scholarly journals Fostering Quality Improvement Capacity in a Network of Primary Care Practices Affiliated With a Pediatric Accountable Care Organization

2019 ◽  
Vol 4 (3) ◽  
pp. e175 ◽  
Author(s):  
Charitha Gowda ◽  
Christina Toth ◽  
Suzanne Hoholik ◽  
Richard J. Brilli ◽  
Sean Gleeson ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Accountable Care Organization ◽  
Care Organization ◽  
Accountable Care ◽  
Care Practices ◽  
Primary Care Practices

Enhancing the Safe and Effective Management of Chronic Pain in Accountable Care Organization Primary Care Practices in Kentucky

2016 ◽  
Vol 32 (2) ◽  
pp. 178-185 ◽  
Author(s):  
Selam Wubu ◽  
Laura Lee Hall ◽  
Paula Straub ◽  
Matthew J. Bair ◽  
Jill A. Marsteller ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Primary Care Physicians ◽  
The United States ◽  
Care Organization ◽  
Chronic Pain Management ◽  
Accountable Care ◽  
Care Practices ◽  
Primary Care Practices

Chronic pain is a prevalent chronic condition with significant burden and economic impact in the United States. Chronic pain is particularly abundant in primary care, with an estimated 52% of chronic pain patients obtaining care from primary care physicians (PCPs). However, PCPs often lack adequate training and have limited time and resources to effectively manage chronic pain. Chronic pain management is complex in nature because of high co-occurrence of psychiatric disorders and other medical comorbidities in patients. This article describes a quality improvement initiative conducted by the American College of Physicians (ACP), in collaboration with the Kentucky ACP Chapter, and the Center for Health Services and Outcomes Research at the Johns Hopkins Bloomberg School of Public Health, to enhance chronic pain management in 8 primary care practices participating in Accountable Care Organizations in Kentucky, with a goal of enhancing the screening, diagnosis, and treatment of patients with chronic pain.

Advance-care planning quality improvement plan: A Cancer Care Ontario toolkit to support primary care teams to implement advance care plans in practice.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 76-76
Author(s):  
Jeff Myers ◽  
Suzanne Strasberg ◽  
Kathi Carroll ◽  
Zabin Dhanji ◽  
Ingrid Harle ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Quality Improvement ◽  
Advance Care Planning ◽  
Cancer Care ◽  
Care Planning ◽  
Advance Care ◽  
Care Practices ◽  
Primary Care Practices ◽  
Eol Care

76 Background: In Ontario, the Ministry of Health and Long Term Care’s (MOHLTC) uses Quality Improvement Plans (QIPs) to drive system improvement aimed at providing high value, high quality care for all. To support the introduction of QIPs into the primary care sector, Cancer Care Ontario has developed an Advance Care Planning (ACP) toolkit for practices that include ACP as part of their annual QIP. ACP is an ongoing and dynamic process that involves a capable individual reflecting on their current values and beliefs for their health care, communicating their personal wishes for future health care and identifying an individual who will make decisions on their behalf in the event that they are unable to provide informed consent. The process is iterative and wishes may change over time with changes in health status. Methods: The ACP QIP was developed based on the Plan, Do, Study, Act cycle of continuous quality improvement. The ACP QIP provides primary care practices with detailed instructions on how to implement, monitor and report on an ACP Quality Improvement initiative. Importantly, the ACP QIP provides guidance and practical tools for developing objectives, establishing targets, and identifying measures and baselines for performance. CCO is actively promoting the ACP QIP in an effort to encourage uptake and broad adoption across Ontario. Results: There is now evidence that with ACP there is a greater likelihood EOL wishes will be both known and followed resulting in improved EOL care. ACP is also associated with decreased distress among the family members. Conclusions: Creating an ACP QIP supports primary care’s focus on advancing quality patient care. Importantly, implementing the ACP QIP into primary care practices has the potential to improve EOL care and secondarily reduce health care costs ultimately working towards achieving the triple aim of “better care, better health, and lower costs”.

After the Collaborative Is Over: What Sustains Quality Improvement Initiatives in Primary Care Practices?

2009 ◽  
Vol 35 (10) ◽  
pp. 502-AP3 ◽  
Author(s):  
Paul Bray ◽  
Doyle M. Cummings ◽  
Marti Wolf ◽  
Mark W. Massing ◽  
Janet Reaves
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Care Practices ◽  
Primary Care Practices

scholarly journals Implementation of cancer screening in rural primary care practices after joining an accountable care organisation: a multiple case study

2021 ◽  
Vol 9 (4) ◽  
pp. e001326
Author(s):  
Heather Nelson-Brantley ◽  
Edward F Ellerbeck ◽  
Stacy McCrea-Robertson ◽  
Jennifer Brull ◽  
Jennifer Bacani McKenney ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Screening ◽  
Multiple Case Study ◽  
Accountable Care ◽  
Rural Primary Care ◽  
Care Organisation ◽  
Multiple Case ◽  
Care Practices ◽  
Primary Care Practices

