Ann O'Malley - Academia.edu (original) (raw)
Papers by Ann O'Malley
Journal of health care for the poor and underserved, 2002
Many areas have high cancer mortality rates and medically underserved populations. This study des... more Many areas have high cancer mortality rates and medically underserved populations. This study describes the feasibility (acceptability and costs) of an urban multiphasic (multiple cancers) screening van. Feasibility was evaluated by literature review and informant interviews. Costs were estimated by resource use from urban mobile screening units; decision analysis estimated the costs per cancer detected for breast, cervix, colorectal, and prostate cancer screening. Acceptability of a multiphasic van varied by the informant's perspective. Feasibility and costs were most sensitive to four parameters: age, prior screening history, risk factors, and volume of simultaneous examinations. Subsidized mobile screening facilities may have the potential to reduce cancer morbidity and mortality if they target hard-to-reach underscreened groups, maintain high volume, coordinate with primary care providers, and build on an infrastructure that provides diagnostic and treatment services regardl...
Excerpt from interview guide. (DOCX 32Â kb)
Excerpt from observation checklist. (DOCX 27Â kb)
Mathematica Policy Research Reports, 2015
Numerous studies have confirmed the central role of excellent primary care to any health system. ... more Numerous studies have confirmed the central role of excellent primary care to any health system. Yet how to define the presence of excellent primary care remains a challenge.
Journal of General Internal Medicine, 2021
Comprehensiveness is a key element of primary care [1, 2, 3], and is highlighted in several natio... more Comprehensiveness is a key element of primary care [1, 2, 3], and is highlighted in several national primary care transformation initiatives [4]. It has been defined as the extent to which a patient’s primary care provider (practitioner, practice, or team) recognizes and meets the large majority of the patient’s physical and common mental health care needs, including prevention and wellness, and acute, chronic, and comorbid condition management [3]. This concept invokes several aspects of patient care [5]. These include the depth and breadth of conditions managed by the primary care practitioner (PCP), as well as the extent to which the PCP can effectively address the many relatively common problems their patients may experience [5, 6]. Recently, Medicare claims have been used to develop reliable and valid measures of these two dimensions of primary care comprehensiveness [6, 7]. The range of services primary care practices provide is a third key aspect of comprehensive primary care...
Journal of General Internal Medicine, 2018
C are management is a patient-centered approach to helping patients and their support systems bet... more C are management is a patient-centered approach to helping patients and their support systems better manage health conditions. 1 It includes patient education, goal setting, and self-management support. As part of such efforts, the term Bcare manager^is often used to refer to the activities of a nurse who works closely with patients and their primary care team to help provide chronic care management and coordination during care transitions. When implemented in a controlled manner-with rigorous training and adequate resources-care managers' work has the potential to improve chronic condition management and to lower costs. 2 However, evaluations of care managers in the Breal-world^have shown that their effectiveness varies, due in part to wide variation in implementation. Determining whether care managers improve patient outcomes and are cost-effective first requires a clearer understanding of how to incorporate them into primary care delivery. Key pieces of this puzzle include understanding where to place the care manager (in the practice, in the larger health-care delivery system, or at a health plan); who is best situated to employ and supervise the care manager (health plans, provider organizations, or practice sites); and how to integrate the care manager into the primary care team. Prior work suggests that embedded care managers are better at improving chronic condition management than care managers who are located outside the practice. 3-5 A study by Holtrop and colleagues 6 in this issue of the Journal of General Internal Medicine brings us a step closer to understanding why this might be the case. Holtrop et al. used social network analysis to gain insight into the communication patterns of primary care teams and care managers across a range of care management structures. Specifically, they sought to answer two questions:
Health Services Research, 2019
