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Rubio K, Fraze TK, Bibi S, Rodriguez HP. Racial-Ethnic Composition of Primary Care Practices and Comprehensive Primary Care Plus Initiative Participation. J Gen Intern Med 2023; 38:2945-2952. [PMID: 36941423 PMCID: PMC10593678 DOI: 10.1007/s11606-023-08160-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/10/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND It remains unclear whether the racial-ethnic composition or the socioeconomic profiles of eligible primary care practices better explain practice participation in the Centers for Medicare and Medicaid Services' (CMS) Comprehensive Primary Care Plus (CPC+) program. OBJECTIVE To examine whether practices serving high proportions of Black or Latino Medicare fee-for-service (FFS) beneficiaries were less likely to participate in CPC+ in 2021 compared to practices serving lower proportions of these populations. DESIGN 2019 IQVIA OneKey data on practice characteristics was linked with 2018 CMS claims data and 2021 CMS CPC+ participation data. Medicare FFS beneficiaries were attributed to practices using CMS's primary care attribution method. PARTICIPANTS 11,718 primary care practices and 7,264,812 attributed Medicare FFS beneficiaries across 18 eligible regions. METHODS Multivariable logistic regression models examined whether eligible practices with relatively high shares of Black or Latino Medicare FFS beneficiaries were less likely to participate in CPC+ in 2021, controlling for the clinical and socioeconomic profiles of practices. MAIN MEASURES Proportion of Medicare FFS beneficiaries attributed to each practice that are (1) Latino and (2) Black. KEY RESULTS Of the eligible practices, 26.9% were CPC+ participants. In adjusted analyses, practices with relatively high shares of Black (adjusted odds ratio, aOR = 0.62, p < 0.05) and Latino (aOR = 0.32, p < 0.01) beneficiaries were less likely to participate in CPC+ compared to practices with lower shares of these beneficiary groups. State differences in CPC+ participation rates partially explained participation disparities for practices with relatively high shares of Black beneficiaries, but did not explain participation disparities for practices with relatively high shares of Latino beneficiaries. CONCLUSIONS The racial-ethnic composition of eligible primary care practices is more strongly associated with CPC+ participation than census tract-level poverty. Practice eligibility requirements for CMS-sponsored initiatives should be reconsidered so that Black and Latino beneficiaries are not left out of the benefits of practice transformation.
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Affiliation(s)
- Karl Rubio
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Taressa K Fraze
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Salma Bibi
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Hector P Rodriguez
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
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2
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Jung OS, Cummings JR. Employee Engagement in Quality Improvement and Patient Sociodemographic Characteristics in Federally Qualified Health Centers. Med Care Res Rev 2023; 80:43-52. [PMID: 36000499 PMCID: PMC9806475 DOI: 10.1177/10775587221118157] [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: 02/05/2023]
Abstract
Quality improvement (QI) work is critical, particularly in federally qualified health centers (FQHCs) that treat underserved populations. In a national sample of 45 FQHCs, we examined how patients' sociodemographic characteristics were associated with employee engagement in QI, via innovation contests that solicited ideas for improving care and offered opportunities to vote on ideas. We posited that patients' sociodemographic characteristics influence the complexity and intensity of clinical work and thus employees' capacity to engage in QI. Regression results indicated that the percentage of patients living in poverty was negatively associated with employee participation in idea submission and voting. Moreover, the percentage of Hispanic patients was negatively associated with participation in voting. The percentage of Black patients, however, was not associated with either outcome. FQHCs that serve a higher share of low income and/or Hispanic patients may face resource and personnel constraints that reduce employees' capacity to contribute to QI efforts.
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Affiliation(s)
- Olivia S. Jung
- Emory University, Atlanta, GA,
USA,Harvard University, Allston, MA,
USA,Massachusetts General Hospital, Boston,
USA,Olivia S. Jung, Department of Health Policy
and Management, Rollins School of Public Health, Emory University, 1518 Clifton
Road, Atlanta, GA 30322, USA.
