Pub Date : 2022-07-01DOI: 10.1097/JAC.0000000000000424
Andrew D Jopson, Allison G Cummings, Bianca K Frogner, Susan M Skillman
Medical assistants (MAs) are among the fastest-growing occupations in the United States, yet health care employers report high turnover rates and difficulty filling MA positions. Employers are increasingly using apprenticeship to meet emerging workforce needs. This qualitative study examined the perspectives of 14 employers using registered MA apprenticeships in 8 states. The findings revealed motivations for using apprenticeship, perceived benefits to the organization, challenges with implementation, and reflections on successful implementation. We detail how MA apprenticeship is successfully meeting recruitment and training needs in a variety of health care organizations, especially where program support resources are available.
{"title":"Employers' Perspectives on the Use of Medical Assistant Apprenticeships: A Qualitative Study.","authors":"Andrew D Jopson, Allison G Cummings, Bianca K Frogner, Susan M Skillman","doi":"10.1097/JAC.0000000000000424","DOIUrl":"https://doi.org/10.1097/JAC.0000000000000424","url":null,"abstract":"<p><p>Medical assistants (MAs) are among the fastest-growing occupations in the United States, yet health care employers report high turnover rates and difficulty filling MA positions. Employers are increasingly using apprenticeship to meet emerging workforce needs. This qualitative study examined the perspectives of 14 employers using registered MA apprenticeships in 8 states. The findings revealed motivations for using apprenticeship, perceived benefits to the organization, challenges with implementation, and reflections on successful implementation. We detail how MA apprenticeship is successfully meeting recruitment and training needs in a variety of health care organizations, especially where program support resources are available.</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":"45 3","pages":"191-201"},"PeriodicalIF":2.3,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10223426","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}
Pub Date : 2022-07-01DOI: 10.1097/JAC.0000000000000416
H. Hamadi, Mei Zhao, D. R. Haley, Jing Xu, Shyam Paryani, A. Spaulding
In 2011, the Centers for Medicare & Medicaid Services (CMS) implemented the Hospital Outpatient Quality Reporting Program to assess the quality of outpatient imaging efficiency (OIE). In this study, trends in hospital performance on these national hospital OIE measures a year after inception and public reporting were described. An observational trend analysis was conducted using 2013-2019 data from CMS 6 OIE measures. The trend analysis of metric scores indicates year-to-year variability in all 6 OIE variables. The reporting of these measures appears to have effectively improved the efficiency of most of the measures since the inception of the program.
{"title":"Observational Trends in Publicly Reported Quality Measures of Hospital Outpatient Quality Reporting Program, 2013-2019","authors":"H. Hamadi, Mei Zhao, D. R. Haley, Jing Xu, Shyam Paryani, A. Spaulding","doi":"10.1097/JAC.0000000000000416","DOIUrl":"https://doi.org/10.1097/JAC.0000000000000416","url":null,"abstract":"In 2011, the Centers for Medicare & Medicaid Services (CMS) implemented the Hospital Outpatient Quality Reporting Program to assess the quality of outpatient imaging efficiency (OIE). In this study, trends in hospital performance on these national hospital OIE measures a year after inception and public reporting were described. An observational trend analysis was conducted using 2013-2019 data from CMS 6 OIE measures. The trend analysis of metric scores indicates year-to-year variability in all 6 OIE variables. The reporting of these measures appears to have effectively improved the efficiency of most of the measures since the inception of the program.","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":"3 1","pages":"202 - 211"},"PeriodicalIF":2.3,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85339117","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}
Pub Date : 2022-07-01DOI: 10.1097/JAC.0000000000000418
Susan E Stockdale, Danielle E Rose, Michael McClean, Ann-Marie Rosland, Evelyn T Chang, Donna M Zulman, Gregory Stewart, Karin M Nelson
Using data from a Veterans Health Administration national primary care survey, this study identified the most highly rated tools and care approaches for patients with complex needs and how preferences varied by professional role, staffing, and training. Nurses were significantly more likely to rate most tools as very important as compared with primary care providers. Having a fully staffed team was also significantly associated with a very important rating on all tools. Nurses and fully staffed teams reported a greater likeliness to use most care approaches, and those with perceived need for training reporting a lower likeliness to use.
