scholarly journals Using the 4 M of the Age Friendly Health System to improve MIPS documentation in Primary care: A Feasibility study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 829-829
Author(s):  
Sweta Tewary ◽  
Denise Kruszynski ◽  
Naushira Pandya ◽  
Nicole Cook ◽  
Sashah Damier ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Systems ◽  
Medication Management ◽  
South Florida ◽  
Coordinated Care ◽  
Quality Healthcare ◽  
Training Clinic ◽  
Nova Southeastern University ◽  
Clinical Measures ◽  
What Matters

Abstract Age Friendly Health Systems (AFHS) commit to evidence-based, low-risk, coordinated care that is centered on what matters most to older adults, their families and caregivers. Nova Southeastern University South Florida Geriatric Workforce Enhancement Program (NSU SFGWEP) has partnered with multiple primary care clinics to provide dedicated AFHS training and support to increase AFHS transformation in Broward and Miami-Dade Counties. As part of the initiative, SFGWEP provide didactic training, clinic on-site brief demonstration, and infographic guidance for EHR documentation. NSU SFGWEP activities are conducted through training surveys, provider feedback, and e-clinical measures that align with CMS MIPS measures. Three participating health systems report annually on seven e-clinical measures that, collectively, provide indicators of the 4Ms of AFHS (what matters, medication management, mentation and mobility.) From baseline to Year 1, NSU SFGWEP saw improvement in controlled hypertension (54% to 94%), opioid screening (<1% to 11%), advance care planning (21% to 35%) and falls risk assessment (45% to 59%). Results demonstrate the need to continue and expand AFHS interventions for sustainability. In Year 2, SFGWEP will continue to expand awareness of best practices and benefits of the AFHS through education and training at NSU and at the various primary care sites. As mutual collaboration and implementation methods are shared among participating members, the expectation is that quality healthcare of our elder community adults will measurably improve.

scholarly journals Developing measures to capture the true value of primary care

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2020.0152
Author(s):  
Tim C olde Hartman ◽  
Andrew Bazemore ◽  
Rebecca Etz ◽  
Ryuki Kassai ◽  
Michael Kidd ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Systems ◽  
Positive Impact ◽  
Health Coverage ◽  
Policy And Practice ◽  
Actual Performance ◽  
Quality Healthcare ◽  
True Value ◽  
Practice Performance ◽  
Overall Performance

Primary care (PC) is an essential building block for any high quality healthcare system, and has a particularly positive impact on vulnerable patients. It contributes to the overall performance of health systems, and countries that reorient their health system towards PC are better prepared to achieve universal health coverage. Monitoring the actual performance of PC in health systems is essential health policy to support PC. However, current indicators are often too narrowly defined to account for quality of care in the complex populations with which PC deals. This article reviews a number of conceptual frameworks developed to capture PC values in robust measures and indicators that can inform policy and practice performance. Each have benefits and limitations. Further work is needed to develop meaningful primary health care (PHC) and PC measures to inform strategic action by policymakers and governments for improved overall performance of health systems.

scholarly journals Assessing Needs, Well-being, and Telehealth Access of Older Adults with Limited Resources during COVID-19 Pandemic

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 738-738
Author(s):  
Sashah Damier ◽  
Assma Twahir ◽  
Sweta Tewary ◽  
Naushira Pandya ◽  
Nicole Cook
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Access To Care ◽  
Low Income ◽  
Well Being ◽  
South Florida ◽  
Management Support ◽  
Nova Southeastern University ◽  
Study Team ◽  
Barriers And Challenges

Abstract The COVID-19 pandemic created new barriers and challenges to accessing primary care services, particularly among older adults who already faced barriers related to access to care, including transportation, health literacy, and self-management support. Nova Southeastern University South Florida Geriatric Workforce Enhancement Program (NSU SFGWEP) partnered with primary care clinics to conduct wellness calls to older adult patients identified through clinic EHR. The wellness calls’ objectives were to 1) discuss COVID-19 protective measures; 2) assess wellness needs and access to care barriers; and 3) screen for telehealth support. From September 2020 to February 2021, the team (including medical students, public health students, and SFGWEP staff) contacted 200 patients via telephone and conducted a comprehensive wellness survey developed by the study team, informed by validated surveys. Among the 200 patients called, 60% (n=34) were very concerned about the Covid-19 pandemic, 33% (n=34) reported often feeling isolated from others, and 20% (n=34) expressed difficulty getting medical care. A smaller subset of patients reported concern about limited COVID-19 testing (n=1), lack of knowledge about seeing their provider via telehealth (n=7), lack of face masks (n=1), and challenges with obtaining medication refills (n=1). Following wellness calls, the NSU SFGWEP team provided education, referred to clinical resources, and, for low-income patients with access to care challenges, provided Samsung Tablets (n=50) with peer training to enable telehealth.

