scholarly journals Improving team coordination in primary-care settings via multifaceted team-based feedback: a non-randomised controlled trial study

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2020.0185
Author(s):  
Sylvia J Hysong ◽  
Amber B Amspoker ◽  
Ashley M Hughes ◽  
Houston F Lester ◽  
Erica K Svojse ◽  
...  
Keyword(s):  
Primary Care ◽  
Implementation Fidelity ◽  
Audit And Feedback ◽  
Patient Portal ◽  
Health Administration ◽  
Team Coordination ◽  
Intervention Teams ◽  
Primary Care Teams ◽  
Low Exposure ◽  
Clinical Records

BackgroundCoordination is critical to successful team-based health care. Most clinicians, however, are not trained in effective coordination or teamwork. Audit and feedback (A&F) could improve team coordination, if designed with teams in mind.AimThe effectiveness of a multifaceted, A&F-plus-debrief intervention was tested to establish whether it improved coordination in primary care teams compared with controls.Design & settingCase-control trial within US Veterans Health Administration medical centres.MethodThirty-four primary care teams selected from four geographically distinct hospitals were compared with 34 administratively matched control teams. Intervention-arm teams received monthly A&F reports about key coordination behaviours and structured debriefings over 7 months. Control teams were followed exclusively via their clinical records. Outcome measures included a coordination composite and its component indicators (appointments starting on time, timely recall scheduling, emergency department utilisation, and electronic patient portal enrolment). Predictors included intervention arm, extent of exposure to intervention, and degree of multiple team membership (MTM).ResultsIntervention teams did not significantly improve over control teams, even after adjusting for MTM. Follow-up analyses indicated cross-team variability in intervention fidelity; although all intervention teams received feedback reports, not all teams attended all debriefings. Compared with their respective baselines, teams with high debriefing exposure improved significantly. Teams with high debriefing exposure improved significantly more than teams with low exposure. Low exposure teams significantly increased patient portal enrolment.ConclusionTeam-based A&F, including adequate reflection time, can improve coordination; however, the effect is dose dependent. Consistency of debriefing appears more critical than proportion of team members attending a debriefing for ensuring implementation fidelity and effectiveness.

scholarly journals An analysis of patient-provider secure messaging at two Veterans Health Administration medical centers: message content and resolution through secure messaging

2017 ◽  
Vol 24 (5) ◽  
pp. 942-949 ◽  
Author(s):  
Stephanie L Shimada ◽  
Beth Ann Petrakis ◽  
James A Rothendler ◽  
Maryan Zirkle ◽  
Shibei Zhao ◽  
...  
Keyword(s):  
Primary Care ◽  
Further Education ◽  
Patient Portal ◽  
Veterans Health ◽  
Test Results ◽  
Message Content ◽  
Health Administration ◽  
Secure Messaging ◽  
Primary Care Teams ◽  
Reported Data

Abstract Objective: We sought to understand how patients and primary care teams use secure messaging (SM) to communicate with one another by analyzing secure message threads from 2 Department of Veterans Affairs facilities. Methods: We coded 1000 threads of SM communication sampled from 40 primary care teams. Results: Most threads (94.5%) were initiated by patients (90.4%) or caregivers (4.1%); only 5.5% were initiated by primary care team members proactively reaching out to patients. Medication renewals and refills (47.2%), scheduling requests (17.6%), medication issues (12.9%), and health issues (12.7%) were the most common patient-initiated requests, followed by referrals (7.0%), administrative issues (6.5%), test results (5.4%), test issues (5.2%), informing messages (4.9%), comments about the patient portal or SM (4.1%), appreciation (3.9%), self-reported data (2.8%), life issues (1.5%), and complaints (1.5%). Very few messages were clinically urgent (0.7%) or contained other potentially challenging content. Message threads were mostly short (2.7 messages), comprising an average of 1.35 discrete content types. A substantial proportion of issues (24.2%) did not show any evidence of being resolved through SM. Time to response and extent of resolution via SM varied by message content. Proactive SM use by teams varied, but was most often for test results (32.7%), medication-related issues (21.8%), medication renewals (16.4%), or scheduling issues (18.2%). Conclusions: The majority of messages were transactional and initiated by patients or caregivers. Not all content categories were fully addressed over SM. Further education and training for both patients and clinical teams could improve the quality and efficiency of SM communication.

scholarly journals Outcomes of Primary Care for People With Dementia: What’s Important?

