Overview To find high-risk patients who might benefit from additional health and social services, we have developed and implemented an artificial intelligence system to identify patients in need of enhanced care coordination in partnership with one of our state’s largest health systems (UW Health). We are currently screening over 120,000 patients in Dane County each… Read more »
Effective clinical teams are considered essential to the production of high-value systems of care particularly within primary care. The clinical microsystems framework is one approach to training primary care teams how to engage in quality improvement activities. From 2008 to 2014, a Microsystems approach was implemented with 58 primary care teams at a large Midwestern… Read more »
It is difficult for primary care physicians to identify patients on their panel, and workloads can differ based on patient variation. To alleviate these issues, the UW PATH collaborative developed and applied a utilization-based weighting system to determine physicians’ panels in a way that accounts for patient complexity using sociodemographic factors. They measured empanelment before… Read more »
Patient engagement in research has become increasingly prioritized in recent years, as patients can provide unique and valuable feedback to researchers on the design, implementation, and dissemination of studies from the perspective of people the research seeks to help. However, researchers often lack the tools to effectively engage patient advisors in the research process. To… Read more »
Complex care programs seek to influence key health outcomes for children with medical complexity (CMC), and investment in program infrastructure is often justified by anticipating savings from lower health care use. HIP Investigator, Dr. Ryan Coller et al. sought to examine the effect of a caregiver coaching intervention, Plans for Action and Care Transitions (PACT),… Read more »
In a recent study, the PATH collaborative examined the 2013 results for 220 ACOs from the Medicare Shared Savings Program to assess key characteristics associated with generating savings. They found that ACOs with higher baseline expenditures were significantly more likely to generate savings than lower cost ACOs, but that the average quality scores for ACOs that reported… Read more »
When there is substantial heterogeneity of treatment effectiveness, it is crucial to identify individualized treatment assignment rules for comparative treatment selection. HIP Investigator, Dr. Menggang Yu et al. propose an outcome weighted learning method that extends estimating individualized treatment rules to multi‐treatment case by using a vector hinge loss as a target function. Consistency of… Read more »
Summary The mission of the UW Health PATH collaborative is to bridge primary care clinical transformation and rigorous scientific study in order to improve our health system for the benefit of patients and communities. We will disseminate learnings locally and nationally, emphasizing scholarly contributions, in order to enable effective implementation. We are a multidisciplinary coalition… Read more »
External change agents can play an essential role in healthcare organizational change efforts. This systematic review by HIP Investigator, Dr. Andrew Quanbeck et al. examines the role that external change agents have played within the context of multifaceted interventions designed to promote organizational change in healthcare-specifically, in primary care settings. The team found that practice… Read more »
To become learning health systems, academic health centers seek to understand performance across the continuum of care and use that information to achieve continuous improvements. Following implementation changes, system-level performance at an academic health center improved in patient satisfaction, population health screenings, improvement education, and patient engagement.
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