Practice Management Strategies Among Current Members of the American Association of Hip and Knee Surgeons.

BACKGROUND: A survey was conducted at the 2021 Annual Meeting of the American Association of Hip and Knee Surgeons (AAHKS) to evaluate current practice management strategies among AAHKS members. METHODS: An application was used by AAHKS members to answer both multiple-choice and yes or no questions. Specific questions were asked regarding the impact of COVID-19 pandemic on practice patterns. RESULTS: There was a dramatic acceleration in same day total joint arthroplasty with 85% of AAHKS members performing same day total joint arthroplasty. More AAHKS members remain in private practice (46%) than other practice types, whereas fee for service (34%) and relative value units (26%) are the major form of compensation. At the present time, 93% of practices are experiencing staffing shortages, and these shortages are having an impact on surgical volume. CONCLUSION: This survey elucidates the current practice patterns of AAHKS members. The pandemic has had a significant impact on some aspects of practice activity. Future surveys need to monitor changes in practice patterns over time.

Practice Management Strategies Among Current Members of the American Association of Hip and Knee Surgeons.

BACKGROUND: At the 2017 annual meeting of the American Association of Hip and Knee Surgeons (AAHKS), a survey was conducted to assess current practice management strategies by AAHKS members. METHODS: During the annual AAHKS meeting, a survey was conducted using an audience response system. The moderator queried AAHKS members with respect to a variety of practice management issues. The survey included both multiple choice and yes or no questions. The answers were collected in a central database and provided to the audience in real time. RESULTS: The survey responses provided valuable information with respect to the practice activity of AAHKS members. A total of 47% of AAHKS members are in private practice, and fee for service remains the major form of compensation for 39% of the membership. Participation in bundled-payment programs was 46%. A minority (22%) had performed a total joint arthroplasty in an outpatient surgery center. CONCLUSION: This survey of AAHKS members' practice patterns provided interesting data. Future surveys should determine potential changes in practice activity related to private practice, fee for service compensation, the use of outpatient surgery centers for total joint arthroplasty, and surgeon participation in bundled-payment programs.

The influence of power and actor relations on priority setting and resource allocation practices at the hospital level in Kenya: a case study.

BACKGROUND: Priority setting and resource allocation in healthcare organizations often involves the balancing of competing interests and values in the context of hierarchical and politically complex settings with multiple interacting actor relationships. Despite this, few studies have examined the influence of actor and power dynamics on priority setting practices in healthcare organizations. This paper examines the influence of power relations among different actors on the implementation of priority setting and resource allocation processes in public hospitals in Kenya. METHODS: We used a qualitative case study approach to examine priority setting and resource allocation practices in two public hospitals in coastal Kenya. We collected data by a combination of in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), review of documents such as hospital plans and budgets, minutes of meetings and accounting records, and non-participant observations in case study hospitals over a period of 7 months. We applied a combination of two frameworks, Norman Long's actor interface analysis and VeneKlasen and Miller's expressions of power framework to examine and interpret our findings RESULTS: The interactions of actors in the case study hospitals resulted in socially constructed interfaces between: 1) senior managers and middle level managers 2) non-clinical managers and clinicians, and 3) hospital managers and the community. Power imbalances resulted in the exclusion of middle level managers (in one of the hospitals) and clinicians and the community (in both hospitals) from decision making processes. This resulted in, amongst others, perceptions of unfairness, and reduced motivation in hospital staff. It also puts to question the legitimacy of priority setting processes in these hospitals. CONCLUSIONS: Designing hospital decision making structures to strengthen participation and inclusion of relevant stakeholders could improve priority setting practices. This should however, be accompanied by measures to empower stakeholders to contribute to decision making. Strengthening soft leadership skills of hospital managers could also contribute to managing the power dynamics among actors in hospital priority setting processes.

Characteristics of primary care practices associated with high quality of care.

BACKGROUND: No primary practice care model has been shown to be superior in achieving high-quality primary care. We aimed to identify the organizational characteristics of primary care practices that provide high-quality primary care. METHODS: We performed a cross-sectional observational study involving a stratified random sample of 37 primary care practices from 3 regions of Quebec. We recruited 1457 patients who had 1 of 2 chronic care conditions or 1 of 6 episodic care conditions. The main outcome was the overall technical quality score. We measured organizational characteristics by use of a validated questionnaire and the Team Climate Inventory. Statistical analyses were based on multilevel regression modelling. RESULTS: The following characteristics were strongly associated with overall technical quality of care score: physician remuneration method (27.0; 95% confidence interval [CI] 19.0-35.0), extent of sharing of administrative resources (7.6; 95% CI 0.8-14.4), presence of allied health professionals (15.3; 95% CI 5.4-25.2) and/or specialist physicians (19.6; 95% CI 8.3-30.9), the presence of mechanisms for maintaining or evaluating competence (7.7; 95% CI 3.0-12.4) and average organizational access to the practice (4.9; 95% CI 2.6-7.2). The number of physicians (1.2; 95% CI 0.6-1.8) and the average Team Climate Inventory score (1.3; 95% CI 0.1-2.5) were modestly associated with high-quality care. INTERPRETATION: We identified a common set of organizational characteristics associated with high-quality primary care. Many of these characteristics are amenable to change through practice-level organizational changes.

