Team-Based Approach to Successful Annual Wellness Visits.

Objective: The purpose of this study was to implement a 2-phase approach to rapidly increase the number of annual wellness visits (AWVs) and build a sustainable model at 3 study units (Mayo Clinic in Rochester, Minnesota, and clinics in 2 regions of Mayo Clinic Health System), which collectively serve approximately 80 000 patients who qualify for an AWV annually.

Methods: In the rapid improvement phase, beginning in July 2022, goals at the facilities were reoriented to prioritize AWVs, educate staff on existing AWV resources, and create low-effort workflows so that AWVs could be incorporated into existing patient appointments. Staff at all 3 study units worked independently and iterated quickly.

Hospitalization Risk Associated With Emergency Department Reasons for Visit and Patient Age: A Retrospective Evaluation of National Emergency Department Survey Data to Help Identify Potentially Avoidable Emergency Department Visits.

Background: Patients often present to emergency departments (EDs) with concerns that do not require emergency care. Self-triage and other interventions may help some patients decide whether they should be seen in the ED. Symptoms associated with low risk of hospitalization can be identified in national ED data and can inform the design of interventions to reduce avoidable ED visits.

Online Self-Triage of Ear or Hearing Concerns in a Patient Portal: Comparison of Subsequent Diagnoses and Hospitalizations to National Emergency Department and National Ambulatory Ear or Hearing Visits.

Background: Although online self-triage is easily accessible, little is known about the patients who use self-triage or their subsequent diagnoses. We compared ear/hearing self-triage subsequent diagnoses to ear/hearing visit diagnoses in emergency departments (ED) and ambulatory clinics across the United States.

Methods: We compared International Classification of Diseases version 10 (ICD10) coded diagnoses following online self-triage for ear/hearing concerns with those from national ED and ambulatory clinic samples.

Self-Triage Use, Subsequent Healthcare Utilization, and Diagnoses: A Retrospective Study of Process and Clinical Outcomes Following Self-Triage and Self-Scheduling for Ear or Hearing Symptoms.

Background: Self-triage is becoming more widespread, but little is known about the people who are using online self-triage tools and their outcomes. For self-triage researchers, there are significant barriers to capturing subsequent healthcare outcomes. Our integrated healthcare system was able to capture subsequent healthcare utilization of individuals who used self-triage integrated with self-scheduling of provider visits.

Clinic Design for Safety During the Pandemic: Safety or Teamwork, Can We Only Pick One?

Objective: This article aims to illustrate the design considerations of team-based primary care clinics in response to the pandemic.

Background: Due to COVID-19, physical distancing became a critical practice in our daily life, especially in healthcare settings where healthcare professionals must continue providing care to patients despite the manifold risks. Many healthcare facilities are implementing physical distancing in their clinic layouts, and healthcare professionals are adjusting their behaviors, so they can stay away from each other.

Designing for Effective and Safe Multidisciplinary Primary Care Teamwork: Using the Time of COVID-19 as a Case Study.

Effective medical teamwork can improve the effectiveness and experience of care for staff and patients, including safety. Healthcare organizations, and especially primary care clinics, have sought to improve medical teamwork through improved layout and design, moving staff into shared multidisciplinary team rooms. While co-locating staff has been shown to increase communication, successful designs balance four teamwork needs: face-to-face communications; situational awareness; heads-down work; perception of teamness.

The Representational Function of Clinic Design: Staff and Patient Perceptions of Teamwork.

Objective: This study empirically investigates the relationships between visibility attributes and both patients' and staff members' teamwork experiences.

Background: Teamwork among healthcare professionals is critical for the safety and quality of patient care. While a patient-centered, team-based care approach is promoted in primary care clinics, little is known about how clinic layouts can support the teamwork experiences of staff and patients in team-based primary clinics.

Spatial Influences on Team Awareness and Communication in Two Outpatient Clinics: a Multiple Methods Study.

Background: Healthcare organizations are moving their primary care teams out of private offices into shared workspaces for many reasons, including teamwork improvement and cost reduction.

Objective: Identify the specific aspects of layout and design that enable two fundamental processes of high-functioning teams: communication and situation awareness.

Design: This was a multi-method study employing qualitative interviews, floor plan analysis, observations, behavior mapping, and surveys.

Association of Neighborhood Measures of Social Determinants of Health With Breast, Cervical, and Colorectal Cancer Screening Rates in the US Midwest.

Importance: Despite advances in cancer treatment and cancer-related outcomes, disparities in cancer mortality remain. Lower rates of cancer prevention screening and consequent delays in diagnosis may exacerbate these disparities. Better understanding of the association between area-level social determinants of health and cancer screening may be helpful to increase screening rates.

Backstage Staff Communication: The Effects of Different Levels of Visual Exposure to Patients.

Objective: This article examines how visual exposure to patients predicts patient-related communication among staff members.