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3
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Smith MA, Mulrooney M, Shipley BL, Sobieraj DM. A technical assistance program approach for pharmacist clinical services integration in primary care organizations. J Am Pharm Assoc (2003) 2022; 63:952-960. [PMID: 36653277 DOI: 10.1016/j.japh.2022.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Little is known about the use of technical assistance (TA) programs to facilitate the integration of pharmacist clinical services in primary care settings. OBJECTIVE Design, implement, and evaluate a TA program to advance pharmacist integration and clinical services in primary care. PRACTICE DESCRIPTION Structured TA program for developing new or enhancing current integrated pharmacist services was utilized in 4 primary care organizations (i.e., federally qualified health center, accountable care organization, and an academic and regional health system). PRACTICE INNOVATION Holistic TA program with a logic model, organizational stages of pharmacist integration, project prioritization, and implementation plans. EVALUATION METHODS A mixed-methods contextual inquiry approach for integration of pharmacist clinical services. Quantitative analysis was used for TA program activities, time spent, pilot project data, and a web-based survey for post-TA program assessment. Coincidence analysis was used to assess organizational commitment to TA services. Qualitative analysis was used for data collected through semi-structured key informant interviews and team meeting activity reports. RESULTS TA program team spent 1872 hours over 11 months on program development, logistics, implementation, and project oversight. TA services included 88 onsite and virtual meetings, 11 onsite pharmacist coaching sessions, 6 workflow mapping sessions, and updating online learning resources. Primary care organizations that had already hired a pharmacist were more likely to uptake TA services. Most useful TA methods were webinar meetings (89%) and on-site pharmacist coaching (88%). TA project results were used for strategic planning (73%), pharmacist value/impact assessment (72%), pharmacist capacity modeling (68%), and workflow design (65%). A key learning from the TA program was the importance of a qualified pharmacist with clinical service experience in primary care settings and population health teams. CONCLUSION TA program for the pharmacist clinical service integration has broad application to primary care organizations with diverse organizational structures, payer mixes, and practice settings.
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Chattopadhyay S. Cost-efficiency in the patient centered medical home model: New evidence from federally qualified health centers. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2021; 21:295-316. [PMID: 33638724 DOI: 10.1007/s10754-021-09295-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/10/2021] [Indexed: 06/12/2023]
Abstract
This research analyzes the cost-efficiency of the Patient Centered Medical Home (PCMH) model vis-à-vis the traditional care delivery model in the Federally Qualified Health Centers (FQHC). We apply the three-stage least squares modeling approach on 2014 UDS data on all FQHCs to estimate per-visit and per-patient cost functions. Log-quadratic and linear-quadratic functional forms of cost are used for the analysis. The estimated models reveal substantial scale economies and cost advantages associated with PCMH status. Aggregate cost-saving impact of PCMH across all FQHCs in 2014 is estimated to be $1.05 billion. Simulations reveal that the PCMH impact on cost savings grows with the size of the patient population. Reaching the full cost-saving potential in PCMH-recognized FQHCs hinges on expanding the health workforce at all levels of care to meet the need of the growing patient population due to aging and Medicaid expansion. For FQHCs that are not PCMH-recognized, capacity/infrastructural expansion appears to be the immediate policy choice.
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Affiliation(s)
- Sudip Chattopadhyay
- San Francisco State University, San Francisco, USA.
- National Center for Health Workforce Analysis, Health Resources and Services Administration, 5600 Fishers Lane, , Rockville, MD, 20857, USA.
