Lessons from the field: the essential elements for point-of-care transformation.

Abstract:

BACKGROUND:The challenges facing healthcare in the 21st century frequently seem intractable and insurmountable. Systemic problems impair the quality and continuity of care and caregivers' quality of life. For over 25 years, the Clinical Practice Model Resource Center (CPMRC) in Grand Rapids, MI, has focused on transforming healthcare at the point of care to achieve its mission to co-create and sustain the best places to work and to receive care. CONCEPTUAL FRAMEWORK:The extent of the vision to transform practice at the point of care calls for a shift from the common quick fix change mindset to a Professional Practice Framework mindset that guides the actions steps to achieve greater clinical integration and standardize, sustainable transformation in a complex healthcare system. METHODS:An overview of the Clinical Practice Model (CPM) Framework's conceptual underpinnings and the importance of the use of a Framework to guide transformation work across an International Consortium of hospitals are summarized. The lessons learned come from shared learning within a growing volunteer interdisciplinary, international consortium of over 276 rural, community, and university clinical settings. RESULTS:The Consortium's collective work has resulted in clinical, financial, and operational outcomes related to healthy work cultures, evidence-based practice, interdisciplinary, integrated documentation, and partnership councils. The cycle of organizational transformation ensures support for the professional processes, scope of practice, service across lifeline and continuum, integration and interoperability, evidence-based tools, interdisciplinary practice, and research-based and updated information. CONCLUSIONS:The power of organizational change flowing from a Framework is evident in replicable interventions and sustainable outcomes.

journal_name

Med Care

journal_title

Medical care

authors

Wesorick B,Doebbeling B

doi

10.1097/MLR.0b013e3182239331

subject

Has Abstract

pub_date

2011-12-01 00:00:00

pages

S49-58

eissn

0025-7079

issn

1537-1948

journal_volume

49 Suppl

pub_type

杂志文章
  • Family violence and the evaluation of behavioral concerns in a pediatric primary care clinic.

    abstract::The goals of this study were to determine 1) the prevalence of exposure to intrafamilial violence among children attending a pediatric primary care clinic; 2) the prevalence of psychosocial distress among mothers bringing their children to the clinic; 3) the extent to which pediatricians are aware of family violence a...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199205001-00013

    authors: Wissow LS,Wilson ME,Roter D,Larson S,Berman HI

    更新日期:1992-05-01 00:00:00

  • Benchmarking Veterans Affairs Medical Centers in the delivery of preventive health services: comparison of methods.

    abstract:OBJECTIVE:To identify consistent provision of clinical preventive services, we sought to benchmark all acute care Veterans Affairs Medical Centers (VAMCs) against each other nationally on the basis of multiple evidence-based, performance measures to identify facilities performing consistently higher and lower than expe...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-200206000-00011

    authors: Doebbeling BN,Vaughn TE,Woolson RF,Peloso PM,Ward MM,Letuchy E,BootsMiller BJ,Tripp-Reimer T,Branch LG

    更新日期:2002-06-01 00:00:00

  • A comparative study of seven measures of patient satisfaction.

    abstract::The acceptability of satisfaction as a quality indicator is qualified by several well known measurement problems. This study examines the variability in satisfaction evaluations related to different measurement methods and the effect of response biases on reported satisfaction. Satisfaction evaluations using seven dif...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199504000-00006

    authors: Ross CK,Steward CA,Sinacore JM

    更新日期:1995-04-01 00:00:00

  • Attitudes toward self-care: a consumer study.

    abstract::Although self-care is emerging as a growing movement wherein lay persons are assuming more responsibility for prvention, detection and treatment of health problems, we have almost no basic descriptive studies of attitudes toward self-care of professionals and consumers. The present study explored the reliability and v...

    journal_title:Medical care

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00005650-198008000-00009

    authors: Green KE,Moore SH

    更新日期:1980-08-01 00:00:00

  • Politics and Policymaking in Medicare Part C.

    abstract:BACKGROUND:Once just a small part of the Medicare program, private managed care plans now cover over one-third of all Medicare beneficiaries and cost the Federal government ~$210 billion each year. Importantly, the evolution of Medicare managed care policy has been far from linear; for several decades there have been d...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000001256

    authors: Adrion ER

    更新日期:2020-03-01 00:00:00

  • Predicting inpatient costs with admitting clinical data.