{"title":"Factors Associated With Patient-Centered Medical Home Teams' Use of Resources for Identifying and Approaches for Managing Patients With Complex Needs.","authors":"Susan E Stockdale, Danielle E Rose, Michael McClean, Ann-Marie Rosland, Evelyn T Chang, Donna M Zulman, Gregory Stewart, Karin M Nelson","doi":"10.1097/JAC.0000000000000418","DOIUrl":"10.1097/JAC.0000000000000418","url":null,"abstract":"<p><p>Using data from a Veterans Health Administration national primary care survey, this study identified the most highly rated tools and care approaches for patients with complex needs and how preferences varied by professional role, staffing, and training. Nurses were significantly more likely to rate most tools as very important as compared with primary care providers. Having a fully staffed team was also significantly associated with a very important rating on all tools. Nurses and fully staffed teams reported a greater likeliness to use most care approaches, and those with perceived need for training reporting a lower likeliness to use.</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":"45 3","pages":"171-181"},"PeriodicalIF":1.6,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9178911/pdf/nihms-1787101.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10216988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.1097/JAC.0000000000000415
D. Liss, A. Guzman, Emily E. Walsh, S. Shaunfield, Tiffany L. Brown
This study explored the goals, and care delivery approaches, of 14 interventions to address patients' medical and social needs. In qualitative interviews with clinicians and researchers, several themes emerged. Participants frequently described their overall goal as meeting patients' diverse needs to prevent avoidable acute care utilization. Medical needs were addressed by ensuring patients received primary care and actively coordinating care across clinical settings. Participants perceived social needs as tightly linked with medical needs, as well as a need for interpersonal skills among intervention staff. Descriptions of overall approaches to meeting patients' needs frequently aligned with principles of trauma-informed care and patient-centered care.
{"title":"Addressing Medical and Social Needs to Reduce Unnecessary Health Care Utilization and Costs","authors":"D. Liss, A. Guzman, Emily E. Walsh, S. Shaunfield, Tiffany L. Brown","doi":"10.1097/JAC.0000000000000415","DOIUrl":"https://doi.org/10.1097/JAC.0000000000000415","url":null,"abstract":"This study explored the goals, and care delivery approaches, of 14 interventions to address patients' medical and social needs. In qualitative interviews with clinicians and researchers, several themes emerged. Participants frequently described their overall goal as meeting patients' diverse needs to prevent avoidable acute care utilization. Medical needs were addressed by ensuring patients received primary care and actively coordinating care across clinical settings. Participants perceived social needs as tightly linked with medical needs, as well as a need for interpersonal skills among intervention staff. Descriptions of overall approaches to meeting patients' needs frequently aligned with principles of trauma-informed care and patient-centered care.","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":"396 1","pages":"212 - 220"},"PeriodicalIF":2.3,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77716260","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}
Pub Date : 2022-07-01DOI: 10.1097/JAC.0000000000000419
Jelena Zurovac, M. Barna, Angela R. Merrill, J. Zickafoose, S. Felt-Lisk, Lauren Vollmer Forrow, Karen Frederick Gallegos, D. Everhart, R. Flemming
The Centers for Medicare & Medicaid Services' (CMS's) Transforming Clinical Practice Initiative (TCPi) was the largest national-scale practice transformation model. We analyzed the effect of TCPi on new enrollment into Medicare Alternative Payment Models (APMs) through January 2020 (3 months after program end), using 6958 physician practices enrolled in TCPi and a closely matched comparison group of 6958 practices. More TCPi practices enrolled in Medicare APMs and Medicare Advanced APMs relative to comparison practices overall and in subgroups, including rural, small, and specialty practices. Results suggest that large-scale technical assistance can boost participation in Medicare APMs for a diverse set of practices.
{"title":"Transforming Clinical Practice Initiative Boosted Participation in Medicare Alternative Payment Models","authors":"Jelena Zurovac, M. Barna, Angela R. Merrill, J. Zickafoose, S. Felt-Lisk, Lauren Vollmer Forrow, Karen Frederick Gallegos, D. Everhart, R. Flemming","doi":"10.1097/JAC.0000000000000419","DOIUrl":"https://doi.org/10.1097/JAC.0000000000000419","url":null,"abstract":"The Centers for Medicare & Medicaid Services' (CMS's) Transforming Clinical Practice Initiative (TCPi) was the largest national-scale practice transformation model. We analyzed the effect of TCPi on new enrollment into Medicare Alternative Payment Models (APMs) through January 2020 (3 months after program end), using 6958 physician practices enrolled in TCPi and a closely matched comparison group of 6958 practices. More TCPi practices enrolled in Medicare APMs and Medicare Advanced APMs relative to comparison practices overall and in subgroups, including rural, small, and specialty practices. Results suggest that large-scale technical assistance can boost participation in Medicare APMs for a diverse set of practices.","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":"27 1","pages":"150 - 160"},"PeriodicalIF":2.3,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76790955","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}
Pub Date : 2022-07-01DOI: 10.1097/JAC.0000000000000414
Seongwon Choi, Ganisher Davlyatov, William Opoku-Agyeman
So-called "geographic expansion race," health care organizations expand physical facilities to different geographical locations as a way to foster growth. This study furthers knowledge on Federally Qualified Health Centers' (FQHCs') geographical expansion in relation to the local market's payer mix. The results indicated that areas with a higher proportion of Medicaid patients with fewer uninsured are more likely to see new FQHC sites opening. The findings are consistent with previous literature on the health care organization's geographical expansion and also indicated that some areas might lack proper FQHC services despite the high needs.