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5
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Patient Activation, Depressive Symptoms, and Self-Rated Health: Care Management Intervention Effects among High-Need, Medically Complex Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115690. [PMID: 34073277 PMCID: PMC8198245 DOI: 10.3390/ijerph18115690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/20/2021] [Accepted: 05/23/2021] [Indexed: 11/17/2022]
Abstract
The purpose of this randomized controlled trial (n = 268) at a Federally Qualified Health Center was to evaluate the outcomes of a care management intervention versus an attention control telephone intervention on changes in patient activation, depressive symptoms and self-rated health among a population of high-need, medically complex adults. Both groups had similar, statistically significant improvements in patient activation and self-rated health. Both groups had significant reductions in depressive symptoms over time; however, the group who received the care management intervention had greater reductions in depressive symptoms. Participants in both study groups who had more depressive symptoms had lower activation at baseline and throughout the 12 month study. Findings suggest that patients in the high-need, medically complex population can realize improvements in patient activation, depressive symptoms, and health status perceptions even with a brief telephone intervention. The importance of treating depressive symptoms in patients with complex health conditions is highlighted.
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6
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Do interventions promoting medical homes in FQHCs improve continuity of care for Medicare beneficiaries? J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-019-01090-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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7
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Webel AR, Schexnayder J, Rentrope CR, Bosworth HB, Hileman CO, Okeke NL, Vedanthan R, Longenecker CT. The influence of healthcare financing on cardiovascular disease prevention in people living with HIV. BMC Public Health 2020; 20:1768. [PMID: 33228623 PMCID: PMC7685650 DOI: 10.1186/s12889-020-09896-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People living with HIV are diagnosed with age-related chronic health conditions, including cardiovascular disease, at higher than expected rates. Medical management of these chronic health conditions frequently occur in HIV specialty clinics by providers trained in general internal medicine, family medicine, or infectious disease. In recent years, changes in the healthcare financing for people living with HIV in the U.S. has been dynamic due to changes in the Affordable Care Act. There is little evidence examining how healthcare financing characteristics shape primary and secondary cardiovascular disease prevention among people living with HIV. Our objective was to examine the perspectives of people living with HIV and their healthcare providers on how healthcare financing influences cardiovascular disease prevention. METHODS As part of the EXTRA-CVD study, we conducted in-depth, semi-structured interviews with 51 people living with HIV and 34 multidisciplinary healthcare providers and at three U.S. HIV clinics in Ohio and North Carolina from October 2018 to March 2019. Thematic analysis using Template Analysis techniques was used to examine healthcare financing barriers and enablers of cardiovascular disease prevention in people living with HIV. RESULTS Three themes emerged across sites and disciplines (1): healthcare payers substantially shape preventative cardiovascular care in HIV clinics (2); physician compensation tied to relative value units disincentivizes cardiovascular disease prevention efforts by HIV providers; and (3) grant-based services enable tailored cardiovascular disease prevention, but sustainability is limited by sponsor priorities. CONCLUSIONS With HIV now a chronic disease, there is a growing need for HIV-specific cardiovascular disease prevention; however, healthcare financing complicates effective delivery of this preventative care. It is important to understand the effects of evolving payer models on patient and healthcare provider behavior. Additional systematic investigation of these models will help HIV specialty clinics implement cardiovascular disease prevention within a dynamic reimbursement landscape. TRIAL REGISTRATION Clinical Trial Registration Number: NCT03643705 .
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Affiliation(s)
- Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA.
