Starting a Clinic for Transgender Youth in an Academic Medical Center: Applications of the Primary Care Medical Home Model

Background: Primary care is playing an ever increasing role in the design and implementation of new models of healthcare focused on achieving policy ends as put forth by government at both the state and federal level. The Patient Centered Medical Home (PCMH) model is a leading design in this endeavor.Objective: We sought to transform family medicine offices at an academic medical center into the PCMH model of care with improvements in patient outcomes as the end result.Results: Transformation to the PCMH model of care resulted in improved rates of control of diabetes and hypertension and improved prevention measures such as smoking cessation, mammograms, Pneumovax administration, and Tdap vaccination. Readmission rates also improved using a care coordination model.Conclusions: It is possible to transform family medicine offices at academic medical centers in methods consistent with newer models of care such as the PCMH model and to improve patient outcomes. Lessons learned along the way are useful to any practice or system seeking to undertake such transformation.

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Qualitative Assessment of Rapid System Transformation to Primary Care Video Visits at an Academic Medical Center

Annals of Internal Medicine ◽

10.7326/m20-1814 ◽

2020 ◽

Vol 173 (7) ◽

pp. 527-535

Author(s):

Malathi Srinivasan ◽

Steven Asch ◽

Stacie Vilendrer ◽

Samuel Crandall Thomas ◽

Rika Bajra ◽

...

Keyword(s):

Primary Care ◽

Medical Center ◽

Academic Medical Center ◽

Qualitative Assessment ◽

System Transformation ◽

Academic Medical

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Family Medicine Patients Have Shorter Length of Stay When Cared for on a Family Medicine Inpatient Service

Journal of Primary Care & Community Health ◽

10.1177/2150132719840517 ◽

2019 ◽

Vol 10 ◽

pp. 215013271984051 ◽

Cited By ~ 1

Author(s):

Gregory M. Garrison ◽

Rachel L. Keuseman ◽

Christopher L. Boswell ◽

Jennifer L. Horn ◽

Nathaniel T. Nielsen ◽

...

Keyword(s):

Primary Care ◽

Family Medicine ◽

Length Of Stay ◽

Medical Center ◽

Academic Medical Center ◽

General Medicine ◽

Inpatient Service ◽

Academic Medical ◽

The Family ◽

Hospital To Home

Introduction: Hospitalists have been shown to have shorter lengths of stays than physicians with concurrent outpatient practices. However, hospitalists at academic medical centers may be less aware of local resources that can support the hospital to home transition for local primary care patients. We hypothesized that local family medicine patients admitted to a family medicine inpatient service have shorter length of stay than those admitted to general hospitalist services which also care for tertiary patients at an academic medical center. Methods: A retrospective cohort study was conducted at an academic medical center with a department of family medicine providing primary care to over 80 000 local patients. A total of 3100 consecutive family medicine patients admitted to either the family medicine inpatient service or a general medicine inpatient service over 3 years were studied. The primary outcome was length of stay, which was adjusted using multivariate linear regression for demographics, prior utilization, diagnosis, and disease severity. Results: Adjusted length of stay was 33% longer (95% CI 24%-44%) for local family medicine patients admitted to general medicine inpatient services as compared with the family medicine inpatient service. Readmission rates within 30 days were not different (19% vs 16%, P = .14). Conclusions: Local primary care patients were safely discharged from the hospital sooner on the family medicine inpatient service than on general medicine inpatient services. This is likely because the family physicians staffing their inpatient service are more familiar with outpatient resources that can be effectively marshaled to help local patients with the transition from hospital to home.

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Coordinated Primary Care (“Medical Home” Model)

Clinical Scholars Review ◽

10.1891/1939-2095.2.2.60 ◽

2009 ◽

Vol 2 (2) ◽

pp. 60-64 ◽

Cited By ~ 2

Author(s):

Mary Petermann Garnica

Keyword(s):

Primary Care ◽

Health Care ◽

Nurse Practitioners ◽

Medical Home ◽

Primary Care Physicians ◽

Team Leaders ◽

Care Nurse ◽

Medical Home Model ◽

Primary Care Practices ◽

Primary Care Medical Home

Health care is inaccessible and too expensive for a large segment of the U.S. population. In addition, the past decade has produced many reports of significant problems related to safety, quality, and effectiveness in U.S. health care. The future of primary care is in question because of a current and projected worsening shortage of primary care physicians. A physician-led coordinated primary care model has been endorsed by major physicians groups as having the potential to address many of these problems. The model, also known as the “medical home,” has gained momentum and appears likely to play a central role as the nation moves forward to reform health care. Nurse practitioners have traditionally practiced “coordinated primary care” and are ideally suited to lead practices adopting this model of care. This article provides rationale for nurse practitioners to be fully recognized as team leaders of coordinated primary care practices.

