Improving access in a VA primary care clinic using an innovative Panel Retention Tool: a quality improvement report

2020 ◽  
Vol 29 (11) ◽  
pp. 947-955
Author(s):  
Andrew T Harris ◽  
Catherine Hoover ◽  
Brendan Cmolik ◽  
Mariel Zaun ◽  
Corinna Falck-Ytter ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Control Limit ◽  
Health Administration ◽  
Care Clinic ◽  
Loss To Follow Up ◽  
Primary Care Teams ◽  
Future Care ◽  
Lost To Follow Up

BackgroundLoss to follow-up is an under-recognised problem in primary care. Continuity with a primary care provider improves morbidity and mortality in the Veterans Health Administration. We sought to reduce the percentage of patients lost to follow-up at the Northeast Ohio Veterans Affairs Healthcare System from October 2017 to March 2019.MethodsThe Panel Retention Tool (PRT) was developed and tested with primary care teams using multiple Plan, Do, Study and Act cycles to identify and schedule lost to follow-up patients. Baseline data on loss to follow-up, defined as the percentage of panelled patients not seen in primary care in the past year, was collected over 6 months during tool development. Outcomes were tracked from implementation through spread and sustainment (12 months) across 14 primary care clinics.ResultsOf the 96 170 panelled patients at the beginning of the study period, 2715 (2.8%) were found to be inactive and removed from provider panels, improving panel reliability. Among the remaining, 1856 (1.9%) patients without scheduled follow-up were scheduled for future care, and 1239 (1.3%) without recent prior care completed encounters during the study period. The percentage of patients lost to follow-up decreased from 10.1% (lower control limit (LCL) 9.8%–upper control limit (UCL) 10.4%) at baseline to 6.4% (LCL 6.2%–UCL 6.7%) postintervention and patients without planned future care decreased from 21.7% (LCL 21.3%–UCL 22.1%) to 17.1% (LCL 16.7%–UCL 17.5%).ConclusionsThe PRT allowed primary care teams in an integrated health system to identify and schedule lost to follow-up patients. Ease of use, adaptability and encouraging outcomes facilitated spread. This has the potential to contribute to more appropriate utilisation of healthcare resources and improved access to primary care.

scholarly journals Clinical experiences at veterans administration primary care clinics: An interprofessional education project for advanced practice nurses and health professions students

2017 ◽  
Vol 7 (12) ◽  
pp. 1
Author(s):  
Margaret Brommelsiek ◽  
Jane Anthony Peterson ◽  
Sarah Knopf-Amelung ◽  
Tracy Lynn Graybill
Keyword(s):  
Primary Care ◽  
Nursing Education ◽  
Interprofessional Education ◽  
Clinical Care ◽  
Primary Care Clinic ◽  
Advanced Practice ◽  
Health Administration ◽  
Clinical Experiences ◽  
Academic Institutions ◽  
Care Clinic

There is limited literature that specifically addresses how academic institutions and healthcare facilities effectively establish and manage clinical experiences for students. Since advanced practice nursing education (APRN) programs strive to provide appropriate clinical experiences as part of their students’ educational training, it is imperative that academic institutions and clinical facilities establish working relationships and protocols for productive collaboration. Barriers may exist in arranging student clinical placements, including scheduling conflicts and provider workload burden. Collaborative approaches for placing APRN students in primary care settings can be beneficial for student learning and the clinical care of patients. The purpose of this paper is to provide an initial roadmap for coordinating APRN and other health professional students’ placement in clinical rotations at a Veterans Health Administration Medical Center (VAMC) primary care clinic in the Midwest.

scholarly journals Formerly Incarcerated Community Health Workers Engaging Individuals Returning From Incarceration Into Primary Care: Results From the Transition Clinic Network

2021 ◽  
Vol 9 ◽  
Author(s):  
Jenerius A. Aminawung ◽  
Tyler D. Harvey ◽  
Jerry Smart ◽  
Joseph Calderon ◽  
Anna Steiner ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Outcomes ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Primary Care Clinic ◽  
Social Needs ◽  
Care Clinic ◽  
Primary Care Teams ◽  
Improve Health

Over half a million individuals return from United States prisons and millions more from jails every year, many of whom with complex health and social needs. Community health workers (CHWs) perform diverse roles to improve health outcomes in disadvantaged communities, but no studies have assessed their role as integrated members of a primary care team serving individuals returning from incarceration. Using data from participants who received primary care through the Transitions Clinic Network, a model of care that integrates CHWs with a lived experienced of incarceration into primary care teams, we characterized how CHWs address participant health and social needs during interactions outside of clinic visits for 6 months after participants established primary care. Among the 751 participants, 79% had one or more CHW interactions outside of the clinic documented. Participants with more comorbid conditions, longer stays during their most recent incarceration, and released with a prescription had more interactions with CHWs compared to those with fewer comorbidities, shorter stays, and no prescription at release. Median number of interactions was 4 (interquartile range, IQR 2–8) and 56% were in person. The most common issues addressed (34%) were social determinants of health, with the most common being housing (35%). CHWs working in interdisciplinary primary care teams caring for people with histories of incarceration perform a variety of functions for clients outside of scheduled primary care visits. To improve health outcomes among disadvantaged populations, CHWs should be able to work across multiple systems, with supervision and support for CHW activities both in the primary care clinic and within the community.