| | - Julie Schexnayder
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - C Robin Rentrope
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | | | - Corrilynn O Hileman
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,The MetroHealth System, Cleveland, OH, USA
| | | | - Rajesh Vedanthan
- New York University Grossman School of Medicine, New York, NY, USA
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8
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Bell N, Wilkerson R, Mayfield-Smith K, Lòpez-De Fede A. Association of Patient-Centered Medical Home designation and quality indicators within HRSA-funded community health center delivery sites. BMC Health Serv Res 2020; 20:980. [PMID: 33109162 PMCID: PMC7588949 DOI: 10.1186/s12913-020-05826-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/15/2020] [Indexed: 11/25/2022] Open
Abstract
Background Patient-Centered Medical Home (PCMH) adoption is an important strategy to help improve primary care quality within Health Resources and Service Administration (HRSA) community health centers (CHC), but evidence of its effect thus far remains mixed. A limitation of previous evaluations has been the inability to account for the proportion of CHC delivery sites that are designated medical homes. Methods Retrospective cross-sectional study using HRSA Uniform Data System (UDS) and certification files from the National Committee for Quality Assurance (NCQA) and the Joint Commission (JC). Datasets were linked through geocoding and an approximate string-matching algorithm. Predicted probability scores were regressed onto 11 clinical performance measures using 10% increments in site-level designation using beta logistic regression. Results The geocoding and approximate string-matching algorithm identified 2615 of the 6851 (41.8%) delivery sites included in the analyses as having been designated through the NCQA and/or JC. In total, 74.7% (n = 777) of the 1039 CHCs that met the inclusion criteria for the analysis managed at least one NCQA- and/or JC-designated site. A proportional increase in site-level designation showed a positive association with adherence scores for the majority of all indicators, but primarily among CHCs that designated at least 50% of its delivery sites. Once this threshold was achieved, there was a stepwise percentage point increase in adherence scores, ranging from 1.9 to 11.8% improvement, depending on the measure. Conclusion Geocoding and approximate string-matching techniques offer a more reliable and nuanced approach for monitoring the association between site-level PCMH designation and clinical performance within HRSA’s CHC delivery sites. Our findings suggest that transformation does in fact matter, but that it may not appear until half of the delivery sites become designated. There also appears to be a continued stepwise increase in adherence scores once this threshold is achieved.
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Affiliation(s)
- Nathaniel Bell
- College of Nursing, University of South Carolina, Columbia, USA
| | - Rebecca Wilkerson
- Division of Integrated Health and Policy Research, Institute for Families in Society, University of South Carolina, Columbia, USA
| | - Kathy Mayfield-Smith
- Division of Integrated Health and Policy Research, Institute for Families in Society, University of South Carolina, Columbia, USA
| | - Ana Lòpez-De Fede
- Division of Integrated Health and Policy Research, Institute for Families in Society, University of South Carolina, 1600 Hampton St., Suite 507, Columbia, SC, 29208, USA.
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9
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Kilany M, Wells R, Morrissey JP, Domino ME. Are There Performance Advantages Favoring Federally Qualified Health Centers in Medical Home Care for Persons with Severe Mental Illness? ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:121-130. [PMID: 32424452 DOI: 10.1007/s10488-020-01050-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To identify whether medical homes in FQHCs have advantages over other group and individual medical practices in caring for people with severe mental illness. Models estimated the effect of the type of medical home on monthly service utilization, medication adherence, and total Medicaid spending over a 4-year period for adults aged 18 or older with a major depressive disorder (N = 65,755), bipolar disorder (N = 19,925), or schizophrenia (N = 8501) enrolled in North Carolina's Medicaid program. Inverse probability of treatment weights (IPTW) were used to adjust for nonrandom assignment of patients to practices. Generalized estimating equations for repeated measures were used with gamma distributions and log links for the continuous measures of medication adherence and spending, and binomial distributions with logit links for binary measures of any outpatient or any emergency department visits. Adults with major depression or bipolar disorders in FQHC medical homes had a lower probability of outpatient service use than their counterparts in individual and group practices. The probability of emergency department use, medication adherence, and total Medicaid spending were relatively similar across the three settings. This study suggests that no one type of medical practice setting-whether FQHC, other group, or individual-consistently outperforms the others in providing medical home services to people with severe mental illness.
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Affiliation(s)
- Mona Kilany
- American Institutes for Research, Washington, D.C., USA
| | - Rebecca Wells
- The University of Texas School of Public Health, Houston, USA
| | - Joseph P Morrissey
- Professor Emeritus, Department of Health Policy and Management, The Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Marisa Elena Domino
- Department of Health Policy and Management, The Gillings School of Global Public Health, Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, 1105B McGavran-Greenberg Hall, CB#7411, 135 Dauer Dr., Chapel Hill, NC, 27599-7411, USA.
