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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results
1 to 25 of 104 Research Studies Displayed
Richardson JE, Rasmussen LV, Dorr DA
Generating and reporting electronic clinical quality measures from electronic health records: strategies from EvidenceNOW cooperatives.
This study’s goal was to characterize strategies that seven regional cooperatives participating in the EvidenceNOW initiative developed to generate and report electronic health record (EHR)-based electronic clinical quality measures (eCQMs) for quality improvement (QI) in small-to-medium-sized practices. Findings showed that cooperatives ultimately generated and reported eCQMs using hybrid strategies because they determined that neither EHRs alone nor centralized sources alone could operationalize eCQMs for QI. In order to attain this goal, cooperatives needed to devise solutions and utilize resources that often are unavailable to typical small-to-medium-sized practices.
AHRQ-funded; HS023921.
Citation:
Richardson JE, Rasmussen LV, Dorr DA .
Generating and reporting electronic clinical quality measures from electronic health records: strategies from EvidenceNOW cooperatives.
Appl Clin Inform 2022 Mar;13(2):485-94. doi: 10.1055/s-0042-1748145..
Keywords:
Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Indicators (QIs), Quality Measures, Quality of Care, Evidence-Based Practice, Primary Care
Perry CK, Linder S, Hall J
How type of practice ownership affects participation with quality improvement external facilitation: findings from EvidenceNOW.
This study examined how practice ownership influences participation in external facilitation using data from EvidenceNOW. The authors collected data from practices on practice characteristics and ownership type via surveys and from facilitators on the number of hours, encounters, and months each practice had with a facilitator via facilitation logs. Semi-structured interviewers with EvidenceNOW leadership (n = 12) and facilitators (n = 51) were conducted, and facilitators (n = 64) were observed for patterns of facilitation. In the fully adjusted model, differences by ownership were non-significant. Federally Qualified Health Centers (FQHCs) however, had significantly less participation in facilitation than clinician-owned practices for the measures number of encounters and number of months with encounters.
AHRQ-funded; HS023940.
Citation:
Perry CK, Linder S, Hall J .
How type of practice ownership affects participation with quality improvement external facilitation: findings from EvidenceNOW.
J Gen Intern Med 2022 Mar;37(4):793-801. doi: 10.1007/s11606-021-07204-7..
Keywords:
Quality Improvement, Quality of Care, Primary Care, Practice Improvement
Burstein DS, Liss DT, Linder JA
Association of primary care physician compensation incentives and quality of care in the United States, 2012-2016.
AHRQ-funded; 233201500020I; HS026506; HS028127.
Citation:
Burstein DS, Liss DT, Linder JA .
Association of primary care physician compensation incentives and quality of care in the United States, 2012-2016.
J Gen Intern Med 2022 Feb;37(2):359-66. doi: 10.1007/s11606-021-06617-8..
Keywords:
Primary Care, Payment, Quality of Care
Hysong Hysong, Arredondo K, Hughes AM
An evidence-based, structured, expert approach to selecting essential indicators of primary care quality.
The purpose of this article was to illustrate the application of an evidence-based, structured performance measurement methodology to identify, prioritize, and generate new measures of health care quality, using primary care as a case example. Subject matter experts identified three fundamental objectives: access, patient-health care team partnerships, and technical quality. The authors indicated that their article provides an actionable guide to applying their Productivity Measurement and Enhancement System, which can be adapted to the needs of various industries, including measure selection and modification from existing data sources, and proposing new measures.
Citation:
Hysong Hysong, Arredondo K, Hughes AM .
An evidence-based, structured, expert approach to selecting essential indicators of primary care quality.
PLoS One 2022 Jan 18;17(1):e0261263. doi: 10.1371/journal.pone.0261263..
Keywords:
Primary Care, Evidence-Based Practice, Quality Improvement, Quality Indicators (QIs), Quality Measures, Quality of Care
Hemler JR, Edwards ST, Valenzuela S
The effects of major disruptions on practice participation in facilitation during a primary care quality improvement initiative.
