Erickson R, Abu Dabrh AM, Chavez A, Cristiani V, DeJesus R, Laabs S, Presutti R, Rosas S, Westfall E, Witt T, Thacher T. Development and Early Experience of a Primary Care Learning Collaborative in a Large Health Care System.
J Prim Care Community Health 2022;
13:21501319221089775. [PMID:
35603490 PMCID:
PMC9130813 DOI:
10.1177/21501319221089775]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction:
Primary care clinicians are presented with hundreds of new clinical
recommendations and guidelines. To consider practice change clinicians must
identify relevant information and develop a contextual framework. Too much
attention to information irrelevant to one’s practice results in wasted
resources. Too little results in care gaps. A small group of primary care
clinicians in a large health system sought to address the problem of vetting
new information and providing peer reviewed context. This was done by
engaging colleagues across the system though a primary care learning
collaborative.
Methods:
The collaborative was a grass roots initiative between community and
academic-based clinicians. They invited all the system’s primary care
clinicians to participate. They selected new recommendations or guidelines
and used surveys as the principal communication instrument. Surveys shared
practice experience and also invited members to give narrative feedback
regarding their acceptance of variation in care relate to the topic. A
description of the collaborative along with its development, processes, and
evolution are discussed. Process changes to address needs during the
COVID-19 pandemic including expanded information sharing was necessary.
Results:
Collaborative membership reached across 5 states and included family
medicine, internal medicine, and pediatrics. Members found involvement with
the collaborative useful. Less variation in care was thought important for
public health crises: the COVID pandemic and opioid epidemic. Greater
practice variation was thought acceptable for adherence to multispecialty
guidelines, such as diabetes, lipid management, and adult ADHD care. Process
changes during the pandemic resulted in more communications between members
to avoid practice gaps.
Conclusion:
An internet-based learning collaborative in a health system had good
engagement from its members. Using novel methods, it was able to provide
members with feedback related to the importance of new practice
recommendations as perceived by their peers. Greater standardization was
thought necessary when adopting measures to address public health crisis,
and less necessary when addressing multispecialty guidelines. By employing a
learning collaborative, this group was able to keep members interested and
engaged. During the first year of the COVID pandemic the collaborative also
served as a vehicle to share timely information.
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