April 25, 2012
“across the nation. Although they each share a common goal, historically they have operated independently of each other. However, new opportunities are emerging that could bring the two sectors together in ways that will yield substantial and lasting improvements in the health of individuals, communities, and populations. Because of this potential, the Centers for Disease Control and Prevention and the Health Resources and Services Administration asked the IOM to examine the integration of primary care and public health.
The interactions between the two sectors are so varied that it is not possible to prescribe a specific model or template for how integration should look. Instead, the IOM identifies a set of core principles derived from successful integration efforts – including a common goal of improving population health, as well as involving the community in defining and addressing its needs. The time is right for action, and the principles provided in this report can serve as a roadmap to move the nation toward a more efficient health system. The challenges in integrating primary care and public health are great – but so are the opportunities and rewards.”
Posted in READ Portal, Reports & Papers | Tagged with Health care reform, Primary health care | No Comments
March 9, 2012
“This report uses the 2008 Canadian Survey of Experiences With Primary Health Care to fill an important gap in our knowledge of primary health care for individuals who have ambulatory care sensitive conditions. An examination of differences in access, use and appropriateness of care
according to income, geography, health conditions and sex reveals the following:
- Individuals with ambulatory care sensitive conditions in the lowest income group, in rural areas or with multiple chronic conditions were twice as likely to report that their last visit to an emergency department was for a condition that they perceived as being treatable by their primary health care provider.
- Women with ambulatory care sensitive conditions were less likely than men to report receiving all four recommended tests for chronic disease monitoring, to have medication side effects explained or to be provided with tools to self-manage their condition.
- Compared with those in the highest income group, individuals with ambulatory care sensitive conditions in the lowest income group were less likely to report that their primary health care physician involved them in clinical decisions or helped them make a treatment plan to manage
their conditions.”
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March 6, 2012
“A robust primary care sector is the foundation of a more effective and efficient health care system. However, achieving a robust primary care sector will require widespread practice transformation. A growing consensus supports the patient-centered medical home (PCMH) model, proposed as joint principles by the major primary care professional associations, as the blueprint for practice transformation. Under these principles, a PCMH would provide each person with a personal physician who leads a team that takes responsibility for ongoing care for all health issues and coordinates care with other service providers. Medical homes would also ensure the quality and safety of their care through performance measurement and continuous quality improvement and provide their patients with enhanced access. Finally, payment systems would reward the added value provided by medical homes. While these joint principles describe the general expectations of a PCMH, they do not make concrete suggestions for how primary care organizations can change their practices to become one.
As part of The Commonwealth Fund’s Safety Net Medical Home Initiative (SNMHI), this report sought to develop a more detailed and concrete definition that describes the changes that most practices would need to make to become PCMHs. After reviewing the literature, the study team proposed eight characteristics of medical homes—called change concepts—which provide general directions for transforming a practice. We further identified more specific practice modifications called key changes for each change concept. A technical expert panel assembled for the SNMHI reviewed the change concepts and key changes and suggested alterations. A second panel, convened for another PCMH transformation project, also provided feedback.”
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February 16, 2012
This TED Talk with Brian Goldman address the some of the issues surrounding the medical culture of denying errors. “Every doctor makes mistakes. ‘But,’ says physician Brian Goldman, ‘medicine’s culture of denial (and shame) keeps doctors from ever talking about those mistakes, or using them to learn and improve.’ Telling stories from his own long practice, he calls on doctors to start talking about being wrong.”
Posted in Multimedia, READ Portal | Tagged with Primary health care, Safety | No Comments
December 9, 2011
“Only 48% of Canadians feel involved and are actively participating in their health care – which affects how they feel about their health. In a report released today, How Engaged are Canadians in their Primary Care? Results from the 2010 Commonwealth Fund International Health Policy Survey, the Health Council of Canada takes a look at why less than half of Canadians are taking a more active role in maintaining their health.
The report shows that engaged patients are happier with their care and more likely to participate in disease prevention, screenings and health promoting activities. The biggest barrier to patient engagement is time, and those patients who had experiences with long waits or who felt they didn’t have enough time with their doctor did not feel as engaged in their care.
Among 10 other countries who take part in the survey, Canada falls in the middle when it pertains to patient engagement. The countries ranking highest – New Zealand, Australia and Switzerland – are the same countries in a past Commonwealth survey (2010) who earned high ratings from citizens on access, affordability, timeliness and coordination of care.”
