A5051689841- Primary Care and Health Outcomes
- Health Policy Implementation Science
- Diabetes Management and Education
- Chronic Disease Management Strategies
- Health Systems, Economic Evaluations, Quality of Life
- Opioid Use Disorder Treatment
- Healthcare Policy and Management
- Patient Satisfaction in Healthcare
- Healthcare cost, quality, practices
- Diabetes Management and Research
- Pharmaceutical Practices and Patient Outcomes
- Clinical practice guidelines implementation
- Patient-Provider Communication in Healthcare
- Healthcare Systems and Technology
- Interprofessional Education and Collaboration
- Pain Management and Opioid Use
- Musculoskeletal pain and rehabilitation
- Mental Health and Patient Involvement
- Geriatric Care and Nursing Homes
- Health Sciences Research and Education
- Cardiac Health and Mental Health
- Diabetes, Cardiovascular Risks, and Lipoproteins
- Food Security and Health in Diverse Populations
- Healthcare Quality and Management
- Substance Abuse Treatment and Outcomes
Kaiser Permanente Washington Health Research Institute
2016-2025
ORCID
2025
Institute of Translational Health Sciences
2018-2024
University of Washington
2016-2024
Kaiser Permanente
2019-2024
Oregon Health & Science University
2020-2021
Qualis Health
2021
Clearwater Valley Hospital and Clinics
2019-2021
Research Network (United States)
2013-2021
HealthPartners
2021
Improving health outcomes relies on patients’ full engagement in prevention, decision-making, and self-management activities. Health literacy, or people’s ability to obtain, process, communicate, understand basic information services, is essential those actions. Yet relatively few Americans are proficient understanding acting available information. We propose a Literate Care Model that would weave literacy strategies into the widely adopted (formerly known as Chronic Model). Our model calls...
<b>PURPOSE</b> Participatory decision making (PDM) is associated with improved diabetes control. We examine a causal model linking PDM to clinical outcomes that included patient activation and medication adherence. <b>METHODS</b> This observational study was conducted in 5 family physician offices. Diabetic patients were recruited by mail completing interest card at the conclusion of their office visit. Two survey questionnaires, administered 12 months apart, elicited patients’ ratings...
Objectives. The authors examine whether the odds of having a hospitalization associated with an ambulatory care sensitive condition can be explained by observed differences in Medicare beneficiary's predisposing, enabling, and need characteristics. Methods. A multivariate cross-sectional analysis Medicare's administrative inpatient claims data Current Beneficiary Survey was conducted on nationally representative sample beneficiaries. Each hospital utilization classified into one three...
The purpose of this study was to examine the relationship between diabetes-specific family support and other psychosocial factors with regard diet exercise self-care behavior among older Mexican Americans type 2 diabetes.Adults aged 55 years who presented for care in a primary clinic diabetes (N=138) completed survey assess specific diabetes, barriers self-management, self-efficacy, activities. Multivariate regression analyses were conducted evaluate activities exercise.Higher levels...
<b>PURPOSE</b> This study aimed to examine the contribution of competing demands changes in hypoglycemic medications and return appointment intervals for patients with type 2 diabetes an elevated glycosylated hemoglobin (A<sub>1c</sub>) level. <b>METHODS</b> We observed 211 primary care encounters by adult 20 clinics documented medications. Competing were assessed from length encounter, number concerns raised, topics brought up clinician. Days next scheduled obtained at patient checkout....
We aimed to advance the internal and external validity of research by sharing our empirical experience recommendations for systematically reporting contextual factors.Fourteen teams conducting on primary care practice transformation retrospectively considered factors important interpreting their findings (internal validity) transporting or reinventing in other settings/situations (external validity). Each team provided a table list interpretive text included as appendices articles this...
Healthcare facilitation, an implementation strategy designed to improve the uptake of effective clinical innovations in routine practice, has produced promising yet mixed results randomized trials and not been fully researched across different contexts.
