A critical qualitative study to understand current black women medical student perspectives on anti-racist reform in US medical education.

Purpose: The US medical education system has a long-standing history of omitting evidence and perpetuating false pseudo-scientific beliefs on the complex and nuanced relationships between race, racism, and health disparities. There is an urgent need to identify and address the historical influence of systemic racism on the current curriculum, organization, and culture of US medical education. The goal of this study was to understand Black women medical student perspectives on race and racism in current medical school training and their recommendations to inform anti-racist action in US medical education.

"Anxiety, COVID, Burnout and Now Depression": a Qualitative Study of Primary Care Clinicians' Perceptions of Burnout.

Background: Clinician burnout has become a major issue in the USA, contributing to increased mental health challenges and problems with quality of care, productivity, and retention.

Objective: The objective of this study was to understand primary care clinicians' perspectives on burnout during the COVID-19 pandemic as well as their perspectives on the causes of burnout and strategies to improve clinician well-being.

Approach: This qualitative research involved in-depth interviews with 27 primary care clinicians practicing in a range of settings across the USA.

Implementation strategies for large scale quality improvement initiatives in primary care settings: a qualitative assessment.

Background And Objectives: The EvidenceNOW: Advancing Heart Health in Primary Care was designed to assist primary care practices in the US in implementing evidence-based practices in cardiovascular care and building capacity for quality improvement. EvidenceNOW, NCT03054090, was registered with ClinicalTrials.gov on 15/02/2017.

Burnout among Primary Care Providers and Staff: Evaluating the Association with Practice Adaptive Reserve and Individual Behaviors.

Background: Workplace burnout among healthcare professionals is a critical public health concern. Few studies have examined organizational and individual factors associated with burnout across healthcare professional groups.

Objective: The purpose of this study was to examine the association between practice adaptive reserve (PAR) and individual behavioural response to change and burnout among healthcare professionals in primary care.

Indicators of Workplace Burnout Among Physicians, Advanced Practice Clinicians, and Staff in Small to Medium-Sized Primary Care Practices.

Background: The rising prevalence of burnout among physicians and other healthcare professionals has become a major concern in the United States. Identifying indicators of burnout could help reduce negative consequences such as turnover, loss of productivity, and adverse health behaviors. The goal of this study was to examine whether individual behaviors and attitudes towards major disruptive change has an effect on workplace burnout.

Care Experiences of Patients with Multiple Chronic Conditions in a Payer-Based Patient-Centered Medical Home.

Individuals with multiple chronic health conditions require additional support and medical services, incur higher health care costs, and often have a higher risk of hospitalization. The goal of this study was to examine care experiences of patients with multiple chronic conditions in the CareFirst patient-centered medical home (PCMH). The study used a repeated cross-sectional research design and included 1308 adult CareFirst plan members with multiple chronic conditions.

A Qualitative Analysis of Implementing EvidenceNOW to Improve Cardiovascular Care.

Purpose: The Heart of Virginia Health care (HVH) was a regional cooperative under the EvidenceNOW initiative to assist primary care practices in implementing evidence-based cardiovascular care and building capacity for quality improvement. The HVH implementation team included individuals from multiple universities, quality improvement organizations, and consulting firms. The goal of this study was to understand HVH team member viewpoints on the challenges, strengths, and lessons learned in each phase of the project.

Pseudophakic mini-monovision: high patient satisfaction, reduced spectacle dependence, and low cost.

Background: Cataract surgery with pseudophakic mini-monovision has lower out-of-pocket patient expense than premium multifocal intraocular lenses (IOL). The purpose of this study was to evaluate patient-reported satisfaction and spectacle dependence for key activities of daily living after cataract surgery with pseudophakic mini-monovision. The study also examined statistical relationships between patient demographic variables, visual acuity and satisfaction.

Primary Care Residents in Teaching Health Centers: Their Intentions to Practice in Underserved Settings After Residency Training.

Purpose: To describe the residents who chose to train in teaching health centers (THCs), which are community-based ambulatory patient care sites that sponsor primary care residencies, and their intentions to practice in underserved settings.

Method: The authors surveyed all THC residents training in academic years 2013-2014, 2014-2015, and 2015-2016, comparing their demographic characteristics with data for residents nationally, and examined THC residents' intentions to practice in underserved settings using logistic regression analysis.

Results: The overall survey response rate was 89% (1,031/1,153).

Dual Eligibles' Experience of Care with North Carolina's Patient-Centered Medical Home.

Although individuals enrolled in both Medicare and Medicaid (dual eligibles) are among those with the nation's greatest need, at $300 billion per year, their care is also expensive and beset by quality problems. Previous research found problems associated with inadequate coordination of benefits and services; however, these studies have largely used quantitative approaches and focused on providers-few studies have explored the perspective of dual eligible patients. In an effort to improve care and reduce costs, North Carolina (NC) developed a Patient-Centered Medical Home (PCMH) model centered on a continuous relationship with a primary care provider who is responsible for coordination of services and addressing patients' health care needs by providing direct services or arranging care with other qualified professionals.

Collaboration Across the Safety Net in the Era of Health Reform: Opportunities or Obstacles?

While implementation of the Patient Protection and Affordable Care Act brings significant opportunities for safety net providers (SNP), local systems vary in how well they adapt to the rapidly evolving environment. Collaboration may enhance SNP capacity to leverage opportunities in the health reform era. Our study examines key opportunities and challenges SNPs face under health reform and how providers use collaboration as a strategy to adapt to the new environment.

Privacy and Confidentiality Practices In Adolescent Family Planning Care At Federally Qualified Health Centers.

