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1.
Ann Fam Med ; 17(Suppl 1): S24-S32, 2019 08 12.
Artículo en Inglés | MEDLINE | ID: mdl-31405873

RESUMEN

PURPOSE: We compared the transformation experience of 2 family medicine practices that implemented the Primary Care Redesign (PCR) team-based model to improve access, quality, and experience without increasing cost. The University of Colorado's A.F. Williams Family Medicine clinic (pilot practice) implemented the model in February 2015, and a smaller, community-based practice (wave 2 practice) did so 2 years later, in February 2017. METHODS: The PCR model increased the ratio of medical assistants to clinicians from about 1:2 to 2.5:1 while expanding the role of the medical assistants, through enhanced rooming procedures, in-room support (eg, scribing), postclinician wrap-up, and in-basket assistance. We assessed access, clinical quality metrics, staffing costs, and clinician and staff experience and burnout for at least 7 months before and 42 months after the intervention. RESULTS: In the pilot practice, compared with preimplementation, there were improvements in total appointments and rates of hypertension control, colorectal cancer screening, and most diabetic quality metrics. In the wave 2 practice, total appointments increased slightly when clinicians were added pre-PCR and then increased substantially after implementation; initially variable hypertension control improved rapidly after implementation. The wave 2 practice's colorectal cancer screening improved gradually, then accelerated postimplementation, while diabetic metrics initially remained stable or declined, then improved postimplementation. New patient appointments began to increase for both practices in late 2015, but grew faster in the pilot practice under PCR. Over time, all experiential domains improved for clinicians; most remained stable for staff. Clinician burnout was reduced by at least one-half in both practices except during low staffing periods, which also adversely affected staff. After a ramp-up period, the number of staff hours per visit remained stable. CONCLUSIONS: The PCR model is associated with simultaneous improvements in quality, access, and clinician experience, as well as reductions in burnout, while maintaining staffing costs.


Asunto(s)
Innovación Organizacional , Atención Primaria de Salud/organización & administración , Calidad de la Atención de Salud/organización & administración , Agotamiento Profesional/prevención & control , Colorado , Humanos , Cuerpo Médico/economía , Modelos Organizacionales
2.
Telemed J E Health ; 25(8): 762-768, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-30394851

RESUMEN

Background: Integrated care is characterized by evolving heterogeneity in models. Using telepsychiatry to enhance these models can increase access, quality, and efficiencies in care. Introduction: The purpose of this report is to describe the process and outcomes of adapting telepsychiatry into an existing integrated care service. Materials and Methods: Telepsychiatry was implemented into an existing integrated care model in a high-volume, urban, primary care clinic in Colorado serving patients with complex physical and behavioral needs. Consultative, direct care, educational/training encounters, provider-to-provider communication, process changes, and patient-level descriptive measures were tracked as part of ongoing quality improvement. Results: Telepsychiatry was adapted into the existing behavioral health services using an iterative team meeting process within a stepped care model. Over 35% of the requests for psychiatry services were medication related-and medication changes (type/dose) were the most frequent referral outcome of psychiatric consultation. Forty percent of patients in the service had multiple behavioral health diagnoses, in addition to physical health diagnoses. Discussion: Telehealth will become an increasingly necessary component in building hybrid/blended integrated care teams. Examples of flexible model implementation will support clinics in tailoring effective applications for their unique patient panels. Conclusions: An adapted integrated care model leveraging telepsychiatry is successfully serving the complex deep end of a primary care patient population in Colorado. Lessons learned in implementing this model include the importance of team attitudes.


Asunto(s)
Trastornos Mentales/terapia , Atención Primaria de Salud/organización & administración , Psiquiatría/organización & administración , Integración de Sistemas , Telemedicina/organización & administración , Comorbilidad , Humanos , Comunicación Interdisciplinaria , Servicios de Salud Mental/organización & administración , Grupo de Atención al Paciente , Mejoramiento de la Calidad , Flujo de Trabajo
3.
Jt Comm J Qual Patient Saf ; 44(6): 353-360, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29793886

RESUMEN

BACKGROUND: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States; however, CRC screening reduces both incidence and mortality rates. Patient decision aids (DAs) are an evidence-based strategy to support patients making health-related decisions. CRC screening DAs can be unsuccessful due to provider preferences for colonoscopy and lack of effective DA implementation strategies within clinical settings. METHODS: A hybrid implementation-effectiveness study was conducted testing the feasibility of using an existing centralized preventive health screening outreach infrastructure to implement a novel CRC DA across a health care system. Participants included primary care patients at one of three study clinics. Implementation was assessed by determining whether patients remembered receiving the DA and were aware of CRC screening options. Effectiveness was measured by comparing overall screening rates between the control and intervention groups. RESULTS: Using a centralized delivery system was a feasible and efficient method for implementing DAs to a large academic health system. More than 90% of the intervention group remembered receiving the DA, and 80% found it helpful in their decision-making process. The DA was successful in improving CRC screening knowledge; however, overall CRC screening rates significantly decreased between the control and intervention periods (50.8% vs. 39.2%, respectively; p = 0.03). CONCLUSION: Centralized delivery is a feasible method for DA implementation. Although DAs increase knowledge, the true effectiveness of CRC DAs in clinical settings is unknown, as a result of the number in screening tests, diversity in DA format, and the variability in dissemination and implementation practices.


Asunto(s)
Neoplasias Colorrectales/diagnóstico , Técnicas de Apoyo para la Decisión , Detección Precoz del Cáncer/métodos , Detección Precoz del Cáncer/psicología , Educación en Salud/organización & administración , Centros Médicos Académicos/organización & administración , Anciano , Colonoscopía/métodos , Colonoscopía/psicología , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Sangre Oculta
10.
Am Fam Physician ; 104(2): 204-205, 2021 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-34383438
11.
16.
Am Fam Physician ; 100(5): 309-310, 2019 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-31478629
18.
J Am Board Fam Med ; 37(1): 150-152, 2024 Mar 11.
Artículo en Inglés | MEDLINE | ID: mdl-38448234

RESUMEN

In hospitalized patients with type 2 diabetes (T2DM), a less aggressive supplemental insulin regimen is noninferior to a standard, more aggressive, supplemental regimen.


Asunto(s)
Diabetes Mellitus Tipo 2 , Insulina , Humanos , Insulina/uso terapéutico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Glucemia , Esquema de Medicación , Pacientes Internos , Hipoglucemiantes/uso terapéutico , Hospitalización
19.
Am Fam Physician ; 97(8): 527-528, 2018 04 15.
Artículo en Inglés | MEDLINE | ID: mdl-29671491
20.
Am Fam Physician ; 98(2): 115-116, 2018 07 15.
Artículo en Inglés | MEDLINE | ID: mdl-30215992
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