To develop claims-based measures of comprehensiveness of primary care physicians (PCPs) and summa... more To develop claims-based measures of comprehensiveness of primary care physicians (PCPs) and summarize their associations with health care utilization and cost. Data Sources and Study Setting: A total of 5359 PCPs caring for over 1 million Medicare fee-for-service beneficiaries from 1404 practices. Study Design: We developed Medicare claims-based measures of physician comprehensiveness (involvement in patient conditions and new problem management) and used a previously developed range of services measure. We analyzed the association of PCPs' comprehensiveness in 2013 with their beneficiaries' emergency department, hospitalizations rates, and ambulatory care-sensitive condition (ACSC) admissions (each per 1000 beneficiaries per year), and Medicare expenditures (per beneficiary per month) in 2014, adjusting for beneficiary, physician, practice, and market characteristics, and clustering. Principal Findings: Each measure varied across PCPs and had low correlation with the other measures-as intended, they capture different aspects of comprehensiveness. For patients whose PCPs' comprehensiveness score was at the 75th vs 25th percentile (more vs less comprehensive), patients had lower service use (P < 0.05) in one or more measures: involvement with patient conditions: total Medicare expenditures, −$17.4 (−2.2 percent); hospitalizations, −5.5 (−1.9 percent); emergency department (ED) visits, −16.3 (−2.4 percent); new problem management: total Medicare expenditures, −$13.3 (−1.7 percent); hospitalizations, −7.0 (−2.4 percent); ED visits, −19.7 (−2.9 percent); range of services: ED visits, −17.1 (−2.5 percent). There were no significant associations between the comprehensiveness measures and ACSC admission rates. Conclusions: These measures demonstrate strong content and predictive validity and reliability. Medicare beneficiaries of PCPs providing more comprehensive care had lower hospitalization rates, ED visits, and total Medicare expenditures.
The American journal of managed care, 2017
Risk-stratified care management is a cornerstone of patient-centered medical home models, but stu... more Risk-stratified care management is a cornerstone of patient-centered medical home models, but studies on patients' perspectives of care management are scarce. We explored patients' experiences with care management, what they found useful, and what needs improvement. Semi-structured qualitative telephone interviews. We interviewed 43 high-risk patients or their caregivers who were receiving care management from 11 practices in CMS' Comprehensive Primary Care initiative, provided by nurse care managers (9 practices) or the physician (2 [solo] practices). Patients' perceptions of care management were mixed. Patients who had regular contact with, and a desire to work with, their care manager valued the care management services provided. These patients valued care managers who listened to them and explained their conditions and options in lay terms, helped them navigate the healthcare system and community resources, and followed up after hospitalizations. However, one-fif...
Public reporting burden for this collection of information is estimated to average 1 hour per res... more Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to
JAMA internal medicine, 2017
JB. Diagnostic yield of syncope investigation (initiated) in the emergency department: a pilot st... more JB. Diagnostic yield of syncope investigation (initiated) in the emergency department: a pilot study.
MDM Policy & Practice, 2016
Introduction: Physicians vary widely in how they treat some health conditions, despite strong evi... more Introduction: Physicians vary widely in how they treat some health conditions, despite strong evidence favoring certain treatments over others. We examined physicians’ perspectives on factors that support or hinder evidence-based decisions and the implications for delivery systems, payers, and policymakers. Methods: We used Choosing Wisely® recommendations to create four clinical vignettes for common types of decisions. We conducted semi-structured interviews with 36 specialists to identify factors that support or hinder evidence-based decisions. We examined these factors using a conceptual framework that includes six levels: patients, physicians, practice sites, organizations, networks and hospital affiliations, and the local market. In this model, population characteristics and payer and regulatory factors interact to influence decisions. Results: Patient openness to behavior modification and expectations, facilitated and hindered physicians in making evidence-based recommendation...
Journal of medical Internet research, 2015
Although there is growing evidence of the positive effects of Internet-based patient-provider com... more Although there is growing evidence of the positive effects of Internet-based patient-provider communication (IPPC) services for both patients and health care providers, their implementation into clinical practice continues to be a challenge. The 3 aims of this study were to (1) identify and compare barriers and facilitators influencing the implementation of an IPPC service in 5 hospital units using the Consolidated Framework for Implementation Research (CFIR), (2) assess the ability of the different constructs of CFIR to distinguish between high and low implementation success, and (3) compare our findings with those from other studies that used the CFIR to discriminate between high and low implementation success. This study was based on individual interviews with 10 nurses, 6 physicians, and 1 nutritionist who had used the IPPC to answer messages from patients. Of the 36 CFIR constructs, 28 were addressed in the interviews, of which 12 distinguished between high and low implementati...
