‘Trying to fly the plane while we were building it’. Applying a learning health systems approach to evaluate early-stage barriers and facilitators to implementing primary care transformation: a qualitative study

ObjectiveA learning health system (LHS) uses data to generate evidence and answer questions required to continually improve system performance and patient care. Given the complexities of practice transformation, an area where LHS is particularly important is the study of primary care transformation (PCT) as PCT generates several practice-level questions that require study where the findings can be readily implemented. In May 2019, a large integrated health delivery system in Minnesota began implementation of a population management PCT in two of its 40 primary care clinics. In this model of care, patients are grouped into one of five service bundles based on their complexity of care; patient appointment lengths and services provided are then tailored to each service bundle. The objective of this study was to examine the use of a LHS in PCT by utilising the Consolidated Framework for Implementation Research (CFIR) to categorise implementation lessons from the initial two PCT clinics to inform further implementation of the PCT within the health system.DesignThis was a formative evaluation in which semistructured qualitative interviews were carried out. Observational field notes were also taken. Inductive coding of the data was performed and resultant codes were mapped to the CFIR.SettingTwo suburban primary care clinics in the Twin Cities, Minnesota.ParticipantsTwenty-two care team members from the first two clinics to adopt the PCT.ResultsSeventeen codes emerged to describe care team members’ perceived implementation influences. Codes occurred in each of the five CFIR domains (intervention characteristics, outer setting, inner setting, characteristics of individuals and process), with most codes occurring in the ‘inner setting’ domain.ConclusionsUsing an LHS approach to determine early-stage implementation influences is key to guiding further PCT implementation, understanding modifications that need to be made and additional research that needs to occur.

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Improving Access to Integrated Behavioral Health in a Nurse-Led Federally Qualified Health Center

Journal of the American Psychiatric Nurses Association ◽

10.1177/1078390321994165 ◽

2021 ◽

pp. 107839032199416

Author(s):

Sarah Stalder ◽

Aimee Techau ◽

Jenny Hamilton ◽

Carlo Caballero ◽

Mary Weber ◽

...

Keyword(s):

Primary Care ◽

Quality Improvement ◽

Behavioral Health ◽

Behavioral Health Care ◽

Primary Care Providers ◽

Care Team ◽

Psychiatric Nurse ◽

Care Providers ◽

Team Members ◽

Task Forces

BACKGROUND: The specific aims of this project were to create a fully integrated, nurse-led model of a psychiatric nurse practitioner and behavioral health care team within primary care to facilitate (1) patients receiving an appropriate level of care and (2) care team members performing at the top of their scope of practice. METHOD: The guiding model for process implementation was Rapid Cycle Quality Improvement. Three task forces were established to develop interventions in the areas of Roles and Responsibilities, Training and Implementation, and the electronic health record. INTERVENTION: The four interventions that emerged from these task forces were (1) the establishment of patient tiers based on diagnosis, medications, and risk assessment; (2) the creation of process maps to engage care team members; (3) just-in-time education regarding psychiatric medication management for primary care providers; and (4) use of a registry to track patients. RESULTS: The process measures of referrals to the psychiatric care team and psychiatric assessment intakes performed as expected. Both measures were higher at the onset of the project and lower 1 year later. The outcome indicator, number of case reviews, increased dramatically over time. CONCLUSIONS: For psychiatric nurse practitioners, this quality improvement effort provides evidence that a consultative role can be effective in supporting primary care providers. Through providing education, establishing patient tiers, and establishing an effective workflow, more patients may have access to psychiatric services.

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Family Physician’s and Primary Care Team’s Perspectives on Supporting Family Caregivers in Primary Care Networks

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18063293 ◽

2021 ◽

Vol 18 (6) ◽

pp. 3293

Author(s):

Jasneet Parmar ◽

Sharon Anderson ◽

Marjan Abbasi ◽

Saeed Ahmadinejad ◽

Karenn Chan ◽

...

Keyword(s):

Primary Care ◽

Family Caregivers ◽

Healthcare Providers ◽

Family Physicians ◽

Care Team ◽

Primary Care Team ◽

Caregiver Support ◽

Team Members ◽

Primary Care Teams ◽

Support Family

Background. Research, practice, and policy have focused on educating family caregivers to sustain care but failed to equip healthcare providers to effectively support family caregivers. Family physicians are well-positioned to care for family caregivers. Methods. We adopted an interpretive description design to explore family physicians and primary care team members’ perceptions of their current and recommended practices for supporting family caregivers. We conducted focus groups with family physicians and their primary care team members. Results. Ten physicians and 42 team members participated. We identified three major themes. “Family physicians and primary care teams can be a valuable source of support for family caregivers” highlighted these primary care team members’ broad recognition of the need to support family caregiver’s health. “What stands in the way” spoke to the barriers in current practices that precluded supporting family caregivers. Primary care teams recommended, “A structured approach may be a way forward.” Conclusion. A plethora of research and policy documents recommend proactive, consistent support for family caregivers, yet comprehensive caregiver support policy remains elusive. The continuity of care makes primary care an ideal setting to support family caregivers. Now policy-makers must develop consistent protocols to assess, and care for family caregivers in primary care.

