Context Matters: The Experience of 14 Research Teams in Systematically Reporting Contextual Factors Important for Practice Change

Tomoaia‐Cotisel, Andrada; Scammon, Debra L.; Waitzman, Norman J.; Cronholm, Peter F.; Halladay, Jacqueline R.; Driscoll, David; Solberg, Leif I.; Hsu, Clarissa; Tai-Seale, Ming; Hiratsuka, Vanessa Y.; Shih, Sarah C.; Fetters, Michael D.; Wise, Christopher G.; Alexander, Jeffrey A.; Hauser, Diane; McMullen, Carmit K.; Scholle, Sarah Hudson; Tirodkar, Manasi A.; Schmidt, Laura A.; Donahue, Katrina E; Parchman, Michael L.; Stange, Kurt C.

doi:10.1370/afm.1549

Cited by 197 publications

(200 citation statements)

References 41 publications

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“…There are several external environment contextual factors 17 related to practice transformation in Vermont. The study period encompasses the early stages of complex delivery system reforms across the state.…”

Section: Discussionmentioning

confidence: 99%

“…There are also several practice-level contextual factors 17 related to practice transformation in Vermont. In collaboration with these state-led practice transformation efforts, VCHIP also had a Children's Health Insurance Program Reauthorization Act quality demonstration grant to help accelerate the pediatric practices' transformation to PCMH.…”

Section: Discussionmentioning

confidence: 99%

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Effects of Patient-centered Medical Home Transformation on Child Patient Experience

Harder

Krulewitz

Jones

et al. 2016

The Journal of the American Board of Family Medicine

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Introduction: Patient experience, 1 of 3 aims for improving health care, is rarely included in studies of patient-centered medical home (PCMH) transformation. This study examines the association between patient experience and National Committee on Quality Assurance (NCQA) PCMH transformation.Methods: This was a cross-sectional study of parent-reported child patient experience from PCMH and non-PCMH practices. It used randomly sampled experience surveys completed by 2599 patients at 29 pediatric and family medicine PCMH (n ‫؍‬ 21) and non-PCMH (n ‫؍‬ 8) practices in Vermont from 2011 to 2013. Patient experiences related to child development and prevention were assessed using the Consumer Assessment of Health care Providers and Systems (CAHPS).Results: A 10-point increase in NCQA score at PCMH practices is associated with a 3.1% higher CAHPS child prevention score (P ‫؍‬ .004). Among pediatric practices, PCMH recognition is associated with 7.7% (P < .0005) and 7.2% (P < .0005) higher CAHPS child development and prevention composite scores, respectively. Among family medicine practices, PCMH recognition is associated with 7.4% (P ‫؍‬ .001) and 11.0% (P < .0005) lower CAHPS child development and prevention composite scores, respectively.Conclusions: Our results suggest that PCMH recognition may improve child patient experience at pediatric practices and worsen experience at family medicine practices. These findings warrant further investigation into the differential influence of NCQA PCMH transformation on family medicine and pediatric practices. (J Am Board Fam Med 2016;29:60 -68.)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effects of Patient-centered Medical Home Transformation on Child Patient Experience

Harder

Krulewitz

Jones

et al. 2016

The Journal of the American Board of Family Medicine

View full text Add to dashboard Cite

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“…The move away from a physician-centric model of care towards one that is truly team-oriented, and the challenges of aligning financial reimbursement with the PCMH's emphasis on proactive prevention, are only two of the model's persistent challenges across diverse primary care practices. [9][10][11] In 2010, the Veterans Health Administration (VA) rolled out its version of the PCMH, the Patient Aligned Care Teams (PACT) initiative. With an initial focus on primary care, PACT emphasizes common features of the PCMH Electronic supplementary material The online version of this article (doi:10.1007/s11606-013-2690-z) contains supplementary material, which is available to authorized users.…”