scholarly journals Learning health systems in primary care: a systematic scoping review

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Danielle M. Nash ◽  
Zohra Bhimani ◽  
Jennifer Rayner ◽  
Merrick Zwarenstein
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Health Systems ◽  
Scoping Review ◽  
Early Stage ◽  
Point Of Care ◽  
The United States ◽  
Stage Of Development ◽  
Integrated Health ◽  
Google Search

Abstract Background Learning health systems have been gaining traction over the past decade. The purpose of this study was to understand the spread of learning health systems in primary care, including where they have been implemented, how they are operating, and potential challenges and solutions. Methods We completed a scoping review by systematically searching OVID Medline®, Embase®, IEEE Xplore®, and reviewing specific journals from 2007 to 2020. We also completed a Google search to identify gray literature. Results We reviewed 1924 articles through our database search and 51 articles from other sources, from which we identified 21 unique learning health systems based on 62 data sources. Only one of these learning health systems was implemented exclusively in a primary care setting, where all others were integrated health systems or networks that also included other care settings. Eighteen of the 21 were in the United States. Examples of how these learning health systems were being used included real-time clinical surveillance, quality improvement initiatives, pragmatic trials at the point of care, and decision support. Many challenges and potential solutions were identified regarding data, sustainability, promoting a learning culture, prioritization processes, involvement of community, and balancing quality improvement versus research. Conclusions We identified 21 learning health systems, which all appear at an early stage of development, and only one was primary care only. We summarized and provided examples of integrated health systems and data networks that can be considered early models in the growing global movement to advance learning health systems in primary care.

scholarly journals The effectiveness of different patient referral systems to shorten waiting times for elective surgeries: systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dimuthu Rathnayake ◽  
Mike Clarke
Keyword(s):  
Primary Care ◽  
Health Systems ◽  
Elective Surgery ◽  
Waiting Times ◽  
Surgical Care ◽  
High Income ◽  
Surgical Patients ◽  
Timely Access ◽  
Referral Systems

Abstract Background Long waiting times for elective surgery are common to many publicly funded health systems. Inefficiencies in referral systems in high-income countries are more pronounced than lower and middle-income countries. Primary care practitioners play a major role in determining which patients are referred to surgeon and might represent an opportunity to improve this situation. With conventional methods of referrals, surgery clinics are often overcrowded with non-surgical referrals and surgical patients experience longer waiting times as a consequence. Improving the quality of referral communications should lead to more timely access and better cost-effectiveness for elective surgical care. This review summarises the research evidence for effective interventions within the scope of primary-care referral methods in the surgical care pathway that might shorten waiting time for elective surgeries. Methods We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library databases in December-2019 to January-2020, for articles published after 2013. Eligibility criteria included major elective surgery lists of adult patients, excluding cancer related surgeries. Both randomised and non-randomised controlled studies were eligible. The quality of evidence was assessed using ROBINS-I, AMSTAR 2 and CASP, as appropriate to the study method used. The review presentation was limited to a narrative synthesis because of heterogeneity. The PROSPERO registration number is CRD42019158455. Results The electronic search yielded 7543 records. Finally, nine articles were considered as eligible after deduplication and full article screening. The eligible research varied widely in design, scope, reported outcomes and overall quality, with one randomised trial, two quasi-experimental studies, two longitudinal follow up studies, three systematic reviews and one observational study. All the six original articles were based on referral methods in high-income countries. The included research showed that patient triage and prioritisation at the referral stage improved timely access and increased the number of consultations of surgical patients in clinics. Conclusions The available studies included a variety of interventions and were of medium to high quality researches. Managing patient referrals with proper triaging and prioritisation using structured referral formats is likely to be effective in health systems to shorten the waiting times for elective surgeries, specifically in high-income countries.

scholarly journals Prevalence and treatment of opioid use disorders among primary care patients in six health systems

2020 ◽  
Vol 207 ◽  
pp. 107732 ◽  
Author(s):  
Gwen Lapham ◽  
Denise M. Boudreau ◽  
Eric A. Johnson ◽  
Jennifer F. Bobb ◽  
Abigail G. Matthews ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Systems ◽  
Opioid Use ◽  
Primary Care Patients ◽  
Opioid Use Disorders

scholarly journals Online Social Environment Impacts Feelings of Social Connection in Older Adults During the COVID-19 Pandemic