    abstract::Hospital cost-containment programs should themselves be cost-effective, targeting high-cost physicians (which requires adjusting for case mix) and patients (which requires early identification). In this study, clinical data available within 24 hours of admission from an electronic medical record system were used to de...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199501000-00001

    authors: Tierney WM,Fitzgerald JF,Miller ME,James MK,McDonald CJ

    更新日期:1995-01-01 00:00:00

  • 27. CPHA patient care data system for long-term care facilities.

    abstract::Earlier efforts of the Commission on Professional and Hospital Activities (CPHA) to develop a patient care data system for long-term care facilities were discontinued for lack of user interest and shortage of funds; however, the facilities were encouraged to participate in the hospital data system (PAS) and to use opt...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-197605001-00033

    authors: Slee VN

    更新日期:1976-05-01 00:00:00

  • Use of illness-related ambulatory physician services in Finland.

    abstract::The total utilization rate of ambulatory illness-related physician services in Finland is higher in big urban health center areas than in rural areas. When only the health center physician utilization rates were studied the finding was opposite. A notable finding related to the impact of the national health planning w...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198208000-00004

    authors: Kekki P

    更新日期:1982-08-01 00:00:00

  • Knowledge management and informatics considerations for comparative effectiveness research: a case-driven exploration.

    abstract:BACKGROUND:As clinical data are increasingly collected and stored electronically, their potential use for comparative effectiveness research (CER) grows. Despite this promise, challenges face those wishing to leverage such data. In this paper we aim to enumerate some of the knowledge management and informatics issues c...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e31829b1de1

    authors: Embi PJ,Hebert C,Gordillo G,Kelleher K,Payne PR

    更新日期:2013-08-01 00:00:00

  • Nonelective Rehospitalizations and Postdischarge Mortality: Predictive Models Suitable for Use in Real Time.

    abstract:BACKGROUND:Hospital discharge planning has been hampered by the lack of predictive models. OBJECTIVE:To develop predictive models for nonelective rehospitalization and postdischarge mortality suitable for use in commercially available electronic medical records (EMRs). DESIGN:Retrospective cohort study using split va...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000435

    authors: Escobar GJ,Ragins A,Scheirer P,Liu V,Robles J,Kipnis P

    更新日期:2015-11-01 00:00:00

  • Comparison of use of outpatient mental health services in an HMO and fee-for-service plans. Sensitivity to definition of a visit.

    abstract::Whereas previous authors have used a variety of strategies to identify use of mental health services, the sensitivity of estimates to the definition of a visit has been little studied. The authors examined the sensitivity of estimates of use of outpatient mental health services in both HMO and fee-for-service plans to...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:

    authors: Wells KB,Manning WG Jr,Benjamin B

    更新日期:1987-09-01 00:00:00

  • Beyond health plans: behavioral health disorders and quality of diabetes and asthma care for Medicaid beneficiaries.

    abstract:BACKGROUND:Most health insurance plans monitor ambulatory care quality using the Healthcare Effectiveness Data and Information Set (HEDIS), publicly reporting results at the plan level. Plan-level comparisons obscure the influence of patients served or settings where care is delivered. Mental illness, substance abuse, ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e318190db45

    authors: Clark RE,Weir S,Ouellette RA,Zhang J,Baxter JD

    更新日期:2009-05-01 00:00:00

  • Quality Enhancement Research Initiative in ischemic heart disease: a quality initiative from the Department of Veterans Affairs. QUERI IHD Executive Committee.

    abstract::Despite the dramatic fall in ischemic heart disease (IHD) mortality rates over the last 3 decades, it remains the number one cause of death in the United States, and one of the most frequent indications for care by the US Department of Veterans Affairs. National practice guidelines have been developed and disseminated...

    journal_title:Medical care

    pub_type: 杂志文章,评审

    doi:

    authors: Every NR,Fihn SD,Sales AE,Keane A,Ritchie JR

    更新日期:2000-06-01 00:00:00

  • Demographic differences in health preferences in the United States.