The New England journal of medicine, Jan 13, 2016
Background The 4-year, multipayer Comprehensive Primary Care Initiative was started in October 20... more Background The 4-year, multipayer Comprehensive Primary Care Initiative was started in October 2012 to determine whether several forms of support would produce changes in care delivery that would improve the quality and reduce the costs of care at 497 primary care practices in seven regions across the United States. Support included the provision of care-management fees, the opportunity to earn shared savings, and the provision of data feedback and learning support. Methods We tracked changes in the delivery of care by practices participating in the initiative and used difference-in-differences regressions to compare changes over the first 2 years of the initiative in Medicare expenditures, health care utilization, claims-based measures of quality, and patient experience for Medicare fee-for-service beneficiaries attributed to initiative practices and a group of matched comparison practices. Results During the first 2 years, initiative practices received a median of $115,000 per cli...
Journal of the American Board of Family Medicine : JABFM
Practice tools such as health information technology (HIT) have the potential to support care pro... more Practice tools such as health information technology (HIT) have the potential to support care processes, such as communication between health care providers, and influence care for "ambulatory care-sensitive conditions" (ACSCs). ACSCs are conditions for which good outpatient care can potentially prevent the need for hospitalization. To date, associations between such primary care practice capabilities and hospitalizations for ambulatory care-sensitive conditions have been primarily limited to smaller, local studies or unique delivery systems rather than nationally representative studies of primary care physicians in the United States. We analyzed a nationally representative sample of 1,819 primary care physicians who responded to the Center for Studying Health System Change's Physician Survey. We linked 3 years of Medicare claims (2007 to 2009) with these primary care physician survey respondents. This linkage resulted in the identification of 123,760 beneficiaries wit...
Journal of general internal medicine, 2015
Comprehensiveness of primary care (the extent to which the clinician, as part of the primary care... more Comprehensiveness of primary care (the extent to which the clinician, as part of the primary care team, recognizes and meets the majority of each patient's physical and mental health care needs) is an important element of primary care, but seems to be declining in the U.S. This is concerning, because more comprehensive primary care is associated with greater equity and efficiency in health care, improved continuity, less care fragmentation and better health outcomes. Without measurement and support for its improvement, comprehensiveness may further decline as other measured aspects of primary care (e.g. access, coordination) improve. To track, support and improve comprehensiveness, it is useful to have valid and reliable ways to measure it. This paper discusses challenges to measuring comprehensiveness for a primary care team's patient panel, presents survey and claims-based measures of comprehensiveness, and provides suggestions for future research.
Journal of general internal medicine, Jan 24, 2015
Primary care plays a central role in the provision of health care, and is an organizing feature f... more Primary care plays a central role in the provision of health care, and is an organizing feature for health care delivery systems in most Western industrialized democracies. For a variety of reasons, however, the practice of primary care has been in decline in the U.S. This paper reviews key primary care concepts and their definitions, notes the increasingly complex interplay between primary care and the broader health care system, and offers research priorities to support future measurement, delivery and understanding of the role of primary care features on health care costs and quality.
The Journal of family practice, 2000
Because of their challenging social and economic environments, low-income women may find particul... more Because of their challenging social and economic environments, low-income women may find particular features of primary care uniquely important. For this qualitative study we explored which features are priorities to women fiumi low-income settings and whether those priorities fit into an established primary care framework. We performed a qualitative analysis of 4 focus groups of women aged 40 to 65 years from 4 community health clinics in Washington, DC. Prompted by semistructured open-ended questions, the focus groups discussed their experiences with ambulatory care and the attributes of primary care that they found important. The focus groups were audiotaped, and the tapes were transcribed verbatim and coded independently by 3 readers. The comments were independently organized into 5 content areas of primary care service delivery plus the construct of patient-provider relationship in the following order of frequency: accessibility (37.4%), the physician-patient relationship (37.4...
Issue brief (Center for Studying Health System Change), 2010
Commercial electronic medical records (EMRs) both help and hinder physician interpersonal communi... more Commercial electronic medical records (EMRs) both help and hinder physician interpersonal communication--real-time, face-to-face or phone conversations--with patients and other clinicians, according to a new Center for Studying Health System Change (HSC) study based on in-depth interviews with clinicians in 26 physician practices. EMRs assist real-time communication with patients during office visits, primarily through immediate access to patient information, allowing clinicians to talk with patients rather than search for information from paper records. For some clinicians, however, aspects of EMRs pose a distraction during visits. Moreover, some indicated that clinicians may rely on EMRs for information gathering and transfer at the expense of real-time communication with patients and other clinicians. Given time pressures already present in many physician practices, EMR and office-work flow modifications could help ensure that EMRs advance care without compromising interpersonal ...
