A5081206712- Primary Care and Health Outcomes
- Health Policy Implementation Science
- Patient-Provider Communication in Healthcare
- Interprofessional Education and Collaboration
- Patient Satisfaction in Healthcare
- Empathy and Medical Education
- Food Security and Health in Diverse Populations
- Public Health Policies and Education
- COVID-19 and Mental Health
- COVID-19 and healthcare impacts
- Telemedicine and Telehealth Implementation
- Blood Pressure and Hypertension Studies
- Mobile Health and mHealth Applications
- Community Health and Development
- Healthcare cost, quality, practices
- Skin Protection and Aging
- Mental Health and Patient Involvement
- Cultural Competency in Health Care
- Global Health Workforce Issues
- Cardiac, Anesthesia and Surgical Outcomes
- Health Systems, Economic Evaluations, Quality of Life
- Chronic Disease Management Strategies
- Sepsis Diagnosis and Treatment
- Innovations in Medical Education
- Interpreting and Communication in Healthcare
Stanford University
2019-2025
Berkeley Public Health Division
2022-2023
University of California, Berkeley
2020-2023
Stanford Health Care
2020
Stanford Medicine
2019
Abstract Introduction The Consolidated Framework for Implementation Research (CFIR) is a commonly used implementation science framework to facilitate design, evaluation, and of evidence‐based interventions. Its comprehensiveness an asset considering facilitators barriers also makes the cumbersome use. We describe adaptations we made CFIR simplify its pragmatic application, use in learning health system context, evaluation complex patient‐centered care transformation. Methods conducted...
Abstract Background Innovations to improve quality and safety in healthcare are increasingly complex, targeting multiple disciplines organizational levels, often requiring significant behavior change by those delivering care. Learning health systems must tackle the crucial task of understanding implementation effectiveness complex interventions, but may be hampered their efforts limitations study design imposed business-cycle timelines into fast-paced clinical environments. Rapid assessment...
Health care systems throughout the United States are initiating collaborations with social services agencies. These cross-sector aim to address patients' needs-such as housing, food, income, and transportation-in health settings. However, such can be challenging service sectors composed of distinct missions, institutions, professional roles, modes distributing resources. This paper examines how "high-risk" patient both medical needs is constructed a shared object intervention across sectors....
Abstract Background Current evaluation methods are mismatched with the speed of health care innovation and needs delivery partners. We introduce a qualitative approach called lightning report method its specific product—the “Lightning Report.” compare implementation results across four projects to explore sensitivity potential depth breadth findings. Methods The was refined over 2.5 years projects: team‐based primary care, cancer center transformation, precision in national life‐sustaining...
Abstract Objective To examine how a preexisting initiative to align health care, public health, and social services influenced COVID‐19 pandemic response. Data Sources Study Setting In‐depth interviews with administrators frontline staff in Contra Costa County, California from October, 2020, May, 2021. Design Qualitative, semi‐structured examined response used resources developed for system alignment prior the pandemic. Collection We interviewed 31 informants including 14 managers or 17...
Objective We sought to investigate the concept and practices of ‘clinician presence’, exploring how physicians professionals create connection, engage in interpersonal interaction, build trust with individuals across different circumstances contexts. Design In 2017–2018, we conducted qualitative semistructured interviews 10 30 non-medical from fields protective services, business, management, education, art/design/entertainment, social legal/personal services. Setting Physicians were...
ABSTRACT Objective To assess the equitable implementation of a case management program integrating medical and social services for Medicaid members. Study Setting Design This qualitative study assessed in Contra Costa County, CA. participants were identified using purposive sampling. Semi‐structured interviews conducted person or by phone. Data Sources Analytic Sample Primary data collected between Fall 2019 Spring 2021 included 92 semi‐structured with patients ( n = 31), managers 47),...
<h3>PURPOSE</h3> Assess effectiveness of Primary Care 2.0: a team-based model that incorporates increased medical assistant (MA) to primary care physician (PCP) ratio, integration advanced practice clinicians, expanded MA roles, and extended the interprofessional team. <h3>METHODS</h3> Prospective, quasi-experimental evaluation staff/clinician team development wellness survey data, comparing 2.0 conventional clinics within our academic health system. We surveyed before launch every 6-9...
