Primary Care Patients' and Staff's Perceptions of Self-Rooming as Alternative to Waiting Rooms.

Purpose: Most patients are escorted to exam rooms (escorted rooming) although patients directing themselves to their exam room (self-rooming) saves patient and staff time while increasing patient satisfaction. This study assesses patient and staff perceptions after pragmatic implementation of self-rooming.

Methods: In October-December 2020, we surveyed patients and staff in 25 primary care clinics after our institution expanded self-rooming from 4 specially built clinics during the COVID-19 pandemic.

Does a Change in Physician Compensation Lead to Changes in Care Delivery in Family Medicine Clinics?

Background And Objectives: Many highly capitated systems still pay physicians based on relative value units (RVU), which may lead to excessive office visits. We reviewed electronic health records from the family medicine clinic panel members of 97 physicians and 42 residents to determine if a change from RVUs to panel-based compensation influenced care delivery as defined by the number of office visits and telephone contacts per panel member per month.

Methods: A retrospective analysis of the electronic health records of patients seen in 4 residency training clinics, 10 community clinics, and 4 regional clinics was conducted.

Reduction in Medication Refill Encounters Through Primary Care Redesign Workflow Changes.

With a goal of improving efficiency and reducing workload outside of visits, we sought to examine a primary care redesign process aimed at reducing refill requests made outside of office visits. Data on the number of refill encounters per panel member were collected at 17 clinics before, during, and after the implementation of a redesign process. There was an initial reduction in the number of medication refill encounters, and the rate of refill encounters continued to decline following implementation.

Influence of Environmental Design on Team Interactions Across Three Family Medicine Clinics: Perceptions of Communication, Efficiency, and Privacy.

Objective: In this study, we explored how two different primary care clinic physical layouts (onstage/offstage and pod-based [PB] designs) influenced pre- and postvisit team experiences and perceptions.

Background: Protocols encourage healthcare team communication before and after primary care visits to support better patient care. Physical clinic environments may influence these behaviors, but limited research has been performed.

Developing primary care teams prepared to improve quality: a mixed-methods evaluation and lessons learned from implementing a microsystems approach.

Background: Health systems in the United States are increasingly required to become leaders in quality to compete successfully in a value-conscious purchasing market. Doing so involves developing effective clinical teams using approaches like the clinical microsystems framework. However, there has been limited assessment of this approach within United States primary care settings.

A Simple Framework for Weighting Panels Across Primary Care Disciplines: Findings From a Large US Multidisciplinary Group Practice.

Background: Health system redesign necessitates understanding patient population characteristics, yet many primary care physicians are unable to identify patients on their panel. Moreover, accounting for differential workload due to patient variation is challenging. We describe development and application of a utilization-based weighting system accounting for patient complexity using sociodemographic factors within primary care at a large multidisciplinary group practice.

Cancer Survivorship Care Plan Utilization and Impact on Clinical Decision-Making at Point-of-Care Visits with Primary Care: Results from an Engineering, Primary Care, and Oncology Collaborative for Survivorship Health.

Every cancer survivor and his/her primary care provider should receive an individualized survivorship care plan (SCP) following curative treatment. Little is known regarding point-of-care utilization at primary care visits. We assessed SCP utilization in the clinical context of primary care visits.

The Impact of a Primary Care Education Program Regarding Cancer Survivorship Care Plans: Results from an Engineering, Primary Care, and Oncology Collaborative for Survivorship Health.

Survivorship care plans (SCPs) have been recommended as tools to improve care coordination and outcomes for cancer survivors. SCPs are increasingly being provided to survivors and their primary care providers. However, most primary care providers remain unaware of SCPs, limiting their potential benefit.

Vasectomy Practice Patterns Among Family Medicine Physicians and Compliance With the American Urological Association 2012 Vasectomy Guidelines.

Objective: To survey urologists and family medicine physicians (FMPs) within a single institution to determine current vasectomy practice patterns and determine compliance with 2012 American Urological Association (AUA) vasectomy guidelines.

Methods: In 2016, a single-institution survey was conducted to understand the vasectomy practice patterns among urologists and nonurologists. The survey questions and 3 clinical scenarios were designed based on the 2012 AUA vasectomy guidelines.

Building the learning health system: Describing an organizational infrastructure to support continuous learning.

Introduction: Academic health centers are reorganizing in response to dramatic changes in the health-care environment. To improve value, they and other health systems must become a learning health system, specifically one that has the capacity to understand performance across the continuum of care and use that information to achieve continuous improvements in efficiency and effectiveness. While learning health system concepts have been well described, the practical steps to create such a system are not well defined.

Across the divide: "Primary care departments working together to redesign care to achieve the Triple Aim".

Background: Primary care is considered the foundation of an effective health care system. However, primary care departments at academic health centers have numerous challenges to overcome when trying to achieve the Triple Aim.

Methods: As part of an organizational initiative to redesign primary care at a large academic health center, departments of internal medicine, general pediatrics and adolescent medicine, and family medicine worked together to comprehensively redesign primary care.

Family Physician Clinical Compensation in an Academic Environment: Moving Away From the Relative Value Unit.

Background And Objectives: Primary care physician compensation structures have remained largely volume-based, lagging behind changes in reimbursement that increasingly include population approaches such as capitation, bundled payments, and care management fees. We describe a population health-based physician compensation plan developed for two departmental family medicine faculty groups (residency teaching clinic faculty and community clinic faculty) along with outcomes before and after the plan's implementation.

Methods: An observational study was conducted.

Primary care team communication networks, team climate, quality of care, and medical costs for patients with diabetes: A cross-sectional study.

Background: Primary care teams play an important role in providing the best quality of care to patients with diabetes. Little evidence is available on how team communication networks and team climate contribute to high quality diabetes care.

Objective: To determine whether primary care team communication and team climate are associated with health outcomes, health care utilization, and associated costs for patients with diabetes.

Development and Impact of a Novel Academic Primary Care Compensation Model.

Background: Traditional productivity-based compensation models do not align well with newer population-based approaches to primary care. There are few published examples of academic general internal medicine compensation models that explicitly reward population health management, including care for patients between visits.

Objective: To describe the development and implementation of an academic general internal medicine compensation plan based upon actual work performed, compare satisfaction across primary care specialties, and evaluate work-related outcomes.

Are waiting rooms Passé? A pilot study of patient self-rooming.

Timeliness of care after patients arrive at the primary care office has received little examination. At 2 community family medicine clinics, an intervention was piloted replacing traditional waits in the waiting room with patients directing themselves to their examination rooms. We examined patient acceptability, experience of care, and staff time and cost savings before and after the intervention.