Medical students in front of laptop

Broadening Medical Students' Exposure to the Range of Illness Experiences: A Pilot Curriculum Focused on Depression Education

Broadening Medical Students' Exposure to the Range of Illness Experiences: A Pilot Curriculum Focused on Depression Education

Exposing medical students to a broad range of illness experiences is crucial for teaching them to practice patient-centered care, but students often have limited interaction with patients with diverse illness presentations. In this pilot, Dr. Rachel Grob et. al developed, implemented, and evaluated a self-directed online curriculum followed by a small group discussion focused on depression education. The curriculum was based on a module created using the Database of Individual Patients’ Experiences methodology.

Read the article

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.

Read the article

Happy doctor with patient

Why Physicians Should Trust in Patients

Why Physicians Should Trust in Patients

Most of the existing literature on trust between patients and physicians focuses on whether patients trust their clinicians. However, the principles underlying the patient-physician relationship must shift from simply emphasizing patients’ adherence to cultivating patients’ ability to contribute to the development of care plans that reflect their own values and preferences. Physicians who wish to advance this transformation can contribute by presuming trust with each patient. Dr. Rachel Grob et al. discusses the efficacy of patient-physician partnerships and co-produced care to improve quality and safety of care, patient health outcomes, and patient experience.

Read the article

Doctor and patient with tablet

What Words Convey: The Potential for Patient Narratives to Inform Quality Improvement

What Words Convey: The Potential for Patient Narratives to Inform Quality Improvement

For the past 25 years, health care providers and health system administrators have sought to improve care by surveying patients about their experiences. More recently, policymakers have acted to promote this learning by deploying financial incentives tied to survey scores. This article explores the potential of systematically elicited narratives about experiences with outpatient care to enrich quality improvement. Dr. Rachel Grob et al. found that in a health policy environment that incentivizes attention to patient experience, rigorously elicited narratives hold substantial promise for improving quality in general and patients’ experiences with care in particular. Most narratives convey experiences that are potentially actionable by those committed to improving health care quality in outpatient settings.

Read the article

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. 

Read the article

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.

Read the article

Doctor talking to patient and writing down notes

Sociodemographics and hypertension control among young adults

Sociodemographics and hypertension control among young adults

Young adults ages 18-39 have low hypertension control rates compared to young adults. Using electronic health record data, Dr. Heather Johnson et al. evaluated the role of sociodemographic factors in hypertension control among young adults with primary care access and incident hypertension. They found that young men had a 39% lower rate of hypertension control compared to young women, and that people for whom English was not their primary language and unmarried people also had lower control rates.

Read the article

Nurse walking with patient and smiling

Variability in care management programs in Medicare ACOs

Variability in care management programs in Medicare ACOs

In this study co-authored by Dr. Maureen Smith and Peter Nordby, investigators surveyed medical directors and clinical leaders in 15 care management programs across the country with the goal of classifying models of care management in Medicare ACOs. They found high variability in multiple domains across programs, and that most programs use cost & utilization measures to determine outcomes with relatively few patient and stakeholder experience measures. Due to the wide variation in structures and processes, classification proved challenging, and a wider range of outcomes is needed to better understand the best processes to achieve those outcomes and the value of the case management programs.

Read the article

Nurse checking senior woman's blood pressure

Frequency and predictors of communication about high blood pressure in RA visits

Frequency and predictors of communication about high blood pressure in RA visits

Patients with rheumatoid arthritis (RA) have a heightened risk of cardiovascular disease. Dr. Christie Bartels et al. conducted a retrospective cohort study to determine whether having high blood pressure increased the likelihood of communication about blood pressure in rheumatology visits. The investigators identified patients in the electronic health record who had both RA and uncontrolled hypertension and who received both primary and rheumatology care, and then trained abstractors reviewed the RA visit notes to determine whether blood pressure communication occurred. They found that only 22% of RA clinic visits contained documented communication about blood pressure, and that patients with stage II elevation of blood pressure were not singificantly more likely to have documented communication. Action steps recommending follow-up for high blood pressure were documented in less than 10% of eligible visits. 

Press about the article was featured in Rheumatology News and Healio.

Read the article

Nurse taking someone's pulse

Assessing unwanted variations in rheumatology clinic previsit rooming

Assessing unwanted variations in rheumatology clinic previsit rooming

Edmond Ramly et al. conducted a cross-sectional time-study and work-system analysis to measure rooming workflows in three rheumatology clinics to assess the current capacity for population management in the clinics. They found that total room duration varied by clinic, with a median of 6.75-8.25 minutes, and vital sign measurement and medication reconciliation took up more than half of the rooming time. Additionally, two of 15 tasks varied significantly in duration across clinics, and 9 tasks varied in frequency. Due to these variations, clinic leaders modified their policies and procedures regarding 6 high-variation tasks, which streamlined the assessment of weight, height, pain scores, tobacco use, disease activity, and refill needs.

Read the article

Pages