Our experiences studying exemplar primary care practices, and our work assisting other practices to become more patient centered, led a formulation of the essential elements care, which we call 10 building blocks high-performing care. The include 4 foundational elements—engaged leadership, data-driven improvement, empanelment, team-based care—that assist implementation 6 blocks—patient-team partnership, population management, continuity prompt access comprehensiveness coordination, template...

We highlight primary care innovations gathered from high-functioning practices, we believe can facilitate joy in practice and mitigate physician burnout. To do so, made site visits to 23 high-performing practices focused on how these distribute functions among the team, use technology their advantage, improve outcomes with data, make job of feasible enjoyable as a life’s vocation. Innovations identified include (1) proactive planned care, previsit planning laboratory tests; (2) sharing...

<h3>PURPOSE</h3> Levels of burnout among primary care clinicians and staff are alarmingly high, there is widespread belief that lack employee engagement contribute to high turnover the workforce. Scant research evidence exists support this assertion, however. <h3>METHODS</h3> We conducted a longitudinal cohort study using survey data on collected in 2013 2014 from 740 2 San Francisco health systems, matched employment roster 2016. <h3>RESULTS</h3> Prevalence burnout, low engagement, were...

Abstract Objectives The study sought to determine whether objective measures of electronic health record (EHR) use—related time, volume work, and proficiency—are associated with either or both components clinician burnout: exhaustion cynicism. Materials Methods We combined Maslach Burnout Inventory survey (94% response rate; 122 130 clinicians) objective, vendor-defined EHR use from log files (time after hours on clinic days; time nonclinic message volume; composite efficiency proficiency)....

<h3>Purpose:</h3> Burnout is a threat to the primary care workforce. We investigated relationship between team structure, culture, and emotional exhaustion of clinicians staff in practices. <h3>Methods:</h3> surveyed 231 280 members 10 public 6 university-run clinics San Francisco 2012. Predictor variables included such as working tight teamlet, perception culture. The outcome variable was Maslach scale. Generalized estimation equation models were used account for clustering at clinic level....

Health coaching by medical assistants could be a financially viable model for providing self-management support in primary care if its effectiveness were demonstrated. We investigated whether in-clinic health improves control of cardiovascular and metabolic risk factors when compared with usual care.We conducted 12-month randomized controlled trial 441 patients at 2 safety net clinics San Francisco, California. The outcome was composite measure being or below goal 12 months least 1 3...

<h3>Background:</h3> A recent regional study found lower burnout among primary care clinicians who perceived that their clinic had greater capacity to meet patients9 social needs. We aimed more comprehensively investigate the association between address needs and by using national data included a representative sample of family physicians comprehensive set practice-level variables are potential confounders an burnout. <h3>Methods:</h3> conducted cross-sectional analysis 1298 in ambulatory...

Many patients with chronic disease do not reach goals for management of their conditions. Self-management support provided by medical assistant health coaches within the clinical setting may help to improve outcomes, but most studies date lack statistical power or methodological rigor. Barriers large scale implementation coach model include clinician buy-in and absence a business that will make coaching sustainable. This study add evidence base determining effectiveness assistants on...

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<h3>Background:</h3> Lack of concordance between medications listed in the medical record and taken by patient contributes to poor outcomes. We sought determine whether patients who received health coaching assistants improved their medication adherence. <h3>Methods:</h3> This was a nonblinded, randomized, controlled, pragmatic intervention trial. English- or Spanish-speaking patients, age 18 75 years, with poorly controlled type 2 diabetes, hypertension, and/or hyperlipidemia were enrolled...

Primary care physicians (PCP) experience high rates of professional burnout. These symptoms may be magnified in underserved populations. This study explores relationships between clinic capacity to address patients' social needs (SN) and PCP burnout.We conducted a cross-sectional survey PCPs from three delivery systems San Francisco. Surveys included components burnout, measured by the Maslach Burnout Inventory (MBI) four-item instrument exploring attitudes, confidence, individual skills...