    abstract:BACKGROUND:The United States has a culturally and demographically diverse populace, and the aim of this study was to examine differences in health preferences by sex, age, ethnicity, and race. METHODS:We assessed preferences for health outcomes defined by the PROMIS-29 survey in a sample of the US population. On the b...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000066

    authors: Craig BM,Reeve BB,Cella D,Hays RD,Pickard AS,Revicki DA

    更新日期:2014-04-01 00:00:00

  • Comparison of two VA laboratory data repositories indicates that missing data vary despite originating from the same source.

    abstract:BACKGROUND:Assessing accuracy and completeness of data is an important component of conducting research. VA Healthcare System benefits from a highly developed electronic medical information system. The Immunology Case Registry was designed to monitor costs and quality of HIV care. The Decision Support System was develo...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e31817d69c2

    authors: McGinnis KA,Skanderson M,Levin FL,Brandt C,Erdos J,Justice AC

    更新日期:2009-01-01 00:00:00

  • Differentiation and specialization in the California hospital industry 1983 to 1988.

    abstract::This article examines changes in the service mix of California hospitals as part of their response to shifts in the system of reimbursement between 1983 and 1988. The Hospital Discharge Data Set and the Annual Hospital Disclosure Report produced by California Office of Statewide Health Planning and Development were us...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199604000-00007

    authors: Zwanziger J,Melnick GA,Simonson L

    更新日期:1996-04-01 00:00:00

  • Overuse and systems of care: a systematic review.

    abstract:BACKGROUND:Current health care reform efforts are focused on reorganizing health care systems to reduce waste in the US health care system. OBJECTIVE:To compare rates of overuse in different health care systems and examine whether certain systems of care or insurers have lower rates of overuse of health care services....

    journal_title:Medical care

    pub_type: 杂志文章,评审

    doi:10.1097/MLR.0b013e31828dbafe

    authors: Keyhani S,Falk R,Howell EA,Bishop T,Korenstein D

    更新日期:2013-06-01 00:00:00

  • Evidence of sample use among new users of statins: implications for pharmacoepidemiology.

    abstract:BACKGROUND:Epidemiologic studies of prescription medications increasingly rely on large administrative health care databases. These data do not capture patients' use of medication samples. This could potentially bias studies of short-term effects where date of initiation may be inaccurate. OBJECTIVES:To assess the ext...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000174

    authors: Li X,Stürmer T,Brookhart MA

    更新日期:2014-09-01 00:00:00

  • Waiting for care. Queuing and resource allocation.

    abstract::Queues arise in medical care and serve as allocators in the absence of an effective market and when resources become perceptibly constrained. This is essentially the case in all countries where money is not the means for gaining access to medical services. A study estimated that the total wait in England was 96 days f...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198702000-00006

    authors: Bloom BS,Fendrick AM

    更新日期:1987-02-01 00:00:00

  • Performance of the Medicare Consumer Assessment of Health Care Providers and Systems (CAHPS) Physical Functioning Items.

    abstract:BACKGROUND:Physical functioning is an important health domain for adults. OBJECTIVE:Evaluate physical functioning items in Medicare beneficiaries. RESEARCH DESIGN:Survey data from the 2010 Consumer Assessment of Healthcare Providers and Systems Medicare survey. SUBJECTS:The 366,701 respondents were 58% female; 38% w...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000475

    authors: Hays RD,Mallett JS,Gaillot S,Elliott MN

    更新日期:2016-02-01 00:00:00

  • Predictors of Multiple Emergency Department Utilization Among Frequent Emergency Department Users in 3 States.

    abstract:BACKGROUND:Research on frequent emergency department (ED) use shows that a subgroup of patients visits multiple EDs. This study characterizes these individuals. OBJECTIVE:The objective of this study was to determine how many frequent ED users seek care at multiple EDs and to identify sociodemographic, clinical, and co...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000001228

    authors: Giannouchos TV,Washburn DJ,Kum HC,Sage WM,Ohsfeldt RL

    更新日期:2020-02-01 00:00:00

  • Benefits and obstacles of health status assessment in ambulatory settings. The clinician's point of view. The Dartmouth Primary Care COOP Project.