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 164-165
Author(s):  
Laura Wray ◽  
Bonnie Vest ◽  
Laura Brady ◽  
Christina Vair ◽  
Gregory Beehler ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Health And Safety ◽  
Limited Attention ◽  
Veterans Health ◽  
Cognitive Screening ◽  
Health Administration ◽  
People With Dementia ◽  
Primary Care Teams ◽  
Care Outcomes

Abstract People with dementia (PWD) typically receive most of their healthcare in primary care (PC), but neurocognitive disorders can be challenging to recognize, assess, and manage in that setting. As a result, cognitive impairment in older adults is often missed or not addressed until later stages. The result is poor management of comorbid health conditions, increased healthcare utilization, and negative outcomes for the patient and family. Further, strategies for improvement and barriers to high quality PC for PWD have received limited attention. To improve PC for PWD, it is essential to understand what care outcomes should be targeted. To address this gap, we used a qualitative approach to examine potential outcomes of PC from the perspectives of older adults, family caregivers, primary care teams, and geriatrics specialists (n=79) from two Veterans Health Administration healthcare systems. Participants were interviewed individually or in focus groups. A directed content analysis based on the adapted Donabedian model was employed and expanded to fully capture transcript content. Three main categories of outcomes were identified: Personhood (i.e., independence), Physical Health and Safety, and Quality of Life. Regardless of participant type, respondents focused on similar desired outcomes and, notably, identified outcomes as important for both patients and their broader social context (i.e., caregivers, family). Discussion will: show how findings align with work conducted in specialty and residential care; describe how challenges to attaining these outcomes in PC can be overcome; and, challenge cognitive screening recommendations for PC that are based primarily on risk/benefit analysis of medication-focused outcomes.

scholarly journals A Remote Collaborative Care Program for Patients with Depression Living in Rural Areas: Open-Label Trial (Preprint)

2017 ◽  
Author(s):  
Graciela Rojas ◽  
Viviana Guajardo ◽  
Pablo Martínez ◽  
Ariel Castro ◽  
Rosemarie Fritsch ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Usual Care ◽  
Collaborative Care ◽  
Rural Areas ◽  
Care Program ◽  
Open Label ◽  
Rural Primary Care ◽  
Primary Care Teams ◽  
Clinical Records

BACKGROUND In the treatment of depression, primary care teams have an essential role, but they are most effective when inserted into a collaborative care model for disease management. In rural areas, the shortage of specialized mental health resources may hamper management of depressed patients. OBJECTIVE The aim was to test the feasibility, acceptability, and effectiveness of a remote collaborative care program for patients with depression living in rural areas. METHODS In a nonrandomized, open-label (blinded outcome assessor), two-arm clinical trial, physicians from 15 rural community hospitals recruited 250 patients aged 18 to 70 years with a major depressive episode (DSM-IV criteria). Patients were assigned to the remote collaborative care program (n=111) or to usual care (n=139). The remote collaborative care program used Web-based shared clinical records between rural primary care teams and a specialized/centralized mental health team, telephone monitoring of patients, and remote supervision by psychiatrists through the Web-based shared clinical records and/or telephone. Depressive symptoms, health-related quality of life, service use, and patient satisfaction were measured 3 and 6 months after baseline assessment. RESULTS Six-month follow-up assessments were completed by 84.4% (221/250) of patients. The remote collaborative care program achieved higher user satisfaction (odds ratio [OR] 1.94, 95% CI 1.25-3.00) and better treatment adherence rates (OR 1.81, 95% CI 1.02-3.19) at 6 months compared to usual care. There were no statically significant differences in depressive symptoms between the remote collaborative care program and usual care. Significant differences between groups in favor of remote collaborative care program were observed at 3 months for mental health-related quality of life (beta 3.11, 95% CI 0.19-6.02). CONCLUSIONS Higher rates of treatment adherence in the remote collaborative care program suggest that technology-assisted interventions may help rural primary care teams in the management of depressive patients. Future cost-effectiveness studies are needed. CLINICALTRIAL Clinicaltrials.gov NCT02200367; https://clinicaltrials.gov/ct2/show/NCT02200367 (Archived by WebCite at http://www.webcitation.org/6xtZ7OijZ)

scholarly journals Supporting the Implementation of Connected Care Technologies in the Veterans Health Administration: Cross-Sectional Survey Findings from the Veterans Engagement with Technology Collaborative (VET-C) Cohort

