Measuring the Process of Preventive Service Delivery in Primary Care Practices for Children

PEDIATRICS ◽  
2000 ◽  
Vol 106 (Supplement_3) ◽  
pp. 879-885
Author(s):  
Kathleen L. Gest ◽  
Peter Margolis ◽  
W. Clayton Bordley ◽  
Jayne Stuart
Keyword(s):  
Primary Care ◽  
Service Delivery ◽  
Care Delivery ◽  
Preventive Services ◽  
Office Visit ◽  
Screening Tests ◽  
Preventive Service ◽  
Care Practices ◽  
Primary Care Practices ◽  
Key Steps

Background. Children may fall behind on preventive services because they do not receive needed services at the time of an office visit (a missed opportunity). However, methods are needed to measure problems in the care delivery process that lead to missed opportunities. We developed a method to examine the key steps in the preventive service delivery process and identify problems; we assessed the feasibility and validity of the method in primary care practices for children. Methods. Using 3 data collection methods, we measured key steps in the process of preventive service delivery in primary care offices: a chart audit was used to measure each child's preventive service status before and after an office visit, a brief parent exit interview was used to assess preventive service delivery not documented in the chart, and a staff checklist was used to assess the role of nursing and other office staff. The feasibility of using this combination of measures to identify problems in the care delivery process was evaluated in 3 representative primary care practices (2 pediatric, 1 family practice) among children 5 years and younger. Results. The measurement method was implemented in all 3 practices. The validity of the method was supported by its ability to detect differences among practices in the proportion of children eligible for immunizations and screening tests and in the proportion of children undergoing key steps in the process of preventive service delivery. The practice with the lowest proportion of children whose charts were screened for preventive services needs had the lowest performance of preventive services. Conclusions. It is possible to assess specific elements in the process of preventive service delivery in primary care practices. Use of this approach may help practices design and monitor interventions to improve the quality of preventive care delivery.

scholarly journals A qualitative study of high-performing primary care practices during the COVID-19 pandemic

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Stephanie L. Albert ◽  
Margaret M. Paul ◽  
Ann M. Nguyen ◽  
Donna R. Shelley ◽  
Carolyn A. Berry
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Disease Management ◽  
Service Delivery ◽  
Preventive Care ◽  
Chronic Disease Management ◽  
High Performing ◽  
Care Processes ◽  
Care Practices ◽  
Primary Care Practices

Abstract Background Primary care practices have remained on the frontline of health care service delivery throughout the COVID-19 pandemic. The purpose of our study was to understand the early pandemic experience of primary care practices, how they adapted care processes for chronic disease management and preventive care, and the future potential of these practices’ service delivery adaptations. Methods We interviewed 44 providers and staff at 22 high-performing primary care practices located throughout the United States between March and May 2020. Interviews were transcribed and coded using a modified rapid assessment process due to the time-sensitive nature of the study. Results Practices reported employing a variety of adaptations to care during the COVID-19 pandemic including maintaining safe and socially distanced access through increased use of telehealth visits, using disease registries to identify and proactively outreach to patients, providing remote patient education, and incorporating more home-based monitoring into care. Routine screening and testing slowed considerably, resulting in concerns about delayed detection. Patients with fewer resources, lower health literacy, and older adults were the most difficult to reach and manage during this time. Conclusion Our findings indicate that primary care structures and processes developed for remote chronic disease management and preventive care are evolving rapidly. Emerging adapted care processes, most notably remote provision of care, are promising and may endure beyond the pandemic, but issues of equity must be addressed (e.g., through payment reform) to ensure vulnerable populations receive the same benefit.

scholarly journals Recruiting Practices for Change Initiatives Is Hard: Findings From EvidenceNOW

2017 ◽  
Vol 33 (3) ◽  
pp. 246-252 ◽  
Author(s):  
Shannon M. Sweeney ◽  
Jennifer D. Hall ◽  
Sarah S. Ono ◽  
Leah Gordon ◽  
David Cameron ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Delivery ◽  
Recruitment Strategies ◽  
Change Initiatives ◽  
Key Stakeholders ◽  
Observational Site ◽  
State Initiatives ◽  
Grant Proposals ◽  
Care Practices ◽  
Primary Care Practices