This study explored the relationship between disruptions in primary care practices and practice participation in facilitated quality improvement (QI). Using data from EvidenceNOW, findings showed that disruptions are prevalent in primary care, but practices can continue participating in QI interventions, particularly when supported by a facilitator.
AHRQ-funded; HS023940.
Citation:
Hemler JR, Edwards ST, Valenzuela S .
The effects of major disruptions on practice participation in facilitation during a primary care quality improvement initiative.
J Am Board Fam Med 2022 Jan-Feb;35(1):124-39. doi: 10.3122/jabfm.2022.01.210205..
Keywords:
Primary Care, Practice Improvement, Quality Improvement, Quality of Care, Workforce
Quigley DD, Elliott MN, Slaughter ME
Shadow coaching improves patient experience with care, but gains erode later.
Health care organizations strive to improve patient care experiences. Some use one-on-one provider counseling (shadow coaching) to identify and target modifiable provider behaviors. In this study, the investigators examined whether shadow coaching improved patient experience across 44 primary care practices in a large urban Federally Qualified Health Center. The investigators concluded that shadow coaching improved providers' overall performance and communication immediately after being coached.
AHRQ-funded; HS025920.
Citation:
Quigley DD, Elliott MN, Slaughter ME .
Shadow coaching improves patient experience with care, but gains erode later.
Med Care 2021 Nov;59(11):950-60. doi: 10.1097/mlr.0000000000001629..
Keywords:
Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Experience, Provider Performance, Quality Improvement, Quality of Care, Primary Care
Lewis VA, Spivack S, Murray GF
FQHC designation and safety net patient revenue associated with primary care practice capabilities for access and quality.
Researchers assessed capabilities around access to and quality of care among primary care practices serving a high share of Medicaid and uninsured patients compared to practices serving a low share of these patients. Data from the National Survey of Healthcare Organizations and Systems was analyzed. They found that federally qualified health centers were more likely than other types of primary care practices (both safety net practices and other practices) to possess capabilities related to access and quality. However, safety net practices were less likely than non-safety net practices to possess health information technology capabilities.
AHRQ-funded; HS024075.
Citation:
Lewis VA, Spivack S, Murray GF .
FQHC designation and safety net patient revenue associated with primary care practice capabilities for access and quality.
J Gen Intern Med 2021 Oct;36(10):2922-28. doi: 10.1007/s11606-021-06746-0..
Keywords:
Safety Net, Vulnerable Populations, Primary Care, Access to Care, Uninsured, Medicaid, Quality of Care
Bierman AS, Wang J, O'Malley PG
Transforming care for people with multiple chronic conditions: Agency for Healthcare Research and Quality's research agenda.
This article describes issues addressing the needs of those with multiple chronic conditions and discusses the AHRQ research agenda.
AHRQ-authored.
Citation:
Bierman AS, Wang J, O'Malley PG .
Transforming care for people with multiple chronic conditions: Agency for Healthcare Research and Quality's research agenda.
Health Serv Res 2021 Oct;56(Suppl 1):973-79. doi: 10.1111/1475-6773.13863..
Keywords:
Chronic Conditions, Health Services Research (HSR), Healthcare Delivery, Quality of Care, Primary Care, Guidelines, Evidence-Based Practice
Ye J, Zhang R, Bannon JE
Identifying practice facilitation delays and barriers in primary care quality improvement.
Practice facilitation is an effective approach to implementing quality improvement (QI) interventions in practice-based research networks (PBRNs). Regular facilitator-practice interactions are necessary for successful facilitation and missed engagements may hinder the process of practice improvement. This study employed a mixed-methods approach to characterize the dynamics of practice facilitation and examine facilitation delays and barriers, as well as their association with the achievement of QI program goals in a PBRN initiative.
AHRQ-funded; HS023921.
Citation:
Ye J, Zhang R, Bannon JE .
Identifying practice facilitation delays and barriers in primary care quality improvement.
J Am Board Fam Med 2020 Sep-Oct;33(5):655-64. doi: 10.3122/jabfm.2020.05.200058..