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10
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Karst A, Colvard M, Bean J, Patel E, Pate R, Lister J. Impact of a mental health trainee interdisciplinary program on a veteran population. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Allison Karst
- Department of Pharmacy, VA Tennessee Valley Healthcare System Murfreesboro Tennessee
| | - Michelle Colvard
- Department of Pharmacy, VA Tennessee Valley Healthcare System Murfreesboro Tennessee
| | - Jennifer Bean
- Department of Pharmacy, VA Tennessee Valley Healthcare System Murfreesboro Tennessee
- University of Tennessee Memphis Tennessee
- Union University Jackson Tennessee
- Lipscomb University Nashville Tennessee
- Belmont University Nashville Tennessee
| | - Erin Patel
- Department of Psychology, Tennessee Valley Healthcare System Murfreesboro Tennessee
- Vanderbilt University Nashville Tennessee
| | - Rebecca Pate
- VA Alexandria Healthcare System Alexandria Louisiana
- University of Tennessee Health Science Center Knoxville Tennessee
| | - Jonathan Lister
- Department of Pharmacy, VA Tennessee Valley Healthcare System Murfreesboro Tennessee
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11
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Shukor AR, Edelman S, Brown D, Rivard C. Developing Community-Based Primary Health Care for Complex and Vulnerable Populations in the Vancouver Coastal Health Region: HealthConnection Clinic. Perm J 2019; 22:18-010. [PMID: 30227907 DOI: 10.7812/tpp/18-010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Designing, delivering, and evaluating high-performing primary health care services for complex and vulnerable subpopulations are challenging endeavors. However, there is a relative paucity of research evidence available to support such work. OBJECTIVE To provide a case study using HealthConnection Clinic, a public primary care center located in Metropolitan Vancouver's North Shore. METHODS Developmental evaluation approach operationalizing the 10 Building Blocks of High-Performing Primary Care framework using qualitative and quantitative methods. RESULTS The clinic provided valuable insights to policymakers and researchers related to development of the Building Blocks' foundational elements, particularly engaged leadership, empanelment, and data-driven improvement. The study highlighted the key enablers, achievements, challenges, and barriers related to operationalizing each Building Block. The Building Blocks were a useful heuristic that enabled the development and evaluation of primary care for complex subpopulations. Particularly salient from a Canadian policy perspective was the demonstration that system integration was possible when highly engaged leaders from a Regional Health Authority and a Division of Family Practice shared a common vision and purpose. HealthConnection Clinic's entrepreneurial spirit has enabled the development of innovative, evidence-based tools such as the AMPS complexity assessment tool (attachment, medical conditions, psychological/mental health/addictions challenges, and socioeconomic status), designed to identify and assess biopsychosocial complexity and needs. The study also highlighted the importance of incorporating community orientation and equity into developmental work. CONCLUSION The study demonstrates how the Building Blocks approach can be adapted to operationalize high-performing primary care standards in settings serving complex and vulnerable populations.