{"title":"Where Are the New Federally Qualified Health Center Sites? Uncovering FQHC Expansion and Ambulatory Care Policy Implications.","authors":"Seongwon Choi, Ganisher Davlyatov, William Opoku-Agyeman","doi":"10.1097/JAC.0000000000000414","DOIUrl":"https://doi.org/10.1097/JAC.0000000000000414","url":null,"abstract":"<p><p>So-called \"geographic expansion race,\" health care organizations expand physical facilities to different geographical locations as a way to foster growth. This study furthers knowledge on Federally Qualified Health Centers' (FQHCs') geographical expansion in relation to the local market's payer mix. The results indicated that areas with a higher proportion of Medicaid patients with fewer uninsured are more likely to see new FQHC sites opening. The findings are consistent with previous literature on the health care organization's geographical expansion and also indicated that some areas might lack proper FQHC services despite the high needs.</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":"45 3","pages":"221-229"},"PeriodicalIF":2.3,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10223427","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}
Pub Date : 2022-07-01DOI: 10.1097/JAC.0000000000000423
Ben Gronowski, Sarah E. Roth, T. T. Woodson, Hannah Cohen-Cline, Natalie Kenton
Effective care coordination relies on organizations working collaboratively to meet medically and socially complex participants' needs. This study examines community health workers' (CHWs') roles in developing the organizational relationships on which care coordination efforts depend. Semistructured interviews (n = 13) were conducted with CHWs, CHWs' supervisors, and executive staff at organizations participating in a Washington State care coordination program. Interviewees described how CHWs developed and furthered multidimensional relationships in service of participants between and within participating organizations, as well as external organizations. Relationship-building challenges included COVID-19, geographic context, and staffing. The study concludes with considerations for care coordination efforts to support CHWs.
{"title":"The Role of Community Health Workers in Developing Multidimensional Organizational Relationships","authors":"Ben Gronowski, Sarah E. Roth, T. T. Woodson, Hannah Cohen-Cline, Natalie Kenton","doi":"10.1097/JAC.0000000000000423","DOIUrl":"https://doi.org/10.1097/JAC.0000000000000423","url":null,"abstract":"Effective care coordination relies on organizations working collaboratively to meet medically and socially complex participants' needs. This study examines community health workers' (CHWs') roles in developing the organizational relationships on which care coordination efforts depend. Semistructured interviews (n = 13) were conducted with CHWs, CHWs' supervisors, and executive staff at organizations participating in a Washington State care coordination program. Interviewees described how CHWs developed and furthered multidimensional relationships in service of participants between and within participating organizations, as well as external organizations. Relationship-building challenges included COVID-19, geographic context, and staffing. The study concludes with considerations for care coordination efforts to support CHWs.","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":"24 1","pages":"242 - 251"},"PeriodicalIF":2.3,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77356173","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}
Pub Date : 2022-07-01DOI: 10.1097/JAC.0000000000000422
Carmen Alvarez, Chidinma Ibe, Katie Dietz, Nicolas Dominguez Carrero, Gideon Avornu, Ruth-Alma Turkson-Ocran, Jagriti Bhattarai, Deidra Crews, Paula Darby Lipman, Lisa A Cooper
The use of nurse care managers (CMs) and community health workers (CHWs) has demonstrated effectiveness in supporting improved blood pressure management among racially, ethnically, and socioeconomically minoritized populations. We partnered with a community advisory board (CAB) to develop a CM and CHW training curriculum and team-based collaborative care intervention to address uncontrolled hypertension. The objective of this study was to train CMs and CHWs to implement patient-centered techniques and address social determinants of health related to hypertension control. In partnership with a CAB, we developed and implemented a training curriculum for the CM/CHW collaborative care team. The training improved CM and CHW confidence in their ability to address medical and nonmedical issues that contribute to uncontrolled hypertension in their patients; however, preexisting norms and beliefs among CMs and CHWs created challenges with teamwork. The training curriculum was feasible and well-received. Additionally, the CMs' and CHWs' reactions provided insights to improve future collaborative care training and teamwork.
