Colorado Residency PCMH Project: Results From a 6-Year Transformation Effort

Abstract

Background and Objectives: Our objective was to describe the results of a 6-year patient-centered medical home (PCMH) transformation program in 11 Colorado primary care residency practices. Methods: We used a parallel qualitative and quantitative evaluation including cross-sectional surveys of practice staff and clinicians, group and individual interviews, meeting notes, and longitudinal practice facilitator field notes. Survey analyses assessed change over time, adjusting for practice-level random effects. Qualitative data analysis used iterative template coding and matrix analyses to synthesize data over time and across cases. Results: There were significant improvements in clinicians’ self-reported routine delivery of patient-centered care, team-based care, self-management support, and use of information systems (P<.0001). Clinicians and staff reported significant gains in practice change culture (P=.001). Self-reported practice-level assessments pointed to additional significant improvements in quality improvement (QI) processes, continuity of care, self-management support/care coordination, and the use of data and population management (P≤.0215). Practices and their practice facilitators reported important changes in how practices operated, significantly improving their QI processes, shared leadership, change culture, and achieving Level III PCMH NCQA Recognition. Important barriers to further progress remain, including inadequate payment models, inflexible staff roles, and difficult access to clinical data. Conclusions: The success of these 11 primary care residency practices in making significant improvements in their delivery of patient-centered care, team-based care, self-management support, and use of information systems took time, effort, and external support. Further practice redesign for advanced primary care models will take sustained sources of well-aligned support, flexibility, shared leadership, and partnerships across residency programs for collaborative learning to assist in their transformation efforts.

Practice Transformation Under the University of Colorado’s Primary Care Redesign Model

“…Different domains of faculty and staff experience in the pilot practice were assessed with questions from existing validated surveys including attitudes about health care teams, 18 participatory safety, 19 and PCMH process measures. 20,21 Burnout was assessed in both practices using the single-item measure from the Physician Worklife Study. [22][23][24] We used a modified Delphi approach to develop PCR-specific questions, 25 which were not subjected to formal psychometric testing.…”

Residency Practice Transformation: Implementation of Team-Based Care in an Academic Continuity Clinic

“…While it has been established that team-based care can improve provider satisfaction in faculty practices, [2][3][4][5] our innovation joins several other interdisciplinary team-based interventions successfully implemented in residency clinics. 10,11 Given that these interventions have been successful across diverse family medicine and internal medicine clinics, this suggests potential generalizability. While the impact of a transition to an XþY schedule has been previously associated with mixed effects on patient-PCP continuity, [12][13][14][15][16][17][18][19] we demonstrated a significant increase in continuity when that scheduling transition was accompanied by a team-based care transformation.…”

“…While Bodenheimer et al included team-based care as 1 of the 10 foundational building blocks of high-performing primary care clinics, 6 with additional recommendations for residency practices, [7][8][9] very few team-based care interventions have discussed implications for residency practices. 10,11 Residency practices face multiple challenges when conducting practice transformation. In recent years, many internal medicine (IM) residency programs have moved to XþY scheduling models (alternating inpatient rotations with dedicated ambulatory blocks), which have been shown to improve resident satisfaction and decrease inpatient-outpatient conflicts, with a mixed effect on continuity and quality of care.…”

An Assessment of Weight Loss Management in Health System Primary Care Practices

“…The Practice Culture Assessment Scale included 22 Likert scale items (1 = Strongly disagree to 5 = Strongly agree) that were used to compute scores for the subscales of Change Culture, Work Culture, and Chaos. [28][29][30][31][32] Subscale scores ranged from 0 to 100, and higher scores represented more of the concept. An Overall Culture score was also computed by averaging the scores of the 3 subscales (reverse coding the Chaos subscale), where a higher score indicated stronger practice culture.…”