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"Practice Transformation"

Jeanne M Ferrante, Eric K Shaw, Jennifer E Bayly, Jenna Howard, M Nell Quest, Elizabeth C Clark, Connie Pascal
BACKGROUND: Many primary care practices participating in patient-centered medical home (PCMH) transformation initiatives are expanding the work roles of their medical assistants (MAs). Little is known about attitudes of MAs or barriers and facilitators to these role changes. METHODS: Secondary data analysis of qualitative cross-case comparison study of 15 New Jersey primary care practices participating in a PCMH project during 2012 to 2013. Observation field notes and in-depth and key informant interviews (with physicians, office managers, staff and care coordinators) were iteratively analyzed using grounded theory...
March 2018: Journal of the American Board of Family Medicine: JABFM
Candace Haddock, Al Ghalgya Al Maawali, Joseph Ting, Julie Bedford, Kourosh Afshar, Erik D Skarsgard
BACKGROUND/PURPOSE: Elimination of unnecessary practice variation through standardization creates opportunities for improved outcomes and cost-effectiveness. A quality improvement (QI) initiative at our institution used evidence and consensus to standardize management of gastroschisis (GS) from birth to discharge. METHODS: An interdisciplinary team utilized best practice evidence and expert opinion to standardize GS care. Following stakeholder engagement and education, care standardization was implemented in September 2014...
February 7, 2018: Journal of Pediatric Surgery
David A Dorr, Deborah J Cohen, Julia Adler-Milstein
Failed diffusion of innovations may be linked to an inability to use and apply data, information, and knowledge to change perceptions of current practice and motivate change. Using qualitative and quantitative data from three large-scale health care delivery innovations-accountable care organizations, advanced primary care practice, and EvidenceNOW-we assessed where data-driven innovation is occurring and where challenges lie. We found that implementation of some technological components of innovation (for example, electronic health records) has occurred among health care organizations, but core functions needed to use data to drive innovation are lacking...
February 2018: Health Affairs
Florian R Schroeck, Nicholas Smith, Jeremy B Shelton
Implementation science is a rapidly developing field dedicated to the scientific investigation of strategies to facilitate improvements in healthcare delivery. These strategies have been shown in several settings to lead to more complete and sustained change. In this essay, we discuss how refined surveillance recommendations for non-muscle-invasive bladder cancer, which involve a complex interplay between providers, healthcare facilities, and patients, could benefit from use of implementation strategies derived from the growing literature of implementation science...
January 26, 2018: Urologic Oncology
Milad Rayka, Mohammad Goli, Shant Shahbazian
An effective set of Hartree-Fock (HF) equations are derived for electrons of muonic systems, i.e., molecules containing a positively charged muon, conceiving the muon as a quantum oscillator, which are completely equivalent to the usual two-component HF equations used to derive stationary states of the muonic molecules. In these effective equations, a non-Coulombic potential is added to the orthodox coulomb and exchange potential energy terms, which describes the interaction of the muon and the electrons effectively and is optimized during the self-consistent field cycles...
January 26, 2018: Physical Chemistry Chemical Physics: PCCP
Angela R Wateska, Mary Patricia Nowalk, Richard K Zimmerman, Kenneth J Smith, Chyongchiou J Lin
BACKGROUND: Adults aged 18-64 years with comorbid conditions are at high risk for complications of certain vaccine-preventable diseases, including influenza and pneumococcal disease. The 4 Pillars™ Practice Transformation Program (4 Pillars Program) increases uptake of pneumococcal polysaccharide vaccine, influenza vaccine and tetanus-diphtheria-acellular pertussis vaccine by 5-10% among adults with high-risk medical conditions, but its cost-effectiveness is unknown. METHODS: A decision tree model estimated the cost-effectiveness of implementing the 4 Pillars Program in primary care practices compared to no program for a population of adults 18-64 years of age at high risk of illness complications over a 10 year time horizon...
January 25, 2018: BMC Infectious Diseases
Haifeng Yang, Peter G Dormer, Nelo R Rivera, Andrew J Hoover
Tritium-labeled molecules are critical tools for elucidating the binding and metabolic properties of bioactive compounds, particularly during pharmaceutical discovery. Direct tritiation of inert C-H bonds with T2 gas is an ideal approach for tritium labeling, but significant gaps remain for direct tritiation of structurally complex molecules with diverse functional groups. Here we report the first application of palladium(II) C-H activation chemistry for tritiation with T2 gas. This practical transformation exhibits novel substrate scope and greater functional group tolerance compared to previous state of the art tritiation methods, and has been applied to directly tritiate 9 complex pharmaceuticals and an unprotected dipeptide...
January 3, 2018: Angewandte Chemie
Peter Mendel, Emily K Chen, Harold D Green, Courtney Armstrong, Justin W Timbie, Amii M Kress, Mark W Friedberg, Katherine L Kahn
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...
December 15, 2017: Health Services Research
Sarah K Lewis, Patricia Thompson
Just as we depend on medical science and research to treat patients, we should connect our teaching methods to educational theory and research. In particular, the foundations of adult education philosophy and adult learning theories can be deliberately applied to further strengthen the clinical learning experience of physician assistants (PAs). We propose that PA educators should be aware of how their personal philosophy of education affects their teaching practice. In addition, educators should apply learning theories to both classroom process and content...
