacting significant human and financial burden of preventable disease. Practice-level interventions to improve immunization rates have produced mixed results. The context of change critically affects implementation of evidence-based interventions. We conducted a randomized controlled cluster trial of the 4 Pillars Practice Transformation Program to increase adult vaccination rates in primary care practices and used qualitative methods to test intervention effects and understand practice characteristics associated with implementation success...
January 11, 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28160758/a-model-for-integrative-transformation-a-back-pain-group-appointment-program
#7
Keith S Rayburn
A back pain treatment program was developed for the outpatient, primary care clinic setting. In this pilot study, measured functional status scores improved in a cohort of patients enrolled in the program. The program consists of a series of 5 monthly group appointments and follows a sequential curriculum involving multiple therapeutic modalities. These modalities include exercise, social interaction, motivation/raison d'être, holistic coaching, music, and behavioral modelling. The program provides a forum for the discussion and implementation of complementary and alternative approaches, alongside mainstream approaches, and represents a model of integrative medical practice...
January 2017: Alternative Therapies in Health and Medicine
https://www.readbyqxmd.com/read/28152839/development-of-a-radiation-oncology-specific-prospective-data-registry-for-clinical-research-and-quality-improvement-a-clinical-workflow-based-solution
#8
Pin-Chieh Wang, Darlene Verittupong, Weber Shao, Susan Ann McCloskey, Vincent Basehart, Michael L Steinberg, Patrick Kupelian
: 197 Background: The computerized 'paperless' medical recording system has transformed the modern health information system and serves as an idea platform for cancer registry development, particularly in a specialty like radiation oncology, where technological advances generate unprecedented amounts of data. METHODS: From May 2011 to May 2015, physicians prospectively inputted data on patients seen during consultation in the Department of Radiation Oncology at UCLA...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28148227/effective-team-based-primary-care-observations-from-innovative-practices
#9
Edward H Wagner, Margaret Flinter, Clarissa Hsu, DeAnn Cromp, Brian T Austin, Rebecca Etz, Benjamin F Crabtree, MaryJoan D Ladden
BACKGROUND: Team-based care is now recognized as an essential feature of high quality primary care, but there is limited empiric evidence to guide practice transformation. The purpose of this paper is to describe advances in the configuration and deployment of practice teams based on in-depth study of 30 primary care practices viewed as innovators in team-based care. METHODS: As part of LEAP, a national program of the Robert Wood Johnson Foundation, primary care experts nominated 227 innovative primary care practices...
February 2, 2017: BMC Family Practice
https://www.readbyqxmd.com/read/28118107/patient-perspectives-on-the-ethical-implementation-of-a-rapid-learning-system-for-oncology-care
#10
Rochelle D Jones, Aaron N Sabolch, Erin Aakhus, Rebecca A Spence, Angela R Bradbury, Reshma Jagsi
INTRODUCTION: A rapid learning system (RLS) of health care harnesses data generated from routine patient care to create a virtuous cycle of data collection and analysis for quality improvement and research. The success of such systems depends on understanding patient perspectives regarding the ethical issues that arise from the ongoing implementation of this transformative concept. METHODS: An interview guide was designed to evaluate patient perspectives to inform the ethical implementation of an oncology RLS...
January 24, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28111008/primary-intraventricular-hemorrhage-clinical-characteristics-and-outcomes
#11
Rachel Weinstein, Kathryn Ess, Bilaal Sirdar, Sarah Song, Shawna Cutting
BACKGROUND: Primary intraventricular hemorrhage (IVH) in adults is a rare neurologic disorder. The typical course, etiology, complications, and outcomes have not been well established. MATERIALS AND METHODS: Consecutive patient records with a diagnosis of intracerebral hemorrhage admitted between May 2009 and June 2014 at a tertiary care center were retrospectively reviewed. Subjects were included in the study cohort if all neurologists and the radiology report agreed that the subject had an isolated IVH...
January 19, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28106511/telementoring-primary-care-clinicians-to-improve-geriatric-mental-health-care
#12
Elisa Fisher, Michael Hasselberg, Yeates Conwell, Linda Weiss, Norma A Padrón, Erin Tiernan, Jurgis Karuza, Jeremy Donath, José A Pagán
Health care delivery and payment systems are moving rapidly toward value-based care. To be successful in this new environment, providers must consistently deliver high-quality, evidence-based, and coordinated care to patients. This study assesses whether Project ECHO(®) (Extension for Community Healthcare Outcomes) GEMH (geriatric mental health)-a remote learning and mentoring program-is an effective strategy to address geriatric mental health challenges in rural and underserved communities. Thirty-three teleECHO clinic sessions connecting a team of specialists to 54 primary care and case management spoke sites (approximately 154 participants) were conducted in 10 New York counties from late 2014 to early 2016...
January 20, 2017: Population Health Management
https://www.readbyqxmd.com/read/28099065/exploring-variation-in-transformation-of-primary-care-practices-to-patient-centered-medical-homes-a-mixed-methods-approach
#13
Robert D Lieberthal, Tom Karagiannis, Evan Bilheimer, Manisha Verma, Colleen Payton, Mona Sarfaty, George Valko
The objective was to quantify the activities required for patient-centered medical home (PCMH) transformation in a sample of small to medium-sized National Committee for Quality Assurance (NCQA) recognized practices, and explore barriers and facilitators to transformation. Eleven small to medium-sized PCMH practices in Southeastern Pennsylvania completed a survey, which was adapted from the 2011 NCQA standards. Semistructured follow-up interviews were conducted, descriptive statistics were computed for the quantitative analysis, and a process of thematic coding was deployed for the qualitative analysis...