Keywords:
Practice Improvement, Primary Care, Quality Improvement, Quality of Care
Quigley DD, Slaughter M, Qureshi N
Practices and changes associated with patient-centered medical home transformation.
Knowing which patient-centered medical home (PCMH) care delivery changes and quality improvement (QI) practices further PCMH implementation is essential. In this study, the investigators used the 2008-2017 National Committee of Quality Assurance (NCQA) PCMH directory of 15,188 primary care practices that received Level 1, 2, or 3 NCQA PCMH recognition to: 1.) construct a stratified national sample of 105 practices engaged in PCMH transformation and 2.) examine their QI practices and PCMH changes associated with PCMH transformation.
AHRQ-funded; HS016980; HS025920.
Citation:
Quigley DD, Slaughter M, Qureshi N .
Practices and changes associated with patient-centered medical home transformation.
Am J Manag Care 2021 Sep;27(9):386-93. doi: 10.37765/ajmc.2021.88740..
Keywords:
Patient-Centered Healthcare, Primary Care, Practice Improvement, Healthcare Delivery, Quality Improvement, Quality of Care
Quigley DD, Qureshi N, AlMasarweh L
Using CAHPS patient experience data for patient-centered medical home transformation.
The purpose of this study was to examine how primary care practices used the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and its patient-centered medical home (PCMH) items during their PCMH transition. The investigators concluded that CAHPS surveys were considered actionable for PCMH transformation and used in standardizing and coordinating care. The CAHPS PCMH items were considered integral to the continuous QI needed for moving beyond formal PCMH recognition and maximizing transformation.
AHRQ-funded; HS016980; HS025920.
Citation:
Quigley DD, Qureshi N, AlMasarweh L .
Using CAHPS patient experience data for patient-centered medical home transformation.
Am J Manag Care 2021 Sep;27(9):e322-e29. doi: 10.37765/ajmc.2021.88745..
Keywords:
Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Experience, Patient-Centered Healthcare, Primary Care, Practice Improvement, Healthcare Delivery, Quality Improvement, Quality of Care
Berry CA, Nguyen AM, Cuthel AM
Measuring implementation strategy fidelity in HealthyHearts NYC: a complex intervention using practice facilitation in primary care.
This study measured implementation strategy fidelity for the HealthyHearts NYC intervention program, an AHRQ-funded program that uses practice facilitation (PF) to improve adoption of cardiovascular disease evidence-based guidelines in primary care practices. Data from 257 practices measured fidelity using 4 categories: frequency, duration, content, and coverage. Almost all (94.2%) of practices received at least the 13 PF visits with an average 26.3 hours spent at each site by facilitators. Most practices (95.7%) completed all Task List items, and 71.2% were educated on all Chronic Care Models, with the majority (65.8%) receiving full coverage.
AHRQ-funded; HS023922.
Citation:
Berry CA, Nguyen AM, Cuthel AM .
Measuring implementation strategy fidelity in HealthyHearts NYC: a complex intervention using practice facilitation in primary care.
Am J Med Qual 2021 Jul-Aug;36(4):270-76. doi: 10.1177/1062860620959450..
Keywords:
Implementation, Heart Disease and Health, Cardiovascular Conditions, Primary Care, Practice Improvement, Quality Improvement, Quality of Care, Evidence-Based Practice, Patient-Centered Outcomes Research, Primary Care: Models of Care
Fagnan LJ, Ramsey K, Kline T
Place matters: closing the gap on rural primary care quality improvement capacity-the Healthy Hearts Northwest study.
This study compared rural independent and health system primary care practices with urban practices to external practice facilitation support in terms of recruitment, readiness, engagement, retention, and change in quality improvement (QI) capacity and quality metric performing. The Healthy Hearts Northwest quality improvement initiative consisting of 135 small or medium-sized primary care practices were used. The practices were stratified by geography, rural or urban, and by ownership. Changes in 3 clinical quality measures (CQMs): appropriate aspirin use, blood pressure (BP) control, and tobacco use screening, were measured at baseline in 2015 and follow-up in 2017. Rural practices were more likely to enroll than urban practices. Rural independent practices had the lowest QI capacity at baseline, making the largest gain in establishing a regular QI process. They made the greatest improvement in meeting the BP control CQM and the smoking cessation metric, from 72.3% to 86.7%.