Issue brief (Center for Studying Health System Change), 2010
Some experts view e-mail between physicians and patients as a potential tool to improve physician... more Some experts view e-mail between physicians and patients as a potential tool to improve physician-patient communication and, ultimately, patient care. Despite indications that many patients want to e-mail their physicians, physician adoption and use of e-mail with patients remains uncommon--only 6.7 percent of office-based physicians routinely e-mailed patients in 2008, according to a new national study from the Center for Studying Health System Change (HSC). Overall, about one-third of office-based physicians reported that information technology (IT) was available in their practice for e-mailing patients about clinical issues. Of those, fewer than one in five reported using e-mail with patients routinely; the remaining physicians were roughly evenly split between occasional users and non-users. Physicians in practices with access to electronic medical records and those working in health maintenance organizations (HMOs) or medical school settings were more likely to adopt and use e-...
Data bulletin (Center for Studying Health System Change), 2009
This Data Bulletin presents findings from the Center for Studying Health System Change (HSC) 2008... more This Data Bulletin presents findings from the Center for Studying Health System Change (HSC) 2008 Health Tracking Physician Survey, a nationally representative mail survey of U.S. physicians providing at least 20 hours per week of direct patient care. The sample of physicians was drawn from the American Medical Association master file and included active, nonfederal, office- and hospital-based physicians. Residents and fellows were excluded, as well as radiologists, anesthesiologists and pathologists. The survey includes responses from more than 4,700 physicians, and the response rate was 62 percent. Estimates from this survey should not be compared to estimates from HSC's previous Community Tracking Study (CTS) Physician Surveys because of changes in the survey administration mode from telephone to mail, question wording, skip patterns, sample structure and population represented. More detailed information on survey content and methodology can be found at www.hschange.org.
Journal of health care for the poor and underserved, 2002
Many areas have high cancer mortality rates and medically underserved populations. This study des... more Many areas have high cancer mortality rates and medically underserved populations. This study describes the feasibility (acceptability and costs) of an urban multiphasic (multiple cancers) screening van. Feasibility was evaluated by literature review and informant interviews. Costs were estimated by resource use from urban mobile screening units; decision analysis estimated the costs per cancer detected for breast, cervix, colorectal, and prostate cancer screening. Acceptability of a multiphasic van varied by the informant's perspective. Feasibility and costs were most sensitive to four parameters: age, prior screening history, risk factors, and volume of simultaneous examinations. Subsidized mobile screening facilities may have the potential to reduce cancer morbidity and mortality if they target hard-to-reach underscreened groups, maintain high volume, coordinate with primary care providers, and build on an infrastructure that provides diagnostic and treatment services regardl...
Excerpt from interview guide. (DOCX 32Â kb)
Excerpt from observation checklist. (DOCX 27Â kb)
Mathematica Policy Research Reports, 2015
Numerous studies have confirmed the central role of excellent primary care to any health system. ... more Numerous studies have confirmed the central role of excellent primary care to any health system. Yet how to define the presence of excellent primary care remains a challenge.
Journal of General Internal Medicine, 2021
Comprehensiveness is a key element of primary care [1, 2, 3], and is highlighted in several natio... more Comprehensiveness is a key element of primary care [1, 2, 3], and is highlighted in several national primary care transformation initiatives [4]. It has been defined as the extent to which a patient’s primary care provider (practitioner, practice, or team) recognizes and meets the large majority of the patient’s physical and common mental health care needs, including prevention and wellness, and acute, chronic, and comorbid condition management [3]. This concept invokes several aspects of patient care [5]. These include the depth and breadth of conditions managed by the primary care practitioner (PCP), as well as the extent to which the PCP can effectively address the many relatively common problems their patients may experience [5, 6]. Recently, Medicare claims have been used to develop reliable and valid measures of these two dimensions of primary care comprehensiveness [6, 7]. The range of services primary care practices provide is a third key aspect of comprehensive primary care...