January 18, 2017: Population Health Management
https://www.readbyqxmd.com/read/28068618/the-effectiveness-of-suicide-prevention-delivered-by-gps-a-systematic-review-and-meta-analysis
#14
REVIEW
Allison Milner, Katrina Witt, Jane Pirkis, Sarah Hetrick, Jo Robinson, Dianne Currier, Matthew J Spittal, Andrew Page, Gregory L Carter
BACKGROUND: The aim of this review was to assess whether suicide prevention provided in the primary health care setting and delivered by GPs results in fewer suicide deaths, episodes of self-harm, attempts and lower frequency of thoughts about suicide. METHODS: We conducted a systematic review and meta-analysis using PRIMSA guidelines. Eligible studies: 1) evaluated an intervention provided by GPs; 2) assessed suicide, self-harm, attempted suicide or suicide ideation as outcomes, and; 3) used a quasi-experimental observational or trial design...
December 24, 2016: Journal of Affective Disorders
https://www.readbyqxmd.com/read/28068135/the-pediatric-patient-centered-medical-home-innovative-models-for-improving-behavioral-health
#15
Joan Rosenbaum Asarnow, David J Kolko, Jeanne Miranda, Anne E Kazak
This article examines the concept of the Patient-Centered Medical Home (PCMH) as it applies to children and adolescents, emphasizing care for behavioral health conditions, the role of psychology and psychological science, and next steps for developing evidence-informed models for the Pediatric-PCMH. The PCMH concept for pediatric populations offers unique opportunities for psychological science to inform and enhance the transformation of the United States health care system and improve health in our nation...
January 2017: American Psychologist
https://www.readbyqxmd.com/read/28062814/from-our-practices-to-yours-key-messages-for-the-journey-to-integrated-behavioral-health
#16
Stephanie B Gold, Larry A Green, C J Peek
BACKGROUND: The historic, cultural separation of primary care and behavioral health has caused the spread of integrated care to lag behind other practice transformation efforts. The Advancing Care Together study was a 3-year evaluation of how practices implemented integrated care in their local contexts; at its culmination, practice leaders ("innovators") identified lessons learned to pass on to others. METHODS: Individual feedback from innovators, key messages created by workgroups of innovators and the study team, and a synthesis of key messages from a facilitated discussion were analyzed for themes via immersion/crystallization...
January 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28062811/moving-upstream-health-extension-and-primary-care
#17
Lyle J Fagnan
Health extension programs represent an opportunity for practice-based research networks (PBRNs) and primary care practices to develop collaborations reaching beyond the clinic walls to address the upstream social determinants of health and engage in community-based research. The Health Extension Regional Officers (HEROs) program at the University of New Mexico described in this issue of the JABFM is an innovative model with a bidirectional approach to linking academic health centers to community-based practices and organizations...
January 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28034916/engaging-patients-in-primary-care-practice-transformation-theory-evidence-and-practice
#18
REVIEW
Anjana E Sharma, Kevin Grumbach
Patient engagement is a fundamental strategy for achieving patient centred care and is receiving increasing attention in primary care reform efforts such as the patient-centred medical home and related care models. Much of the prior published theory and evidence supporting patient engagement has focused on improving engagement in individual care. Much less is understood about engaging patients as partners in practice improvement at the primary care clinic or practice level. We review the historical and policy context for the growing interest in the USA and UK in patient engagement at the primary care practice level, highlight findings from systematic reviews of the research evidence on practice-level patient engagement and discuss practical considerations for implementing patient engagement...
December 29, 2016: Family Practice
https://www.readbyqxmd.com/read/28034342/an-evaluation-of-experiences-and-views-of-scottish-leadership-training-opportunities-amongst-primary-care-professionals
#19
Ailsa Power, Helen Allbutt, Lucy Munro, Marion MacLeod, Susan Kennedy, Donald Cameron, Ken Scoular, Graham Orr, John Gillies
AIM: To determine experiences of leadership training of six primary care professions in Scotland and consider future development. METHODS: A questionnaire on previous leadership course attendance and future intentions was distributed to community pharmacists, general dental practitioners, general practitioners, practice nurses, practice managers and optometrists. Analysis comprised descriptive statistics for closed questions and management of textual data. RESULTS: Formal leadership training participation was fairly low except for practice managers...
December 30, 2016: Education for Primary Care
https://www.readbyqxmd.com/read/28033146/health-service-management-interns-serve-as-practice-facilitators-for-patient-centered-medical-home-recognition-east-carolina-university-appalachian-state-university-initiative
#20
Bonita Sasnett, R W Watkins, Marianne Ferlazzo
East Carolina University College of Allied Health Science's Department of Health Services Management program is partnering with Community Care of North Carolina and Access East to transform medical practices and educate students on the Patient-Centered Medical Home (PCMH) model of health care delivery. Why now? The Affordable Care Act (2010) and other health care reform changes brought to the forefront the need to focus on improving the quality of care while lowering the overall cost of care. This article describes the first year of implementation of a PCMH initiative where students in a health services management internship program act as facilitators to assist practices in the PCMH recognition process...
January 2017: Health Care Manager
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