A retrospective assessment comparing pharmacist-managed anticoagulation clinic with physician management using international normalized ratio stability.

To assess the rates of therapeutic international normalized ratio (INR) levels between pharmacist-managed clinics compared to traditional physician-management and to determine the variation in rates of therapeutic INR levels between pharmacist-managed clinic data compared to physician-management. Retrospective, randomized, chart review. Referral only, outpatient, pharmacist based anticoagulation clinic under a community based tertiary care health system. Sixty-four patients with at least 1 year's worth of visits to the pharmacist managed clinic were reviewed for INR stability. The average percentage of visits within the defined therapeutic range, was 71.1% for the physician-managed group versus 81.1% for the pharmacist-managed group (P < 0.0001). The estimated variance in average therapeutic INR rates was double for the physician-managed group (365.7) versus the pharmacist-managed group (185.2) (P = 0.004). The pharmacist-managed anti-coagulation clinic had higher rates of INRs determined to be therapeutic and also exhibited significantly less variability in therapeutic INR rates relative to the physician-managed service.

[Amputation in low-income countries: particularities in epidmiological features and management practices]. / Les amputations dans les pays à faibles revenus: particularités de l'épidémiologie, de l'appareillage et de la rééducation.

The epidemiological features and management practices associated with amputation in low-income countries, generally synonymous with the tropics, are different from those observed in Western countries. Unlike developed countries, amputation most frequently involves traumatic injury in young active people. However, Westernization of the lifestyle is leading to an increasing number of cases involving diabetes and atherosclerotic disease. In the developing world, leprosy and Buruli ulcer are still significant etiologic factors for amputation. In war-torn countries, use of antipersonnel landmines is another major cause of amputation with characteristic features. Management of amputees in the developing world is hindered by the lack of facilities for rehabilitation and prosthetic fitting. Many international organizations are supporting national programs to develop such facilities. In addition to being affordable, prosthetics and orthotics must be adapted to the living conditions of a mostly rural amputee population, i.e., heat, humidity, and farm work. The rehabilitation process must be part of a global handicap policy aimed at changing attitudes about disability and reintegrating amputees both socially and professionally.

Impact of Coronavirus Disease 2019 (COVID-19) on the Practice of Clinical Radiology.

The speed at which coronavirus disease 2019 (COVID-19) spread quickly fractured the radiology practice model in ways that were never considered. In March 2020, most practices saw an unprecedented drop in their volume of greater than 50%. The profound changes that have interrupted the arc of the radiology narrative may substantially dictate how health care and radiology services are delivered in the future. We examine the impact of COVID-19 on the future of radiology practice across the following domains: employment, compensation, and practice structure; location and hours of work; workplace environment and safety; activities beyond the "usual scope" of radiology practice; and CME, national meetings, and professional organizations. Our purpose is to share ideas that can help inform adaptive planning.

Promoting professional behaviour in general practitioner training practices: The views of practice managers.

BACKGROUND AND OBJECTIVES: General practitioners (GPs) are required by the Australian professional colleges of general practice - The Royal Australian College of General Practitioners and The Australian College of Rural and Remote Medicine - to practise a high standard of professional behaviour. General practice registrars (GPRs) learn this in their training practices not only from their general practice supervisors, but also the practice managers (PMs). Little is known of PMs' views of the meaning of the term 'professional behaviour' and how they view their role in GPR education. METHOD: Nineteen semi-structured interviews with PMs were conducted. Saturation was reached and consensus achieved on the analysis. RESULTS: PMs held nuanced views on the meaning of the term 'professional behaviour' and actively promoted and modelled this to their staff, including GPRs. PMs believed they had a role in GPR education. DISCUSSION: Practice managers are well placed to model and teach professional behaviour, and their skills should be further used to educate GPRs.

Assessment of Practice Management Entrustable Professional Activities by Pharmacists in North Dakota.

Objective. To quantify the use of core entrustable practice activities (EPAs) in contemporary pharmacy practice in North Dakota. Methods. Given the large number of core EPAs, this study focused on those supporting tasks categorized within the practice manager domain. The survey instrument was sent to all registered pharmacists living and practicing in North Dakota (n=990). This manuscript reports on the practice manager domain and the activities and examples of supportive tasks in this domain. Results. Four hundred fifty-seven (46.1%) of the pharmacists responded; however, only 102 survey instruments were fully completed and usable. Respondents rated the "fulfill a medication order" activity the highest EPA overall (mean=9.1, SD=2.7). The "oversee the pharmacy operations for an assigned work shift" activity (mean=7.8, SD=3.9) was also rated highly. Responses to "oversee the pharmacy operations for an assigned work shift" were significantly different between independent practice settings and all other practice settings. The manager was more likely than other pharmacy positions to report performing seven of the nine tasks within this EPA. Significant differences in five of nine tasks were found across pharmacies located in rural or more urban communities, including "assist in the evaluation of pharmacy technicians" and "identify pharmacy service problems and/or medication safety issues." Conclusion. This study provides empirical evidence suggesting that EPAs can be a useful means to assess outcomes in pharmacy education.

