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AHRQ Research Studies Date
Topics
- Access to Care (1)
- Behavioral Health (1)
- Cardiovascular Conditions (1)
- Care Coordination (1)
- Care Management (2)
- Chronic Conditions (3)
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- Comparative Effectiveness (2)
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- Primary Care (11)
- (-) Primary Care: Models of Care (12)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 12 of 12 Research Studies DisplayedQureshi N, Quigley DD, Hays RD
Nationwide qualitative study of practice leader perspectives on what it takes to transform into a patient-centered medical home.
The purpose of this study was to examine reasons practices obtained and maintained patient-centered medical home (PCMH) recognition and what resources were needed. The investigators concluded that PCMH efforts necessitated support and assistance to frontline, on-site practice leaders leading care delivery changes. They suggested that change efforts should include financial incentives (e.g., direct payment or additional reimbursement), leadership direction and support, and internal or external staff with experience with the PCMH application process, implementation changes, and QI expertise in monitoring process and outcome data.
AHRQ-funded; HS016980.
Citation: Qureshi N, Quigley DD, Hays RD .
Nationwide qualitative study of practice leader perspectives on what it takes to transform into a patient-centered medical home.
J Gen Intern Med 2020 Dec;35(12):3501-09. doi: 10.1007/s11606-020-06052-1..
Keywords: Patient-Centered Healthcare, Primary Care: Models of Care, Primary Care, Quality Improvement, Quality of Care, Healthcare Delivery
Harvey JB, Vanderbrink J, Mahmud Y
Understanding how health systems facilitate primary care redesign.
The objectives of this study were to understand how health systems are facilitating primary care redesign (PCR), examine the PCR initiatives taking place within systems, and identify barriers to this work. A sample of 24 health systems in 4 states was used to identify how system leaders define and implement initiatives to redesign primary care delivery and identify challenges. Codes based on the theoretical PCR literature was used and researchers also created new codes. Semi-structured telephone interviews with 162 system executives and physician organization leaders from 24 systems were conducted. Initiatives to redesign the delivery of primary care were described by leaders, but many were still in the early stages. Motivating factors for team-based care included improvement efficiency and enhancing clinician job satisfaction. Changes in payment and risk assumption as well as community needs were commonly cited as motivators for population health management and care coordination. Challenges health systems face in redesigning primary included return on investment and slower than anticipated rate in moving from fee-for-service to value-based payment.
AHRQ-funded; HS024067.
Citation: Harvey JB, Vanderbrink J, Mahmud Y .
Understanding how health systems facilitate primary care redesign.
Health Serv Res 2020 Dec;55(Suppl 3):1144-54. doi: 10.1111/1475-6773.13576..
Keywords: Health Systems, Primary Care: Models of Care, Primary Care, Healthcare Delivery
Guo F, Lin YL, Raji M
Processes and outcomes of diabetes mellitus care by different types of team primary care models.
This study compared processes and outcomes of care provided to older patients with diabetes by primary care teams composed of only primary care physicians (PCPs) versus team care that included nurse practitioners (NPs) or physician assistants (PAs). The authors studied 3,524 primary care practices identified via social network analysis and 306,741 patients aged 66 and older diagnosed with diabetes mellitus in or before 2015 from Medicare data. Outcomes looked for was more adherence to guideline-recommended care including eye examination, hemoglobin A1c test, and nephropathy monitoring. Preventable hospitalizations and high-risk medication prescribing rates were also measured. Patients in the team care practices received more guideline-recommended diabetes care than patients in PCP only teams. Patients in team care practices had a slightly higher likelihood of being prescribed high-risk medications. The likelihood of preventable hospitalizations was similar among all types of practices.
AHRQ-funded; HS020642.
Citation: Guo F, Lin YL, Raji M .
Processes and outcomes of diabetes mellitus care by different types of team primary care models.
PLoS One 2020 Nov 5;15(11):e0241516. doi: 10.1371/journal.pone.0241516..
Keywords: Elderly, Teams, Primary Care: Models of Care, Healthcare Delivery, Outcomes, Care Coordination, Practice Patterns
Islam N, Rogers ES, Schoenthaler EA
A cross-cutting workforce solution for implementing community-clinical linkage models.