The COVID-19 pandemic created new challenges to delivering safe and effective health care while minimizing virus exposure among staff patients without COVID-19. Health systems worldwide have moved quickly implement telemedicine in diverse settings reduce infection, but little is understood about how best connect who are acutely ill with nearby clinical team members, even the next room.To inform these efforts, this paper aims provide an early example of inpatient implementation its perceived...
In recent years, health care policy makers have focused increasingly on addressing social drivers of as a strategy for improving and equity. Impacts social, economic, environmental conditions are well established. However, less is known about the implementation impact approaches used by providers payers to address in clinical settings. This article reviews current efforts US organizations public such Medicaid Medicare at individual community levels. We summarize limited available evidence...
Abstract Background Humanwide was precision health embedded in primary care aiming to leverage high-tech and high-touch medicine promote wellness, predict prevent illness, tailor treatment individual medical psychosocial needs. Methods We conducted a study assessing implementation outcomes inform spread scale, using mixed methods of semi-structured interviews with diverse stakeholders chart reviews. included: 1) coaching; 2) four digital tools for blood-pressure, weight, glucose, activity;...
To assess multi-level factors influencing the sustainability of 26 social care pilots integrating medical and services for Medicaid enrollees across California in newly developed benefits. This qualitative study assessed Whole Person Care (WPC) implemented between 2016 2021. Pilots (n = 26) represented a majority counties California. Primary data were collected June August 2021 included 58 hour-long, semi-structured individual group interviews with administrators, middle managers, frontline...
Implementing team-based care into existing primary is challenging; understanding facilitators and barriers to implementation critical. We assessed adoption acceptability of new roles in the first 6 months launching a model focused on preventive care, population health, psychosocial support.We conducted qualitative rapid ethnography at community-based test clinic, including 74 hours observations 28 semi-structured interviews. identified themes related specifically integration three...
To identify communication practices that clinicians can use to address racism faced by Black patients, build trusting relationships, and empower individuals in clinical care.Qualitative data (N = 112 participants, August 2020-March 2021) collected partnership with clinics primarily serving patients Leeds, AL; Memphis, TN; Oakland, CA; Rochester, NY.This multi-phased project was informed human-centered design thinking community-based participatory research principles. We mapped emergent...
Social needs case management programs are a strategy to coordinate social and medical care for high-risk patients. Despite widespread interest in management, not all interventions have shown effectiveness. A lack of evidence about the mechanisms through which these complex benefit patients inhibits effective translation new settings. The CommunityConnect program Contra Costa County, California recently demonstrated an ability reduce inpatient hospital admissions by 11% randomized study. We...
Abstract Objective To identify collaboration strategies used to integrate health, behavioral and social services for Medicaid members in California's Medi‐Cal Whole Person Care Pilot program (WPC). Data Sources Study Setting WPC was a care intervention implemented address eligible members' needs. included semi‐structured key informant interviews conducted 2018–2019 ( n = 221) 2021 167); pilot‐level surveys; whole‐network surveys of 507 organizations all 25 pilots participating WPC; documents...
Background The early identification of clinical deterioration in patients hospital units can decrease mortality rates and improve other patient outcomes; yet, this remains a challenge busy settings. Artificial intelligence (AI), the form predictive models, is increasingly being explored for its potential to assist clinicians predicting deterioration. Objective Using Systems Engineering Initiative Patient Safety (SEIPS) 2.0 model, study aims assess whether an AI-enabled work system improves...
Hypertension is the most prevalent and important risk factor for cardiovascular disease, affecting nearly 50% of US adult population; however, only 30% these patients achieve controlled blood pressure (BP). Incorporating strategies into primary care that take consideration individual patient needs, such as remote BP monitoring, may improve hypertension management.From March 2018 to December 2018, Stanford implemented a precision health pilot called Humanwide, which aimed leverage...