Engaging primary care practices in initiatives designed to enhance quality, reduce costs, and promote safety is challenging as practices are already participating in numerous projects and mandated programs designed to improve care delivery and quality. Recruiters must expand their recruitment tools to engage today’s practices in quality improvement. Using grant proposals, online diaries, observational site visits, and interviews with key stakeholders, the authors identify successful practice recruitment strategies in the EvidenceNOW initiative, which aimed to recruit approximately 1500 small- to medium-sized primary care practices. Recruiters learned they needed to articulate how participation in EvidenceNOW aligned with other initiatives and could help practices succeed with federal and state initiatives, recognition programs, and existing or future payment requirements. Recruiters, initiative leaders, and funders must now consider how their efforts align with ongoing initiatives to successfully recruit and engage practices, ease practice burden, and encourage participation in efforts that support practice transformation.

scholarly journals Novel Computerized Health Risk Appraisal May Improve Longitudinal Health and Wellness in Primary Care

2013 ◽  
Vol 04 (01) ◽  
pp. 75-87 ◽  
Author(s):  
V. Voncken-Brewster ◽  
C.B. Aspy ◽  
J.W. Mold ◽  
Z.J. Nagykaldi
Keyword(s):  
Primary Care ◽  
Health Risk ◽  
Intervention Group ◽  
Preventive Services ◽  
Health And Wellness ◽  
Patient Centeredness ◽  
Web Based ◽  
Health Risk Appraisal ◽  
Care Practices ◽  
Primary Care Practices

SummaryObjectives: Health Risk Appraisals (HRAs) have been implemented in a variety of settings, however few studies have examined the impact of computerized HRAs systematically in primary care. The study aimed at the development and pilot testing of a novel, comprehensive HRA tool in primary care practices.Methods: We designed, implemented and pilot tested a novel, web-based HRA tool in four pair-matched intervention and control primary care practices (N = 200). Outcomes were measured before and 12 months after the intervention using the HRA, patient surveys, and qualitative feedback. Intervention patients received detailed feedback from the HRA and they were encouraged to discuss the HRA report at their next wellness visit in order to develop a personalized wellness plan.Results: Estimated life expectancy and its derivatives, including Real Age and Wellness Score were significantly impacted by the HRA implementation (P<0.001). The overall rate of 10 preventive maneuvers improved by 4.2% in the intervention group vs. control (P = 0.001). The HRA improved the patient-centeredness of care, measured by the CAHPS PCC-10 survey (P = 0.05). HRA use was strongly associated with better self-rated overall health (OR = 4.94; 95% CI, 3.85–6.36) and improved up-to-dateness for preventive services (OR = 1.22; 95% CI, 1.12–1.32). A generalized linear model suggested that increase in Wellness Score was associated with improvements in patient-centeredness of care, up-to-dateness for preventive services and being in the intervention group (all P<0.03). Patients were satisfied with their HRA-experience, found the HRA report relevant and motivating and thought that it increased their health awareness. Clinicians emphasized that the HRA tool helped them and their patients converge on high-impact, evidence-based preventive measures.Conclusions: Despite study limitations, results suggest that a comprehensive, web-based, and goal-directed HRA tool can improve the receipt of preventive services, patient-centeredness of care, behavioral health outcomes, and various wellness indicators in primary care settings.Citation: Nagykaldi ZJ, Voncken-Brewster V, Aspy CB, Mold JW. Novel Computerized Health Risk Appraisal May Improve Longitudinal Health and Wellness in Primary Care. Appl Clin Inf 2013; 4: 75–87http://dx.doi.org/10.4338/ACI-2012-10-RA-0048

Cardiovascular Disease Preventive Services Among Smaller Primary Care Practices

2021 ◽  
Author(s):  
Miguel Marino ◽  
Leif Solberg ◽  
Rachel Springer ◽  
K. John McConnell ◽  
Stephan Lindner ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Primary Care ◽  
Preventive Services ◽  
Care Practices ◽  
Primary Care Practices

scholarly journals The Need for Co-Creation of Care with Multi-Morbidity Patients—A Longitudinal Perspective