Section: Introductionmentioning

confidence: 99%

“We’ve Not Gotten Even Close to What We Want to Do”: a Qualitative Study of Early Patient-Centered Medical Home Implementation

et al. 2014

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BACKGROUND:The Veterans Health Administration (VA) Patient Aligned Care Team (PACT) initiative is designed to deliver a medical home model of care associated with better patient outcomes, but success will depend in part on the model's acceptability and sustainability among clinic employees. OBJECTIVE: We sought to identify key themes in the experience of primary care providers, nurse care managers, clerical and clinical associates, and clinic administrators implementing PACT, with the aim of informing recommendations for continued development of the model and its components. DESIGN: Observational qualitative study; data collection from 2010 to 2013, using role-stratified and team focus groups and semi-structured interviews. PARTICIPANTS: 241 of 337 (72 %) identified primary care clinic employees in PACT team or administrative roles, from 15 VA clinics in Oregon and Washington. APPROACH: Data coded and analyzed using conventional content analysis techniques. KEY RESULTS: Overall, participants were enthusiastic about the PACT concept, but felt necessary resources for success were not yet in place. Well-functioning teams were perceived as key to successful implementation. Development of such teams depended on adequate staffing, training, and dedicated time for team development. Changes within the broader VA system were also seen as necessary, including devolving greater control to the clinic level and improving system alignment with the PACT model. PACT advocates from among clinic and institutional level leadership were identified as a final key ingredient for success. These themes were consistent despite differences in clinic settings and characteristics. CONCLUSIONS: PACT implementation faced significant challenges in its early years. Realizing PACT's transformative potential will require acting on the needs identified by clinic workers in this study: ensuring adequate staffing in all team roles, devoting resources to in-depth training for all employees in communication and other skills needed to maximize team success, and aligning the broader VA hospital system with PACT's decentralized, team-based approach.KEY WORDS: primary care redesign; patient-centered medical home; team-based care; Veterans; health services research; qualitative research.

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“…7 While some recent evaluations have not identified significant effects of PCMH initiatives on health care utilization and cost, [8][9][10] the heterogeneity of PCMH interventions and contexts may lead to differential effectiveness, the patterns of which could illuminate facilitators and barriers to effective transformation. 11 In addition, few studies of PCMH pilots have evaluated outcomes beyond two years, even though the literature suggests that practice transformation takes time to unfold. 8 We examined the cumulative effects of a PCMH intervention after two and three years, and endeavored to document details of both the initiative and context to enable comparison with similar studies.…”

mentioning

confidence: 99%

A Difference-in-Difference Analysis of Changes in Quality, Utilization and Cost Following the Colorado Multi-Payer Patient-Centered Medical Home Pilot

et al. 2015

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BACKGROUND:Research on the effects of patientcentered medical homes on quality and cost of care is mixed, so further study is needed to understand how and in what contexts they are effective. OBJECTIVE: We aimed to evaluate effects of a multi-payer pilot promoting patient-centered medical home implementation in 15 small and medium-sized primary care groups in Colorado. DESIGN: We conducted difference-in-difference analyses, comparing changes in utilization, costs, and quality between patients attributed to pilot and non-pilot practices. PARTICIPANTS: Approximately 98,000 patients attributed to 15 pilot and 66 comparison practices 2 years before and 3 years after the pilot launch. MAIN MEASURES: Healthcare Effectiveness Data and Information Set (HEDIS) derived measures of diabetes care, cancer screening, utilization, and costs to payers. KEY RESULTS: At the end of two years, we found a statistically significant reduction in emergency department use by 1.4 visits per 1000 member months, or approximately 7.9 % (p=0.02). At the end of three years, pilot practices sustained this difference with 1.6 fewer emergency department visits per 1000 member months, or a 9.3 % reduction from baseline (p=0.01). Emergency department costs were lower in the pilot practices after two (13.9 % reduction, p<0.001) and three years (11.8 % reduction, p=0.001). After three years, compared to control practices, primary care visits in the pilot practices decreased significantly (1.5 % reduction, p=0.02). The pilot was associated with increased cervical cancer screening after two (12.5 % increase, p<0.001) and three years (9.0 % increase, p<0.001), but lower rates of HbA1c testing in patients with diabetes (0.7 % reduction at three years, p=0.03) and colon cancer screening (21.1 % and 18.1 % at two and three years, respectively, p<0.001). For patients with two or more comorbidities, similar patterns of association were found, except that there was also

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Context Matters: The Experience of 14 Research Teams in Systematically Reporting Contextual Factors Important for Practice Change

Cited by 197 publications

References 41 publications

Effects of Patient-centered Medical Home Transformation on Child Patient Experience

Effects of Patient-centered Medical Home Transformation on Child Patient Experience

“We’ve Not Gotten Even Close to What We Want to Do”: a Qualitative Study of Early Patient-Centered Medical Home Implementation

A Difference-in-Difference Analysis of Changes in Quality, Utilization and Cost Following the Colorado Multi-Payer Patient-Centered Medical Home Pilot

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