Tamar Wyte-Lake, Steffani Bailey, Deborah Cohen, Shannon Williams
{"title":"Implications of a hybrid approach to care in primary care practices","authors":"Tamar Wyte-Lake, Steffani Bailey, Deborah Cohen, Shannon Williams","doi":"10.1370/afm.22.s1.4954","DOIUrl":"https://doi.org/10.1370/afm.22.s1.4954","url":null,"abstract":"","PeriodicalId":199163,"journal":{"name":"Practice management and organization","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139304231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Shuldiner, T. Kiran, P. Agarwal, M. Daneshvarfard, Kirsten Eldridge, Susie Kim, M. Greiver, Iffat Jokhio, N. Ivers
{"title":"Developing an Audit and Feedback Dashboard for Family Physicians: A User-Centered Design Process","authors":"J. Shuldiner, T. Kiran, P. Agarwal, M. Daneshvarfard, Kirsten Eldridge, Susie Kim, M. Greiver, Iffat Jokhio, N. Ivers","doi":"10.1370/afm.21.s1.4134","DOIUrl":"https://doi.org/10.1370/afm.21.s1.4134","url":null,"abstract":"","PeriodicalId":199163,"journal":{"name":"Practice management and organization","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130282335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Sifri, A. Cunningham, C. Arenson, Alexis Silverio
Context: Assessment of wellness and burnout in primary care often focuses on providers. Less is known about wellness and burnout in other primary care team members, including actions that would improve wellness. Objective: To assess wellness and burnout in primary care providers and staff and identify actions to increase work-related wellness. Study Design: Cross-sectional survey. Setting: Jefferson Health system, with 100 primary care practices in the Philadelphia region. Population studied: Survey was emailed to all primary care providers and staff (N=1155) in February 2021, including providers, behavioral health consultants, nurses, medical assistants and all other clinical staff, quality/research staff, and all administrative staff. Instrument: Thirty-item survey: demographic items (age, sex, race/ethnicity, practice region, professional role), Perceived Stress Reactivity Prolonged Reactivity Subscale (PRS), Abbreviated Maslach Burnout Inventory (aMBI) with emotional exhaustion, depersonalization, and personal accomplishment subscales, Mini-Z Burnout Survey , 1-10 rating of work-related wellness, and an open-ended question asking what one thing would improve work-related wellness. Outcome Measures: Primary outcomes were average wellness and burnout scores: mean(standard deviation) (SD) PRS, mean (SD) aMBI emotional exhaustion, median and interquartile range aMBI depersonalization and personal accomplishment, mean(SD) Mini-Z score and response to Mini-Z burnout item, and mean(SD) 1-10 wellness rating. Responses were compared across demographic categories for significant differences (p<.05). Open-ended responses were analyzed for themes. Results: 429 providers and staff completed the survey (37% response rate). All roles were represented. Mean PRS score was 3.89(1.55), aMBI: emotional exhaustion: 9.11(5.25), depersonalization 1.00(4.00), personal accomplishment 15.00(4.00), Mini-Z 32.09(3.99) with 48% reporting some burnout, and 5.85(2.45) on 1-10 wellness scale. Results varied significantly by region and role. Open-ended responses (N=202) recommended increased staffing, increased administrative time, and better practice and leadership communication/teamwork. Conclusions: Our sample reported elevated prolonged stress reactivity but similar/slightly lower burnout than prior studies. Findings were shared with participants and action steps developed; survey will be readministered every 6 months.
