Health Care/System Redesign

Health care/system redesign involves making systematic changes to primary care practices and health systems to improve the quality, efficiency, and effectiveness of patient care.

Health care/system redesign involves making systematic changes to primary care practices and health systems to improve the quality, efficiency, and effectiveness of patient care. Frameworks, models, and concepts such as the Chronic Care Model and the Patient-Centered Medical Home (PCMH) can be used independently or together to reorganize care delivery for the purpose of improving patient outcomes.

The redesign of primary care systems and practices includes the following:

  • Adopting strategies for transforming a practice to improve quality, reduce costs, and better satisfy the needs of patients and families.
  • Incorporating preventive services and self-management support into care.
  • Empowering all clinic staff to suggest and help implement effective changes.
  • Develop leadership for change and ongoing quality improvement.
  • May involve practice "coaches" or facilitators to help with the process of health care redesign.

AHRQ's work in health care redesign includes the following project areas:

  • Health literacy and cultural competency. Health literacy is the ability to get, process, and understand basic health information and services needed to make appropriate decisions. Research suggests that clear communication and removing literacy-related obstacles that stem from racial, ethnic, cultural, and linguistic differences will improve care for all patients, regardless of their level of health literacy.
  • Health risk assessment. The health risk appraisal or assessment collects information from patients to form a snapshot of the patient's overall health, identify health risk factors, and develop a personalized prevention and treatment plan. Health risk assessments can improve the delivery of preventive and chronic care services and result in safer, more effective primary care.
  • Patient-centered medical home. The PCMH is a promising model for transforming the way primary care practices provide care. The model includes five critical functions: comprehensive, team-based care; patient-centered care; coordinated care; quicker and better access to care; and a systems-based approach to quality and safety.
  • Practice-based research networks. Practice-based research networks (PBRNs) are groups of primary care clinicians and practices working together, in real-world settings, to investigate questions of importance to primary care practice. Many PBRN leaders have begun to envision their networks as places of learning, where clinicians, patients, and researchers collaborate in the search for answers. There are over 130 primary care PBRNs in the United States today.
  • Practice facilitation. Practice facilitation is a support service provided to a primary care practice by a trained individual or team, using a range of quality improvement and practice improvement approaches to build the internal capacity of a practice to improve over time. Practice facilitation is an effective way of improving primary health care processes and outcomes, including the delivery of preventive services, through the creation of an ongoing, trusting relationship between an outside facilitator and a primary care practice.

Why Is Health Care/System Redesign Important?

Chronic diseases such as heart disease, stroke, cancer, and diabetes are among the most common, expensive, and preventable health problems Americans experience. According to the Institute of Medicine, evidence has shown that half of these Americans are not receiving good care for chronic diseases. The current structure of America's health care system makes it difficult for patients to access affordable, effective care.

Using models such as the Chronic Care Model and PCMH in health care redesign can produce better care for patients, while improving clinical and financial performance for health systems. These approaches shift the health system's focus from reacting to the acute care needs of individuals to proactively engaging a population of patients and focusing on their health goals, needs, and abilities to achieve desired health outcomes. The models encourage the use of the expertise of all members of the care team, including patients and their families.

How Can Health Care/System Redesign Be Put Into Action?

Putting health care redesign into action can be done in the following four general phases:

  1. Getting started. The first phase involves assembling a team to focus on quality improvement efforts. The team should include senior leaders, clinical champions (clinicians who promote the redesign), and administrative leaders.
  2. Review data and set priorities for improvement. The second phase involves gathering data to help inform the priorities for improvement. Once data are gathered, performance measures that represent the major clinical, business, satisfaction, and operations goals for the practice can be identified.
  3. Redesign care and business systems. The third phase involves organizing the care team around their roles, responsibilities, and workflows. The care team offers ideas for improvement and evaluates the effects of changes made.
  4. Continuously improve performance and maintain changes. The fourth phase includes ongoing review of clinical and financial outcomes and making adjustments for continued improvement.

AHRQ resources on health care redesign include:

The following AHRQ Annual Conference presentations on health care/system redesign are also available:

The Power of Maps: Exploring the Frontiers of Geospatial Analysis to Address Health Equity – 2011

Facilitating Chronic Disease Improvement in Primary Care – 2009

Moving Beyond Institution-Based Service Delivery: Medical Homes and Health 2.0 – 2009

TeamSTEPPS™: Producing Effective Medical Teams to Achieve Optimal Patient Outcomes – 2008

Improving Teamwork in Health Care – 2007

Improving Prevention in Primary Care Practice-Based Research Networks – 2007