Will Consolidation of Primary Care Into Hospital Systems Spell Doom for the Patient-Centered Medical Home and the US Health Care System?

Gill, James M.

doi:10.22454/fammed.2018.989867

Cited by 3 publications

(4 citation statements)

References 18 publications

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“…A learning health system, as envisioned by the Institute of Medicine, generates “evidence by driving the process of discovery as a natural outgrowth and product of care.” 29 A learning health system integrates education, research, and care delivery to learn, apply evidence, and improve health and health care. 30 Aspiring to achieve the virtuous cycles articulated by Magill and Baxley, 31 the Quality Program attempts to align education in improvement science, care delivery improvement, and scholarship in improvement science. Returning to examples of completed initiatives, the effort to promote appropriate utilization of laboratory tests for inflammation was led by a resident physician who had received training in the fundamentals of improvement science.…”

Section: Discussionmentioning

confidence: 99%

“…29 A learning health system integrates education, research, and care delivery to learn, apply evidence, and improve health and health care. 30 Aspiring to achieve the virtuous cycles articulated by Magill and Baxley, 31 the learning beyond our institution through peer-reviewed publication. 18 In contrast, we learned that routine hepatitis C screening in hospitalized adults was a low-value practice, prompting discontinuation of the initiative.…”

Section: Discussionmentioning

confidence: 99%

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Promoting scholarship in improvement science: A model for academic clinical departments

DeVoe

Kennedy

Tompkins

et al. 2022

Learning Health Systems

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Introduction Clinical departments at academic medical centers strive to deliver clinical care, provide education and training, support faculty development, and promote scholarship. These departments have experienced increasing demands to improve the quality, safety, and value of care delivery. However, many academic departments lack a sufficient number of clinical faculty members with expertise in improvement science to lead initiatives, teach, and generate scholarship. In this article, we describe the structure, activities, and early outcomes of a program within an academic department of medicine to promote scholarly improvement work. Methods The Department of Medicine at the University of Vermont Medical Center launched a Quality Program with three primary goals: (a) improve care delivery, (b) provide education and training, and (c) promote scholarship in improvement science. The program serves as a resource center for students, trainees and faculty, offering education and training, analytic support, consultation in design and methodology, and project management. It strives to integrate education, research, and care delivery to learn, apply evidence and improve health care. Results Over the first 3 years of full implementation, the Quality Program supported an average of 123 projects annually, including prospective clinical quality improvement initiatives, retrospective assessment of clinical programs and practices, and curriculum development and evaluation. The projects have yielded a total of 127 scholarly products, defined as peer‐reviewed publications and abstracts, posters, and oral presentations at local, regional, and national conferences. Conclusions The Quality Program may serve as a practical model for promoting care delivery improvement, training, and scholarship in improvement science while advancing the goals of a learning health system at the level of an academic clinical department. Dedicated resources within such departments offer the potential to enhance care delivery while promoting academic success for faculty and trainees in improvement science.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Promoting scholarship in improvement science: A model for academic clinical departments

DeVoe

Kennedy

Tompkins

et al. 2022

Learning Health Systems

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“…Just as we realized years ago that we need whole person care, we saw the need for whole faculty jobs where the missions are experienced as mutually reinforcing-virtuous cycles 9 ; one satisfying academic life rather than competing priorities and values.…”

Section: A Shared Vision Of "Harmonized"mentioning

confidence: 99%

Harmonizing the Tripartite Mission in Academic Family Medicine: A Longitudinal Case Example

Peek,

Allen,

Loth

et al. 2024

Ann Fam Med

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Academic practices and departments are defined by a tripartite mission of care, education, and research, conceived as being mutually reinforcing. But in practice, academic faculty have often experienced these 3 missions as competing rather than complementary priorities. This siloed approach has interfered with innovation as a learning health system in which the tripartite missions reinforce each other in practical ways. This paper presents a longitudinal case example of harmonizing academic missions in a large family medicine department so that missions and people interact in mutually beneficial ways to create value for patients, learners, and faculty. We describe specific experiences, implementation, and examples of harmonizing missions as a feasible strategy and culture. "Harmonized" means that no one mission subordinates or drives out the others; each mission informs and strengthens the others (quickly in practice) while faculty experience the triparate mission as a coherent whole faculty job. Because an academic department is a complex system of work and relationships, concepts for leading a complex adaptive system were employed: (1) a "good enough" vision, (2) frequent and productive interactions, and (3) a few simple rules. These helped people harmonize their work without telling them exactly what to do, when, and how. Our goal here is to highlight concrete examples of harmonizing missions as a feasible operating method, suggesting ways it builds a foundation for a learning health system and potentially improving faculty well-being.

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“…While research has examined whether interorganizational linkages are associated with hospital adoption of innovations (Goes & Park, 1987), it has not examined how different features of these linkages (e.g., geographic concentration, size) may be associated with adoption decisions. Moreover, research to date has not addressed the role of hospitals in adopting and disseminating the medical home, despite health systems driving a large portion of primary care services in the United States (Gill, 2018). Townley and Mooney (2014) suggest that hospital medical home adoption among outpatient clinics may lead to reduced penalizations for readmissions, a competitive advantage in the market, and improved care transition/coordination.…”

Section: Introductionmentioning

confidence: 99%

Assessing the Impact of Interorganizational Linkages on Medical Home Model Adoption by U.S. Acute Care Hospitals

Hearld

Tafili

2022

Med Care Res Rev

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The medical home model aims to increase care coordination and health care quality. While the adoption of the model has been increasing, the role of U.S. acute care hospitals’ interorganizational linkages on adoption is yet to be explored. Using a national sample of hospitals throughout the United States, we examined what interorganizational linkage features are associated with medical home adoption of hospital-owned physician practices and assess the pattern of adoption by acute care hospitals between 2011 and 2019. A generalized estimating equation with binomial distribution was utilized to assess the association between interorganizational linkages and medical home adoption. Hospitals with structural linkages and institutional linkages were more likely to have adopted the medical home. Moreover, the likelihood of medical home adoption increased relative to an increasing number of interorganizational linkages. Medical home adoption and dissemination efforts may be more effective when focused on hospitals possessing interorganizational linkages, specifically those with structural linkages.

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Will Consolidation of Primary Care Into Hospital Systems Spell Doom for the Patient-Centered Medical Home and the US Health Care System?

Cited by 3 publications

References 18 publications

Promoting scholarship in improvement science: A model for academic clinical departments

Promoting scholarship in improvement science: A model for academic clinical departments

Harmonizing the Tripartite Mission in Academic Family Medicine: A Longitudinal Case Example

Assessing the Impact of Interorganizational Linkages on Medical Home Model Adoption by U.S. Acute Care Hospitals

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