Population health challenges in primary care: What are the unfinished tasks and who should do them?

Abstract

Background:There are numerous recommendations from expert sources that help guide primary care providers in cancer screening, infectious disease screening, metabolic screening, monitoring of drug levels, and chronic disease management. Little is known about the potential effort needed for a healthcare system to address these recommendations, or the patient effort needed to complete the recommendations.Methods:For 73 recommended population healthcare items, we examined each of 28,742 patients in a primary care internal medicine practice to determine whether they were up-to-date on recommended screening, immunizations, counseling, and chronic disease management goals. We used a rule-based software tool that queries the medical record for diagnoses, dates, laboratory values, pathology reports, and other information used in creating the individualized recommendations. We counted the number of uncompleted recommendations by age groups and examined the healthcare staff needed to address the recommendations and the potential patient effort needed to complete the recommendations.Results:For the 28,742 patients, there were 127,273 uncompleted recommendations identified for population health management (mean recommendations per patient 4.36, standard deviation of 2.65, range of 0–17 recommendations per patient). The age group with the most incomplete recommendations was age of 50–65 years with 5.5 recommendations per patient. The 18–35 years age group had the fewest incomplete recommendations with 2.6 per patient. Across all age groups, initiation of these recommendations required high-level input (physician, nurse practitioner, or physician’s assistant) in 28%. To completely adhere to recommended services, a 1000-patient cross-section cohort would require a total of 464 procedures and 1956 lab tests.Conclusion:Providers and patients face a daunting number of tasks necessary to meet guideline-generated recommendations. We will need new approaches to address the burgeoning numbers of uncompleted recommendations.

The Effect of Automated Mammogram Orders Paired With Electronic Invitations to Self-schedule on Mammogram Scheduling Outcomes: Observational Cohort Comparison

“…Because automated bulk ordering of mammograms was part of the self-scheduling process, providers were freed up to do other activities besides ordering routine mammograms. As preventive services and other chronic care services take up an increasing amount of provider time, decreasing provider time for this activity is very important [ 8 , 9 ].…”

“…In addition, screening mammography is often just one of many recommended actions that primary care providers need to address with their patients. In a study at Mayo Clinic, we found that primary care patients aged 50-65 years, on average, had 5.5 unmet health care recommendations, with the conclusion that there needs to be “new approaches to address the burgeoning numbers of uncompleted recommendations” [ 8 ]. Yarnall et al [ 9 ] also noted the large amount of time that is required for primary care providers to address every preventive service, including screening mammography.…”

Primary Care Provider Continuity Is Associated With Improved Preventive Service Ordering During Brief Visits for Acute Symptoms

“…[9][10][11] It has also been used to describe routine primary care task distribution and efforts required to complete these tasks. 12…”