This study examines the Chronic Care Model (CCM) as a framework for preventing health risk behaviors such tobacco use, risky drinking, unhealthy dietary patterns, and physical inactivity. Data were obtained from primary care practices participating in national promotion initiative sponsored by Robert Wood Johnson Foundation. Practices owned hospital system exhibiting culture of quality improvement more likely to offer recommended services assessment, behavioral counseling, referral...

Background: Lean is a leading change strategy used in health care to achieve short-term efficiency and quality improvement while promising longer-term system transformation. Most research examines intervention address isolated problems, rather than broader systemic changes delivery. Moreover, no studies examine contextual influences on system-wide implementation efforts primary care. Purpose: The aim of this study was identify factors most critical implementing scaling redesigns across all...

In response to growing pressures on primary care, leaders have introduced a wide range of workforce and practice innovations, including team redesigns that delegate some physician tasks nonphysicians. One important question is how such innovations affect care members, particularly in view dissatisfaction burnout among healthcare professionals. We examine the work experiences physicians staff after implementing Lean-based workflow redesigns. This included co-locating medical assistant dyads,...

Although Lean management techniques are increasingly used in health care to improve quality and reduce costs, lessons about how successfully implement this approach on the front lines of delivery not well documented. In study, we highlight key facilitators barriers implementing among frontline primary providers.This case study took place at a large, ambulatory system serving nearly 1 million patients. In-depth interviews were conducted with physicians, staff, administrators identify factors...

Thailand has one of the 10 highest national rates traffic accidents, leading to a high incidence urethral stricture from bulbar straddle and pelvic fracture injuries. Various treatment options are offered including urethroplasty; however, failure significant societal burden. Outreach relationships were established between United States America (USA), Vietnam, by creating an intensive hands-on workshop mentorship model improve urethroplasty success. We aim report impact this partnership...

Background: Organizational culture is an important but underinvestigated feature of the work environment that can impact provider behavior, including adherence to clinical practice guidelines. There substantial evidence physician assistance smokers produce significant reductions in tobacco use. However, this has not been well translated into practice, as only a small proportion receive recommended treatment during medical visits. Purpose: This study examines organizational contextual primary...

As hospitals around the world increasingly face pressure to improve efficiency, “Lean” process improvement has become a popular approach improving patient flow. In this article, we examine nurses’ perspectives on implementation of Lean redesigns inpatient discharge process. We found that nurses experienced competing demands and tensions related their time professional roles responsibilities as result Lean. Four main themes included (a) addressing needs individual patients, while still...

To examine the chronic care model (CCM) as a framework for improving provider delivery of 5A tobacco cessation services.Cross-sectional surveys were used to obtain data from 497 health providers in 60 primary clinics serving low-income patients New York City. A hierarchical generalized linear modeling approach ordinal regression was estimate probability full service delivery, adjusting covariates and clustering effects. We examined associations between services, clinic implementation CCM...

The Affordable Care Act has extended coverage for uninsured and underinsured Americans, but it could exacerbate existing problems of access to primary care. Shared medical appointments (SMAs) are one way improve increase practice productivity, few studies have examined the patient's perspective on participation in SMAs. To understand patient experiences, 5 focus group sessions were conducted with a total 30 people San Francisco Bay Area. revealed that most participants felt they received...

This study characterized adult primary care medical assistant (MA) staffing. National Survey of Healthcare Organizations and Systems (n = 1,252) data were analyzed to examine practice characteristics associated with MA per clinician (PCC) staffing ratios. In 2021, few practices (11.4%) had ratios 2 or more MAs PCCs. Compared system-owned practices, independent (odds ratio [OR] 1.76, <i>P</i> &lt;0.05) group-owned (OR 2.09, likely have PCCs, as organizational cultures oriented innovation...

Tobacco taxes are one of the most effective policy interventions to reduce tobacco use. Tax avoidance, however, lessens public health benefits higher-priced cigarettes. Few studies examine responses cigarette tax policies, particularly among high-risk minority populations. This study examined prevalence and correlates avoidance changes in smoking behaviors Chinese American smokers New York City after a large increase.We conducted cross-sectional with data for 614 male from in-person...

To assess the reliability of data in electronic health records (EHRs) for measuring processes care among primary physicians (PCPs) and examine relationship between these measures clinical outcomes.EHR from 15,370 patients with diabetes, 49,561 hypertension, a group practice serving four Northern California counties.Exploratory factor analysis (EFA) multilevel analyses relationships variables scales control hemoglobin A1c, blood pressure (BP), low density lipoprotein (LDL) diabetes BP...

Abstract Objective To examine the effect of Lean primary care redesigns on patient satisfaction with and timeliness received. Data/Setting We used surveys time‐stamped electronic health record (EHR) data in a large ambulatory system. Design Lean‐based changes to clinical spaces team workflows were implemented one pilot site then scaled all departments across Redesigns included standardizing equipment education materials examination rooms, streamlining call management functions, co‐locating...

<h3>PURPOSE</h3> Little is known about reasons why a medical group would seek recognition as patient-centered home (PCMH). We examined the motivations for seeking in one and assessed allowed to lapse 3 years later. <h3>METHODS</h3> As part of larger mixed methods case study, we conducted 38 key informant interviews with executives, clinicians, front-line staff. Interviews were according guide that evolved during project audio-recorded fully transcribed. Transcripts analyzed thematically...

Background: Complex system interventions benefit from close attention to factors affecting implementation and resultant outcomes. This article describes a framework for examining these in process redesign (PR) assessing PR Methods: Using literature scans expert comment on draft frameworks based the Consolidated Framework Implementation Research, team of researchers developed Agency Healthcare Research Quality. As case study, an independent large care subsequently applied Lean-based primary...

Although organizational context can affect the implementation of quality initiatives, we know less about influence contextual conditions on outcomes. We examined features primary care clinics that achieved greatest performance improvements after implementing Lean redesigns.We used operational data and baseline (ie, pre-Lean implementation) surveys 1333 physicians staff in 43 located across a large ambulatory system. Segmented regression with interrupted time series analysis was to identify...