This article discusses the use of employing community health workers (CHWs) in primary care practices to create community-clinical linkage models to address the underlying role of social determinants of health and achieve health equity. Federal initiatives such as EvidenceNOW and Million Hearts have supported a renewed focus on small, independently owned practices. These initiatives emphasize the role of practice facilitation. The authors drew from the literature and propose that small, independently owned practices strategically employ practice facilitators to help integrate CHWs into their primary care teams. These facilitators help provide a “population health management” infrastructure to develop effective partnerships. Several ways that practice facilitation can help do this is outlined in this paper.
AHRQ-funded; HS023922.
Citation: Islam N, Rogers ES, Schoenthaler EA .
A cross-cutting workforce solution for implementing community-clinical linkage models.
Am J Public Health 2020 Jul;110(S2):S191-s93. doi: 10.2105/ajph.2020.305692..
Keywords: Community-Based Practice, Primary Care, Workforce, Primary Care: Models of Care, Healthcare Delivery
Upadhya KK, Psoter KJ, Connor KA
AHRQ Author: Mistry KB
Cluster randomized trial of a pre/interconception health intervention for mothers in pediatric visits.
Recognizing that pediatric primary care focuses on family health and is an important location of contact for women of childbearing age, this project assessed the effectiveness of a pre/interconception women's health intervention delivered during pediatric primary care using a cluster randomized trial. The investigators concluded that pediatric visits are an opportune location for addressing maternal health. They indicated that this intervention demonstrated feasibility and improved outcomes for some but not all outcome.
AHRQ-authored.
Citation: Upadhya KK, Psoter KJ, Connor KA .
Cluster randomized trial of a pre/interconception health intervention for mothers in pediatric visits.
Acad Pediatr 2020 Jul;20(5):660-69. doi: 10.1016/j.acap.2019.10.003..
Keywords: Family Health and History, Pregnancy, Women, Primary Care: Models of Care, Primary Care, Healthcare Delivery
Persell SD, Liss DT, Walunas TL
Effects of 2 forms of practice facilitation on cardiovascular prevention in primary care: a practice-randomized, comparative effectiveness trial.
Effective quality improvement (QI) strategies are needed for small practices. The objective of this study was to compare practice facilitation implementing point-of-care (POC) QI strategies alone versus facilitation implementing point-of-care plus population management (POC+PM) strategies on preventive cardiovascular care. The investigators concluded that facilitator-led QI promoting population management approaches plus POC improvement strategies was not clearly superior to POC strategies alone.
AHRQ-funded; HS023921.
Citation: Persell SD, Liss DT, Walunas TL .
Effects of 2 forms of practice facilitation on cardiovascular prevention in primary care: a practice-randomized, comparative effectiveness trial.
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Keywords: Cardiovascular Conditions, Prevention, Primary Care: Models of Care, Primary Care, Comparative Effectiveness, Patient-Centered Outcomes Research, Evidence-Based Practice, Quality Improvement, Quality of Care, Care Management, Healthcare Delivery
Golberstein E, Joseph JM, Druss BG
The use of psychiatric econsults in primary care.
This study examined the use of an electronic consultation tool (eConsult) by primary care physicians (PCPs) with psychiatrists. The authors investigated the use of psychiatric eConsults in a large integrated delivery system in Minnesota (Allina Health). The tool was introduced in 22 of its primary care clinics on August 1, 2015. Patients had no fee and psychiatrists received 0.75 work relative value units for each eConsult. Out of 95,105 encounters across 219 PCPs from August 2015 through December 2016 only 256 (0.27%) had a psychiatric eConsult order. Among 37.606 encounters with a primary mental health diagnosis only 138 (0.37%) had an eConsult order. Anxiety and depressive disorders were the most common diagnosis types for PCP visits without an eConsult order as well as bipolar disorder, but schizophrenia and psychotic disorder diagnoses were more common with eConsult orders. Over half of eConsults were for medication-related issues, 33% for a specific mental health diagnosis, and 15% for psychiatry without any details. Most PCPs (63%) never ordered an eConsult but the top ten users of eConsults accounted for 46% of the total orders.
AHRQ-funded; HS025245.
Citation: Golberstein E, Joseph JM, Druss BG .
The use of psychiatric econsults in primary care.
J Gen Intern Med 2020 Feb;35(2):616-17. doi: 10.1007/s11606-019-05048-w..
Keywords: Telehealth, Health Information Technology (HIT), Behavioral Health, Primary Care: Models of Care, Primary Care, Healthcare Delivery
Parchman ML, Ike B, Osterhage KP
Barriers and facilitators to implementing changes in opioid prescribing in rural primary care clinics.