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 954-955
Author(s):  
Brittany Derynda ◽  
Mary Goodyear ◽  
Jade Kushner ◽  
Nicole Cook
Keyword(s):  
Older Adults ◽  
Online Survey ◽  
South Florida ◽  
Social Connection ◽  
Start Time ◽  
Cross Sectional ◽  
Nova Southeastern University ◽  
Social Opportunities ◽  
Specific Feedback ◽  
Lifelong Learning Institute

Abstract Evidence suggests that nearly one-third of older adults experience loneliness and/or social isolation; an increase in these rates during the current pandemic is anticipated. The Lifelong Learning Institute (LLI) at Nova Southeastern University (NSU) in South Florida has worked to engage seniors in fun learning activities and social opportunities since 1977. When “stay at home” orders went into effect in March, 2020 the LLI moved to online program delivery via Zoom. To understand the implementation of zoom among LLI members, NSU students, researchers and LLI member advisory committee developed a cross-sectional research study using an online survey that was administered to LLI members three months post-zoom implementation in May, 2020. Results among the 127 responders demonstrated that a majority of members were not comfortable using zoom (57%) especially the chat, reactions or camera features. More than 80% of responders did report that zoom helped them keep their spirits up. Respondents had specific feedback to improve Zoom programming including Youtube videos on use, retraining, training on features (e.g. chat, camera, reaction), closed captioning, program reminders and links sent out more frequently and within 30 minutes of start time. There were also several comments about internet connectivity, identifying opportunities for router and internet plan education. Finally, respondents noted new opportunities to enhance virtual programming including engaging speakers from across the nation and world. In summary, direct feedback from seniors on how to improve the online social and learning environment is pivotal to improving experience, programming and social connection during COVID-19.

Pharmacists on primary care teams: Effect on antihypertensive medication management in patients with type 2 diabetes

2015 ◽  
Vol 55 (3) ◽  
pp. 265-268 ◽  
Author(s):  
Dima Omran ◽  
Sumit R. Majumdar ◽  
Jeffrey A. Johnson ◽  
Ross T. Tsuyuki ◽  
Richard Z. Lewanczuk ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Antihypertensive Medication ◽  
Medication Management ◽  
Primary Care Teams

scholarly journals Impact of event notification services on timely follow-up and rehospitalization among primary care patients at two Veterans Affairs Medical Centers

2021 ◽  
Author(s):  
Brian E Dixon ◽  
Kimberly M Judon ◽  
Ashley L Schwartzkopf ◽  
Vivian M Guerrero ◽  
Nicholas S Koufacos ◽  
...  
Keyword(s):  
Primary Care ◽  
Usual Care ◽  
Acute Care ◽  
Health Systems ◽  
Veterans Affairs ◽  
Care Team ◽  
Primary Care Team ◽  
Medical Centers ◽  
Event Notification

Abstract Objective To examine the effectiveness of event notification service (ENS) alerts on health care delivery processes and outcomes for older adults. Materials and methods We deployed ENS alerts in 2 Veterans Affairs (VA) medical centers using regional health information exchange (HIE) networks from March 2016 to December 2019. Alerts targeted VA-based primary care teams when older patients (aged 65+ years) were hospitalized or attended emergency departments (ED) outside the VA system. We employed a concurrent cohort study to compare postdischarge outcomes between patients whose providers received ENS alerts and those that did not (usual care). Outcome measures included: timely follow-up postdischarge (actual phone call within 7 days or an in-person primary care visit within 30 days) and all-cause inpatient or ED readmission within 30 days. Generalized linear mixed models, accounting for clustering by primary care team, were used to compare outcomes between groups. Results Compared to usual care, veterans whose primary care team received notification of non-VA acute care encounters were 4 times more likely to have phone contact within 7 days (AOR = 4.10, P < .001) and 2 times more likely to have an in-person visit within 30 days (AOR = 1.98, P = .007). There were no significant differences between groups in hospital or ED utilization within 30 days of index discharge (P = .057). Discussion ENS was associated with increased timely follow-up following non-VA acute care events, but there was no associated change in 30-day readmission rates. Optimization of ENS processes may be required to scale use and impact across health systems. Conclusion Given the importance of ENS to the VA and other health systems, this study provides guidance for future research on ENS for improving care coordination and population outcomes. Trial Registration ClinicalTrials.gov NCT02689076. “Regional Data Exchange to Improve Care for Veterans After Non-VA Hospitalization.” Registered February 23, 2016.

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