December 2017: Journal of Physician Assistant Education
Mary Patricia Nowalk, Krissy K Moehling, Song Zhang, Jonathan M Raviotta, Richard K Zimmerman, Chyongchiou J Lin
OBJECTIVES: To compare changes in vaccination rates (pneumococcal polysaccharide vaccine [PPSV]; tetanus, diphtheria, and pertussis [Tdap] vaccine; and influenza vaccine) among high-risk adults following an intervention (June 1, 2013, to January 31, 2015) that used the 4 Pillars Practice Transformation Program (4 Pillars Program). STUDY DESIGN: Post hoc analysis of data from a randomized controlled cluster trial. METHODS: Eighteen primary care practices received staff education, guidance for using the 4 Pillars Program, and support for a practice immunization champion...
November 2017: American Journal of Managed Care
Adam B Scanlan, Alex V Nguyen, Anna Ilina, Andras Lasso, Linnea Cripe, Anusha Jegatheeswaran, Elizabeth Silvestro, Francis X McGowan, Christopher E Mascio, Stephanie Fuller, Thomas L Spray, Meryl S Cohen, Gabor Fichtinger, Matthew A Jolley
Mastering the technical skills required to perform pediatric cardiac valve surgery is challenging in part due to limited opportunity for practice. Transformation of 3D echocardiographic (echo) images of congenitally abnormal heart valves to realistic physical models could allow patient-specific simulation of surgical valve repair. We compared materials, processes, and costs for 3D printing and molding of patient-specific models for visualization and surgical simulation of congenitally abnormal heart valves...
March 2018: Pediatric Cardiology
Michelle Miller-Day, Janelle Applequist, Keri Zabokrtsky, Alexandra Dalton, Katherine Kellom, Robert Gabbay, Peter F Cronholm
Purpose The Patient-Centered Medical Home (PCMH) has become a dominant model of primary care re-design. This transformation presents a challenge to many care delivery organizations. The purpose of this paper is to describe attributes shaping successful and unsuccessful practice transformation within four medical practice groups. Design/methodology/approach As part of a larger study of 25 practices transitioning into a PCMH, the current study focused on diabetes care and identified high- and low-improvement medical practices in terms of quantitative patient measures of glycosylated hemoglobin and qualitative assessments of practice performance...
September 18, 2017: Journal of Health Organization and Management
Richard K Zimmerman, Jonathan M Raviotta, Mary Patricia Nowalk, Krissy K Moehling, Evelyn Cohen Reis, Sharon G Humiston, Chyongchiou Jeng Lin
OBJECTIVES: To report the results of an intervention using the 4 Pillars™ Practice Transformation Program (4 Pillars™ Program) to increase adolescent vaccinations including human papillomavirus vaccine (HPV) and influenza vaccines, which remain underutilized in this population. STUDY DESIGN: Eleven pediatric and family medicine practices, previously control sites from a randomized controlled cluster trial, with ≥50 adolescent patients participated. The 4 Pillars™ Program was the foundation of the intervention...
October 27, 2017: Vaccine
LeAnn Michaels, Tracy Anastas, Elizabeth Needham Waddell, Lyle Fagnan, David A Dorr
PURPOSE: To understand how focused versus general practice facilitation can impact goal setting, action planning, and team performance in primary care transformation. BACKGROUND: Practice transformation in primary care is a crucial part of health reform, but can fatigue teams, leading to variable results. Practice facilitation may reduce primary care fatigue to help teams reach challenging transformation goals, but may require a more focused approach than previous studies suggest...
September 2017: Journal of the American Board of Family Medicine: JABFM
Grace Anglin, H A Tu, Kristie Liao, Laura Sessums, Erin Fries Taylor
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...
September 2017: Milbank Quarterly
Donald E Nease, Denise Campbell-Scherer, Jill Haught
No abstract text is available yet for this article.
September 2017: Annals of Family Medicine
Shannon M Sweeney, Jennifer D Hall, Sarah S Ono, Leah Gordon, David Cameron, Jennifer Hemler, Leif I Solberg, Benjamin F Crabtree, Deborah J Cohen
Engaging primary care practices in initiatives designed to enhance quality, reduce costs, and promote safety is challenging as practices are already participating in numerous projects and mandated programs designed to improve care delivery and quality. Recruiters must expand their recruitment tools to engage today's practices in quality improvement. Using grant proposals, online diaries, observational site visits, and interviews with key stakeholders, the authors identify successful practice recruitment strategies in the EvidenceNOW initiative, which aimed to recruit approximately 1500 small- to medium-sized primary care practices...
September 1, 2017: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
Kenneth J Smith, Mary Patricia Nowalk, Chyongchiou J Lin, Richard K Zimmerman
The cost-effectiveness of the 4 Pillars™ Practice Transformation Program to improve vaccination rates in adults <65-years-old is unknown. Two vaccines, influenza and Tdap (tetanus, diphtheria, acellular pertussis), were targeted for this age group. Cost-effectiveness of the intervention compared with control, with a primary outcome of cost per quality adjusted life year (QALY) gained, was estimated from societal and third party payer perspectives over a 10-year time horizon using a decision analysis model...
October 3, 2017: Human Vaccines & Immunotherapeutics
Mary Norine Walsh
No abstract text is available yet for this article.
August 22, 2017: Journal of the American College of Cardiology
Shelly Ann Fischer
Healthcare is a complex area with significant potential for service improvement despite the effects of increasing economic and social pressures on the quality and safety of patient care. As the largest group of healthcare professionals in direct contact with patients, nurses are well positioned to contribute to improvements in healthcare services and to the development of new policies. To influence healthcare improvements and policies effectively, nurses require leadership skills. Historically, it was thought that only nurses in management roles required leadership skills; however, the ability to influence change is a requirement at all levels of clinical practice...
August 16, 2017: Nursing Standard
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