Infrastructures for healthcare: From synergy to reverse synergy.

The Danish General Practitioners Database has over more than a decade developed into a large-scale successful information infrastructure supporting medical research in Denmark. Danish general practitioners produce the data, by coding all patient consultations according to a certain set of classifications, on the entire Danish population. However, in the Autumn of 2014, the system was temporarily shut down due to a lawsuit filed by two general practitioners. In this article, we ask why and identify a political struggle concerning authority, control, and autonomy related to a transformation of the fundamental ontology of the information infrastructure. We explore how the transformed ontology created cracks in the inertia of the information infrastructure damaging the long-term sustainability. We propose the concept of reverse synergy as the awareness of negative impacts occurring when uncritically adding new actors or purposes to a system without due consideration to the nature of the infrastructure. We argue that while long-term information infrastructures are dynamic by nature and constantly impacted by actors joining or leaving the project, each activity of adding new actors must take reverse synergy into account, if not to risk breaking down the fragile nature of otherwise successful information infrastructures supporting research on healthcare.

Organisational capacity and chronic disease care: an Australian general practice perspective.

Although we are rapidly improving our understanding of how to manage patients with chronic illness in Australian general practice, many patients are still receiving suboptimal care. General practices have limited organisational capacity to provide the structured care that is required for managing chronic conditions: regular monitoring, decision support, patient recall, supporting patient self management, team work, and information management. This requires a shift away from episodic, acute models. Overseas research has shown that areas such as team work, clinical information systems, decision support, linkages and leadership are also important in managing chronic illness, but we do not know which of these are most important in Australia.

Barriers to electronic medical record implementation: a comparison between ophthalmology and other surgical specialties in Canada.

OBJECTIVE: In the present study, the barriers limiting widespread adoption of electronic medical records (EMRs) among Canadian ophthalmologists were evaluated in comparison with physicians from other surgical specialities. The published literature regarding EMR use in ophthalmic practice was also reviewed. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: A total of 1199 Canadian surgeons participating in the 2014 National Physician Survey (NPS). METHODS: Data regarding speciality surgeons' adoption of EMR programs were extracted from the 2014 NPS, a nationwide survey of practicing physicians in Canada. The data were entered into a spreadsheet, and basic statistical analyses, including χ2 analyses, were performed to compare the responses of ophthalmologists to other surgeons. RESULTS: Compared with other surgeons, ophthalmologists surveyed were significantly more likely to identify the following barriers to EMR adoption: "no suitable product for my practice" (p = 0.01), "too costly" (p = 0.0006), "too time consuming" (p < 0.0001), and "planning to retire soon" (p = 0.001). No statistically detectable differences were found between ophthalmologists and other surgeons for the following barriers: privacy concerns, reliability concerns, and lack of training. CONCLUSIONS: The barriers that limit increased EMR adoption among Canadian ophthalmologists are different from those of other surgeons. This may be attributed to unique features of the field, including heavy reliance on hand-drawn figures in documentation, high patient volume, and the high costs associated with independent practice. Given the well-established benefits of EMR technology, consideration should be given to implementing strategies to mitigate these barriers. Additional research may help determine which specific improvements can be made to increase the use of EMR systems by ophthalmologists.

A somewhat unorthodox explanation for the rise and fall of physician practice management companies: the application of Gaia theory.

PURPOSE: The purpose of this article is to present an alternative theory to why publicly-traded physician practice management companies in the US were popular and successful for a limited number of years and then essentially self-destructed. DESIGN/METHODOLOGY/APPROACH: The short history of publicly-traded practice management companies suggests that they had limited value and utility in the US healthcare industry. It is the premise of the paper that the sudden appearance these for-profit companies upset the natural order within the healthcare industry and created a disequilibria which ultimately resulted in their demise. While Gaia theory is most commonly applied to the natural sciences, it has been applied to a number of interdisciplinary issues. FINDINGS: Physicians gravitated to these for-profit companies either out of fear of encroaching managed care or out a desire to sell their practice to the highest bidder. Physician practice management companies, on the other hand, saw a way to entice stockholders to invest in a growth industry. The paper suggests that the physician practice management companies added little new value to the health care industry and applies Gaia theory as a possible explanation for this phenomena. Gaia theory was first postulated in 1979 to address the evolution of the material environment and corresponding organisms as a tightly coupled system which attempt to manipulate the environment for the purpose of creating biologically favorable conditions. ORIGINALITY/VALUE: The paper is one of the first to suggest that the laws of nature, as understood from the perspective of Gaia theory, may have applicability to the US health care industry.