Abstract:
PURPOSE:Practice transformation is the cornerstone of the future of family medicine and health care reform, but little is known about how the process occurs. We sought to develop and test a model of the natural history of practice transformation. METHODS:We developed an outcomes-based model of how a practice moves through practice transformation in 2 phases: (1) initial model created through meetings with collaborative experts and practice facilitators, and (2) clinical and practice systems change reports examined from the first group of participating North Carolina Improving Performance In Practice practices to test and further refine the model. RESULTS:The resultant model described motivators and supports to transformation. Three emerging practice patterns were identified with the model: transformed practices experiencing robust improvement, activated practices with moderate change, and engaged practices with minimal change in measured quality over a 2-year period. Transformed practices showed broad-based improvement; some reached a threshold and others continued to improve. These practices had highly engaged leadership and used data to drive decisions. Activated practices had a slower improvement trajectory, usually encountering a barrier that took time to overcome (eg, extracting population data, spreading practice changes). Engaged practices did not improve or were unable to sustain change; despite good intentions, multiple competing distractions interfered with practice transformation. CONCLUSIONS:Practice transformation is a continuous and long-term process. Internal and external practice motivations and specific practice supports provided by a community-based quality improvement program appear to have an impact on engagement, rate of quality improvement, and long-term sustainability. Early successes play a key role as practices learn how to change their performance.
journal_name
Ann Fam Medjournal_title
Annals of family medicineauthors
Donahue KE,Newton WP,Lefebvre A,Plescia Mdoi
10.1370/afm.1497subject
Has Abstractpub_date
2013-05-01 00:00:00pages
212-9issue
3eissn
1544-1709issn
1544-1717pii
11/3/212journal_volume
11pub_type
杂志文章abstract::During a night of severe pain and weakness, I found several plausible-sounding diagnoses online: occipital neuralgia, nerve damage, and meningitis. The next day, I consulted a physician who did not offer professional guidance; instead the physician suggested tests entirely based on my self-diagnoses. What resulted was...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2414
更新日期:2019-09-01 00:00:00
abstract::Cultural values and beliefs about the primary care physician bolster the myth of the lone physician: a competent professional who is esteemed by colleagues and patients for his or her willingness to sacrifice self, accept complete responsibility for care, maintain continuity and accessibility, and assume the role of l...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1353
更新日期:2012-03-01 00:00:00
abstract:PURPOSE:Practice transformation in primary care is a movement toward data-driven redesign of care, patient-centered care delivery, and practitioner activation. A critical requirement for achieving practice transformation is availability of tools to engage practices. METHODS:A total of 48 practices with 109 practice si...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2382
更新日期:2019-08-12 00:00:00
abstract::Two voices tell the story of an evolving doctor-patient relationship. Seizures are the first indication of squamous cell lung cancer metastatic to the brain. Both doctor and patient describe the course of the illness, treatment, and remarkable recovery, each from his own perspective. The patient describes how the canc...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.9
更新日期:2003-05-01 00:00:00
abstract:PURPOSE:Potentially inappropriate prescribing (PIP) is a common yet preventable medical error among older persons in primary care. It is uncertain whether PIP produces adverse outcomes in this population, however. We conducted a systematic review with meta-analysis to pool the adverse outcomes of PIP specific to primar...
journal_title:Annals of family medicine
pub_type: 杂志文章,meta分析
doi:10.1370/afm.2373
更新日期:2019-05-01 00:00:00
abstract:PURPOSE:Few clinical guidelines focus on how physicians can identify intimate partner violence (IPV) perpetration or victimization among male patients, and little is known of men's experiences and beliefs regarding screening in health care settings. Our objective was to determine prevalence of men's experiences with IP...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2536
更新日期:2020-07-01 00:00:00
abstract:PURPOSE:Despite growing calls for team-based care, the current staff composition of primary care practices is unknown. We describe staffing patterns for primary care practices in the Centers for Medicare and Medicaid Services (CMS) Comprehensive Primary Care (CPC) initiative. METHODS:We undertook a descriptive analysi...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1626
更新日期:2014-03-01 00:00:00
abstract:PURPOSE:Targeted interventions to reduce the risk and increase the early detection of melanoma have the potential to save lives. We aimed to assess the effect of such an intervention on patient prevention behavior. METHODS:We conducted a pilot clustered randomized controlled trial, comparing a targeted screening and e...