AHRQ-funded; HS023908; HS023921.
Citation:
Fagnan LJ, Ramsey K, Kline T .
Place matters: closing the gap on rural primary care quality improvement capacity-the Healthy Hearts Northwest study.
J Am Board Fam Med 2021 Jul-Aug;34(4):753-61. doi: 10.3122/jabfm.2021.04.210011..
Keywords:
Rural Health, Primary Care, Primary Care: Models of Care, Practice Improvement, Quality Improvement, Quality of Care, Heart Disease and Health, Cardiovascular Conditions
Abraham CM, Zheng K, Norful AA
Primary care nurse practitioner burnout and perceptions of quality of care.
Researchers investigated the relationship between primary care nurse practitioner (NP) burnout on perceptions of care quality and if the practice environment moderated the relationship between burnout and care quality. This was a secondary analysis of cross-sectional survey data from 396 NPs; the practice environment was measured using the Nurse Practitioner Primary Care Organizational Climate Questionnaire. The researchers found that burnout was related to lower perceptions of care quality but favorable environments were related to higher perceptions of quality.
AHRQ-funded; HS027290.
Citation:
Abraham CM, Zheng K, Norful AA .
Primary care nurse practitioner burnout and perceptions of quality of care.
Nurs Forum 2021 Jul;56(3):550-59. doi: 10.1111/nuf.12579..
Keywords:
Burnout, Provider: Nurse, Primary Care, Quality of Care
Pham-Singer H, Onakomaiya M, Cuthel A
Using a customer relationship management system to manage a quality improvement intervention.
HealthyHearts New York City (HHNYC), one of 7 cooperatives funded through the Agency for Healthcare Research and Quality's EvidenceNOW initiative, evaluated the impact of practice facilitation on implementation of the Million Hearts guidelines for cardiovascular disease prevention and treatment. Tracking the intervention required a system to facilitate process data collection that was also user-friendly and flexible. Coupled with protocols and training, a strategically planned and customizable customer relationship management system (CRMS) was implemented to support the quality improvement intervention with 257 small independent practices.
AHRQ-funded; HS023922.
Citation:
Pham-Singer H, Onakomaiya M, Cuthel A .
Using a customer relationship management system to manage a quality improvement intervention.
Am J Med Qual 2021 Jul-Aug;36(4):247-54. doi: 10.1177/1062860620953214..
Keywords:
Quality Improvement, Quality of Care, Implementation, Evidence-Based Practice, Cardiovascular Conditions, Heart Disease and Health, Primary Care
Hung DY, Mujal G, Jin A
Patient experiences after implementing lean primary care redesigns.
The authors examined the effect of Lean primary care redesigns on patient satisfaction with care and timeliness of care received. After implementation of Lean redesigns, they found that patients reported a 44.8 percent increase in satisfaction with the adequacy of time spent with care providers during office visits. They also reported 71.6 percent higher satisfaction with their care provider's ability to listen to their concerns and a 55.4 percent increase in perceived staff helpfulness at the visit. The amount of time elapsed between a patient request for a routine appointment and the scheduled visit day decreased. On the day of the visit, patient wait times to be seen also decreased gradually.
AHRQ-funded; HS024529.
Citation:
Hung DY, Mujal G, Jin A .
Patient experiences after implementing lean primary care redesigns.
Health Serv Res 2021 Jun;56(3):363-70. doi: 10.1111/1475-6773.13605..
Keywords:
Patient Experience, Primary Care: Models of Care, Primary Care, Workflow, Quality Improvement, Quality of Care
Hung DY, Truong QA, Liang SY
Implementing lean quality improvement in primary care: impact on efficiency in performing common clinical tasks.
Investigators examined 3-year impacts of Lean implementation on the amount of time taken for physicians to complete common clinical tasks. They found that Lean redesigns led to improvements in timely completion of 3 out of 4 common clinical tasks, thus supporting the use of Lean techniques to engage teams in routine aspects of patient care. They recommended more research to understand the mechanisms by which Lean promotes quality improvement and effectiveness of care team workflows.
