'Do they care?': a qualitative examination of patient perspectives on primary care clinician communication related to opioids in the USA.

Objectives: This substudy's objectives were to (1) examine the transferability of a four archetype framework (simplified pattern of prototypical features) for patients at high risk for opioid use disorder (OUD) developed from a previous study with a similar population; (2) explore how patient preferences for terminology can inform clinician communication strategies for patients with OUD across archetypes and (3) explore how patient perceptions of opioid risks can inform clinician communication strategies across patient archetypes.

Design: This qualitative study collected data via semistructured phone interviews with patients about views on opioid-related discussions with primary care clinicians. Qualitative data were coded using the Rigorous and Accelerated Data Reduction technique and analysed via iterative inductive/deductive thematic analysis.

Care Coordination in Primary Care: Views of Clinicians and Clinic Leaders.

Background: Care coordination is an important strategy for addressing patient needs and improving outcomes of care.

Purpose: The Minnesota Care Coordination Effectiveness Study sought to better understand the perspectives and experiences of clinicians/clinic leaders regarding the value, barriers, and facilitators for care coordination in primary care.

Methods: We conducted semi-structured interviews with 18 clinic managers, physicians, and advanced practice clinicians.

Barriers and Facilitators to Using a Clinical Decision Support Tool for Opioid Use Disorder in Primary Care.

Purpose: Clinical decision support (CDS) tools are designed to help primary care clinicians (PCCs) implement evidence-based guidelines for chronic disease care. CDS tools may also be helpful for opioid use disorder (OUD), but only if PCCs use them in their regular workflow. This study's purpose was to understand PCC and clinic leader perceptions of barriers to using an OUD-CDS tool in primary care.

The Impact of Text Messaging to Promote Patient Reported Outcome Measures (PROMs) Completion in Orthopedic Practice: Findings From a Randomized Controlled Study.

It is difficult to achieve high response rates to Patient Reported Outcome Measures (PROMs) surveys collected as part of clinical care. However, they are operationally and clinically important. To understand the impact of text message reminders on response rates to PROMs collected via email as part of routine care for hip or knee replacement surgery, initial nonresponders were randomized to receive a text reminder or not at 7 and 12 days, if needed.

Patient Experiences and Perceptions of Care Coordination in Primary Care.

Background: Understanding patient perceptions of care coordination in primary care can help improve responsiveness to patients' needs, outcomes, and quality of care.

Purpose: The purpose of this study was to explore patient experiences and perceptions of care coordination in primary care.

Method: Interviews with 13 patients from 10 clinics were conducted and analyzed using directed content analysis.

Is There Room for Individual Patient-Specified Preferences in the Patient-Reported Outcome Measurement Revolution?

Purpose: The study aim was to test the feasibility of collecting qualitative patient-preferred outcomes or goals and the degree of their attainment as an addition to a standardized process for collecting quantitative composite patient-reported outcome measures (PROMs) from patients undergoing knee joint replacement.

Methods: Patients of a large Midwestern medical group scheduled to have total replacement of their knee joint have been asked to complete a PROMs survey preoperatively and at 3 and 12 months after surgery since 2014. In March 2020, an open-ended question about their most important preferred outcome was added to the existing questionnaire.

Care coordination in primary care: mapping the territory.

Objective: To document the current approaches to care coordination among different types of care systems in Minnesota.

Study Design: Observational survey of leaders of most of the care systems in Minnesota that have implemented care coordination.

Methods: Survey questions about organizational structure, size, and approach to care coordination were sent to the leaders of 42 care systems with a total of 327 primary care clinics.

Successful Change Management Strategies for Improving Diabetes Care Delivery Among High-Performing Practices.

Purpose: To learn how the highest-performing primary care practices manage change when implementing improvements to diabetes care delivery.

Methods: We ranked a total of 330 primary care practices submitting practice management assessments and diabetes reports to the Understanding Infrastructure Transformation Effects on Diabetes study in 2017 and 2019 by Optimal Diabetes Care performance. We ranked practices from the top quartile by greatest annual improvement to capture dynamic change.