Background. The influence of continuity care on outcomes for patients with type 2 diabetes is poorly understood. Objective. To examine the relationships between continuity, glucose control, and advancement through stages change selfmanagement behaviors. Design. Prospective cohort study. Setting. Five community health centers Texas-Mexico border. Subjects. A random sample 256 adults, 18 years age older an established diagnosis diabetes. Measures. Stage diet exercise were assessed during two...
Health care outcomes among vulnerable elderly populations (defined in this study as Medicare beneficiaries who rated their overall general health "fair" or "poor") are a growing concern. Recent studies suggest that potentially preventable hospitalizations may be useful for identifying poor ambulatory populations.To determine if fair at increased risk of experiencing hospitalization they reside primary professional shortage areas.A survey from the 1991 Current Beneficiary Survey.Medicare...
Despite the development of several models care delivery for patients with chronic illness, consistent improvements in outcomes have not been achieved. These inconsistent results may be less related to content themselves, but their underlying conceptualization clinical settings as linear, predictable systems. The science complex adaptive systems (CAS), suggests that are non-linear, and increasingly has used a framework describing understanding purpose this study is broaden by examining...
Our purpose in this article is to describe and illustrate the application of cluster analysis identify clinically relevant multimorbidity groups. Multimorbidity co-occurrence 2 or more illnesses within a single person, which raises question whether consistent, useful groups exist among sets chronic illnesses. Application involves sequence critical methodological analytic decisions that influence quality meaning clusters produced. We set 45 primary care patients (N = 1,327,328), with...
Although multiple co-occurring chronic illnesses within the same individual are increasingly common, few studies have examined challenges of multimorbidity from patient perspective.The aim this study is to examine self-management learning needs and willingness see non-physician providers patients with compared single illnesses.This research designed as a cross-sectional survey.Based upon ICD-9 codes, VHA healthcare system were stratified into clusters or groups illness corresponding cluster....
Recent research from a complexity theory perspective suggests that implementation of complex models care, such as the Chronic Care Model (CCM), requires strong relationships and learning capacities among primary care teams.Our aim was to assess extent which practice member perceptions relational coordination reciprocal were associated with presence CCM elements in community-based practices.We used baseline measures cluster randomized controlled trial testing facilitation intervention...
Practice facilitation (PF) is an implementation strategy now commonly used in primary care settings for improvement initiatives. PF occurs when a trained external facilitator engages and supports the practice its change efforts. The purpose of this group-randomized trial to assess as intervention improve delivery chronic illness care. A randomized 40 small practices who were initial or delayed (control) group. Trained facilitators worked with each one year implement tailored changes diabetes...
<h3>Summary</h3> Cognitive capacities afford contingent associations between sensory information and behavioral responses. We studied this problem using an olfactory delayed match to sample task whereby a odor specifies the association subsequent test rewarding action. Multi-neuron recordings revealed representations of odors in cortex, which were sufficient identify as match/non-match. Yet, inactivation downstream premotor area (ALM), but not orbitofrontal confined epoch preceding odor, led...
Many primary care practices are changing the roles played by members of their health teams. The purpose this article is to describe some these new roles, using authors' preliminary observations from 25 site visits high-performing across United States in 2012-2013. These sites visits, workforce creatively, were part Robert Wood Johnson Foundation-funded initiative, Primary Care Team: Learning From Effective Ambulatory Practices.Examples that authors observed on include medical assistants...
Unnecessary care contributes to high costs and places patients at risk of harm. While most providers support reducing low-value care, changing established practice patterns is difficult requires active engagement in sustained behavioral, organizational, cultural change. Here we describe an action-planning framework engage overused services.The informed by a comprehensive review social science theory literature, published reports successful unsuccessful efforts reduce interviews with...
Objective: The purpose of the study was to evaluate uses handheld computers (also called personal digital assistants, or PDAs) in family practice residency programs United States. Study Design: In November 2000, authors mailed a questionnaire program directors all American Academy Family Physicians (AAFP) and College Osteopathic Practice (ACOFP) Measurements: Data patterns use non-use were identified. Results: Approximately 50 percent (306 610) responded survey. Two thirds reported that used...