Implementation of a brief screening tool to identify needs of cancer survivors.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23075-e23075 ◽  
Author(s):  
Allison L. McDonough ◽  
Yvonne Y. Lei ◽  
Dana Haggett ◽  
Rachel Jimenez ◽  
Katherine T. Johnston ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Primary Care Clinic ◽  
Qualitative Assessment ◽  
Plain Language ◽  
Convenience Sample ◽  
Care Clinic

e23075 Background: Innovation in health care delivery is needed to improve care for cancer survivors. We report a pragmatic study intended to evaluate our experience with adopting screening guidelines from the National Comprehensive Cancer Network (NCCN) to the routine care of breast cancer survivors in primary care and oncology follow up. Methods: We adapted the NCCN recommended screening questions into a plain language self-administered 1 page intake questionnaire. The tool was administered to a convenience sample of female breast cancer survivors in routine follow-up at an oncology or primary care clinic from September through December 2018. Domains included symptoms, lifestyle concerns, and financial issues. Frequency of concerns was assessed as “never”, “rarely”, “sometimes”, “very frequently” and “always”. We dichotomized results and evaluated feasibility of administration, prevalence of reported symptoms and qualitative assessment of burden as well as utility of the tool among participating clinicians. Results: 165 out of 169 patients offered the questionnaire participated (98%). Office staff provided the questionnaire at routine visits without notable impact on clinic flow. Most commonly endorsed concerns (sometimes or more) were: desire to improve fitness or nutrition (80%), worry about cancer recurrence (72%), and problems with sleep (57%). A majority also reported feeling nervous or worried (55%) and aches or pains in limbs or joints (55%). Several issues known to be underreported in clinic visits were endorsed including lack of satisfaction with sexual function (30% sometimes or more, 12% very often or always) and difficulty remembering things (47% sometimes or more, 13% very often or always). Among 7 participating clinicians, the tool was deemed useful and not burdensome. Several noted that it led to discussing issues that may not otherwise have been addressed. Suggestions included systematically identifying resources and strategies to address common issues and incorporating the tool into the electronic health record to increase utility. Conclusions: Screening for individual needs among survivors is feasible and efficient and may identify prevalent issues that otherwise can be missed in routine survivorship care.

377 Insomnia Treatment Practices of Primary Care Providers in Primary Care Settings

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A150-A150
Author(s):  
Cassandra Godzik ◽  
Adam Sorscher
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Sleep Medicine ◽  
Quality Metrics ◽  
Care Providers ◽  
National Guidelines ◽  
Daytime Functioning ◽  
Care Clinic

Abstract Introduction Insomnia is highly prevalent in adult populations, with rates found to be between 10% and 40% as reported in a metanalysis conducted by Zhang et al. (2019). Insomnia is associated with worsened health outcomes and increased healthcare utilization. Primary care providers (PCPs) are the first point of contact for most people seeking treatment for insomnia. The American Academy of Sleep Medicine has proposed six quality metrics for the evaluation and treatment of insomnia (Edinger et al., 2015). In this study, we investigate how often primary care providers meet these quality metrics when they encounter a patient with a new complaint of insomnia. Methods We reviewed the charts of adult patients seen in our primary care clinic department with a new presenting complaint of insomnia between 2014–2016. The clinic notes were scored to see if any of the six metrics of quality care for insomnia as proposed by the AASM were addressed in the index appointment (T1) and in follow up appointments (T2) within three months. Results Demographic variables were analyzed (N=155; 48 males, 107 females); mean age 64 years (range 24–98). We found that PCPs documented the following: at T1, assessment of sleep quality (68%), evidence-based treatment provided (82%), daytime functioning assessed (19%), and adverse side effects assessed (11%). 29% of subjects returned for a follow up visit with 3 months. At T2, there was an assessment of sleep satisfaction/quality (40%), and of improved daytime functioning (87%). Conclusion Presently, evaluation and treatment of insomnia by PCPs is not standardized. By identifying how providers address insomnia in practice, we can develop interventions to help promote adherence to the national guidelines for treatment of insomnia in a non-sleep medicine healthcare setting. Support (if any) Dr. Cassandra M. Godzik’s Postdoctoral Research Fellowship: NIMH - T32 MH073553

scholarly journals Injury Prevention Education in the Waiting Room of an Underserved Pediatric Primary Care Clinic

2018 ◽  
Vol 58 (1) ◽  
pp. 73-78 ◽  
Author(s):  
Nikita Habermehl ◽  
Elizabeth Diekroger ◽  
Rina Lazebnik ◽  
Grace Kim
Keyword(s):  
Primary Care ◽  
Injury Prevention ◽  
Primary Care Clinic ◽  
The United States ◽  
Childhood Mortality ◽  
Pediatric Primary Care ◽  
Waiting Room ◽  
Care Clinic ◽  
Prevention Education

Unintentional injuries are the leading cause of childhood mortality in the United States. Study aims included educating families about injury prevention and improving satisfaction with the waiting room experience. Two hundred caregivers with young children in the waiting room of an underserved pediatric primary care clinic participated in brief individual education sessions and received a toolkit containing small safety items and content highlighting age-appropriate safety topics. Participants completed 2 follow-up surveys, and most caregivers (94%) reported learning new information about injury prevention and thought that the intervention resulted in a better waiting room experience (91%). Of those who completed the 2-week follow-up survey (84%), 93.5% made changes at home and 42.7% bought new safety equipment. Injury prevention education can be effectively provided in the waiting room of a pediatric primary care clinic by improving reported caregiver safety knowledge and behaviors as well as satisfaction with the waiting room experience.