10.2196/21214 ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. e21214
Author(s):  
Bella Etingen ◽  
Daniel J Amante ◽  
Rachael N Martinez ◽  
Bridget M Smith ◽  
Stephanie L Shimada ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Veterans Health Administration ◽  
Advanced Degree ◽  
Patient Portal ◽  
Veterans Health ◽  
Health Administration ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Clinical Records

Background Widespread adoption, use, and integration of patient-facing technologies into the workflow of health care systems has been slow, thus limiting the realization of their potential. A growing body of work has focused on how best to promote adoption and use of these technologies and measure their impacts on processes of care and outcomes. This body of work currently suffers from limitations (eg, cross-sectional analyses, limited patient-generated data linked with clinical records) and would benefit from institutional infrastructure to enhance available data and integrate the voice of the patient into implementation and evaluation efforts. Objective The Veterans Health Administration (VHA) has launched an initiative called the Veterans Engagement with Technology Collaborative cohort to directly address these challenges. This paper reports the process by which the cohort was developed and describes the baseline data being collected from cohort members. The overarching goal of the Veterans Engagement with Technology Collaborative cohort is to directly engage veterans in the evaluation of new VHA patient-facing technologies and in so doing, to create new infrastructure to support related quality improvement and evaluation activities. Methods Inclusion criteria for veterans to be eligible for membership in the cohort included being an active user of VHA health care services, having a mobile phone, and being an established user of existing VHA patient-facing technologies as represented by use of the secure messaging feature of VHA’s patient portal. Between 2017 and 2018, we recruited veterans who met these criteria and administered a survey to them over the telephone. Results The majority of participants (N=2727) were male (2268/2727, 83.2%), White (2226/2727, 81.6%), living in their own apartment or house (2519/2696, 93.4%), and had completed some college (1176/2701, 43.5%) or an advanced degree (1178/2701, 43.6%). Cohort members were 59.9 years old, on average. The majority self-reported their health status as being good (1055/2725, 38.7%) or very good (524/2725, 19.2%). Most cohort members owned a personal computer (2609/2725, 95.7%), tablet computer (1616/2716, 59.5%), and/or smartphone (2438/2722, 89.6%). Conclusions The Veterans Engagement with Technology Collaborative cohort is an example of a VHA learning health care system initiative designed to support the data-driven implementation of patient-facing technologies into practice and measurement of their impacts. With this initiative, VHA is building capacity for future, rapid, rigorous evaluation and quality improvement efforts to enhance understanding of the adoption, use, and impact of patient-facing technologies.

Communication between community mental health services and primary care

2011 ◽  
Vol 28 (3) ◽  
pp. 134-137
Author(s):  
Vincent IO Agyapong ◽  
Olorunfemi Ahmodu ◽  
Allys Guerandel
Keyword(s):  
Primary Care ◽  
Odds Ratio ◽  
Bipolar Affective Disorder ◽  
Community Mental Health Services ◽  
Psychiatric Services ◽  
P Value ◽  
Primary Care Teams ◽  
Psychiatric Outpatient Clinic ◽  
The Mean ◽  
Clinical Records

AbstractObjectives: This study aims to assess the rate of six monthly communications between specialised psychiatric services and primary care and to determine factors which predict such communication.Methods: A retrospective review of the clinical records of all patients attending the relevant local psychiatric outpatient clinic was carried out by all members of the multidisciplinary team to identify patient demographic and clinical variables as well as to determine if there has been documentation of communication with primary care in the preceding six months. Letters were sent to the relevant primary care teams regarding progress on their patients in cases where it was identified that no communication had occurred in the preceding six months.Results: A total of 145 patients' charts were reviewed. Of these, 53.3% of the patients were females and 46.7% were males. The mean age was 47.9 years (SD = 14). Patients' diagnoses included; depression (41%), bipolar affective disorder (6.7%), schizophrenia/schizoaffective disorder (27.6%), anxiety disorders (6.7%), alcohol dependency syndrome (11%) and other disorders (7%). Overall, only 36% of patients' charts had a record of communication with primary care in the last six months. Only one variable, ‘changes made to the patents medication in the last six months’ was significantly associated with the likelihood that there had been communication with primary care with an odds ratio of 15 and a p-value of 0.00.Conclusion: A six monthly review has a potential to improve the level of communication between specialised psychiatric services and primary care.