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Affiliation(s)
- Ali Rafik Shukor
- Regional Primary Care Evaluator for the Vancouver Coastal Health Authority in Vancouver, British Columbia, Canada
| | - Sandra Edelman
- Manager of Public Health and Chronic Disease Services for the North Shore Division of Community Family Health in Vancouver, British Columbia, Canada
| | - Dean Brown
- Medical Director of the North Shore Division of Community Family Health in Vancouver, British Columbia, Canada
| | - Cheryl Rivard
- Project Manager for the Vancouver Coast Health Authority in Vancouver, British Columbia, Canada
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12
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Rose AJ, Timbie JW, Setodji C, Friedberg MW, Malsberger R, Kahn KL. Primary Care Visit Regularity and Patient Outcomes: an Observational Study. J Gen Intern Med 2019; 34:82-89. [PMID: 30367329 PMCID: PMC6318173 DOI: 10.1007/s11606-018-4718-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 09/17/2018] [Accepted: 10/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Regular primary care visits may allow an opportunity to deliver high-value, proactive care. However, no previous study has examined whether more temporally regular primary care visits predict better outcomes. OBJECTIVE To examine the relationship between the temporal regularity of primary care (PC) visits and outcomes. DESIGN Retrospective cohort study. PARTICIPANTS We used Medicare claims for 378,862 fee-for-service Medicare beneficiaries, who received PC at 1328 federally qualified health centers from 2010 to 2014. MAIN MEASURES We created five beneficiary groups based upon their annual number of PC visits. We further subdivided those groups according to whether PC visits occurred with more or less regularity than the median value. We compared these 10 subgroups on three outcomes, adjusting for beneficiary characteristics: emergency department (ED) visits, hospitalizations, and total Medicare expenditures. We also aggregated to the clinic level and divided clinics into tertiles of more, less, and similarly regular to predicted. We compared these three groups of clinics on the same three outcomes of care. KEY RESULTS Within each visit frequency group, beneficiaries in the subgroup with fewer regular visits had more ED visits, more hospitalizations, and higher costs. Among beneficiaries with the most frequent PC visits, the less regular subgroup had more ED visits (1.70 vs. 1.31 per person-year), more hospitalizations (0.69 vs. 0.57), and greater Medicare expenditures ($20,731 vs. $17,430, p < 0.001 for all comparisons). Clinics whose PC visits were more regular than predicted also had better outcomes than other clinics, although the effect sizes were smaller. CONCLUSIONS Temporal patterns of PC visits are correlated with outcomes, even among beneficiaries who appear otherwise similar. Measuring the temporal regularity of PC visits may be useful for identifying beneficiaries at risk for adverse events, and as a barometer for and an impetus to clinic-level quality improvement.
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Affiliation(s)
- Adam J Rose
- RAND Corporation, Boston, MA, USA. .,Boston University School of Medicine, Boston, MA, USA.
| | | | | | - Mark W Friedberg
- RAND Corporation, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Katherine L Kahn
- RAND Corporation, Santa Monica, CA, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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13
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Holt JM. An evolutionary view of patient experience in primary care: A concept analysis. Nurs Forum 2018; 53:555-566. [PMID: 30196531 DOI: 10.1111/nuf.12286] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 06/10/2018] [Accepted: 06/28/2018] [Indexed: 06/08/2023]
Abstract
AIM This concept analysis explores "patient experience" in the context of primary care. BACKGROUND In the 21st century, person-centered care became the manner to address the healthcare quality needs of the United States. This study led to using measures of patient experience as an evaluation of patient-centered care. DESIGN Concept analysis. DATA SOURCES CINAHL, Cochrane Review, PUBMED Central, PsycINFO, Web of Science, and Scopus were queried using "patient experience" and "primary care." All peer-reviewed US-based articles were included from January 2000 to October 2017 (n = 59). REVIEW METHODS Rodgers' evolutionary view of concept analysis guided this inquiry. RESULTS Patient experience is any process discernible by patients, including subjective experiences, objective experiences, and observations of provider or staff behavior. Patient experience reports are mediated and moderated by many variables and reflect care experiences that directly measure patient-centeredness from the patient's viewpoint. Consequences of patient experience may lead to adherence to shared plans of care, patient engagement, and appropriate use of healthcare services. CONCLUSION Conceptual clarity of patient experience adds to the understanding of how patients experience healthcare quality. If healthcare aspires to deliver patient-centered care, understanding quality from the viewpoint of the patient is essential.