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Predictors of Primary Care Referral to Bariatric Surgery or Weight Loss Medicine at a Major Academic Medical Center

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2020.07.055 ◽

2020 ◽

Vol 231 (4) ◽

pp. S27-S28

Author(s):

Jacob Nudel ◽

Susanna W.L. de Geus ◽

Jayakanth Srinivasan ◽

Jonathan Woodson ◽

Donald Thomas Hess

Keyword(s):

Bariatric Surgery ◽

Primary Care ◽

Weight Loss ◽

Medical Center ◽

Academic Medical Center ◽

Academic Medical

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864. Adolescent Primary Care Provider Knowledge of HIV Pre-Exposure Prophylaxis (PrEP) and Universal Screening at a Midwest Academic Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1059 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S523-S524

Author(s):

Genevieve Allen ◽

Jamie Riddell

Keyword(s):

Internal Medicine ◽

Primary Care ◽

Family Medicine ◽

Hiv Testing ◽

Medical Center ◽

Academic Medical Center ◽

Primary Care Providers ◽

Care Providers ◽

Academic Medical ◽

Exposure Prophylaxis

Abstract Background HIV remains a problem for adolescents with 21% of new infections in the United States in 2018 occurring in youth. In this study we attempted to assess the knowledge of and comfort with pre-exposure prophylaxis and universal HIV testing among adolescent primary care providers affiliated with one academic medical center. Methods We conducted a survey of internal medicine/pediatrics, pediatrics, and family medicine residents and attending physicians affiliated with an academic medical center. Data collected included provider prescribing and referring habits for PrEP and information on their universal HIV testing habits. A “test your knowledge” section followed the survey which asked participants to name PrEP medications and to correctly select laboratory monitoring required for PrEP. Correct answers and prescribing resources were provided on completion of the survey. Results 138 (76%) respondents were aware that PrEP is approved for adolescents. There was no significant difference across specialties or between residents and attendings. 44.8% of respondents felt uncomfortable prescribing PrEP and two thirds had never prescribed PrEP. Reasons for not prescribing PrEP included: not seeing adolescents who qualify (n=80), not having enough training (66), confidentiality concerns (22), forgetting to address PrEP (19), and concern incidence of HIV is too low to recommend PrEP (15). Pediatricians were the least likely to test for HIV with 11% of pediatrician, 32% of internal medicine/pediatric, and 38% of family medicine respondents reported universal HIV testing for patients 15 years and older (p < 0.05). Residents were more likely to test for HIV than attendings (33.3% versus 16%, p < 0.05). 111 participants completed the “test your knowledge” section. 31.5% correctly named two approved PrEP medications. There were 183 responses to the survey (49% response rate). Conclusion Adolescent primary care providers are aware that PrEP is FDA approved for adolescents but a gap in PrEP prescribing and HIV testing persists. There remain perceptions that HIV incidence is too low to discuss PrEP and that providers are not seeing patients who qualify. Next steps include developing an institutional PrEP guideline and creating an electronic medical record order set to facilitate PrEP prescribing. Disclosures All Authors: No reported disclosures

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Integrating education into primary care quality and cost improvement at an academic medical center

Journal of Continuing Education in the Health Professions ◽

10.1002/chp.80 ◽

2006 ◽

Vol 26 (4) ◽

pp. 268-284 ◽

Cited By ~ 6

Author(s):

R. Van Harrison ◽

Connie J. Standiford ◽

Lee A. Green ◽

Steven J. Bernstein

Keyword(s):

Primary Care ◽

Medical Center ◽

Academic Medical Center ◽

Care Quality ◽

Academic Medical ◽

Primary Care Quality

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Enhancing Pediatricians’ Behavioral Health Competencies Through Child Psychiatry Consultation and Education

Clinical Pediatrics ◽

10.1177/0009922817738330 ◽

2017 ◽

Vol 57 (8) ◽

pp. 958-969 ◽

Cited By ~ 4

Author(s):

Heather J. Walter ◽

Gina Kackloudis ◽

Emily K. Trudell ◽

Louis Vernacchio ◽

Jonas Bromberg ◽

...

Keyword(s):

Primary Care ◽

Learning Community ◽

Behavioral Health ◽

Self Efficacy ◽

Large Scale ◽

Medical Center ◽

Academic Medical Center ◽

Child And Adolescent Psychiatry ◽

Academic Medical ◽

Primary Care Practitioners

The objective of this study was to assess feasibility, utilization, perceived value, and targeted behavioral health (BH) treatment self-efficacy associated with a collaborative child and adolescent psychiatry (CAP) consultation and BH education program for pediatric primary care practitioners (PCPs). Eighty-one PCPs from 41 member practices of a statewide pediatric practice association affiliated with an academic medical center participated in a program comprising on-demand telephonic CAP consultation supported by an extensive BH learning community. Findings after 2 years of implementation suggest that the program was feasible for large-scale implementation, was highly utilized and valued by PCPs, and was attributed by PCPs with enhancing their BH treatment self-efficacy and the quality of their BH care. After participation in the program, nearly all PCPs believed that mild to moderate presentations of common BH problems can be effectively managed in the primary care setting, and PCP consultation utilization was congruent with that belief.

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