{"title":"Taking the pulse of primary care teams: Provider and staff wellness and burnout in a large primary care network","authors":"R. Sifri, A. Cunningham, C. Arenson, Alexis Silverio","doi":"10.1370/afm.20.s1.2789","DOIUrl":"https://doi.org/10.1370/afm.20.s1.2789","url":null,"abstract":"Context: Assessment of wellness and burnout in primary care often focuses on providers. Less is known about wellness and burnout in other primary care team members, including actions that would improve wellness. Objective: To assess wellness and burnout in primary care providers and staff and identify actions to increase work-related wellness. Study Design: Cross-sectional survey. Setting: Jefferson Health system, with 100 primary care practices in the Philadelphia region. Population studied: Survey was emailed to all primary care providers and staff (N=1155) in February 2021, including providers, behavioral health consultants, nurses, medical assistants and all other clinical staff, quality/research staff, and all administrative staff. Instrument: Thirty-item survey: demographic items (age, sex, race/ethnicity, practice region, professional role), Perceived Stress Reactivity Prolonged Reactivity Subscale (PRS), Abbreviated Maslach Burnout Inventory (aMBI) with emotional exhaustion, depersonalization, and personal accomplishment subscales, Mini-Z Burnout Survey , 1-10 rating of work-related wellness, and an open-ended question asking what one thing would improve work-related wellness. Outcome Measures: Primary outcomes were average wellness and burnout scores: mean(standard deviation) (SD) PRS, mean (SD) aMBI emotional exhaustion, median and interquartile range aMBI depersonalization and personal accomplishment, mean(SD) Mini-Z score and response to Mini-Z burnout item, and mean(SD) 1-10 wellness rating. Responses were compared across demographic categories for significant differences (p<.05). Open-ended responses were analyzed for themes. Results: 429 providers and staff completed the survey (37% response rate). All roles were represented. Mean PRS score was 3.89(1.55), aMBI: emotional exhaustion: 9.11(5.25), depersonalization 1.00(4.00), personal accomplishment 15.00(4.00), Mini-Z 32.09(3.99) with 48% reporting some burnout, and 5.85(2.45) on 1-10 wellness scale. Results varied significantly by region and role. Open-ended responses (N=202) recommended increased staffing, increased administrative time, and better practice and leadership communication/teamwork. Conclusions: Our sample reported elevated prolonged stress reactivity but similar/slightly lower burnout than prior studies. Findings were shared with participants and action steps developed; survey will be readministered every 6 months.","PeriodicalId":199163,"journal":{"name":"Practice management and organization","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131764390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elyse Gonzales, Jonathan Shaw, Ian Nelligan, M. Winget, Doris Chen
Context: The COVID-19 pandemic has catalyzed the use of video visits in primary care. It is estimated that 73% of primary care visits can be effectively completed via video. However, there are no studies that demonstrate clinical effectiveness of video visits for specific chief complaints. Objective: To evaluate the clinical effectiveness of video visits compared to in-person visits for 2 common primary care chief complaints. Study design: Retrospective chart review. Dataset: Manual chart review of in-person visits from August-October 2019 and video visits from August-October 2020 from our institution’s outpatient urgent care clinic (Stanford Express Car e), restricted to 2 of the most common presenting chief complaints (CCs): low back pain and headache. Population studied: Patients who presented to a Stanford Express Care clinic with one of the aforementioned CCs. Outcome measures: Frequency of clinician recommendation for an urgent office or ED visit after the initial patient visit and frequency of follow-up visits within a 3-week period were used to assess clinical effectiveness of the visit. A visit is considered clinically effective when a clinician does not recommend an urgent office or ED visit after the initial patient visit and the patient does not have in-person follow-up visits within 3 weeks of the initial visit. Frequency of referrals placed and diagnostic imaging studies ordered during the initial patient visit were also measured. Results: Video visits for low back pain were less likely to be effectively assessed compared to in-person visits [74% (37/50) vs 82% (54/66), chi-square p=0.3]. During video visits for low back pain clinicians placed fewer referrals [24% (12/50) vs 36% (24/66), chi-square p=0.2] and ordered fewer diagnostic imaging studies [12% (6/50) vs 21% (14/66), chi-square p=0.2]. Video visits for headache were more likely to be effectively assessed compared to in-person visits [86% (43/50) vs 74% (37/50), chi-square p=0.1]. During video visits for headache, clinicians placed fewer referrals [14% (7/50) vs 22% (11/50), (chi-square p=0.3 ) and ordered fewer diagnostic imaging studies [2% (1/50) vs 18% (9/50), chi-square p=0.007]. Conclusions: For low back pain and headache, video visits were not significantly less likely than in-person visits to be effective. There was a statistically significant decrease in diagnostic imaging studies ordered during video visits for headaches.