{"title":"Development and Implementation of a Combined Nurse Care Manager and Community Health Worker Training Curriculum to Address Hypertension Disparities.","authors":"Carmen Alvarez, Chidinma Ibe, Katie Dietz, Nicolas Dominguez Carrero, Gideon Avornu, Ruth-Alma Turkson-Ocran, Jagriti Bhattarai, Deidra Crews, Paula Darby Lipman, Lisa A Cooper","doi":"10.1097/JAC.0000000000000422","DOIUrl":"https://doi.org/10.1097/JAC.0000000000000422","url":null,"abstract":"The use of nurse care managers (CMs) and community health workers (CHWs) has demonstrated effectiveness in supporting improved blood pressure management among racially, ethnically, and socioeconomically minoritized populations. We partnered with a community advisory board (CAB) to develop a CM and CHW training curriculum and team-based collaborative care intervention to address uncontrolled hypertension. The objective of this study was to train CMs and CHWs to implement patient-centered techniques and address social determinants of health related to hypertension control. In partnership with a CAB, we developed and implemented a training curriculum for the CM/CHW collaborative care team. The training improved CM and CHW confidence in their ability to address medical and nonmedical issues that contribute to uncontrolled hypertension in their patients; however, preexisting norms and beliefs among CMs and CHWs created challenges with teamwork. The training curriculum was feasible and well-received. Additionally, the CMs' and CHWs' reactions provided insights to improve future collaborative care training and teamwork.","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":"45 3","pages":"230-241"},"PeriodicalIF":2.3,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9186266/pdf/nihms-1796463.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10223420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.1097/JAC.0000000000000417
Zahi R. Jurdi, Joseph F. Crosby
This study highlights the key drivers that form particular patient impressions resulting in exemplary overall provider performance ratings across service lines in the ambulatory environment. Two national samples of CG-CAHPS data were analyzed. Results indicate variance of impact among all CG-CAHPS questions on “top-box” scores for overall rating of provider among specialties. Interestingly, the same 5 explanatory variables—provider listened carefully, provider spent enough time, provider showed respect, provider knew important information about medical history, and provider explained things clearly—had the greatest explanatory power across the primary and specialty care samples when analyzed via multiple logistic regression analysis.
{"title":"Key Patient Experience Drivers That Result in Exemplary Overall Provider Performance Ratings in the Ambulatory Environment","authors":"Zahi R. Jurdi, Joseph F. Crosby","doi":"10.1097/JAC.0000000000000417","DOIUrl":"https://doi.org/10.1097/JAC.0000000000000417","url":null,"abstract":"This study highlights the key drivers that form particular patient impressions resulting in exemplary overall provider performance ratings across service lines in the ambulatory environment. Two national samples of CG-CAHPS data were analyzed. Results indicate variance of impact among all CG-CAHPS questions on “top-box” scores for overall rating of provider among specialties. Interestingly, the same 5 explanatory variables—provider listened carefully, provider spent enough time, provider showed respect, provider knew important information about medical history, and provider explained things clearly—had the greatest explanatory power across the primary and specialty care samples when analyzed via multiple logistic regression analysis.","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":"34 1","pages":"182 - 190"},"PeriodicalIF":2.3,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81102438","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}
Pub Date : 2022-07-01DOI: 10.1097/JAC.0000000000000420
A. Selim, J. Rothendler, S. Qian, Hannah M. Bailey, L. Kazis
There has been an increasing emphasis on placing patients at the center of clinical care and health care research and, in particular, assessing outcomes and experiences from the patient's perspective. One of the most widely used patient-reported outcome instruments is the Veterans RAND 12-item Health Survey (VR-12). This article reviews the VR-12 development and its applications over the last 2 decades, including research and potential uses in clinical care.
{"title":"The History and Applications of the Veterans RAND 12-Item Health Survey (VR-12)","authors":"A. Selim, J. Rothendler, S. Qian, Hannah M. Bailey, L. Kazis","doi":"10.1097/JAC.0000000000000420","DOIUrl":"https://doi.org/10.1097/JAC.0000000000000420","url":null,"abstract":"There has been an increasing emphasis on placing patients at the center of clinical care and health care research and, in particular, assessing outcomes and experiences from the patient's perspective. One of the most widely used patient-reported outcome instruments is the Veterans RAND 12-item Health Survey (VR-12). This article reviews the VR-12 development and its applications over the last 2 decades, including research and potential uses in clinical care.","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":"12 1","pages":"161 - 170"},"PeriodicalIF":2.3,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74674919","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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