Background: Communication among healthcare professionals private from patients, or backstage communication, is critical for staff teamwork and patient care. While patients and visitors are a core group of users in healthcare settings, not much attention has been given to how patients' presence impacts staff communication.

The impact of clinic design on teamwork development in primary care.

Background: Traditional clinic design supports a high-volume, hierarchical practice model. New design models are evolving to foster a high-functioning team delivery model.

Purpose: The goal of this study was to determine whether new design models, specifically colocation, improve care team development.

Development and Implementation of a Team-Based, Primary Care Delivery Model: Challenges and Opportunities.

In this article, we describe the implementation of a team-based care model during the first 2 years (2016-2017) after Mayo Clinic designed and built a new primary care clinic in Rochester, Minnesota. The clinic was configured to accommodate a team-based care model that included complete colocation of clinical staff to foster collaboration, designation of a physician team manager to support a physician to advanced practice practitioner ratio of 1:2, expanded roles for registered nurses, and integration of clinical pharmacists, behavioral health specialists, and community specialists; this model was designed to accommodate the growth of nonvisit care. We describe the implementation of this team-based care model and the key metrics that were tracked to assess performance related to the quadruple aim of improving population health, improving patient experience, reducing cost, and supporting care team's work life.

Making the Paradigm Shift from Siloed Population Health Management to an Enterprise-Wide Approach.

Health systems across the United States have started their journeys toward population health management and the future of accountable care. Models of population health management include patient-centered medical homes and private sector accountable care organizations (ACOs). Other models include public sector efforts, such as Physician Group Practice Transition Demonstrations, Medicare Health Care Quality Demonstration Programs, Beacon Communities, Medicare Shared Savings Program, and Pioneer ACOs.

The Method for Performance Measurement Matters: Diabetes Care Quality as Measured by Administrative Claims and Institutional Registry.

Objectives: Performance measurement is used by health care providers, payers, and patients. Historically accomplished using administrative data, registries are used increasingly to track and improve care. We assess how measured diabetes care quality differs when calculated using claims versus registry.

Clinical decision support improves quality of telephone triage documentation--an analysis of triage documentation before and after computerized clinical decision support.

Background: Clinical decision support (CDS) has been shown to be effective in improving medical safety and quality but there is little information on how telephone triage benefits from CDS. The aim of our study was to compare triage documentation quality associated with the use of a clinical decision support tool, ExpertRN©.

Methods: We examined 50 triage documents before and after a CDS tool was used in nursing triage.

Impact of patient portal secure messages and electronic visits on adult primary care office visits.

Introduction: Secure messages and electronic visits ("e-visits") through patient portals provide patients with alternatives to face-to-face appointments, telephone contact, letters, and e-mails. Limited information exists on how portal messaging impacts face-to-face visits in primary care.

Materials And Methods: We conducted a retrospective cohort study of 2,357 primary care patients who used electronic messaging (both secure messages and e-visits) on a patient portal.

Risk-stratification methods for identifying patients for care coordination.

Background: Care coordination is a key component of the patient-centered medical home. However, the mechanism for identifying primary care patients who may benefit the most from this model of care is unclear.

Objectives: To evaluate the performance of several risk-adjustment/stratification instruments in predicting healthcare utilization.

Telemedicine barriers associated with regional quality measures.

Telemedicine practitioners are familiar with multiple barriers to delivering care at a distance. Licensing and reimbursement barriers are well known and are being addressed at national and state levels by the American Telemedicine Association. Another telemedicine barrier comes in the form of quality measures for diabetes.

Trends in computed tomography utilization rates: a longitudinal practice-based study.

Objectives: Computed tomography (CT) use has increased dramatically over the past 2 decades, leading to increased radiation exposure at the population level. We assessed trends in CT use in a primary care (PC) population from 2000 to 2010.

Methods: Trends in CT use from 2000 to 2010 were assessed in an integrated, multi-specialty group practice.

Patient-generated secure messages and eVisits on a patient portal: are patients at risk?

Background: Patient portals are becoming increasingly common, but the safety of patient messages and eVisits has not been well studied. Unlike patient-to-nurse telephonic communication, patient messages and eVisits involve an asynchronous process that could be hazardous if patients were using it for time-sensitive symptoms such as chest pain or dyspnea.

Methods: We retrospectively analyzed 7322 messages (6430 secure messages and 892 eVisits).

Episode-based payment: evaluating the impact on chronic conditions.

Background: Policy makers are interested in aggregating fee-for-service reimbursement into episode-based bundle payments, hoping it will lead to greater efficiency in the provision of care. The focus of bundled payment initiatives has been upon surgical or discrete procedures. Relatively little is known about calculating and implementing episode-based payments for chronic conditions.

Qualities of care managers in chronic disease management: patients and providers' expectations.

Background: The collaborative care model has been shown in studies to be effective in achieving sustained treatment outcomes in chronic disease management. Its success is highly dependent on active patient engagement, provider endorsement and effective care management. This study sought to ask patients and providers what qualities they look for in a care manager.