This paper discusses the barriers and facilitators to implementing changes in opioid prescription in rural areas using the Six Building Blocks evidence-based program to reduce opioid prescription in primary care practices. The program was implemented at 6 rural and rural-serving organizations with 20 clinic locations over a 15-month period. Interviews and focus groups with conducted with the organizations at the end of the program period. Facilitators included a desire to help patients and their community; external pressures to make changes in opioid management; a desire to reduce workplace stress; external support for the clinic; supportive clinic leadership; and receptivity of patients. Barriers included competing demands on clinicians and staff; a culture of clinician autonomy; inadequate data systems; and a lack of patient resources in rural areas.
AHRQ-funded; HS023750.
Citation: Parchman ML, Ike B, Osterhage KP .
Barriers and facilitators to implementing changes in opioid prescribing in rural primary care clinics.
J Clin Transl Sci 2020 Jan 10;4(5):425-30. doi: 10.1017/cts.2019.448..
Keywords: Opioids, Medication, Rural Health, Primary Care, Primary Care: Models of Care, Implementation, Pain, Chronic Conditions, Healthcare Delivery
Bierman AS, Tinetti ME
AHRQ Author: Bierman AS
Precision medicine to precision care: managing multimorbidity.
Multimorbidity is the most common condition managed in practice. The authors argue that health-care delivery must be transformed to provide precision care to people with multimorbidity. Accomplishing this transition will require a change in practice, research, and policy from disease-specific to patient-centered models of care delivery.
AHRQ-authored.
Citation: Bierman AS, Tinetti ME .
Precision medicine to precision care: managing multimorbidity.
Lancet 2016 Dec 3;388(10061):2721-23. doi: 10.1016/s0140-6736(16)32232-2.
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Keywords: Healthcare Delivery, Chronic Conditions, Guidelines, Patient-Centered Healthcare, Primary Care, Primary Care: Models of Care
Luo Z, Chen Q, Annis AM
A comparison of health plan- and provider-delivered chronic care management models on patient clinical outcomes.
Two contrasting strategies of chronic care management include provider-delivered care management (PDCM) and health plan-delivered care management (HPDCM). The researchers aimed to compare the effectiveness of PDCM vs. HPDCM on improving clinical outcomes for patients with chronic diseases. They found that in a commercially insured population, neither PDCM nor HPDCM resulted in substantial improvement in patients' clinical indicators in the first year.
AHRQ-funded; HS020108.
Citation: Luo Z, Chen Q, Annis AM .
A comparison of health plan- and provider-delivered chronic care management models on patient clinical outcomes.
J Gen Intern Med 2016 Jul;31(7):762-70. doi: 10.1007/s11606-016-3617-2.
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Keywords: Chronic Conditions, Care Management, Primary Care: Models of Care, Primary Care, Healthcare Delivery, Comparative Effectiveness, Patient-Centered Outcomes Research, Health Insurance
Stults CD, McClellan S, Panattoni L
Estimating the human resource costs of developing and implementing shared medical appointments in primary care.
The authors conducted interviews to estimate the human resource costs for developing and implementing a program to support shared medical appointments (SMAs) and an additional SMA on cancer survivorship. They found that introducing new providers or a new type of SMA may require relatively modest incremental organizational resources and provider time. They concluded that time and cost could possibly be further decreased by leveraging relevant materials from existing SMAs.
AHRQ-funded; HS022631.
Citation: Stults CD, McClellan S, Panattoni L .
Estimating the human resource costs of developing and implementing shared medical appointments in primary care.
J Ambul Care Manage 2016 Jan-Mar;39(1):23-31. doi: 10.1097/jac.0000000000000084.
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Keywords: Primary Care: Models of Care, Primary Care, Healthcare Delivery, Implementation
Wexler RK
Invited letter: the evolving model of health care in the United States: system change is not enough.
In this letter, the author argues that the spread of new health care delivery models such as the Patient-Centered Medical Home and Accountable Care Organizations are necessary to improve population health but do not fully address the need for a fundamental change in how patients think about and access care. He calls for raising patient awareness of how the health care delivery system works and draws attention to practitioners’ concerns about patient satisfaction as a definitive marker of quality.
AHRQ-funded; HS020693
Citation: Wexler RK .
Invited letter: the evolving model of health care in the United States: system change is not enough.
Adv Health Care Manag. 2014;16:173-6..
Keywords: Access to Care, Healthcare Delivery, Patient-Centered Healthcare, Patient Experience, Primary Care, Primary Care: Models of Care