Initial and Follow-Up Evaluations of Integrated Psychological Services for Anxiety and Depression in a Safety Net Primary Care Clinic

2017 ◽  
Vol 73 (10) ◽  
pp. 1462-1481 ◽  
Author(s):  
Elizabeth Sadock ◽  
Paul B. Perrin ◽  
Renée M. Grinnell ◽  
Bruce Rybarczyk ◽  
Stephen M. Auerbach
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Safety Net ◽  
Psychological Services ◽  
Anxiety And Depression ◽  
Care Clinic

Measuring Perceived Level of Integration During the Process of Primary Care Behavioral Health Implementation

2017 ◽  
Vol 33 (3) ◽  
pp. 253-261 ◽  
Author(s):  
Erin M. Staab ◽  
Mara Terras ◽  
Pooja Dave ◽  
Nancy Beckman ◽  
Sachin Shah ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Behavioral Health ◽  
Primary Care Clinic ◽  
Health Clinic ◽  
Care Clinic ◽  
Primary Care Behavioral Health ◽  
Item Level ◽  
Levels Of Integration

Provider- and staff-perceived levels of integration were measured during implementation of a primary care behavioral health clinic; these data were used to tailor and evaluate quality improvement strategies. Providers and staff at an urban, academic, adult primary care clinic completed the 32-item Level of Integration Measure (LIM) at baseline and 7 months. The LIM assesses 6 domains of integrated care. Overall and domain scores were calibrated from 0 to 100, with ≥80 representing a highly integrated clinic. Response rate was 79% (N = 46/58) at baseline and 83% (N = 52/63) at follow-up. Overall, LIM score increased from 64.5 to 70.1, P = .001. The lowest scoring domains at baseline were targeted for quality improvement and increased significantly: integrated clinical practice, 60.0 versus 68.4, P < .001; systems integration, 57.0 versus 63.8, P = .001; and training, 56.7 versus 65.3, P = .001. Ongoing quality improvement, including organizational and financial strategies, is needed to achieve higher levels of integration.

scholarly journals Follow-up and Time to Treatment in an Urban Cohort of Children with Sleep-Disordered Breathing

2018 ◽  
Vol 159 (2) ◽  
pp. 371-378 ◽  
Author(s):  
Vandra C. Harris ◽  
Anne R. Links ◽  
Julia M. Kim ◽  
Jonathan Walsh ◽  
David E. Tunkel ◽  
...  
Keyword(s):  
Primary Care ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Loss To Follow Up ◽  
Obstructive Sleep Apnea Severity ◽  
Obstructive Sleep ◽  
Lost To Follow Up ◽  
Disordered Breathing

Objective To evaluate follow-up and timing of sleep-disordered breathing diagnosis and treatment in urban children referred from primary care. Study Design Retrospective longitudinal cohort analysis. Setting Tertiary health system. Subjects and Methods Pediatric outpatients with sleep-disordered breathing, referred from primary care for subspecialty appointment or polysomnography in 2014, followed for 2 years. Timing of polysomnography or subspecialty appointments, loss to follow-up, and sleep-disordered breathing severity were main outcomes. Chi-square and t-test identified differences in children referred for polysomnography, surgery, and loss to follow-up. Logistic regression identified predictors of loss to follow-up. Days to polysomnography or surgery were evaluated using the Kaplan-Meier estimator, with Cox regression comparing estimates by polysomnography receipt and disease severity. Results Of 216 children, 188 (87%) had public insurance. Half (109 [50%]) were lost to follow-up after primary care referral. More children were lost to follow-up when referred for polysomnography (50 [76%]) compared with subspecialty evaluation (35 [32%]; P < .001). Children referred to both polysomnography and subspecialty were more likely to be lost to follow-up (odds ratio = 2.73, 95% confidence interval = 1.29-5.78; P = .009). For children who obtained polysomnography, an asymmetric distribution of obstructive sleep apnea severity was not observed ( P = .152). Median time to polysomnography and surgery was 75 and 226 days, respectively. Obstructive sleep apnea severity did not influence time to surgery ( P = .410). Conclusion In this urban population, half of the children referred for sleep-disordered breathing evaluation are lost to follow-up from primary care. Obstructive sleep apnea severity did not predict follow-up or timeliness of treatment. These findings suggest social determinants may pose barriers to care in addition to the clinical burden of sleep-disordered breathing.

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