Journal of General Internal Medicine, 2018
C are management is a patient-centered approach to helping patients and their support systems bet... more C are management is a patient-centered approach to helping patients and their support systems better manage health conditions. 1 It includes patient education, goal setting, and self-management support. As part of such efforts, the term Bcare manager^is often used to refer to the activities of a nurse who works closely with patients and their primary care team to help provide chronic care management and coordination during care transitions. When implemented in a controlled manner-with rigorous training and adequate resources-care managers' work has the potential to improve chronic condition management and to lower costs. 2 However, evaluations of care managers in the Breal-world^have shown that their effectiveness varies, due in part to wide variation in implementation. Determining whether care managers improve patient outcomes and are cost-effective first requires a clearer understanding of how to incorporate them into primary care delivery. Key pieces of this puzzle include understanding where to place the care manager (in the practice, in the larger health-care delivery system, or at a health plan); who is best situated to employ and supervise the care manager (health plans, provider organizations, or practice sites); and how to integrate the care manager into the primary care team. Prior work suggests that embedded care managers are better at improving chronic condition management than care managers who are located outside the practice. 3-5 A study by Holtrop and colleagues 6 in this issue of the Journal of General Internal Medicine brings us a step closer to understanding why this might be the case. Holtrop et al. used social network analysis to gain insight into the communication patterns of primary care teams and care managers across a range of care management structures. Specifically, they sought to answer two questions:
Health Services Research, 2019
To develop claims-based measures of comprehensiveness of primary care physicians (PCPs) and summa... more To develop claims-based measures of comprehensiveness of primary care physicians (PCPs) and summarize their associations with health care utilization and cost. Data Sources and Study Setting: A total of 5359 PCPs caring for over 1 million Medicare fee-for-service beneficiaries from 1404 practices. Study Design: We developed Medicare claims-based measures of physician comprehensiveness (involvement in patient conditions and new problem management) and used a previously developed range of services measure. We analyzed the association of PCPs' comprehensiveness in 2013 with their beneficiaries' emergency department, hospitalizations rates, and ambulatory care-sensitive condition (ACSC) admissions (each per 1000 beneficiaries per year), and Medicare expenditures (per beneficiary per month) in 2014, adjusting for beneficiary, physician, practice, and market characteristics, and clustering. Principal Findings: Each measure varied across PCPs and had low correlation with the other measures-as intended, they capture different aspects of comprehensiveness. For patients whose PCPs' comprehensiveness score was at the 75th vs 25th percentile (more vs less comprehensive), patients had lower service use (P < 0.05) in one or more measures: involvement with patient conditions: total Medicare expenditures, −$17.4 (−2.2 percent); hospitalizations, −5.5 (−1.9 percent); emergency department (ED) visits, −16.3 (−2.4 percent); new problem management: total Medicare expenditures, −$13.3 (−1.7 percent); hospitalizations, −7.0 (−2.4 percent); ED visits, −19.7 (−2.9 percent); range of services: ED visits, −17.1 (−2.5 percent). There were no significant associations between the comprehensiveness measures and ACSC admission rates. Conclusions: These measures demonstrate strong content and predictive validity and reliability. Medicare beneficiaries of PCPs providing more comprehensive care had lower hospitalization rates, ED visits, and total Medicare expenditures.
The American journal of managed care, 2017
Risk-stratified care management is a cornerstone of patient-centered medical home models, but stu... more Risk-stratified care management is a cornerstone of patient-centered medical home models, but studies on patients' perspectives of care management are scarce. We explored patients' experiences with care management, what they found useful, and what needs improvement. Semi-structured qualitative telephone interviews. We interviewed 43 high-risk patients or their caregivers who were receiving care management from 11 practices in CMS' Comprehensive Primary Care initiative, provided by nurse care managers (9 practices) or the physician (2 [solo] practices). Patients' perceptions of care management were mixed. Patients who had regular contact with, and a desire to work with, their care manager valued the care management services provided. These patients valued care managers who listened to them and explained their conditions and options in lay terms, helped them navigate the healthcare system and community resources, and followed up after hospitalizations. However, one-fif...