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Affiliation(s)
- Jeana M Holt
- University of Wisconsin-Milwaukee, College of Nursing, Milwaukee, Wisconsin
- Department of Family & Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Kranz AM, Dalton S, Damberg C, Timbie JW. Using Health IT to Coordinate Care and Improve Quality in Safety-Net Clinics. Jt Comm J Qual Patient Saf 2018; 44:731-740. [PMID: 30064959 DOI: 10.1016/j.jcjq.2018.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/05/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Health centers provide care to vulnerable and high-need populations. Recent investments have promoted use of health information technology (HIT) capabilities for improving care coordination and quality of care in health centers. This study examined factors associated with use of these HIT capabilities and the association between these capabilities and quality of care in a census of health centers in the United States. METHODS Cross-sectional secondary data from the 2015 Health Resources and Services Administration's Uniform Data System was used to examine 6 measures of HIT capability related to care coordination and clinical decision support and 16 measures of quality (12 process measures, 3 outcome measures, 1 composite measure) for health centers in the United States. Adjusted logistic regressions were used to examine health center characteristics associated with use of HIT capabilities, and adjusted linear regressions were used to examine associations between HIT capabilities and quality of care. RESULTS Many health centers reported using HIT for care coordination activities, including coordinating enabling services (67.3%) or engaging patients (81.0%). Health center size and medical home recognition were associated with significantly greater odds of using HIT for enabling services and engaging patients. These HIT capabilities were associated with higher overall quality and higher rates of six process measures (adult screening and maternal and child health) and hemoglobin A1c control. CONCLUSION Use of HIT for such activities as arranging enabling services and engaging patients are underleveraged tools for care coordination. There may be opportunities to further improve quality of care for vulnerable patients by promoting health centers' use of these HIT capabilities.
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Matzke GR, Moczygemba LR, Williams KJ, Czar MJ, Lee WT. Impact of a pharmacist-physician collaborative care model on patient outcomes and health services utilization. Am J Health Syst Pharm 2018; 75:1039-1047. [PMID: 29789318 DOI: 10.2146/ajhp170789] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The impact of a pharmacist-physician collaborative care model on patient outcomes and health services utilization is described. METHODS Six hospitals from the Carilion Clinic health system in southwest Virginia, along with 22 patient-centered medical home (PCMH) practices affiliated with Carilion Clinic, participated in this project. Eligibility criteria included documented diagnosis of 2 or more of the 7 targeted chronic conditions (congestive heart failure, hypertension, hyperlipidemia, diabetes mellitus, asthma, chronic obstructive pulmonary disease, and depression), prescriptions for 4 or more medications, and having a primary care physician in the Carilion Clinic health system. A total of 2,480 evaluable patients were included in both the collaborative care group and the usual care group. The primary clinical outcomes measured were the absolute change in values associated with diabetes mellitus, hypertension, and hyperlipidemia management from baseline within and between the collaborative care and usual care groups. RESULTS Significant improvements (p < 0.01) in glycosylated hemoglobin, blood pressure, low-density-lipoprotein cholesterol, and total cholesterol were observed in the collaborative care group compared with the usual care group. Hospitalizations declined significantly in the collaborative care group (23.4%), yielding an estimated cost savings of $2,619 per patient. The return on investment (net savings divided by program cost) was 504%. CONCLUSION Inclusion of clinical pharmacists in this physician-pharmacist collaborative care-based PCMH model was associated with significant improvements in patients' medication-related clinical health outcomes and a reduction in hospitalizations.
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Affiliation(s)
- Gary R Matzke
- Department of Pharmacotherapy and Outcome Sciences, Virginia Commonwealth University School of Pharmacy, Richmond, VA.
| | - Leticia R Moczygemba
- Health Outcomes and Pharmacy Practice Division, University of Texas at Austin College of Pharmacy, Austin, TX
| | | | - Michael J Czar
- Department of Pharmacy, Carilion New River Valley Medical Center, Christiansburg, VA
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Patient-Centered Medical Home Undergraduate Internship, Benefits to a Practice Manager. Health Care Manag (Frederick) 2018; 37:136-141. [DOI: 10.1097/hcm.0000000000000212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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