Improving Delivery of Clinical Preventive Services

Ballard, David J.; Nicewander, David; Qin, Haili; Fullerton, Cliff; Winter, F. David; Couch, Carl

doi:10.1016/j.amepre.2007.07.040

Cited by 23 publications

(15 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Margolis' program of primary care office practice improvement in primary care settings 16 showed significant improvements in the performance of preventive services in pediatrics; similarly the STEP-UP program in northern Ohio showed significant and sustained improvements (although absolute levels of performance remained lower than desirable) 17,18 while other projects had less positive results. [19][20][21] A reasonable conclusion from these projects is that, in some settings with sufficient support, practices could operate with a higher level of reliability in the performance of preventive interventions, but that meaningful and sustained adoption of these reliability practices was difficult. None of these studies were intended to trigger or study spread beyond those receiving the direct intervention.…”

Section: How?mentioning

confidence: 99%

How to Scale Up Primary Care Transformation: What We Know and What We Need to Know?

Homer

Baron

2010

J GEN INTERN MED

View full text Add to dashboard Cite

Becoming a medical home is a radical change, requiring both a new mental model for primary care and the skills and resources to accomplish it. Although numerous reports indicate practice change is feasible-particularly with technical support and either insulation from or alignment with financial incentives-sustained transformation appears difficult. We identified the following critical success factors: leadership, financial resources, personal and organizational relationships, engagement with patients and families, competence in management, improvement methods and coaching, health information technology properly applied, care coordination support, and staff development. Each factor raises researchable questions about what policies can facilitate achieving success so that transformation becomes mainstream rather than the province of the innovative few.

show abstract

Section: How?mentioning

confidence: 99%

How to Scale Up Primary Care Transformation: What We Know and What We Need to Know?

Homer

Baron

2010

J GEN INTERN MED

View full text Add to dashboard Cite

show abstract

“…The system's quality improvement initiatives in both the inpatient and ambulatory care settings have included linking administrators' compensation to performance on clinical quality measures; 18 participating in the Institute for Healthcare Improvement's 100,000 Lives and 5 Million Lives Campaigns; 19,20 introducing a rapid-cycle improvement training course; 21 and using a multiprong approach to improve the delivery of adult preventive services. 22 Typically, quality improvement initiatives and evaluations within HealthTexas are approved, overseen, and monitored by the HealthTexas Best Care Committee. This committee of approximately thirty-five physicians is chaired by the senior vice president for disease management and quality.…”

Section: Implementing An Electronic Record Systemmentioning

confidence: 99%

The Financial And Nonfinancial Costs Of Implementing Electronic Health Records In Primary Care Practices

Fleming

Culler

McCorkle³

et al. 2011

Health Affairs

Self Cite

108

View full text Add to dashboard Cite

The incentives in the American Recovery and Reinvestment Act to expand the "meaningful use" of electronic health record systems have many health care professionals searching for information about the cost and staff resources that such systems require. We report the cost of implementing an electronic health record system in twenty-six primary care practices in a physician network in north Texas, taking into account hardware and software costs, as well as the time and effort invested in implementation. For an average five-physician practice, implementation cost an estimated $162,000, with $85,500 in maintenance expenses during the first year. We also estimate that the HealthTexas network implementation team and the practice implementation team needed 611 hours, on average, to prepare for and implement the electronic health record system, and that "end users"-physicians, other clinical staff, and nonclinical staff-needed 134 hours per physician, on average, to prepare for use of the record system in clinical encounters. 1 Potential adopters of this technology need information about the financial and other resources required to implement and maintain the systems.We quantified the costs of implementing one system-GE Healthcare's Centricity Electronic Medical Record 2 -at HealthTexas Provider Network, a large physician network in north Texas that provides fee-for-service ambulatory care. Financial costs included those pertaining to purchases of hardware and of software licenses. We also considered the maintenance costs for software licenses, hosting, and technical support for the first year following implementation.We considered nonfinancial costs to be related to the time spent by many parties to bring the system online and into full use. These parties included three groups of people.First was the HealthTexas network implementation team, which consisted of the manager for training and work flow, the senior vice president for disease management and quality, the vice presidents for informatics and for electronic health records and information technology (IT), a project manager, a process improvement consultant, and staff who conducted the workflow analyses and electronic health record training for physicians and clinic staff. This team planned and led the implementation of the system throughout the network.Second were the individual practice implementation teams, which prepared for the practice's implementation through planning, workflow reengineering, and training, and which consisted of "physician champions" chosen to spearhead the implementation at the particular practice, clinical staff "superusers," and office managers. Third were the end users-the physicians, other clinical staff, and nonclinical staff. End users had to be trained to use the electronic health record and had to prepare for its use in clinical encounters-for example, by loading information from patients' paper records.We interviewed key leaders of HealthTexas's electronic health record implementation: the vice presidents for informatics an...

show abstract

“…This program gave upfront financial investment directly to smaller MSSP ACOs centered on physician groups lacking inpatient facilities, which could go to labor or capital devoted to quality performance. 35 Better performance by these ACOs on preventive care may be driven by the investment itself, or some other quality common to ACOs targeted for the program. Additionally, for disease prevention measures specifically, we observed significant relationships between certain components of ACO infrastructure, inclusion of a hospital and more extensive EHR capabilities, with better performance.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple intervention studies have found effectiveness of leveraging EHR for preventive care, often focusing on electronic reminders. 35–40 Such technology for reminders and data management would be expected to have a greater impact on the more irregular and complex disease prevention preventive services.…”

Section: Discussionmentioning

confidence: 99%

Preventive Care Quality of Medicare Accountable Care Organizations

et al. 2016

View full text Add to dashboard Cite

Background Accountable Care Organizations (ACOs) are a delivery and payment model aiming to coordinate care, control costs, and improve quality. Medicare ACOs are responsible for eight measures of preventive care quality. Objectives To create composite measures of preventive care quality and examine associations of ACO characteristics with performance. Design Cross-sectional study of Medicare Shared Savings Program and Pioneer participants. We linked quality performance to descriptive data from the National Survey of ACOs. We created composite measures using exploratory factor analysis, and used regression to assess associations with organizational characteristics. Results Of 252 eligible ACOs, 246 reported on preventive care quality, 177 of which completed the survey (response rate=72%). In their first year, ACOs lagged behind PPO performance on the majority of comparable measures. We identified two underlying factors among eight measures and created composites for each: disease prevention, driven by vaccines and cancer screenings, and wellness screening, driven by annual health screenings. Participation in the Advanced Payment Model, having fewer specialists, and having more Medicare ACO beneficiaries per primary care provider were associated with significantly better performance on both composites. Better performance on disease prevention was also associated with inclusion of a hospital, greater electronic health record capabilities, a larger primary care workforce, and fewer minority beneficiaries. Conclusions ACO preventive care quality performance is related to provider composition and benefitted by upfront investment. Vaccine and cancer screening quality performance is more dependent on organizational structure and characteristics than performance on annual wellness screenings, likely due to greater complexity in eligibility determination and service administration.

show abstract

Improving Delivery of Clinical Preventive Services

Cited by 23 publications

References 32 publications

How to Scale Up Primary Care Transformation: What We Know and What We Need to Know?

How to Scale Up Primary Care Transformation: What We Know and What We Need to Know?

The Financial And Nonfinancial Costs Of Implementing Electronic Health Records In Primary Care Practices

Preventive Care Quality of Medicare Accountable Care Organizations

Contact Info

Product

Resources

About