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 Embedding Social Workers In Veterans Health Administration Primary Care Teams Reduces Emergency Department Visits

2020 ◽  
Vol 39 (4) ◽  
pp. 603-612
Author(s):  
Portia Y. Cornell ◽  
Christopher W. Halladay ◽  
Joseph Ader ◽  
Jaime Halaszynski ◽  
Melinda Hogue ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Social Workers ◽  
Veterans Health Administration ◽  
Emergency Department Visits ◽  
Veterans Health ◽  
Health Administration ◽  
Primary Care Teams

Multidisciplinary review to identify patients who could be managed in primary care

2011 ◽  
Vol 28 (3) ◽  
pp. 138-140 ◽  
Author(s):  
Vincent IO Agyapong ◽  
Olorunfemi Ahmodu ◽  
Allys Guerandel
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Service ◽  
Health Service ◽  
Multidisciplinary Team ◽  
Psychiatric Clinic ◽  
Community Mental Health Service ◽  
Primary Care Teams ◽  
Specialist Services ◽  
Clinical Records

AbstractObjectives: Primary care teams have the potential to deliver much of the care currently provided by specialist services. The aim of this review was to determine from patients' clinical records and multidisciplinary team discussions, those that may be suitable for discharge back into primary care.Methods: A retrospective review of the clinical notes of all patients attending a psychiatric outpatient clinic was carried out by all members of the multidisciplinary team to determine the appropriateness of continuing to provide psychiatric services in a specialised psychiatric clinic rather than in a primary care setting, taking into account the patients demographic and clinical variables.Results: It was recommended that 60% of all the patients needed to continue attending the local mental health service, 35.2% could be discharged back into primary care for continuing management whilst the remaining 4.8% could be managed jointly between primary care and the community mental health service. The bulk of the patients recommended for discharge into primary care had a diagnosis of anxiety disorder or depression and all of them had been stable on their treatment for more than six months.Conclusion: Regular multidisciplinary team review has a potential to identify patients who could be discharged back into primary care.

scholarly journals Supporting the Implementation of Connected Care Technologies in the Veterans Health Administration: Cross-Sectional Survey Findings from the Veterans Engagement with Technology Collaborative (VET-C) Cohort (Preprint)

2020 ◽  
Author(s):  
Bella Etingen ◽  
Daniel J Amante ◽  
Rachael N Martinez ◽  
Bridget M Smith ◽  
Stephanie L Shimada ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Veterans Health Administration ◽  
Advanced Degree ◽  
Patient Portal ◽  
Veterans Health ◽  
Health Administration ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Clinical Records

BACKGROUND Widespread adoption, use, and integration of patient-facing technologies into the workflow of health care systems has been slow, thus limiting the realization of their potential. A growing body of work has focused on how best to promote adoption and use of these technologies and measure their impacts on processes of care and outcomes. This body of work currently suffers from limitations (eg, cross-sectional analyses, limited patient-generated data linked with clinical records) and would benefit from institutional infrastructure to enhance available data and integrate the voice of the patient into implementation and evaluation efforts. OBJECTIVE The Veterans Health Administration (VHA) has launched an initiative called the Veterans Engagement with Technology Collaborative cohort to directly address these challenges. This paper reports the process by which the cohort was developed and describes the baseline data being collected from cohort members. The overarching goal of the Veterans Engagement with Technology Collaborative cohort is to directly engage veterans in the evaluation of new VHA patient-facing technologies and in so doing, to create new infrastructure to support related quality improvement and evaluation activities. METHODS Inclusion criteria for veterans to be eligible for membership in the cohort included being an active user of VHA health care services, having a mobile phone, and being an established user of existing VHA patient-facing technologies as represented by use of the secure messaging feature of VHA’s patient portal. Between 2017 and 2018, we recruited veterans who met these criteria and administered a survey to them over the telephone. RESULTS The majority of participants (N=2727) were male (2268/2727, 83.2%), White (2226/2727, 81.6%), living in their own apartment or house (2519/2696, 93.4%), and had completed some college (1176/2701, 43.5%) or an advanced degree (1178/2701, 43.6%). Cohort members were 59.9 years old, on average. The majority self-reported their health status as being good (1055/2725, 38.7%) or very good (524/2725, 19.2%). Most cohort members owned a personal computer (2609/2725, 95.7%), tablet computer (1616/2716, 59.5%), and/or smartphone (2438/2722, 89.6%). CONCLUSIONS The Veterans Engagement with Technology Collaborative cohort is an example of a VHA learning health care system initiative designed to support the data-driven implementation of patient-facing technologies into practice and measurement of their impacts. With this initiative, VHA is building capacity for future, rapid, rigorous evaluation and quality improvement efforts to enhance understanding of the adoption, use, and impact of patient-facing technologies.

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