Health care meeting

Influence of Environmental Design on Team Interactions Across Three Family Medicine Clinics: Perceptions of Communication, Efficiency, and Privacy

Influence of Environmental Design on Team Interactions Across Three Family Medicine Clinics: Perceptions of Communication, Efficiency, and Privacy

Protocols encourage healthcare team communication before and after primary care visits to support better patient care. Physical clinic environments may influence these behaviors, but limited research has been performed. The UW PATH collaborative explored how two different primary care clinic physical layouts (onstage/offstage and pod-based [PB] designs) influenced pre- and postvisit team experiences and perceptions.

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young boy patient

Complex Care Hospital Use and Postdischarge Coaching: A Randomized Controlled Trial.

Complex Care Hospital Use and Postdischarge Coaching: A Randomized Controlled Trial.

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), on hospital use among children with medical complexity (CMC) within a complex care medical home. Among CMC within a complex care program, a health coaching intervention designed to identify, prevent, and manage patient-specific crises and postdischarge transitions appears to lower hospitalizations and charges.

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Optimal treatment assignment to maximize expected outcome with multiple treatments.

Optimal treatment assignment to maximize expected outcome with multiple treatments.

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 the resulting estimator is shown in the article.

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The use of external change agents to promote quality improvement and organizational change in healthcare organizations.

The use of external change agents to promote quality improvement and organizational change in healthcare organizations.

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 facilitation with regular, tailored follow up is a powerful component of a successful organizational change strategy.

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The importance of health insurance claims data in creating learning health systems: evaluating care for high-need high-cost patients using the National Patient-Centered Clinical Research Network (PCORNet)

The importance of health insurance claims data in creating learning health systems: evaluating care for high-need high-cost patients using the National Patient-Centered Clinical Research Network (PCORNet)

Case management programs for high-need high-cost patients are spreading rapidly among health systems. PCORNet has substantial potential to support learning health systems in rapidly evaluating these programs, but access to complete patient data on health care utilization is limited as PCORNet is based on electronic health records not health insurance claims data. Because matching cases to comparison patients on baseline utilization is often a critical component of high-quality observational comparative effectiveness research for high-need high-cost patients, limited access to claims may negatively affect the quality of the matching process. HIP Investigator, Dr. Maureen Smith and team (including HIP Investigator, Dr. Menggang Yu) sought to determine whether the evaluation of programs for high-need high-cost patients required claims data to match cases to comparison patients.

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doctors and nurses meeting

Developing primary care teams prepared to improve quality: a mixed-methods evaluation

Developing primary care teams prepared to improve quality: a mixed-methods evaluation

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 academic health care center that was aligning its primary care disciplines and embarking upon an ambitious primary care delivery system redesign. The UW PATH collaborative evaluated the implementation of the Microsystems approach using mixed methods and found that a microsystems approach is valuable for building team relationships and quality improvement skills but is challenged in a larger, diverse academic primary care context. Microsystem investment alone may faciliatte change but is not sufficient to respond to the challenges of a rapidly changing health care environment. 

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Doctor talking to patient

A simple framework for weighting panels across primary care disciplines

A simple framework for weighting panels across primary care disciplines

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 and after the implementation of the weighting system in 27 primary care clinics by comparing weighted and unweighted panel size and the number of physicians accepting patients. After the weighting system was implemented, the percentage of physicians in family medicine and pediatrics with open panels decreased, but the percentage of open panels increased in general internal medicine and the number of active patients increased by 2%. In addition, patients' perceived access to care improved significantly in family and general internal medicine clinics. 

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Medicare spending

Medicare shared savings programs: Higher cost ACOs more likely to achieve savings

Medicare shared savings programs: Higher cost ACOs more likely to achieve savings

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 on quality were not different between organizations that did or did not generate savings. The findings suggest that ACOs that had lower utilization before they enrolled in the MSSP are less likely to see financial rewards from the program.

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Patient in hospital

Apples and oranges: 4 definitions of multiple chronic conditions and their relationship to 30-day rehospitalization

Apples and oranges: 4 definitions of multiple chronic conditions and their relationship to 30-day rehospitalization

In this study, Melissa Dattalo et al. used HIP's Chronic Conditions Warehouse data to examine the extent of agreement of 4 commonly used definitions of multiple chronic conditions (MCC) and compare each definition's ability to predict 30-day hospital readmissions. They found that MCC definitions should not be used interchangeably. The two definitions with the greatest agreement (Charlson Comorbidity Index and Chronic Condition Special Needs Plan) were also the best predictors of readmissions. 

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Building the learning health system: describing an organizational infrastructure to support continuous learning

Building the learning health system: describing an organizational infrastructure to support continuous learning

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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