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December 8, 2011
“ABSTRACT: Recent reforms in Australia, England, and the Netherlands have sought to enhance the quality and accessibility of primary care. Quality improvement strategies include postgraduate training programs for family physicians, accreditation of general practitioner (GP) practices, and efforts to modify professional behaviors—for example, through clinical guideline development. Strategies for improving access include national performance targets, greater use of practice nurses, assured after-hours care, and medical advice telephone lines. All three countries have established midlevel primary care organizations both to coordinate primary care health services and to serve other functions, such as purchasing and population health planning. Better coordination of primary health care services is also the objective driving the use of patient enrollment in a single general practice. Payment reform is also a key element of English and Australian reforms, with both countries having introduced payment for quality initiatives. Dutch payment reform has stressed financial incentives for better management of chronic disease.
With well-developed primary care systems that have track records of strong performance, Australia, England, and the Netherlands offer some potentially useful lessons to the United States as it implements health care reforms. This brief outlines how primary care is provided in those three countries, it evaluates data on a range of primary care system performance indicators, and it examines the three countries’ major strategies for strengthening primary care:
- Promoting coordination of care;
- Reforming primary care payment;
- Improving quality and access.
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Posted in READ Portal, Reports & Papers | Tagged with Benchmarking, Health care reform, Primary health care, Quality control, Quality improvement | No Comments
November 9, 2011
“Context: During the 1980s and 1990s, innovations in the organization, funding, and delivery of primary health care in Canada were at the periphery of the system rather than at its core. In the early 2000s, a new policy environment emerged.
Methods: This policy analysis examines primary health care reform efforts in Canada during the last decade, drawing on descriptive information from published and gray literature and from a series of semistructured interviews with informed observers of primary health care in Canada.
Findings: Primary health care in Canada has entered a period of potentially transformative change. Key initiatives include support for interprofessional primary health care teams, group practices and networks, patient enrollment with a primary care provider, financial incentives and blended-payment schemes, development of primary health care governance mechanisms, expansion of the primary health care provider pool, implementation of electronic medical records, and quality improvement training and support.
Conclusions: Canada’s experience suggests that primary health care transformation can be achieved voluntarily in a pluralistic system of private health care delivery, given strong government and professional leadership working in concert.”
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September 22, 2011
“Major discrepancies exist between patient preferences and the medical care they receive for many common conditions. Shared decision making (SDM) is a process where a patient and clinician faced with more than one medically acceptable treatment option jointly decide which option is best based on current evidence and the patient’s needs, pref- erences and values. Many believe shared decision making can help bridge the gap between the care patients want and the care they receive. At the same time, SDM may help con- strain heath care spending by avoiding treatments that patients don’t want. However, barriers exist to wider use of shared decision making, including lack of reimbursement for physicians to adopt SDM under the existing fee-for-service payment system that rewards higher service volume; insufficient information on how best to train clinicians to weigh evidence and discuss treatment options for preference-sensitive conditions with patients; and clinician concerns about malpractice liability. Moreover, challenges to engaging some patients in shared decision making range from low health literacy to fears they will be denied needed care. Adding to these challenges is a climate of political hyperbole that stifles discussion about shared decision making, particularly when applied to difficult end- of-life-care decisions.”
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Posted in READ Portal, Reports & Papers | Tagged with Patient satisfaction, Patient-centered care, Primary health care | No Comments
June 17, 2011
“Most Americans get their health care in small physician practices. Yet, small practice settings are often unable to provide the same range of services or participate in quality improvement initiatives as large practices because they lack the staff, information technology, and office systems. One promising strategy is to share clinical support services and information systems with other practices. New findings from the 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians suggest smaller practices that share resources are more likely than those without shared resources to have advanced electronic medical records and health information technology, routinely track and manage patient information, have after-hours care arrangements, and engage in quality monitoring and benchmarking. This issue brief highlights strategies that can increase resources among small- and medium-sized practices and efforts supported by states, the private sector, and the Affordable Care Act that encourage the expansion of shared-resource models.”
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May 24, 2011
“Many of the estimated thirty-two million Americans expected to gain coverage under the Affordable Care Act are likely to have high levels of unmet need because of various chronic illnesses and to live in areas that are already underserved. In New Mexico an innovative new model of health care education and delivery known as Project ECHO (Extension for Community Healthcare Outcomes) provides high-quality primary and specialty care to a comparable population. Using state-of-the-art telehealth technology and case-based learning, Project ECHO enables specialists at the University of New Mexico Health Sciences Center to partner with primary care clinicians in underserved areas to deliver complex specialty care to patients with hepatitis C, asthma, diabetes, HIV/AIDS, pediatric obesity, chronic pain, substance use disorders, rheumatoid arthritis, cardiovascular conditions, and mental illness. As of March 2011, 298 Project ECHO teams across New Mexico have collaborated on more than 10,000 specialty care consultations for hepatitis C and other chronic diseases.”
Posted in Journal Articles, READ Portal | Tagged with Access to care, Chronic disease, Disease management, Primary health care | No Comments