Context: The confidentiality of family planning services remains a high priority to adolescents, but barriers to implementing confidentiality and privacy practices exist in settings designed for teenagers who are medically underserved, including federally qualified health centers (FQHCs).

Methods: A sample of 423 FQHCs surveyed in 2011 provided information on their use of five selected privacy and confidentiality practices, which were examined separately and combined into an index. Regression modeling was used to assess whether various state policies and organizational characteristics were associated with FQHCs' scores on the index.

The Role of Primary Care Practices in Advancing Population Health.

Improving population health requires the contribution of many entities including state and local governments, hospitals, community organizations, health centers, and private practices. Primary care practices have the potential to play a key role in improving population health. While sporadic, primary care practices engage in a spectrum of practice- and community-based population health activities.

Hospital Culture of Transitions in Care: Survey Development.

Understanding hospital culture is important to effectively manage patient flow. The purpose of this study was to develop a survey instrument that can assess a hospital's culture related to in-hospital transitions in care. Key transition themes were identified using a multidisciplinary team of experts from 3 health care systems.

The Role of Federally Qualified Health Centers in Delivering Family Planning Services to Adolescents.

Purpose: The purpose of this article was to examine the role of community health centers (CHCs) in providing comprehensive family planning services to adolescents, looking at the range of services offered and factors associated with provision of these services.

Methods: This study employed a mixed methods approach comprising a national survey of CHCs and six in-depth case studies of health centers to examine the organization and delivery of family planning services. We developed an adolescent family planning index comprising nine family planning services specifically tailored to adolescents.

The organization and delivery of family planning services in community health centers.

Background: Family planning and related reproductive health services are essential primary care services for women. Access is limited for women with low incomes and those living in medically underserved areas. Little information is available on how federally funded health centers organize and provide family planning services.

Accessibility of long-acting reversible contraceptives (LARCs) in Federally Qualified Health Centers (FQHCs).

Objective(s): This study examines the on-site availability of long-acting reversible contraception (LARC) methods, defined here as intrauterine devices and contraceptive implants, at Federally Qualified Health Centers (FQHCs). We also describe factors associated with on-site availability and specific challenges and barriers to providing on-site access to LARC as reported by FQHCs.

Study Design: An original survey of 423 FQHC organizations was fielded in 2011.

Scope of family planning services available in Federally Qualified Health Centers.

Objectives: Federally Qualified Health Centers (FQHCs) are a major and growing source of primary care for low-income women of reproductive age; however, only limited knowledge exists on the scope of family planning care they provide and the mechanisms for delivery of these essential reproductive health services, including family planning. In this paper, we report on the scope of services provided at FQHCs including on-site provision, prescription only and referral options for the range of contraceptive methods.

Study Design: An original survey of 423 FQHC organizations was fielded in 2011.

Team-based care: a critical element of primary care practice transformation.

The purpose of this study was to gain an in-depth understanding of how primary care practices in the United States are transforming their practice to deliver patient-centered care. The study used qualitative research methods to conduct case studies of small primary care practices in the state of Virginia. The research team collected data from practices using in-depth interviews, structured telephone questionnaires, observation, and document review.

Why do some primary care practices engage in practice improvement efforts whereas others do not?

Objective: To understand what motivates primary care practices to engage in practice improvement, identify external and internal facilitators and barriers, and refine a conceptual framework.

Data Sources: In-depth interviews and structured telephone surveys with clinicians and practice staff (n = 51), observations, and document reviews.

Study Design: Comparative case study of primary care practices (n = 8) to examine aspects of the practice and environment that influence engagement in improvement activities.

Primary care in the United States: practice-based innovations and factors that influence adoption.

Purpose: This study aims to explore the use of specific innovations in primary care practices. The research seeks to examine whether a relationship exists between environmental factors and organizational characteristics and the level of innovation in primary care practices in Virginia.

Design/methodology/approach: The study utilized multiple secondary data sets and an organizational survey of primary care practices to define the external environment and the level of innovation.

EHRs in primary care practices: benefits, challenges, and successful strategies.

Objectives: To understand the current use of electronic health records (EHRs) in small primary care practices and to explore experiences and perceptions of physicians and staff toward the benefits, challenges, and successful strategies for implementation and meaningful use of advanced EHR functions.

Study Design: Qualitative case study of 6 primary care practices in Virginia.

Methods: We performed surveys and in-depth interviews with clinicians and administrative staff (N = 38) and observed interpersonal relations and use of EHR functions over a 16-month period.

Development and alumni assessment of an interdisciplinary PhD program offered through a blended learning environment.

There is a growing need for doctoral-prepared allied health professionals in health care practice, research, and teaching. This paper describes the development and evolution of the PhD Program in Health Related Sciences at Virginia Commonwealth University, which was designed to meet the demand for flexible learning environments by working allied health professionals. The program, now on its 14th year, offers interdisciplinary education in allied health fields through a blended learning environment that includes online and on-site education.

The relationship between organizational culture and practice systems in primary care.

The patient-centered medical home is an approach to comprehensive primary care relying on well-developed systems. Research has shown that for practices to meet patient-centered medical home requirements, care models may need to be redesigned. However, there is a dearth of information about what factors are important to achieve this goal.

Medical home infrastructure: effect of the environment and practice characteristics on adoption in Virginia.

This study examined whether environmental factors and practice characteristics influence the existence of patient-centered medical home elements in family practices in Virginia. The study used multiple secondary data sets to measure the external environment and a survey of family practices to enumerate and describe medical home elements and practice environment. Results show a positive association between organizational slack, organizational relationships, and stakeholder expectations on the existence of medical home elements.