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"Practice Transformation"

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https://www.readbyqxmd.com/read/28282245/live-with-the-disease-like-you-used-to-before-you-knew-you-were-infected-a-qualitative-study-among-10-year-survivors-living-with-hiv-in-haiti
#1
Samuel Pierre, Vanessa Riviera, Circee Phara Jean, Marie Jude Jean Louis, Lindsey K Reif, Patrice Severe, Vanessa Rouzier, Warren D Johnson, Jean W Pape, Daniel W Fitzgerald, Margaret L McNairy, Carla Boutin-Foster
In 2003, the Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), a nonprofit organization, began administering antiretroviral therapy (ART) to its patients. This practice transformed HIV from a fatal disease to a more manageable chronic condition. However, relatively few studies focus on the experiences of survivors. This study provided a unique opportunity to interview patients who survived at least 10 years after being treated with ART at GHESKIO. The goal of the study was to elicit from patients their perspectives on what enabled them to survive with AIDS...
March 2017: AIDS Patient Care and STDs
https://www.readbyqxmd.com/read/28250024/care-system-redesign-for-preterm-children-after-discharge-from-the-nicu
#2
Dennis Z Kuo, Robert E Lyle, Patrick H Casey, Christopher J Stille
Approximately 1 in 8 children in the United States are born preterm. Existing guidelines and research examine the cost of prematurity from the NICU stay and developmental surveillance and outcomes after discharge from the NICU. Preterm children are at greater risk for excess hospitalizations, outpatient visits, and societal costs after NICU discharge. Improved delivery of care and health promotion from the community setting, particularly from the patient-centered medical home, may result in improved growth, health, and development, with accompanying reduction of post-NICU discharge costs and encounters...
March 1, 2017: Pediatrics
https://www.readbyqxmd.com/read/28243874/primary-care-practice-transformation-and-the-rise-of-consumerism
#3
William H Shrank
Americans are increasingly demanding the same level of service in healthcare that they receive in other services and products that they buy. This rise in consumerism poses challenges for primary care physicians as they attempt to transform their practices to succeed in a value-based reimbursement landscape, where they are rewarded for managing costs and improving the health of populations. In this paper, three examples of consumer-riven trends are described: retail healthcare, direct and concierge care, and home-based diagnostics and care...
February 27, 2017: Journal of General 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
#4
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/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
#5
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/28152753/data-driven-quality-improvement-in-an-oncology-patient-centered-medical-home
#6
Maureen Lowry, Brian Flounders, Susan Higman Tofani
54 Background: In a 2012 abstract, Data driven transformation for an Oncology Patient-Centered Medical Home, Consultants in Medical Oncology (CMOH) demonstrated that standardized processes and enhanced IT capabilities (IRIS software app) provided a rapid learning system for the practice. Iris aggregated data became the basis for Quality Improvement Projects (QIPs) allowing CMOH to continue to improve in quality and cost measures. Deviation from performance trend is readily identifiable, providing operational direction...
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
#7
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/28062814/from-our-practices-to-yours-key-messages-for-the-journey-to-integrated-behavioral-health
#8
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
#9
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/28062808/practice-innovation-for-care-integration-opioid-management-and-quality-measurement-in-family-medicine
#10
EDITORIAL
Anne Victoria Neale, Marjorie A Bowman, Dean A Seehusen
Ringing in the new year 2017! This may finally be the year of real practice improvement after many false starts. Research into practice transformation has informed both local work and national policy. Human factors and payment structures are key. And payment structures depend on how quality is measured. Large gaps between practicing physician recommendations for the most important quality measures and those currently imposed externally are exposed in this issue. Also see information on in-practice social work consultations and their outcomes and recommendations from innovators in integrated care, and for chronic opioid therapy management based on visits to many family medicine offices...
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
#11
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/28030459/implementation-and-sequencing-of-practice-transformation-in-urban-practices-with-underserved-patients
#12
Denise D Quigley, Zachary S Predmore, Alex Y Chen, Ron D Hays
BACKGROUND: Patient-centered medical home (PCMH) has gained momentum as a model for primary-care health services reform. METHODS: We conducted interviews at 14 primary care practices undergoing PCMH transformation in a large urban federally qualified health center in California and used grounded theory to identify common themes and patterns. RESULTS: We found clinics pursued a common sequence of changes in PCMH transformation: Clinics began with National Committee for Quality Assurance (NCQA) level 3 recognition, adding care coordination staff, reorganizing data flow among teams, and integrating with a centralized quality improvement and accountability infrastructure...
January 2017: Quality Management in Health Care
https://www.readbyqxmd.com/read/28024090/cost-effectiveness-of-the-4-pillars-practice-transformation-program-to-improve-vaccination-of-adults-aged-65-and-older
#13
Kenneth J Smith, Richard K Zimmerman, Mary Patricia Nowalk, Chyongchiou J Lin
OBJECTIVES: To estimate the cost-effectiveness of an intervention to increase pneumococcal, influenza, and pertussis-containing vaccine uptake in adults aged 65 and older in primary care practices. DESIGN: Markov decision analysis model, comparing the cost-effectiveness of the 4 Pillars Practice Transformation Program with no intervention. SETTING: Diverse primary care practices in two U.S. cities. PARTICIPANTS: Clinical trial participants aged 65 and older...