    abstract::In the past decade physicians have identified the need to expand patient assessment to include global function and quality of life. During the same period, the busy clinic has evolved into the location where this assessment seems most appropriate. Integrating functional health assessment into a busy clinical practice ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199205001-00004

    authors: Wasson J,Keller A,Rubenstein L,Hays R,Nelson E,Johnson D

    更新日期:1992-05-01 00:00:00

  • Interpreter use and satisfaction with interpersonal aspects of care for Spanish-speaking patients.

    abstract:OBJECTIVES:Many patients have limited English proficiency and require an interpreter. The authors evaluated the effect of current interpreting practices on Spanish-speaking patients' satisfaction with the patient-provider relationship. METHODS:A cross-sectional survey was conducted of 457 patients seen in a public hos...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199810000-00004

    authors: Baker DW,Hayes R,Fortier JP

    更新日期:1998-10-01 00:00:00

  • Regression analysis in health services research: the use of dummy variables.

    abstract::Dummy variables frequently are used in regression analysis but often in an incorrect fashion. A brief review of examples in the medical care literature showed that the interpretation of dummy variable regression coefficients and their significance was often incorrect or unclear. This article shows how dummy variables ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198209000-00008

    authors: Polissar L,Diehr P

    更新日期:1982-09-01 00:00:00

  • The Pediatric Economic Database Evaluation (PEDE) Project: establishing a database to study trends in pediatric economic evaluation.

    abstract:BACKGROUND:While standard methods for conducting economic evaluations have evolved, little attention has been paid to the conduct of these studies in special populations such as children. OBJECTIVES:To build a database of pediatric economic evaluations and to examine trends in publication characteristics over a 20-yea...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/01.MLR.0000088451.56688.65

    authors: Ungar WJ,Santos MT

    更新日期:2003-10-01 00:00:00

  • Beyond the uninsured: problems in access to care.

    abstract::This paper investigates the difficulties that people encounter in their attempt to obtain needed health services, other than their third-party coverage or lack of it. These problems can be temporal, geographic, attitudinal, or financial (even with insurance). A state-wide sample survey conducted in 1989 revealed that ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199405000-00001

    authors: Bashshur RL,Homan RK,Smith DG

    更新日期:1994-05-01 00:00:00

  • Outcomes are Worse in US Patients Undergoing Surgery on Weekends Compared With Weekdays.

    abstract:BACKGROUND:Increasing surgical access to previously underserved populations in the United States may require a major expansion of the use of operating rooms on weekends to take advantage of unused capacity. Although the so-called weekend effect for surgery has been described in other countries, it is unknown whether US...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000532

    authors: Glance LG,Osler T,Li Y,Lustik SJ,Eaton MP,Dutton RP,Dick AW

    更新日期:2016-06-01 00:00:00

  • Antidepressant use: concordance between self-report and claims records.

    abstract:BACKGROUND:Researchers need valid methods to assess whether patients are taking their antidepressant medications. Two important sources of data on drug exposure are patients' self-reports and pharmacy claims. OBJECTIVE:To compare self-report and claims data for antidepressant exposure. RESEARCH DESIGN:Cross-sectional...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/01.MLR.0000053019.79054.B6

    authors: Kwon A,Bungay KM,Pei Y,Rogers WH,Wilson IB,Zhou Q,Adler DA

    更新日期:2003-03-01 00:00:00

  • Availability of Outpatient Telemental Health Services in the United States at the Outset of the COVID-19 Pandemic.

    abstract:BACKGROUND:Since COVID-19 has caused dramatic changes in everyday life, a major concern is whether patients have adequate access to mental health care despite shelter-in-place ordinances, school closures, and social distancing practices. OBJECTIVES:The aim was to examine the availability of telehealth services at outp...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000001512

    authors: Cantor JH,McBain RK,Kofner A,Stein BD,Yu H

    更新日期:2021-01-21 00:00:00

  • Disproportionate share hospital subsidies for treating the uninsured.

    abstract:BACKGROUND:Federal, state, and local governments provide substantial subsidies to so-called "safety-net" hospitals, in part, to offset the loss in revenue associated with providing a disproportionate share (DSH) of care to low-income and uninsured patients, with the goal to improve access to care for uninsured and ensu...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e3181e3572c

    authors: Fonkych K,Melnick G

    更新日期:2010-09-01 00:00:00