<h3>PURPOSE</h3> Primary care clinicians disproportionately report symptoms of burnout, threatening workforce sustainability and quality care. Recent surveys that these are greater when perceive fewer clinic resources to address patients' social needs. We undertook this study better understand the relationship between burnout capacity <h3>METHODS</h3> completed semistructured, in-person interviews brief with 29 primary serving low-income populations. Interview survey topics included analyzed...

<h3>Context and Objective:</h3> Patient advisory councils (PACs) are a strategy for primary care clinics to engage patients in practice improvement. However, there is scant research on how PACs function. This study aimed understand organized identify common challenges perceived benefits of high-functioning PACs. <h3>Setting Population:</h3> Key informants identified 8 California with Leaders from each the nominated 1 clinic staff member PAC patient be interviewed. <h3>Study Design:</h3>...

To assess the impact of health coaching on patients' in their primary care provider.Randomized controlled trial comparing with usual care.Low-income English or Spanish speaking patients age 18-75 poorly type 2 diabetes, hypertension and/or hyperlipidemia.Patient trust provider measured by 11-item Trust Physician Scale, converted to a 0-100 scale.Linear mixed modeling.A total 441 were randomized receive 12 months (n=224) vs. (n=217). At baseline, two groups similar those group respect...

<h3>PURPOSE</h3> Health coaching is effective for chronic disease self-management in the primary care safety-net setting, but little known about persistence of its benefits. We conducted an observational study evaluating maintenance improved cardiovascular risk factors following a health intervention. <h3>METHODS</h3> performed naturalistic follow-up to Coaching Primary Care Study, 12-month randomized controlled trial (RCT) comparing usual patients with uncontrolled diabetes, hypertension,...

Abstract Background In 2021, CMS changed ambulatory evaluation and management (E/M) documentation requirements to reduce physician burden. No prior work has assessed primary care (PCP) perceptions of the impact these changes. Objective To determine whether physicians both perceived objectively experienced a reduction in time. Design We used cross-sectional longitudinal survey data PCPs linked it electronic health record (EHR) data. The setting was large academic medical center (UCSF Health)....

Recruitment and retention are two significant barriers in research, particularly for historically underrepresented groups, including racial ethnic minorities, patients who low-income, or people with substance use mental health issues. Chronic obstructive pulmonary disease (COPD) is the third leading cause of death disproportionately affects many groups. The lack representation these groups research limits generalizability applicability clinical results. In this paper we describe our...

<h3>PURPOSE</h3> The quadruple aim of primary care transformation includes promoting well-being among the workforce. We longitudinally assessed burnout clinicians and staff in 2 health delivery organizations engaged redesign guided by a shared model. <h3>METHODS</h3> conducted descriptive longitudinal study, using repeated cross-sectional measures from 6 waves surveys employed (physicians, nurse practitioners, physician assistants) between 2012 to 2018 San Francisco Health Network UCSF...

Socioeconomically disadvantaged patients with chronic obstructive pulmonary disease (COPD) often face barriers to evidence-based care that are difficult address in public settings limited resources.

<h3>Introduction:</h3> The delivery of team-based care relies on team structure and teamwork. Little is known about the landscape configurations in family medicine practices United States. Teamwork between diverse members likely impacts both performance physician well-being. We examined configuration teamwork whether they are associated with (FP) <h3>Methods:</h3> used data from practice demographic questionnaires completed by FPs who registered for American Board Family Medicine...

Many primary care practices have created a team structure in which clinician and medical assistant "teamlet" form the core of larger team. The comprises few teamlets supported by other clinical personnel. Patients are empaneled to particular teamlet. teamlet structure, turns large into small units, is attractive patients, most whom prefer rather than practices. Clinicians working stable teamlets, with same every day, less burnout clinicians different assistants on days. model can thus create...

<h3>PURPOSE</h3> Poor adherence to medications is more prevalent for chronic obstructive pulmonary disease (COPD) than other conditions and associated with unfavorable health outcomes. Few interventions have successfully improved COPD medications; none of these use unlicensed care personnel. We explored the efficacy lay coaches improve inhaler technique. <h3>METHODS</h3> Within a randomized controlled trial, we recruited English- Spanish-speaking patients moderate severe from urban, public...