Building Pandemic-Resilient Primary Care Systems: Lessons Learned From COVID-19.

On January 30, 2023, the Biden Administration announced its intention to end the existing COVID-19 public health emergency declaration. The transition to a "postpandemic" landscape presents a unique opportunity to sustain and strengthen pandemic-era changes in care delivery. With this in mind, we present 3 critical lessons learned from a primary care perspective during the COVID-19 pandemic.

Catalyzing System Change: 100 Quality Improvement Projects in 1000 Days.

Background: Health system change requires quality improvement (QI) infrastructure that supports frontline staff implementing sustainable innovations. We created an 8-week rapid-cycle QI training program, Stanford Primary Care-Project Engagement Platform (PC-PEP), open to patient-facing primary care clinicians and staff.

Objective: Examine the feasibility and outcomes of a scalable QI program for busy practicing providers and staff in an academic medical center.

Trends in Pediatric Primary Care Visits During the COVID-19 Pandemic: Opportunity to Address Adolescent Behavioral Health Through Telemedicine.

Background And Objectives: The COVID-19 pandemic impacted the volume and nature of pediatric primary care visits nationwide. This study aimed to identify trends in pediatric visits at our institution during the pandemic to reveal opportunities to improve care of children and adolescents.

Methods: We performed a retrospective chart review of all pediatric visits conducted at a single family medicine clinic within a large academic medical center in Northern California from January 1, 2019, through September 30, 2021.

Evaluating the Implementation of a Model of Integrated Behavioral Health in Primary Care: Perceptions of the Healthcare Team.

Objectives: This study aims to compare primary care providers and medical assistants in degrees of comfort, confidence, and consistency when addressing behavioral health concerns with patients before and after the implementation of a model of integrated behavioral health in primary care (IBHPC), and evaluate whether these perceptions differ based on increased access to behavioral health clinicians.

Methods: This longitudinal study was conducted at 2 primary care clinics in Northern California while implementing an IBHPC model. was administered to assess the comfort, confidence, and consistency of behavioral health practices.

Considerations in the reliability and fairness audits of predictive models for advance care planning.

Multiple reporting guidelines for artificial intelligence (AI) models in healthcare recommend that models be audited for reliability and fairness. However, there is a gap of operational guidance for performing reliability and fairness audits in practice. Following guideline recommendations, we conducted a reliability audit of two models based on model performance and calibration as well as a fairness audit based on summary statistics, subgroup performance and subgroup calibration.

Transforming Interprofessional Roles During Virtual Health Care: The Evolving Role of the Medical Assistant, in Relationship to National Health Profession Competency Standards.

Introduction: Medical assistants (MAs) were once limited to obtaining vital signs and office work. Now, MAs are foundational to team-based care, interacting with patients, systems, and teams in many ways. The transition to Virtual Health during the COVID-19 pandemic resulted in a further rapid and unique shift of MA roles and responsibilities.

From Code to Bedside: Implementing Artificial Intelligence Using Quality Improvement Methods.

Despite increasing interest in how artificial intelligence (AI) can augment and improve healthcare delivery, the development of new AI models continues to outpace adoption in existing healthcare processes. Integration is difficult because current approaches separate the development of AI models from the complex healthcare environments in which they are intended to function, resulting in models developed without a clear and compelling use case and not tested or scalable in a clinical setting. We propose that current approaches and traditional research methods do not support successful AI implementation in healthcare and outline a repeatable mixed-methods approach, along with several examples, that facilitates uptake of AI technologies into human-driven healthcare processes.

A Model Medical Student-Led Interprofessional QI Project on Lab Monitoring.

Introduction: Teaching quality improvement (QI) in undergraduate medical education to meet entrustable professional activities (EPA) requirements is a challenge. We describe a model where first-year medical students learn QI methods using online modules and then apply their knowledge by leading an interprofessional project in a clinical setting. This model project, set in an outpatient family medicine clinic, sought to improve patient compliance with the preventive care metric of annual serum potassium and creatinine monitoring for patients taking a diuretic, angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB) medication.

One Year of Family Physicians' Observations on Working with Medical Scribes.

Purpose: The immense clerical burden felt by physicians is one of the leading causes of burnout. Scribes are increasingly being used to help alleviate this burden, yet few published studies investigate how scribes affect physicians' daily work, attitudes and behaviors, and relationships with patients and the workplace.

Methods: Using a longitudinal observational design, data were collected, over 1 year, from 4 physicians working with 2 scribes at a single academic family medicine practice.

Impact of Scribes on Physician Satisfaction, Patient Satisfaction, and Charting Efficiency: A Randomized Controlled Trial.

Purpose: Scribes are increasingly being used in clinical practice despite a lack of high-quality evidence regarding their effects. Our objective was to evaluate the effect of medical scribes on physician satisfaction, patient satisfaction, and charting efficiency.

Methods: We conducted a randomized controlled trial in which physicians in an academic family medicine clinic were randomized to 1 week with a scribe then 1 week without a scribe for the course of 1 year.

Actual and Standardized Patient Evaluations of Medical Students' Skills.

Background And Objectives: Physicians must communicate effectively with patients. Actual patients (APs) rarely evaluate medical students' clinical skills; instead, standardized patients (SPs) provide proxy ratings. It is unclear how well SP ratings mirror AP experiences.

Rethinking empathy decline: results from an OSCE.

Background: The phenomenon of empathy decline among medical students during training is widely accepted, with evidence based largely on studies using self-administered instruments. Recently, researchers have called into question this phenomenon, in light of new findings that suggest a discrepancy between self-administered empathy scores and observed empathic behaviours: for example, during objective structured clinical examinations (OSCEs). Our objective was to compare observed empathy among medical students in different clerkship years using an OSCE.

Impact of a scholarly track on quality of residency program applicants.

Introduction: It is generally believed that residency programs offering scholarly tracks attract higher quality applicants, although there is little evidence of this in the literature. We explored the impact of a clinician-educator track on the quality of applicants to our residency program by comparing the volume and characteristics of applicants before (2008-2011) and after (2012-2015) the track was introduced.

Methods: The total number of applications received was compared between the pre-track and post-track years.

Training Future Clinician-Educators: A Track for Family Medicine Residents.

Background And Objectives: Despite a growing demand for skilled clinician-educators, residents today rarely receive formal training in clinical teaching, curriculum development, administration, leadership, or educational scholarship. The authors describe the development, implementation, and preliminary evaluation of the O'Connor Stanford Leaders in Education Residency (OSLER) track, a novel clinician-educator track within the family medicine residency program affiliated with Stanford University School of Medicine.

Methods: In 2010, the OSLER track was introduced at O'Connor Hospital, a community hospital that houses an 8-8-8 family medicine residency program.

Sexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis.

Objective: To systematically assess the evidence for an association between sexual abuse and a lifetime diagnosis of psychiatric disorders.

Patients And Methods: We performed a comprehensive search (from January 1980-December 2008, all age groups, any language, any population) of 9 databases: MEDLINE, EMBASE, CINAHL, Current Contents, PsycINFO, ACP Journal Club, CCTR, CDSR, and DARE. Controlled vocabulary supplemented with keywords was used to define the concept areas of sexual abuse and psychiatric disorders and was limited to epidemiological studies.

Sexual abuse and lifetime diagnosis of somatic disorders: a systematic review and meta-analysis.

Context: Many patients presenting for general medical care have a history of sexual abuse. The literature suggests an association between a history of sexual abuse and somatic sequelae.

Objective: To systematically assess the association between sexual abuse and a lifetime diagnosis of somatic disorders.