The Impact of COVID-19 on Patients Receiving Care Coordination in Primary Care: A Qualitative Study.

Introduction: Care coordination addresses the needs of patients with complex chronic illness and psychosocial issues, coordinating their care and social needs. It is not known how such patients receiving these services managed during the COVID-19 pandemic. The objective of this study was to learn how the health, health care, social needs, and finances of patients receiving care coordination were affected by the disruptions caused by the COVID-19 pandemic.

Care Management Processes Important for High-Quality Diabetes Care.

Objective: Identify the improvement in diabetes performance measures and population-based clinical outcomes resulting from changes in care management processes (CMP) in primary care practices over 3 years.

Research Design And Methods: This repeated cross-sectional study tracked clinical performance measures for all diabetes patients seen in a cohort of 330 primary care practices in 2017 and 2019. Unit of analysis was patient-year with practice-level CMP exposures.

The Role of Care Coordination: A Qualitative Study of Care Coordinator Perceptions.

Background: Care coordination is important for patients with complex needs; yet, little is known about the factors impacting implementation from the care coordinator perspective.

Purpose: To understand how care coordination implementation differs across clinics and what care coordinators perceive as barriers and facilitators of effective coordination.

Methods: Nineteen care coordinators from primary care clinics in Minnesota participated in interviews about their perceptions of care coordination.

COVID-19 Impacts on Primary Care Clinic Care Management Processes.

Purpose: To learn whether the COVID-19 pandemic's disruptions and associated reduced health outcomes for people with chronic conditions might have been caused by a decrease in care management processes (CMPs) in primary care clinics METHODS: Longitudinal cohort design with repeated survey-based measures of CMPs from 2017, 2019, and 2021 in 269 primary care clinics in Minnesota.

Results: There were only small differences in organizational characteristics and no differences in overall CMPs between the 269 clinics analyzed and the 287 that only completed surveys in 1 or 2 years. Overall CMP scores rose by similar amounts (1.

How Does Prior Experience Pay Off in Large-Scale Quality Improvement Initiatives?

Introduction: To examine the association of prior investment on the effectiveness of organizations delivering large-scale external support to improve primary care.

Methods: Mixed-methods study of 7 EvidenceNOW grantees (henceforth, Cooperatives) and their recruited practices (n = 1720). : Cooperatives's experience level prior to EvidenceNOW, defined as a sustained track record in delivering large-scale quality improvement (QI) to primary care practices (high, medium, or low).

Quality and team care response to the pandemic stresses in high performing primary care practices: A qualitative study.

Objective: To learn how high performing primary care practices organized care for patients with diabetes during the initial months of the COVID-19 pandemic.

Participants And Methods: Semi-structured interviews were conducted between August 10 and December 10, 2020 with 16 leaders from 11 practices that had top quartile performance measures for diabetes outcomes pre-COVID. Each clinic had completed a similar interview and a survey about the existence of care management systems associated with quality outcomes before the pandemic.

Clinician Experiences With Telepsychiatry Collaborative Care for Posttraumatic Stress Disorder and Bipolar Disorder.

Objective: Posttraumatic stress disorder (PTSD) and bipolar disorder are common in primary care. Evidence supports collaborative care in primary care settings to treat depression and anxiety, and recent studies have evaluated its effectiveness in treating complex conditions such as PTSD and bipolar disorder. This study aimed to examine how primary care clinicians experience collaborative care for patients with these more complex psychiatric disorders.

Patient Perspectives on Opioid Risk Discussions in Primary Care.

Purpose: Both patients and clinicians have described discussions of potential opioid risks as challenging. This study's goal was to understand patient perspectives on discussing opioid risks with primary care clinicians (PCCs).

Methods: Patients identified to be at elevated risk for problems with opioids (ie, opioid use disorder [OUD] diagnosis, taking a medication for OUD, or having ≥3 opioid prescriptions in the last year) were recruited from an integrated, Upper Midwest health system to participate in semi-structured qualitative interviews.