December 26, 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27909251/-in-principle-we-have-agreement-but-in-practice-it-is-a-bit-more-difficult-obtaining-organizational-buy-in-to-patient-centered-medical-home-transformation
#14
Janelle Applequist, Michelle Miller-Day, Peter F Cronholm, Robert A Gabbay, Deborah S Bowen
The patient-centered medical home (PCMH) is a model of care that emphasizes the coordination of patient treatment among health care providers. Practice transformation to this model, however, presents a number of challenges. One of these challenges is getting the buy-in of all personnel to commit to making organizational changes in the journey to becoming a nationally recognized medical home. This study investigated internal messages of buy-in as communicated by practices transitioning to this type of care. Grounding itself in stakeholder theory, this study analyzed interviews with staff, administration, and practitioners from 20 medical practices in a mid-Atlantic state...
November 30, 2016: Qualitative Health Research
https://www.readbyqxmd.com/read/27893519/effects-of-hospital-systems-on-medical-home-transformation-in-primary-care-residency-training-practices
#15
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/27876200/improving-adolescent-hpv-vaccination-in-a-randomized-controlled-cluster-trial-using-the-4-pillars%C3%A2-practice-transformation-program
#16
Richard K Zimmerman, Krissy K Moehling, Chyongchiou J Lin, Song Zhang, Jonathan M Raviotta, Evelyn C Reis, Sharon G Humiston, Mary Patricia Nowalk
OBJECTIVE: Uptake of meningococcal vaccine (MCV) and tetanus, diphtheria and pertussis (Tdap) vaccine among adolescents has approached Healthy People 2020 goals, but human papillomavirus (HPV) vaccination has not. This study evaluated an intervention using the 4 Pillars™ Practice Transformation Program to increase HPV, MCV and Tdap uptake among adolescents in primary care practices. METHODS: Practices with at least 50 patients 11-17years old with estimated vaccination rates less than national goals, were assigned to intervention (n=11) and control (n=11) groups in a randomized controlled cluster trial; 9 intervention and 11 control sites completed the study...
January 3, 2017: Vaccine
https://www.readbyqxmd.com/read/27875602/practice-facilitation-for-pcmh-implementation-in-residency-practices
#17
Emilie Buscaj, Tristen Hall, Linda Montgomery, Douglas H Fernald, Jaclyn King, Nicole Deaner, W Perry Dickinson
BACKGROUND AND OBJECTIVES: Primary care residency programs continue to adapt and change to become high-performing training sites for advanced primary care. Practice facilitation is a key method to assist practices in implementing organizational changes. This evaluation described the unique nature and essential roles and qualities of practice facilitation for residency program patient-centered medical home (PCMH) transformation. METHODS: Evaluation of the Colorado Residency PCMH Project from 2009 through 2014 included template and immersion-crystallization approaches to qualitative analysis of field notes, key informant interviews, and meeting documentation to identify themes related to external facilitation for practice transformation in 11 Colorado primary care residency practices...
November 2016: Family Medicine
https://www.readbyqxmd.com/read/27849352/medical-home-transformation-and-breast-cancer-screening
#18
Amy W Baughman, Phyllis Brawarsky, Tracy Onega, Tor D Tosteson, Qianfei Wang, Anna N A Tosteson, Jennifer S Haas
OBJECTIVES: The patient-centered medical home (PCMH) continues to gain momentum as a primary care delivery system. We evaluated whether medical home transformation of primary care practices is associated with the use of breast cancer screening, a broadly endorsed preventive service. STUDY DESIGN: Retrospective cohort study evaluating 12 Brigham and Women's Hospital (BWH)-affiliated primary care clinics in greater Boston, Massachusetts. METHODS: Practice transformation was measured quarterly using a continuous PCMH transformation score (range = 0-100) modeled after National Committee for Quality Assurance recognition requirements...
November 1, 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27809793/using-the-4-pillars%C3%A2-practice-transformation-program-to-increase-adult-influenza-vaccination-and-reduce-missed-opportunities-in-a-randomized-cluster-trial
#19
Chyongchiou J Lin, Mary Patricia Nowalk, Valory N Pavlik, Anthony E Brown, Song Zhang, Jonathan M Raviotta, Krissy K Moehling, Mary Hawk, Edmund M Ricci, Donald B Middleton, Suchita Patel, Jeannette E South-Paul, Richard K Zimmerman
BACKGROUND: An evidence-based, step-by-step guide, the 4 Pillars™ Practice Transformation Program, was the foundation of an intervention to increase adult immunizations in primary care and was tested in a randomized controlled cluster trial. The purpose of this study is to report changes in influenza immunization rates and on factors related to receipt of influenza vaccine. METHODS: Twenty five primary care practices were recruited in 2013, stratified by city (Houston, Pittsburgh), location (rural, urban, suburban) and type (family medicine, internal medicine), and randomized to the intervention (n = 13) or control (n = 12) in Year 1 (2013-14)...
November 3, 2016: BMC Infectious Diseases
https://www.readbyqxmd.com/read/27755655/using-the-4-pillars-practice-transformation-program-to-increase-pneumococcal-immunizations-for-older-adults-a-cluster-randomized-trial
#20
Richard K Zimmerman, Anthony E Brown, Valory N Pavlik, Krissy K Moehling, Jonathan M Raviotta, Chyongchiou J Lin, Song Zhang, Mary Hawk, Shakala Kyle, Suchita Patel, Faruque Ahmed, Mary Patricia Nowalk
OBJECTIVES: To test the effectiveness of a step-by step, evidence-based guide, the 4 Pillars Practice Transformation Program, to increase adult pneumococcal vaccination. DESIGN: Randomized controlled cluster trial (RCCT) in Year 1 (June 1, 2013 to May 31, 2014) and pre-post study in Year 2 (June 1, 2014 to January 31, 2015) with data analyzed in 2016. Baseline year was June 1, 2012, to May 31, 2013. Demographic and vaccination data were derived from deidentified electronic medical record extractions...
January 2017: Journal of the American Geriatrics Society
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