AHRQ-funded; HS024529.
Citation:
Hung DY, Truong QA, Liang SY .
Implementing lean quality improvement in primary care: impact on efficiency in performing common clinical tasks.
J Gen Intern Med 2021 Feb;36(2):274-79. doi: 10.1007/s11606-020-06317-9..
Keywords:
Primary Care, Quality Improvement, Quality of Care, Primary Care: Models of Care, Primary Care, Implementation, Workflow, Teams, Healthcare Delivery
Solberg LI, Kuzel A, Parchman ML
A taxonomy for external support for practice transformation.
There is no commonly accepted comprehensive framework for describing the practical specifics of external support for practice change. In this study, the researchers’goal was to develop a taxonomy that could be used by both external groups or researchers and health care leaders. The leaders of 8 grants from Agency for Research and Quality for the EvidenceNOW study of improving cardiovascular preventive services in over 1500 primary care practices nationwide worked collaboratively over 18 months to develop descriptions of key domains that might comprehensively characterize any external support intervention.
AHRQ-funded; HS023940.
Citation:
Solberg LI, Kuzel A, Parchman ML .
A taxonomy for external support for practice transformation.
J Am Board Fam Med 2021 Jan-Feb;34(1):32-39. doi: 10.3122/jabfm.2021.01.200225..
Keywords:
Primary Care: Models of Care, Primary Care, Healthcare Delivery, Cardiovascular Conditions, Evidence-Based Practice, Prevention, Innovations and Emerging Issues, Quality Improvement, Quality of Care, Practice Improvement
Soylu TG, Cuellar AE, Goldberg DG
Engagement of small to medium-sized primary care practices in quality improvement efforts.
Engaging primary care practices in quality improvement (QI) efforts has been challenging. This study examined the association between practice readiness and practice characteristics and engagement during a targeted QI effort. The study analyzed cross-sectional data collected by the Heart of Virginia Health care, a cardiovascular disease QI intervention study with 195 practices. The investigators concluded that clinicians and leadership involvement in QI efforts was critical. They indicated that the findings suggested QI plans should involve clinicians and leaders early in the process to foster commitment, establish practice readiness, and sustain improvement efforts.
AHRQ-funded; HS023913.
Citation:
Soylu TG, Cuellar AE, Goldberg DG .
Engagement of small to medium-sized primary care practices in quality improvement efforts.
J Am Board Fam Med 2021 Jan-Feb;34(1):40-48. doi: 10.3122/jabfm.2021.01.200153..
Keywords:
Primary Care, Quality Improvement, Quality of Care, Provider
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.
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
Quigley DD, Qureshi N, Masarweh LA
Practice leaders report targeting several types of changes in care experienced by patients during patient-centered medical home transformation.
This study looked at how primary care practices implemented changes during the transition to becoming a patient-centered medical home (PCMH). The authors examined 105 primary care practice leader experiences during PCMH transformation using semi-structured interviews. Practices most commonly targeted changes in care coordination (30%), access to care (25%), and provider communication (24%). Reported areas for PCMH transformation were measured by Clinician & Group CAHPS, PCMH CAHPS, or supplemental CAHPS survey items, including team-based care (35%), providing more on-site services (28%), care management (22%), patient-centered culture (18%), and chronic condition health education (13%). Many PCMH changes are captured by CAHPS survey items, but some are not.
AHRQ-funded; HS025920.
Citation:
Quigley DD, Qureshi N, Masarweh LA .
Practice leaders report targeting several types of changes in care experienced by patients during patient-centered medical home transformation.
J Patient Exp 2020 Dec;7(6):1509-18. doi: 10.1177/2374373520934231..
Keywords:
Consumer Assessment of Healthcare Providers and Systems (CAHPS), Primary Care: Models of Care, Primary Care, Patient-Centered Healthcare, Patient Experience, Care Coordination, Quality Improvement, Quality of Care, Implementation
Zhou RA, Beaulieu ND, Cutler D
Primary care quality and cost for privately insured patients in and out of US health systems: evidence from four states.