Public reporting burden for this collection of information is estimated to average 1 hour per res... more Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to
JAMA internal medicine, 2017
JB. Diagnostic yield of syncope investigation (initiated) in the emergency department: a pilot st... more JB. Diagnostic yield of syncope investigation (initiated) in the emergency department: a pilot study.
MDM Policy & Practice, 2016
Introduction: Physicians vary widely in how they treat some health conditions, despite strong evi... more Introduction: Physicians vary widely in how they treat some health conditions, despite strong evidence favoring certain treatments over others. We examined physicians’ perspectives on factors that support or hinder evidence-based decisions and the implications for delivery systems, payers, and policymakers. Methods: We used Choosing Wisely® recommendations to create four clinical vignettes for common types of decisions. We conducted semi-structured interviews with 36 specialists to identify factors that support or hinder evidence-based decisions. We examined these factors using a conceptual framework that includes six levels: patients, physicians, practice sites, organizations, networks and hospital affiliations, and the local market. In this model, population characteristics and payer and regulatory factors interact to influence decisions. Results: Patient openness to behavior modification and expectations, facilitated and hindered physicians in making evidence-based recommendation...
Journal of medical Internet research, 2015
Although there is growing evidence of the positive effects of Internet-based patient-provider com... more Although there is growing evidence of the positive effects of Internet-based patient-provider communication (IPPC) services for both patients and health care providers, their implementation into clinical practice continues to be a challenge. The 3 aims of this study were to (1) identify and compare barriers and facilitators influencing the implementation of an IPPC service in 5 hospital units using the Consolidated Framework for Implementation Research (CFIR), (2) assess the ability of the different constructs of CFIR to distinguish between high and low implementation success, and (3) compare our findings with those from other studies that used the CFIR to discriminate between high and low implementation success. This study was based on individual interviews with 10 nurses, 6 physicians, and 1 nutritionist who had used the IPPC to answer messages from patients. Of the 36 CFIR constructs, 28 were addressed in the interviews, of which 12 distinguished between high and low implementati...
The New England journal of medicine, Jan 13, 2016
Background The 4-year, multipayer Comprehensive Primary Care Initiative was started in October 20... more Background The 4-year, multipayer Comprehensive Primary Care Initiative was started in October 2012 to determine whether several forms of support would produce changes in care delivery that would improve the quality and reduce the costs of care at 497 primary care practices in seven regions across the United States. Support included the provision of care-management fees, the opportunity to earn shared savings, and the provision of data feedback and learning support. Methods We tracked changes in the delivery of care by practices participating in the initiative and used difference-in-differences regressions to compare changes over the first 2 years of the initiative in Medicare expenditures, health care utilization, claims-based measures of quality, and patient experience for Medicare fee-for-service beneficiaries attributed to initiative practices and a group of matched comparison practices. Results During the first 2 years, initiative practices received a median of $115,000 per cli...
Journal of the American Board of Family Medicine : JABFM
Practice tools such as health information technology (HIT) have the potential to support care pro... more Practice tools such as health information technology (HIT) have the potential to support care processes, such as communication between health care providers, and influence care for "ambulatory care-sensitive conditions" (ACSCs). ACSCs are conditions for which good outpatient care can potentially prevent the need for hospitalization. To date, associations between such primary care practice capabilities and hospitalizations for ambulatory care-sensitive conditions have been primarily limited to smaller, local studies or unique delivery systems rather than nationally representative studies of primary care physicians in the United States. We analyzed a nationally representative sample of 1,819 primary care physicians who responded to the Center for Studying Health System Change's Physician Survey. We linked 3 years of Medicare claims (2007 to 2009) with these primary care physician survey respondents. This linkage resulted in the identification of 123,760 beneficiaries wit...
Journal of general internal medicine, 2015
Comprehensiveness of primary care (the extent to which the clinician, as part of the primary care... more Comprehensiveness of primary care (the extent to which the clinician, as part of the primary care team, recognizes and meets the majority of each patient's physical and mental health care needs) is an important element of primary care, but seems to be declining in the U.S. This is concerning, because more comprehensive primary care is associated with greater equity and efficiency in health care, improved continuity, less care fragmentation and better health outcomes. Without measurement and support for its improvement, comprehensiveness may further decline as other measured aspects of primary care (e.g. access, coordination) improve. To track, support and improve comprehensiveness, it is useful to have valid and reliable ways to measure it. This paper discusses challenges to measuring comprehensiveness for a primary care team's patient panel, presents survey and claims-based measures of comprehensiveness, and provides suggestions for future research.