Is the Promise of PROMs Being Realized? Implementation Experience in a Large Orthopedic Practice.

Patient-reported outcome measures (PROMs), increasingly used for research and quality measurement, are lauded for their potential to improve patient-centered care, both through aggregate reporting and when integrated into clinical practice. However, there are few published studies of the resultant use of PROMs in clinical practice. This case study describes the implementation and use of PROMS in a Midwestern multispecialty medical group orthopedic practice among patients undergoing total knee and hip surgery.

Comparing Pharmacist-Led Telehealth Care and Clinic-Based Care for Uncontrolled High Blood Pressure: The Hyperlink 3 Pragmatic Cluster-Randomized Trial.

Background: A team approach is one of the most effective ways to lower blood pressure (BP) in uncontrolled hypertension, but different models for organizing team-based care have not been compared directly.

Methods: A pragmatic, cluster-randomized trial compared 2 interventions in adult patients with moderately severe hypertension (BP≥150/95 mm Hg): (1) clinic-based care using best practices and face-to-face visits with physicians and medical assistants; and (2) telehealth care using best practices and adding home BP telemonitoring with home-based care coordinated by a clinical pharmacist or nurse practitioner. The primary outcome was change in systolic BP over 12 months.

How Does Prior Experience Pay Off in Large-Scale Quality Improvement Initiatives?

Introduction: To examine the association of prior investment on the effectiveness of organizations delivering large-scale external support to improve primary care.

Methods: Mixed-methods study of 7 EvidenceNOW grantees (henceforth, Cooperatives) and their recruited practices (n = 1720). : Cooperatives's experience level prior to EvidenceNOW, defined as a sustained track record in delivering large-scale quality improvement (QI) to primary care practices (high, medium, or low).

Reach in a pragmatic hypertension trial: A critical RE-AIM component.

Background: Hypertension control is falling in the US yet efficacious interventions exist. Poor patient reach has limited the ability of pragmatic trials to demonstrate effectiveness. This paper uses quantitative and qualitative data to understand factors influencing reach in Hyperlink 3, a pragmatic hypertension trial testing an efficacious pharmacist-led Telehealth Care intervention in comparison to a physician-led Clinic-based Care intervention.

Comparison of explanatory and pragmatic design choices in a cluster-randomized hypertension trial: effects on enrollment, participant characteristics, and adherence.

Background: Explanatory trials are designed to assess intervention efficacy under ideal conditions, while pragmatic trials are designed to assess whether research-proven interventions are effective in "real-world" settings without substantial research support.

Methods: We compared two trials (Hyperlink 1 and 3) that tested a pharmacist-led telehealth intervention in adults with uncontrolled hypertension. We applied PRagmatic Explanatory Continuum Indicator Summary-2 (PRECIS-2) scores to describe differences in the way these studies were designed and enrolled study-eligible participants, and the effect of these differences on participant characteristics and adherence to study interventions.

Patient and Clinician Perspectives on Two Telemedicine Approaches for Treating Patients with Mental Health Disorders in Underserved Areas.

Background: Primary care practices in underserved and/or rural areas have limited access to mental health specialty resources for their patients. Telemedicine can help address this issue, but little is known about how patients and clinicians experience telemental health care.

Methods: This pragmatic randomized effectiveness trial compared telepsychiatry collaborative care, where telepsychiatrists provided consultation to primary care teams, to a referral approach, where telepsychiatrists and telepsychologists assumed responsibility for treatment.

Diabetes care quality: do large medical groups perform better?

Objectives: To compare primary care management processes (CMPs) and outcome measures for diabetes quality among large, medium, and small medical groups.

Study Design: Observational comparison of differences in processes and outcomes over time among 329 primary care practices that agreed to participate and returned completed surveys in both 2017 and 2019.

Methods: We used a standardized composite measure of diabetes quality along with its 5 components and a survey measure of the presence of systematic CMPs to compare the outcomes and processes of care among clinics that were in large (≥ 12 sites), medium (4-11 sites), and small (1-3 sites) medical groups.