Contextual levers for team-based primary care: lessons from reform interventions in five jurisdictions in three countries.

Background: Most Western nations have sought primary care (PC) reform due to the rising costs of health care and the need to manage long-term health conditions. A common reform-the introduction of inter-professional teams into traditional PC settings-has been difficult to implement despite financial investment and enthusiasm.

Objective: To synthesize findings across five jurisdictions in three countries to identify common contextual factors influencing the successful implementation of teamwork within PC practices.

Uncovering the wisdom hidden between the lines: the Collaborative Reflexive Deliberative Approach.

Background: Meta-analysis and meta-synthesis have been developed to synthesize results across published studies; however, they are still largely grounded in what is already published, missing the tacit 'between the lines' knowledge generated during many research projects that are not intrinsic to the main objectives of studies.

Objective: To develop a novel approach to expand and deepen meta-syntheses using researchers' experience, tacit knowledge and relevant unpublished materials.

Methods: We established new collaborations among primary health care researchers from different contexts based on common interests in reforming primary care service delivery and a diversity of perspectives.

Parks as Social and Cultural Spaces Among U.S.- and Foreign-Born Latinas.

Parks provide opportunities for people to engage in activities that can promote physical and emotional well-being. Using focus groups and personal interviews conducted in select neighborhoods of a Northeastern city with a high rate of obesity, we examined perceptions of barriers and facilitators regarding the use of parks and park features that would promote physical activity among Latina women ( N = 39). Foreign-born Latinas emphasized the environmental characteristics of parks and the types of amenities that can support preferred cultural and social activities, while U.

Interprofessional teamwork innovations for primary health care practices and practitioners: evidence from a comparison of reform in three countries.

Context: A key aim of reforms to primary health care (PHC) in many countries has been to enhance interprofessional teamwork. However, the impact of these changes on practitioners has not been well understood.

Objective: To assess the impact of reform policies and interventions that have aimed to create or enhance teamwork on professional communication relationships, roles, and work satisfaction in PHC practices.

Coaching strategies for enhancing practice transformation.

Background: Current research on primary care practice redesign suggests that outside facilitation can be an important source of support for achieving substantial change.

Objectives: To analyse the specific sequence of strategies used by a successful practice facilitator during the American Academy of Family Physicians' (AAFP) National Demonstration Project (NDP).

Methods: This secondary analysis describes a sequence of strategies used to produce change in family medicine practices attempting to adopt a new model of care.

The transformational role of nursing in health care reform.

Successful health care reform will require more than insuring 32 million additional Americans. It will demand that our expensive, hospital and provider-driven model of care adopt a community-driven wellness model that emphasizes disease prevention. Nursing is perfectly situated to lead this transformation.

More black box to explore: how quality improvement collaboratives shape practice change.

Background: Quality improvement collaboratives (QICs) are used extensively to promote quality improvement in health care. Evidence of their effectiveness is limited, prompting calls to "open up the black box" to better understand how and why such collaboratives work.

Methods: We selected a cohort of 5 primary care practices that participated in a 6-month intervention study aimed at improving colorectal cancer screening rates.

Meeting the challenge of practice quality improvement: a study of seven family medicine residency training practices.

Purpose: Incorporating quality improvement (QI) into resident education and clinical care is challenging. This report explores key characteristics shaping the relative success or failure of QI efforts in seven primary care practices serving as family medicine residency training sites.

Method: The authors used data from the 2002-2008 Using Learning Teams for Reflective Adaptation study to conduct a comparative case analysis.

Evaluation of patient centered medical home practice transformation initiatives.

Background: The patient-centered medical home (PCMH) has become a widely cited solution to the deficiencies in primary care delivery in the United States. To achieve the magnitude of change being called for in primary care, quality improvement interventions must focus on whole-system redesign, and not just isolated parts of medical practices.

Methods: Investigators participating in 9 different evaluations of Patient Centered Medical Home implementation shared experiences, methodological strategies, and evaluation challenges for evaluating primary care practice redesign.

Using Learning Teams for Reflective Adaptation (ULTRA): insights from a team-based change management strategy in primary care.

Purpose: The Using Learning Teams for Reflective Adaptation (ULTRA) study used facilitated reflective adaptive process (RAP) teams to enhance communication and decision making in hopes of improving adherence to multiple clinical guidelines; however, the study failed to show significant clinical improvements. The purpose of this study was to examine qualitative data from 25 intervention practices to understand how they engaged in a team-based collaborative change management strategy and the types of issues they addressed.

Methods: We analyzed field notes and interviews from a multimethod practice assessment, as well as field notes and audio-taped recordings from RAP meetings, using an iterative group process and an immersion-crystallization approach.