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Innovative Partnership Between Primary Care, AAA, and Academia Connects 4Ms and Social Determinants of Health

Innovation in Aging ◽

10.1093/geroni/igaa057.352 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 107-107

Author(s):

Suzanne Leahy ◽

Katie Ehlman ◽

Lisa Maish ◽

Brad Conrad ◽

Jillian Hall ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Health System ◽

Preliminary Evaluation ◽

Language And Literacy ◽

Community Based ◽

Primary Care Clinics ◽

College Of Nursing ◽

Value Based Care ◽

The University

Abstract Nationally, there is a growing focus on addressing geriatric care in primary care settings. HRSA’s Geriatric Workforce Enhancement Program (GWEP) has called for academic and health system partners to develop a reciprocal, innovative, cross-sector partnership that includes primary care sites and community-based agencies serving older adults. Through the University of Southern Indiana’s GWEP, the College of Nursing and Health Professions, the Deaconess Health System, three primary care clinics, and two Area Agencies on Aging (AAA) have joined to transform the healthcare of older adults regionally, including rural residents in the 12-county area. Core to the project is a value-based care model that “embeds” AAA care managers in primary care clinics. Preliminary evaluation indicates early success in improving the healthcare of older adults at one primary clinic, where clinical teams have referred 64 older adult patients to the AAA care manager. Among these 64 patients, 80% were connected to supplemental, community-based health services; 22% to programs addressing housing and transportation; and, nearly 10% to a range of other services (e.g., job training; language and literacy; and technology). In addition to presenting limited data on referred patients and referral outcomes, the presentation will share copies of the AAA referral log, to illustrate how resources were categorized by SDOH and added to support integration of the 4Ms.

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The Association of Team-Specific Workload and Staffing with Odds of Burnout Among VA Primary Care Team Members

Journal of General Internal Medicine ◽

10.1007/s11606-017-4011-4 ◽

2017 ◽

Vol 32 (7) ◽

pp. 760-766 ◽

Cited By ~ 44

Author(s):

Christian D. Helfrich ◽

Joseph A. Simonetti ◽

Walter L. Clinton ◽

Gordon B. Wood ◽

Leslie Taylor ◽

...

Keyword(s):

Primary Care ◽

Care Team ◽

Primary Care Team ◽

Team Members

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The Primary Care Spend Model: a systems approach to measuring investment in primary care

BMJ Global Health ◽

10.1136/bmjgh-2019-001601 ◽

2019 ◽

Vol 4 (4) ◽

pp. e001601 ◽

Cited By ~ 2

Author(s):

Robert Baillieu ◽

Michael Kidd ◽

Robert Phillips ◽

Martin Roland ◽

Michael Mueller ◽

...

Keyword(s):

Primary Care ◽

Health System ◽

Systems Approach ◽

Dynamic Assessment ◽

International Health ◽

Coordinated Care ◽

Healthcare Budget ◽

Care Services ◽

Primary Care Services ◽

Data Limitations

Increased investment in primary care is associated with lower healthcare costs and improved population health. The allocation of scarce resources should be driven by robust models that adequately describe primary care activities and spending within a health system, and allow comparisons within and across health systems. However, disparate definitions result in wide variations in estimates of spending on primary care. We propose a new model that allows for a dynamic assessment of primary care spending (PC Spend) within the context of a system’s total healthcare budget. The model articulates varied definitions of primary care through a tiered structure which includes overall spending on primary care services, spending on services delivered by primary care professionals and spending delivered by providers that can be characterised by the ‘4Cs’ (first contact, continuous, comprehensive and coordinated care). This unifying framework allows a more refined description of services to be included in any estimate of primary care spend and also supports measurement of primary care spending across nations of varying economic development, accommodating data limitations and international health system differences. It provides a goal for best accounting while also offering guidance, comparability and assessments of how primary care expenditures are associated with outcomes. Such a framework facilitates comparison through the creation of standard definitions and terms, and it also has the potential to foster new areas of research that facilitate robust policy analysis at the national and international levels.

