JOURNAL OF AMBULATORY CARE MANAGEMENT最新文献

Patients have multiple outpatient appointments for various reasons. Analyzing patients' related appointments provides insight into referral patterns, leading to recommendations for ideal care and more efficient planning. We model these appointments with causal graphs via Judea Pearl's causal graph approach. Once we define the causal relationships in the appointment data, we leverage a graph database and visualization software to investigate valuable patterns and relationships in patient care over time. The Pathways tool allows yield management at specialty, provider, or appointment levels. Leaders use this tool to anticipate a patient's downstream appointments; the tool provides insights into staffing and the impact of growing demand.

The projected increase of dementia in the diverse aging US population calls for a well-prepared public health workforce. Community health workers (CHWs) can address dementia in culturally appropriate ways. Collaborating with stakeholders, we developed a train-the-trainer curriculum for CHWs and used a virtual training platform to test its feasibility with 77 CHWs. Pre-/post-evaluation data demonstrated modestly increased dementia knowledge scores. Training participants valued the resources shared and interacting with peers. Disseminating this training could contribute to closing gaps in dementia care in diverse communities, along with policies supporting CHWs as a workforce that reduces age-related disparities and promotes health equity.

In ambulatory care, monitoring process performance measures (PPMs) is essential to meet regulatory requirements, establish targets for care, seek reimbursement, and evaluate patient care responsibilities. We implemented a comprehensive program, "Engage to Sustain," for licensed practical nurses (LPNs) and certified medical assistants (CMAs) to practice at the top of their licensure/certification. Screening rates for 4 key PPMs (depression screening, fall risk screening, and tobacco use screening and counseling) markedly increased following this intervention across 18 ambulatory departments with more than 2 million patient visits. These results suggest that shifting responsibilities for patient screening from physicians and advanced practitioners to LPNs and CMAs may improve screening rates.

This study examined changes in provider and staff burnout in 4 Boston-area federally qualified community health centers (FQHCs) participating in a pediatric behavioral health integration project. Utilizing the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSSMP), the study found that emotional exhaustion among primary care providers ( M = 20.5; confidence interval [CI], 17.8-23.2) was higher ( P = .001) than that among behavioral health clinicians ( M = 13.6; CI, 10.4-16.8) and ( P = .00005) community health workers ( M = 10.8; CI, 7.3-14.2). Emotional exhaustion among staff increased ( P = .04) from baseline ( M = 16.8; CI, 15.0-18.6) to follow-up ( M = 20.8; CI, 17.5-24.2), but burnout at follow-up was lower than national averages. FQHCs are integral in caring for marginalized patients; therefore, supporting a stable workforce by minimizing burnout is essential.

The COVID-19 pandemic forced us to face the growing realization that our expectations of staff redeployed to areas other than their usual role did not fully align with their perceptions of safety, competence, and teamwork. This mixed-methods study assessed perceptions of role, preparedness, and management among staff who were deployed from March through June 2020. Our findings support that the rapid reassignment of interprofessional role groups to respiratory illness clinics in the first wave, albeit necessary at the time, may not be the best response in future infectious disease outbreaks.