2020 ◽  
Vol 17 (9) ◽  
pp. 3201
Author(s):  
Sanne J. Kuipers ◽  
Anna P. Nieboer ◽  
Jane M. Cramm
Keyword(s):  
Primary Care ◽  
Healthcare Professionals ◽  
Care Delivery ◽  
Well Being ◽  
Satisfaction With Care ◽  
Care Needs ◽  
Primary Care Delivery ◽  
Care Practices ◽  
Primary Care Practices ◽  
Multimorbid Patients

Background: Primary care delivery for multimorbid patients is complex, due to single disease–oriented guidelines, complex care needs, time constraints and the involvement of multiple healthcare professionals. Co-creation of care, based on the quality of communication and relationships between healthcare professionals and patients, may therefore be valuable. This longitudinal study investigates the relationships of co-creation of care to physical and social well-being and satisfaction with care among multimorbid patients in primary care. Methods: In 2017 and 2018, longitudinal surveys were conducted among multimorbid patients from seven primary care practices in Noord-Brabant, the Netherlands (n = 138, age = 73.50 ± 9.99). Paired sample t-tests and multivariate regression analyses were performed. (3) Results: Co-creation of care improved significantly over time (t = 2.25, p = 0.026), as did social well-being (t = 2.31, p = 0.022) and physical well-being (t = 2.72, p = 0.007) but not satisfaction with care (t = 0.18, p = 0.858). Improvements in co-creation of care from T0 to T1 were associated with social well-being (B = 0.157, p = 0.002), physical well-being (B = 0.216, p = 0.000) and satisfaction with care (B = 0.240, p = 0.000). (4) Conclusions: Thus, investment in co-creation of care by primary care practices may lead to better outcomes for multimorbid patients.

scholarly journals Potential COVID-19 vaccination opportunities in primary care practices in the United States

2021 ◽  
Author(s):  
Sanjay Basu ◽  
Rebecca Weintraub ◽  
Ishani Ganguli ◽  
Russell Phillips ◽  
Robert Phillips ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Primary Care Physicians ◽  
Medical Expenditure Panel Survey ◽  
Care Delivery ◽  
The United States ◽  
Medical Expenditure ◽  
Care Utilization ◽  
Care Practices ◽  
Primary Care Practices

AbstractRapid, widespread COVID-19 vaccination is critical to pandemic mitigation and recovery. To help policymakers interested in further enhancing primary care delivery of COVID-19 vaccines, it is important to estimate the absolute number of vaccination opportunities, and identify how these opportunities may fall disproportionately among different communities given the unequal way that COVID-19 falls upon communities of color, low-income, and rural communities. To quantify the potential benefits of greater primary care engagement in vaccination efforts, we estimated the number of potential vaccination opportunities (PVOs) in primary care in the remaining calendar months of year 2021, and the possible uptake if we supplied enough vaccine to primary care practices to fulfill their opportunities. To estimate how many potential vaccination opportunities (PVOs) may occur in primary care, we used three sets of data, analyzing the latest available waves of the following: (i) the National Ambulatory Medical Care Survey (NAMCS, 2016, N = 677 providers); (ii) the National Health Interview Survey (NHIS, 2018, N = 29,839 individuals in 29,839 households); and (iii) the Medical Expenditure Panel Survey (MEPS, 2018, N = 40,025 individuals in 14,500 households). Per the NAMCS data, which provide a nationally-representative sample of ambulatory care visits, primary care physicians normally provide 40.2 million primary care visits per month. The majority of the primary care utilization is absorbed by those aged 16 to 64 years old who are not otherwise priority groups (i.e., not having chronic diseases as defined by ACIP) but the second large group of visits are those with a chronic disease (27.2% of all visits). As compared to the NAMCS data providing an estimate of care from the perspective of providers, the overall sample in NHIS provides a view of primary care access and utilization from a population perspective. Per NHIS, 34% of the civilian US population saw a generalist physician in the prior calendar year, or 109.8 million people. Overall, we would estimate that over the latter half of calendar year 2021, approximately 15 million potential vaccine opportunities per month would be available through US primary care practices.

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