ObjectiveTo describe common strategies and practice-specific barriers, adaptations and determinants of cancer screening implementation in eight rural primary care practices in the Midwestern United States after joining an accountable care organisation (ACO).DesignThis study used a multiple case study design. Purposive sampling was used to identify a diverse group of practices within the ACO. Data were collected from focus group interviews and workflow mapping. The Consolidated Framework for Implementation Research (CFIR) was used to guide data collection and analysis. Data were cross-analysed by clinic and CFIR domains to identify common themes and practice-specific determinants of cancer screening implementation.SettingThe study included eight rural primary care practices, defined as Rural-Urban Continuum Codes 5–9, in one ACO in the Midwestern United States.ParticipantsProviders, staff and administrators who worked in the primary care practices participated in focus groups. 28 individuals participated including 10 physicians; one doctor of osteopathic medicine; three advanced practice registered nurses; eight registered nurses, quality assurance and licensed practical nurses; one medical assistant; one care coordination manager; and four administrators.ResultsWith integration into the ACO, practices adopted four new strategies to support cancer screening: care gap lists, huddle sheets, screening via annual wellness visits and information spread. Cross-case analysis revealed that all practices used both visit-based and population-based cancer screening strategies, although workflows varied widely across practices. Each of the four strategies was adapted for fit to the local context of the practice. Participants shared that joining the ACO provided a strong external incentive for increasing cancer screening rates. Two predominant determinants of cancer screening success at the clinic level were use of the electronic health record (EHR) and fully engaging nurses in the screening process.ConclusionsJoining an ACO can be a positive driver for increasing cancer screening practices in rural primary care practices. Characteristics of the practice can impact the success of ACO-related cancer screening efforts; engaging nurses to the fullest extent of their education and training and integrating cancer screening into the EHR can optimise the cancer screening workflow.

scholarly journals Assessing Quality Improvement Capacity in Primary Care Practices

2019 ◽  
Author(s):  
Michael Parchman ◽  
Melissa L. Anderson ◽  
Katie F Coleman ◽  
LeAnn Michaels ◽  
Linnaea Schuttner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Primary Care ◽  
Quality Improvement ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Prior Experience ◽  
Pressure Control ◽  
Care Practices ◽  
Primary Care Practices

Abstract Background: Healthy Hearts Northwest (H2N) is a study of external support strategies to build quality improvement (QI) capacity in primary care with a focus on cardiovascular risk factors: appropriate aspirin use, blood pressure control, and tobacco screening/cessation. Methods: To guide practice facilitator support, experts in practice transformation identified seven domains of QI capacity and mapped items from a previously validated medical home assessment tool to them. A practice facilitator (PF) met with clinicians and staff in each practice to discuss each item on the Quality Improvement Capacity Assessment (QICA) resulting in a practice-level response to each item. We examined the association between the QICA total and sub-scale scores, practice characteristics, a measure of prior experience with managing practice change, and performance on clinical quality measures (CQMs) for the three cardiovascular risk factors. Results: The QICA score was associated with prior experience managing change and moderately associated with two of the three CQMs: aspirin use (r=0.16, p=0.049) and blood pressure control (r=0.18, p=0.013). Rural practices and those with 2-5 clinicians had lower QICA scores. PFs notes provide examples of high scoring practices devoting time and attention to quality improvement whereas low scoring practices did not. Conclusions: The QICA is useful for assessing QI capacity within a practice and may serve as a guide for both facilitators and primary care practices in efforts to build this capacity and improve measures of clinical quality.

impact of a Pharmacy-Led Transitions of Care Program Within a Primary Care-Based Accountable Care Organization

2021 ◽  
Vol 36 (6) ◽  
pp. 311-316
Author(s):  
Tina Joseph ◽  
Genevieve M. Hale ◽  
Cynthia Moreau ◽  
Stephanie L. Kourtakis ◽  
William R. Wolowich
Keyword(s):  
Primary Care ◽  
Primary Outcome ◽  
Care Setting ◽  
Primary Care Setting ◽  
Care Program ◽  
Accountable Care Organization ◽  
Transitions Of Care ◽  
Care Organization ◽  
Pharmacy Services ◽  
Accountable Care

OBJECTIVE: To assess the impact of pharmacist-led transitions of care program on 30-day readmission rates in the accountable care organization (ACO) primary care setting. DESIGN: Retrospective cohort study. SETTING: Two primary care provider (PCP) offices with an ACO in South Florida. PATIENTS, PARTICIPANTS: Adult Medicare patients who completed a post-discharge follow-up visit at two primary care offices within an ACO from July to December 2017. INTERVENTIONS: To supplement postdischarge visits with a PCP, the pharmacy services were also provided two days per week with a PCP. The comparator groups were patients who only saw a PCP or those who saw a PCP and pharmacist. MAIN OUTCOME MEASUREMENTS: The primary outcome was hospital readmission or emergency department visit within 30 days. RESULTS: A total of 190 subjects were included. There were 113 patients in the PCP group and 77 patients in the PCP/pharmacist group. There was a reduction in the primary outcome when comparing the PCP-only versus PCP/pharmacist groups (6.2% versus 3.9%; P = 0.74). CONCLUSION: Involving pharmacists in patient transitions of care in the primary care setting may be beneficial as previous studies have demonstrated. Further studies evaluating pharmacy services in emerging health care models are needed in order to most effectively utilize the expertise of the pharmacy team.

Payment Reform for Primary Care Within the Accountable Care Organization

JAMA ◽  
2012 ◽  
Vol 308 (6) ◽  
pp. 577 ◽  
Author(s):  
Allan H. Goroll ◽  
Stephen C. Schoenbaum
Keyword(s):  
Primary Care ◽  
Accountable Care Organization ◽  
Care Organization ◽  
Accountable Care ◽  
Payment Reform
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