{"title":"Clinical effectiveness of video visits for low back pain and headache in a primary care setting","authors":"Elyse Gonzales, Jonathan Shaw, Ian Nelligan, M. Winget, Doris Chen","doi":"10.1370/afm.20.s1.3266","DOIUrl":"https://doi.org/10.1370/afm.20.s1.3266","url":null,"abstract":"Context: The COVID-19 pandemic has catalyzed the use of video visits in primary care. It is estimated that 73% of primary care visits can be effectively completed via video. However, there are no studies that demonstrate clinical effectiveness of video visits for specific chief complaints. Objective: To evaluate the clinical effectiveness of video visits compared to in-person visits for 2 common primary care chief complaints. Study design: Retrospective chart review. Dataset: Manual chart review of in-person visits from August-October 2019 and video visits from August-October 2020 from our institution’s outpatient urgent care clinic (Stanford Express Car e), restricted to 2 of the most common presenting chief complaints (CCs): low back pain and headache. Population studied: Patients who presented to a Stanford Express Care clinic with one of the aforementioned CCs. Outcome measures: Frequency of clinician recommendation for an urgent office or ED visit after the initial patient visit and frequency of follow-up visits within a 3-week period were used to assess clinical effectiveness of the visit. A visit is considered clinically effective when a clinician does not recommend an urgent office or ED visit after the initial patient visit and the patient does not have in-person follow-up visits within 3 weeks of the initial visit. Frequency of referrals placed and diagnostic imaging studies ordered during the initial patient visit were also measured. Results: Video visits for low back pain were less likely to be effectively assessed compared to in-person visits [74% (37/50) vs 82% (54/66), chi-square p=0.3]. During video visits for low back pain clinicians placed fewer referrals [24% (12/50) vs 36% (24/66), chi-square p=0.2] and ordered fewer diagnostic imaging studies [12% (6/50) vs 21% (14/66), chi-square p=0.2]. Video visits for headache were more likely to be effectively assessed compared to in-person visits [86% (43/50) vs 74% (37/50), chi-square p=0.1]. During video visits for headache, clinicians placed fewer referrals [14% (7/50) vs 22% (11/50), (chi-square p=0.3 ) and ordered fewer diagnostic imaging studies [2% (1/50) vs 18% (9/50), chi-square p=0.007]. Conclusions: For low back pain and headache, video visits were not significantly less likely than in-person visits to be effective. There was a statistically significant decrease in diagnostic imaging studies ordered during video visits for headaches.","PeriodicalId":199163,"journal":{"name":"Practice management and organization","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124669828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Varun Malik, AL Volo, Monica L. Cales, Joseph Sonner, Christina Scartozzi
Context: Patient no show (N/S) rates in the outpatient setting have a large effect on healthcare systems nationwide. The use of technology, such as scheduling-reminder software, has been used to curb the N/S rate in many settings. There remains a paucity of data in both the effectiveness of such software and the demographic factors contributing to the N/S rate. Objective: Analyze the effects of TelevoxTM software optimization on N/S rate. Study Design: Prospective cohort study. Setting: Family Medicine residency practice site located in downtown of a small city (population 50,000). Population Studied: All scheduled patients who had an appointment scheduled at least 24 hours prior. Intervention: Prospective patient chart data modified for one month, ensuring updated fields in contact information, decreasing number of uncontacted patients. Patients were provided education regarding TelevoxTM system at the end of each appointment. Outcome Measures: Primary: The comparison of N/S rates from: when TelevoxTM was NOT Launched, after TelevoxTM was launched, and after our intervention. Secondary: the effect of a covariate on N/S probability; economic impact of N/S to our clinic. Results: Crude modeling shows a significant (16%) increase in a patient showing for visit [OR 1.16, p=.0310] after the intervention; this is not apparent after the launch of the software, but before intervention group [OR 1.09, p=.1195]. Age showed significance in the adjusted model – with a 1% increase in chance of showing for a visit correlating to a 1-year increase in age. Being an uninsured patient led to a 66% decrease in the chance of showing. December was statistically the lowest month of those captured regarding show rate. At an average captured N/S rate of 27%, our clinic missed an average of $11,400.00 of billable funds a month. Conclusions: N/S rates may have decreased significantly by our