Journal of general internal medicine, Jan 24, 2015
Primary care plays a central role in the provision of health care, and is an organizing feature f... more Primary care plays a central role in the provision of health care, and is an organizing feature for health care delivery systems in most Western industrialized democracies. For a variety of reasons, however, the practice of primary care has been in decline in the U.S. This paper reviews key primary care concepts and their definitions, notes the increasingly complex interplay between primary care and the broader health care system, and offers research priorities to support future measurement, delivery and understanding of the role of primary care features on health care costs and quality.
The Journal of family practice, 2000
Because of their challenging social and economic environments, low-income women may find particul... more Because of their challenging social and economic environments, low-income women may find particular features of primary care uniquely important. For this qualitative study we explored which features are priorities to women fiumi low-income settings and whether those priorities fit into an established primary care framework. We performed a qualitative analysis of 4 focus groups of women aged 40 to 65 years from 4 community health clinics in Washington, DC. Prompted by semistructured open-ended questions, the focus groups discussed their experiences with ambulatory care and the attributes of primary care that they found important. The focus groups were audiotaped, and the tapes were transcribed verbatim and coded independently by 3 readers. The comments were independently organized into 5 content areas of primary care service delivery plus the construct of patient-provider relationship in the following order of frequency: accessibility (37.4%), the physician-patient relationship (37.4...
Issue brief (Center for Studying Health System Change), 2010
Commercial electronic medical records (EMRs) both help and hinder physician interpersonal communi... more Commercial electronic medical records (EMRs) both help and hinder physician interpersonal communication--real-time, face-to-face or phone conversations--with patients and other clinicians, according to a new Center for Studying Health System Change (HSC) study based on in-depth interviews with clinicians in 26 physician practices. EMRs assist real-time communication with patients during office visits, primarily through immediate access to patient information, allowing clinicians to talk with patients rather than search for information from paper records. For some clinicians, however, aspects of EMRs pose a distraction during visits. Moreover, some indicated that clinicians may rely on EMRs for information gathering and transfer at the expense of real-time communication with patients and other clinicians. Given time pressures already present in many physician practices, EMR and office-work flow modifications could help ensure that EMRs advance care without compromising interpersonal ...
Issue brief (Center for Studying Health System Change), 2010
Some experts view e-mail between physicians and patients as a potential tool to improve physician... more Some experts view e-mail between physicians and patients as a potential tool to improve physician-patient communication and, ultimately, patient care. Despite indications that many patients want to e-mail their physicians, physician adoption and use of e-mail with patients remains uncommon--only 6.7 percent of office-based physicians routinely e-mailed patients in 2008, according to a new national study from the Center for Studying Health System Change (HSC). Overall, about one-third of office-based physicians reported that information technology (IT) was available in their practice for e-mailing patients about clinical issues. Of those, fewer than one in five reported using e-mail with patients routinely; the remaining physicians were roughly evenly split between occasional users and non-users. Physicians in practices with access to electronic medical records and those working in health maintenance organizations (HMOs) or medical school settings were more likely to adopt and use e-...
Data bulletin (Center for Studying Health System Change), 2009
This Data Bulletin presents findings from the Center for Studying Health System Change (HSC) 2008... more This Data Bulletin presents findings from the Center for Studying Health System Change (HSC) 2008 Health Tracking Physician Survey, a nationally representative mail survey of U.S. physicians providing at least 20 hours per week of direct patient care. The sample of physicians was drawn from the American Medical Association master file and included active, nonfederal, office- and hospital-based physicians. Residents and fellows were excluded, as well as radiologists, anesthesiologists and pathologists. The survey includes responses from more than 4,700 physicians, and the response rate was 62 percent. Estimates from this survey should not be compared to estimates from HSC's previous Community Tracking Study (CTS) Physician Surveys because of changes in the survey administration mode from telephone to mail, question wording, skip patterns, sample structure and population represented. More detailed information on survey content and methodology can be found at www.hschange.org.