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Clinical Pharmacist Integration Into Veterans' Primary Care: Team Members Perspectives

The Journal of the American Board of Family Medicine ◽

10.3122/jabfm.2021.02.200328 ◽

2021 ◽

Vol 34 (2) ◽

pp. 320-327

Author(s):

Anna Zogas ◽

Chris Gillespie ◽

Felicia Kleinberg ◽

Joel I. Reisman ◽

Ndindam Ndiwane ◽

...

Keyword(s):

Primary Care ◽

Clinical Pharmacist ◽

Care Team ◽

Primary Care Team ◽

Team Members

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Beyond Co-location: Visual Connections of Staff Workstations and Staff Communication in Primary Care Clinics

Environment and Behavior ◽

10.1177/0013916520950270 ◽

2020 ◽

pp. 001391652095027

Author(s):

Lisa Lim ◽

Ruth Kanfer ◽

Robert J. Stroebel ◽

Craig M. Zimring

Keyword(s):

Primary Care ◽

Empirical Studies ◽

Healthcare Providers ◽

Healthcare Organizations ◽

Spatial Metrics ◽

Team Members ◽

Primary Care Clinics ◽

Staff Members ◽

Work Spaces ◽

Team Based Care

The importance of communication among healthcare providers has been long recognized, and many healthcare organizations are implementing team-based care, with emphasis on staff communication. While previous empirical studies in various settings illustrate the role of built environments in user communication, there is a lack of quantified interpersonal spatial metrics to predict interactions. This study investigates how interpersonal spatial metrics at different scales predict staff communication patterns by empirically studying four primary care clinics that provide team-based care. We found that staff members in clinics with higher visual connections among staff members reported more timely and frequent communication. We also found that staff members talked to each other more frequently when their workstations were visually connected. The findings of this study are expected to help designers and facility managers provide well-designed team-based clinic layouts, beyond just shared work spaces for team members, for improved staff communication.

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Abstract 385: The Impact of Aspirin Primary Prevention Treatment Guidelines: Temporal Trends in Aspirin Use for Primary vs Secondary Prevention, 2005-2013

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.385 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Jeremy R Van't Hof ◽

Niki Oldenburg ◽

Sue Duval ◽

Serban Dronca ◽

Andrew Olson ◽

...

Keyword(s):

Primary Care ◽

Peptic Ulcer ◽

Primary Prevention ◽

Secondary Prevention ◽

Health System ◽

Peptic Ulcer Disease ◽

Ulcer Disease ◽

Primary Care Clinics ◽

History Of ◽

Artery Disease

Background: Current national prevention guidelines recommend use of low dose aspirin (ASA) for both the primary prevention (PP) and secondary prevention (SP) of heart attack and stroke. ASA use for SP has been documented to have increased over the past decade. Since the publication of the 2009 United States Preventative Services Task Force (USPSTF) recommendations for PP ASA use, data describing the trends in PP ASA use in primary care are sparse. This study evaluates trends in PP and SP ASA use in primary care clinics from a large, regional health system over an 8 year period (2005-2013). Methods: A bi-annual cross-sectional electronic medical record (EMR) chart extraction was performed from 2005 to 2013 to evaluate documented ASA use for all patient encounters within primary care clinics in the Fairview Health System (Minnesota). Primary prevention candidates were defined as individuals within the USPSTF guideline age and sex target populations (men aged 45-79, and women aged 55-79 years) with no documented history of an atherosclerotic syndrome or contraindication to ASA use (aspirin allergy, peptic ulcer disease, or concurrent antithrombotic therapy). Secondary prevention candidates were defined as adults within the same age and gender range with a history of coronary artery disease, peripheral artery disease or ischemic stroke. The ASA treatment to candidacy ratio was calculated for the PP and SP populations. Results: Over 225,000 unique encounters at 66 primary care clinics were analyzed over the 8 year study period. The PP population was younger (60.4±8.7 vs. 66.2±8.3 years), with lower prevalence of hypertension (49 vs. 79%), hyperlipidemia (54 vs. 84%), and diabetes (17 vs. 35%) compared to the SP cohort. The mean SP ASA use of 86% was high, concordant with national trends, and did not change over this period. In contrast, PP ASA average use was 44% with no increase after publication of the 2009 USPSTF guideline. Documented contraindications to ASA use were uncommon (ASA allergy, 2.1 and 2.8%; peptic ulcer disease, 3.2 and 7.2%; and use of other antithrombotic medications, 4.6 and 32.6% in PP and SP populations respectively). Conclusion: Secondary prevention ASA use in primary care settings remains high, but ASA use for primary prevention of cardiovascular events is low. Despite creation of national guidelines, aspirin use in the PP population is half the rate of ASA use for secondary prevention. Additional methods to safely and effectively disseminate this primary prevention aspirin use recommendation, targeting both the public and health care providers, are warranted.

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