Understanding Organizational Designs of Primary Care Practices

Tallia, Alfred F.; Stange, Kurt C.; McDaniel, Reuben R.; Aita, Virginia A.; Miller, William L.; Crabtree, Benjamin F.

doi:10.1097/00115514-200301000-00009

Cited by 32 publications

(29 citation statements)

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“…Family medicine practices are often organizational units of hospital and insurance health systems, and shared management arrangements have met with varying degrees of success (Tallia et al, 2003). Already challenged by shrinking reimbursement to increase patient throughput by enhanced office efficiency, managers are increasingly facing pay-for-performance arrangements requiring service quality.…”

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confidence: 99%

Family medicine practice performance and knowledge management

Orzano

McInerney

Tallia

et al. 2008

Health Care Management Review

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confidence: 99%

Family medicine practice performance and knowledge management

Orzano

McInerney

Tallia

et al. 2008

Health Care Management Review

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“…Item selection was based on a literature review, prior experience, and exploratory factor analysis combined with expert consensus and item analysis. 12,35 Items selected for the Practice Culture Assessment were also separately used, along with related items, in the evaluation of the National Demonstration Project. 36 Each practice also provided basic practice information, including patient demographics, patient volume, and implementation of health information technology.…”

Section: Clinician and Staff Surveysmentioning

confidence: 99%

“…10,11 Primary care practices have few mechanisms for incorporating new programs, which can slow adoption of innovations and cause disruptions when innovations are finally implemented. [12][13][14][15][16] With the central importance of primary care in health care redesign models such as the PCMH and accountable care organizations, effective strategies for enhancing primary care practice improvement and transformation are critically important. Practice facilitation has emerged as a key method for assisting practices in implementing organizational changes.…”

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Practice Facilitation to Improve Diabetes Care in Primary Care: A Report From the EPIC Randomized Clinical Trial

Dickinson

Nutting

et al. 2014

The Annals of Family Medicine

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PURPOSEWe investigated 3 approaches for implementing the Chronic Care Model to improve diabetes care: (1) practice facilitation over 6 months using a reflective adaptive process (RAP) approach; (2) practice facilitation for up to 18 months using a continuous quality improvement (CQI) approach; and (3) providing selfdirected (SD) practices with model information and resources, without facilitation. METHODSWe conducted a cluster-randomized trial, called Enhancing Practice, Improving Care (EPIC), that compared these approaches among 40 small to midsized primary care practices. At baseline and 9 months and 18 months after enrollment, we assessed practice diabetes quality measures from chart audits and Practice Culture Assessment scores from clinician and staff surveys. RESULTSAlthough measures of the quality of diabetes care improved in all 3 groups (all P <.05), improvement was greater in CQI practices compared with both SD practices (P <.0001) and RAP practices (P <.0001); additionally, improvement was greater in SD practices compared with RAP practices (P <.05). In RAP practices, Change Culture scores showed a trend toward improvement at 9 months (P = .07) but decreased below baseline at 18 months (P <.05), while Work Culture scores decreased from 9 to 18 months (P <.05). Both scores were stable over time in SD and CQI practices.CONCLUSIONS Traditional CQI interventions are effective at improving measures of the quality of diabetes care, but may not improve practice change and work culture. Short-term practice facilitation based on RAP principles produced less improvement in quality measures than CQI or SD interventions and also did not produce sustained improvements in practice culture. INTRODUCTIONT o meet the challenges of a reformed health care system, primary care must adopt substantially new models such as the PatientCentered Medical Home (PCMH) and integrate their work within accountable care organizations. [1][2][3][4] The PCMH has emerged as a cornerstone of primary care redesign with its strong appeal of uniting 4 compelling areas of health care reform: (1) the well-demonstrated value of primary care based on 4 core attributes, [5][6] (2) proactive, population-based approaches to chronic care, (3) consumerism and patient-centered care, and (4) new health information technology. Much of the redesign effort has focused on implementing the Chronic Care Model,6,7 which has been associated with better health outcomes for patients with chronic conditions and, specifically, type 2 diabetes 8,9 ; however, data regarding adoption of this model's principles into primary care practices have been disappointing. 10,11 Primary care practices have few mechanisms for incorporating new programs, which can slow adoption of innovations and cause disruptions when innovations are finally implemented. [12][13][14][15][16] With the central importance of primary care in health care redesign models such as the PCMH and accountable care organizations, effective strategies for enhancing primary care practice improvement...

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“…5 Study of such patterns and how they change with time or in response to interventions requires an ability to look at the entire complex web of relationships and interactions within a primary care practice. Although qualitative description [6][7][8][9][10] and practice genograms 11 have demonstrated utility for understanding the complex interactions in practices, a tool that captures quantitative aspects of the patterns of relationships within practices would be a useful aid in studies of primary care practices. Social network analysis (SNA) is such a tool.…”

Section: Introductionmentioning

confidence: 99%

Social Network Analysis as an Analytic Tool for Interaction Patterns in Primary Care Practices

Scott

Tallia²,

Crosson³

et al. 2005

The Annals of Family Medicine

119

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PURPOSE Social network analysis (SNA) provides a way of quantitatively analyzing relationships among people or other information-processing agents. Using 2 practices as illustrations, we describe how SNA can be used to characterize and compare communication patterns in primary care practices.METHODS Based on data from ethnographic fi eld notes, we constructed matrices identifying how practice members interact when practice-level decisions are made. SNA software (UCINet and KrackPlot) calculates quantitative measures of network structure including density, centralization, hierarchy and clustering coeffi cient. The software also generates a visual representation of networks through network diagrams. RESULTSThe 2 examples show clear distinctions between practices for all the SNA measures. Potential uses of these measures for analysis of primary care practices are described.CONCLUSIONS SNA can be useful for quantitative analysis of interaction patterns that can distinguish differences among primary care practices. INTRODUCTIONP rimary care practices are complex systems that are characterized by dynamic patterns of interactivity among practice members and their environment. [1][2][3] One feature of complex systems is the property of emergence, which is the tendency of organized patterns to emerge that cannot be predicted from the properties of individual parts of the system. 4 Thus, to understand how primary care practices function, it is necessary to study not only the individuals within the practice or individual practice components but also the relationships among individuals.5 Study of such patterns and how they change with time or in response to interventions requires an ability to look at the entire complex web of relationships and interactions within a primary care practice. Although qualitative description 6-10 and practice genograms 11 have demonstrated utility for understanding the complex interactions in practices, a tool that captures quantitative aspects of the patterns of relationships within practices would be a useful aid in studies of primary care practices. Social network analysis (SNA) is such a tool.SNA 13 More recent work examines the association of these quantitative measures with organizational performance outcomes. Cummings and Cross, for example, found that degree of hierarchy, core-periphery structure, and structural holes of leaders correlated negatively with performance in 182 work groups in a large telecommunications company, 14 and Aydin et al found that increased network communication density was associated with higher use of an electronic medical record system by nurse practitioners and physician' s assistants. 15 There have also been studies showing how network parameters change with time. Shah, for example showed that network centrality decreased after downsizing in a consumer electronics fi rm, 16 whereas Burkhardt and Brass documented increased network centrality after introduction of a new computer system in a federal agency. 17In this article, using data from 2 primary ...

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Understanding Organizational Designs of Primary Care Practices

Cited by 32 publications

References 0 publications

Family medicine practice performance and knowledge management

Family medicine practice performance and knowledge management

Practice Facilitation to Improve Diabetes Care in Primary Care: A Report From the EPIC Randomized Clinical Trial

Social Network Analysis as an Analytic Tool for Interaction Patterns in Primary Care Practices

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