The purpose of this study was to characterize physician health system membership in four states between 2012 and 2016 and to compare primary care quality and cost between in-system providers and non-system providers for the commercially insured population. Investigators concluded that a growing share of physicians were part of a health system from 2012 to 2016.
AHRQ-funded; HS024072.
Citation:
Zhou RA, Beaulieu ND, Cutler D .
Primary care quality and cost for privately insured patients in and out of US health systems: evidence from four states.
Health Serv Res 2020 Dec;55(Suppl 3):1098-106. doi: 10.1111/1475-6773.13590.
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Keywords:
Primary Care, Quality of Care, Health Insurance, Healthcare Costs
Harder VS, Shaw JS, McCulloch CE
Statewide asthma learning collaborative participation and asthma-related emergency department use.
This study looked at outcomes from participation of pediatric practices in a quality improvement (QI) collaborative to decrease asthma-related emergency department (ED) visits. A statewide network of practices participated in the collaborative from 2015 to 2016. Asthma-related ED visit rates per 100 child-years for children ages 3 to 21 was evaluated using the state’s all-payer claims databases. The authors found that in the postintervention year (2017) participating practices’ ED visit rate decreased by 5.8 per 100 child-years, compared to an increase of 1.8 per 100 child-years in non-participating practices. There were no statistically significant differences in asthma-related ED visit rates during 2016, which indicated that it took some time for QI elements to be successfully implemented in pediatric practices.
AHRQ-funded; HS025297.
Citation:
Harder VS, Shaw JS, McCulloch CE .
Statewide asthma learning collaborative participation and asthma-related emergency department use.
Pediatrics 2020 Dec;146(6):e20200213. doi: 10.1542/peds.2020-0213..
Keywords:
Children/Adolescents, Asthma, Emergency Department, Quality Improvement, Quality of Care, Primary Care, Guidelines
Aysola J, Xu C, Huo H
The relationships between patient experience and quality and utilization of primary care services.
This study examined the associations between visit-triggered patient-reported experience measures and both quality of care measures and the number of missed primary care appointments. A cross-sectional analysis of 8355 primary care patients from 22 primary care practices was conducted. Outcomes measured included: smoking cessation discussion, diabetes eye examination referral, mammography, colonoscopy screening, current smoking status, diabetes control hemoglobin A1c, blood pressure control, cholesterol control LDL among patients with diabetes, and visit no shows 2 and 5 years after the index visit. The authors found that patient experience can be an important stand-alone metric of care quality, although it may not relate to clinical outcomes or process measures in the outpatient setting.
AHRQ-funded; HS021706.
Citation:
Aysola J, Xu C, Huo H .
The relationships between patient experience and quality and utilization of primary care services.
J Patient Exp 2020 Dec;7(6):1678-84. doi: 10.1177/2374373520924190..
Keywords:
Patient Experience, Primary Care, Primary Care: Models of Care, Patient-Centered Healthcare, Quality Improvement, Quality of Care
Fernald DH, Mullen R,, Hall T
Exemplary practices in cardiovascular care: results on clinical quality measures from the EvidenceNOW Southwest Cooperative.
The authors identified practice characteristics associated with high performance on four cardiovascular disease cardiovascular clinical quality measures (CQMs). They found that multiple strategies - registries, prompts and protocols, patient self-management support, and patient-team partnership activities - were associated with delivering high-quality cardiovascular care over time, measured by CQMs.
AHRQ-funded; HS023904.
Citation:
Fernald DH, Mullen R,, Hall T .
Exemplary practices in cardiovascular care: results on clinical quality measures from the EvidenceNOW Southwest Cooperative.
J Gen Intern Med 2020 Nov;35(11):3197-204. doi: 10.1007/s11606-020-06094-5..
Keywords:
Cardiovascular Conditions, Quality Indicators (QIs), Quality Measures, Quality Improvement, Quality of Care, Evidence-Based Practice, Patient-Centered Outcomes Research, Primary Care
