Burned out physician

Physician Burnout and Timing of Electronic Health Record Use

Physician Burnout and Timing of Electronic Health Record Use

Burnout among primary care physicians is a major problem in the United States. In addition to negatively impacting physician health, burnout is also associated with reduced quality of patient care and increased physician turnover, further contributing to health care costs and the shortage of physicians.

The PATH group conducted a study to determine the association between physician burnout and timing of EHR use in an academic internal medicine primary care practice. The group hypothesized that increased time spent in the EHR, particularly outside of normal work-hours, would be associated with higher levels of burnout.

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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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Female doctor talking to patient

Engaging Patients in Primary Care Quality Improvement Initiatives: Facilitators and Barriers

Engaging Patients in Primary Care Quality Improvement Initiatives: Facilitators and Barriers

Health care transformation calls for patient engagement in quality improvement (PEQI), yet practice participation remains low. This pilot study of 8 primary care clinics at 7 statewide locations sought to determine the most effective strategies for disseminating a previously successful single-system PEQI intervention. Qualitative data were obtained through site visits, interviews, observations, and journaling. The UW PATH collaborative found that five teams partially completed the intervention and 3 finished. These findings suggest that quality improvement facilitation and dedicated time can help primary care teams identify and overcome barriers to PEQI.

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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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Doctors discussing around table

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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Medical professionals around table

Across the divide: primary care departments working together to redesign care to achieve the Triple Aim

Across the divide: primary care departments working together to redesign care to achieve the Triple Aim

Primary care departments at academic health centers face many challenges in achieving the Triple Aim. This article by the UW PATH collaborative describes the collaboration they formed between the departments of internal medicine, general pediatrics and adolescent medicine, and family medicine to redesign primary care in pursuit of the Triple Aim. A primary care leadership team adopted a common vision to find solutions to shared problems. 

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Business handshake

Strange bedfellows: A local insurer/physician practice partnership to fund innovation

Strange bedfellows: A local insurer/physician practice partnership to fund innovation

In this article by the UW PATH collaborative, investigators describe a novel program that funds ambulatory care improvements through a partnership between an academic health system and an insurance firm. The program is designed as a competitive grant program and both organizations benefit from completed improvement projects. Factors contributing to success as well as lessons learned are discussed to inform the development of similar programs in other markets.

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Doctors office waiting room

Are waiting rooms passé: A pilot study of patient self-rooming

Are waiting rooms passé: A pilot study of patient self-rooming

Timeliness of care after patients arrive at the primary care office has received little focus. In this article, the UW PATH collaborative describes an intervention at 2 community family medicine clinics that allowed patients to direct themselves into exam rooms. After the intervention, 95% of patients said they preferred rooming themselves and patient satisfaction remained high. Others interested in redirecting staff time toward value-added patient care should consider trialing this intervention.

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