{"title":"Optimizing appointment reminder software to reduce the no-show rate in a rural outpatient setting","authors":"Varun Malik, AL Volo, Monica L. Cales, Joseph Sonner, Christina Scartozzi","doi":"10.1370/afm.20.s1.2969","DOIUrl":"https://doi.org/10.1370/afm.20.s1.2969","url":null,"abstract":"Context: Patient no show (N/S) rates in the outpatient setting have a large effect on healthcare systems nationwide. The use of technology, such as scheduling-reminder software, has been used to curb the N/S rate in many settings. There remains a paucity of data in both the effectiveness of such software and the demographic factors contributing to the N/S rate. Objective: Analyze the effects of TelevoxTM software optimization on N/S rate. Study Design: Prospective cohort study. Setting: Family Medicine residency practice site located in downtown of a small city (population 50,000). Population Studied: All scheduled patients who had an appointment scheduled at least 24 hours prior. Intervention: Prospective patient chart data modified for one month, ensuring updated fields in contact information, decreasing number of uncontacted patients. Patients were provided education regarding TelevoxTM system at the end of each appointment. Outcome Measures: Primary: The comparison of N/S rates from: when TelevoxTM was NOT Launched, after TelevoxTM was launched, and after our intervention. Secondary: the effect of a covariate on N/S probability; economic impact of N/S to our clinic. Results: Crude modeling shows a significant (16%) increase in a patient showing for visit [OR 1.16, p=.0310] after the intervention; this is not apparent after the launch of the software, but before intervention group [OR 1.09, p=.1195]. Age showed significance in the adjusted model – with a 1% increase in chance of showing for a visit correlating to a 1-year increase in age. Being an uninsured patient led to a 66% decrease in the chance of showing. December was statistically the lowest month of those captured regarding show rate. At an average captured N/S rate of 27%, our clinic missed an average of $11,400.00 of billable funds a month. Conclusions: N/S rates may have decreased significantly by our","PeriodicalId":199163,"journal":{"name":"Practice management and organization","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121409238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ian Nelligan, Doris Chen, J. Shaw, M. Winget, Elyse Gonzales
{"title":"Video visit triage and clinical effectiveness in a primary care setting","authors":"Ian Nelligan, Doris Chen, J. Shaw, M. Winget, Elyse Gonzales","doi":"10.1370/afm.20.s1.3032","DOIUrl":"https://doi.org/10.1370/afm.20.s1.3032","url":null,"abstract":"","PeriodicalId":199163,"journal":{"name":"Practice management and organization","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114554433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Defining and measuring primary care panels: A systematic review","authors":"M. Mayo-Smith","doi":"10.1370/afm.20.s1.2954","DOIUrl":"https://doi.org/10.1370/afm.20.s1.2954","url":null,"abstract":"","PeriodicalId":199163,"journal":{"name":"Practice management and organization","volume":"18 5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122372971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Colleen Grady, Mary Martin, David Pinkerton, Laura Di Quinzio
{"title":"Mitigating Occupational Stressors: Project Design by Family Physicians","authors":"Colleen Grady, Mary Martin, David Pinkerton, Laura Di Quinzio","doi":"10.1370/afm.21.s1.3583","DOIUrl":"https://doi.org/10.1370/afm.21.s1.3583","url":null,"abstract":"","PeriodicalId":199163,"journal":{"name":"Practice management and organization","volume":"14 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"113938502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Where are Pharmacists and Primary Care Providers Teaming up for Patient Access","authors":"Emily Hawes","doi":"10.1370/afm.21.s1.3846","DOIUrl":"https://doi.org/10.1370/afm.21.s1.3846","url":null,"abstract":"","PeriodicalId":199163,"journal":{"name":"Practice management and organization","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121405252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kimberly G. Fulda, Richard Young, Anna M. Espinoza, Noah Hendrix, Yan Xiao
{"title":"Patient Provider Engagement in Family Medicine: A Qualitative Study from the PROMIS Learning Lab","authors":"Kimberly G. Fulda, Richard Young, Anna M. Espinoza, Noah Hendrix, Yan Xiao","doi":"10.1370/afm.21.s1.3915","DOIUrl":"https://doi.org/10.1370/afm.21.s1.3915","url":null,"abstract":"","PeriodicalId":199163,"journal":{"name":"Practice management and organization","volume":"107 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122608152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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