journal_title:Annals of family medicine
pub_type: 杂志文章,随机对照试验
doi:10.1370/afm.1600
更新日期:2014-01-01 00:00:00
abstract:PURPOSE:This study was conducted to document current immunization practices by family physicians. METHODS:In 2008 the American Academy of Family Physicians (AAFP) conducted a survey among a random sample of 2,000 of its members who reported spending 80% or more of their time in direct patient care. The survey consiste...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1185
更新日期:2010-11-01 00:00:00
abstract:PURPOSE:We undertook a study to evaluate the effectiveness of corticosteroid injections in primary care patients with greater trochanteric pain syndrome (GTPS). METHODS:We evaluated the effect of corticosteroid injections compared with expectant treatment (usual care) in a pragmatic, multicenter, open-label, randomize...
journal_title:Annals of family medicine
pub_type: 杂志文章,随机对照试验
doi:10.1370/afm.1232
更新日期:2011-05-01 00:00:00
abstract:BACKGROUND:We wanted to determine the frequency of self-reported receipt of screening mammography and Papanicolaou (Pap) tests in older women and investigate important predictors of utilization, based on 2 national longitudinal surveys. METHODS:This cohort study includes participants from 4 waves (1994-2000) of the He...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.54
更新日期:2003-11-01 00:00:00
abstract:PURPOSE:The US Preventive Services Task Force (USPSTF) is authorized by the US government to review and disseminate the scientific evidence for clinical preventive services. The purpose of this study was to evaluate the alignment of Medicare preventive services coverage with the recommendations of the USPSTF before imp...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1194
更新日期:2011-01-01 00:00:00
abstract:PURPOSE:Although screening with fecal occult blood testing (FOBT) reduces colorectal cancer (CRC) mortality, its effectiveness may diminish if patients do not adhere with repeated screenings. Among patients who had previously engaged in FOBT screening, we assessed subsequent adherence with FOBT screening. METHODS:We a...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1133
更新日期:2010-09-01 00:00:00
abstract::Hatpins is a first-person narrative that delves into a physician's experience of a patient death during the early years of residency. The essay reflects on the conflicted physician-patient relationships that can develop even over the short tenure of residency. While residency seeks to create medically prepared and com...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2135
更新日期:2017-11-01 00:00:00
abstract::William Osler is quoted as saying, "Nothing will sustain you more potently than the power to recognize in your humdrum routine, as perhaps it may be thought, the true poetry of life-the poetry of the commonplace, of the plain, toil-worn woman, with their loves and their joys, their sorrows and their griefs."(1) A fami...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1622
更新日期:2014-05-01 00:00:00
abstract:PURPOSE:Our goal was to describe an approach to patient-centered medical home (PCMH) measurement based on delineating the desired properties of the measurement relative to assumptions about the PCMH and the uses of the measure by Blue Cross Blue Shield of Michigan (BCBSM) and health services researchers. METHODS:We de...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1472
更新日期:2013-05-01 00:00:00
abstract:PURPOSE:We wanted to identify characteristics of adults who do not have a usual source of care and then stratify the analysis by those who prefer vs those who do not prefer to have a usual source of care. METHODS:We analyzed data from a nationally representative sample of 9,011 adults to identify characteristics of th...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.557
更新日期:2006-07-01 00:00:00
abstract:PURPOSE:We wanted develop a reliable and valid objective measure of patient-physician collaborative decision making, the Rochester Participatory Decision-Making Scale (RPAD). METHODS:Based on an informed decision-making model, the RPAD assesses physician behavior that encourages patient participation in decision makin...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.305
更新日期:2005-09-01 00:00:00
abstract:PURPOSE:Conducting studies in national practice-based research networks presents logistic and methodologic challenges. Pediatric Research in Office Settings (PROS) has learned valuable lessons in implementing new strategies and adapting to challenges. We describe practical challenges and results of novel applied strate...
journal_title:Annals of family medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1370/afm.1809
更新日期:2015-09-01 00:00:00
abstract:BACKGROUND:Notions about the most common errors in medicine currently rest on conjecture and weak epidemiologic evidence. We sought to determine whether cascade analysis is of value in clarifying the epidemiology and causes of errors and whether physician reports are sensitive to the impact of errors on patients. METH...
journal_title:Annals of family medicine
pub_type: 杂志文章,多中心研究
doi:10.1370/afm.126
更新日期:2004-07-01 00:00:00
abstract:PURPOSE:Whether patients with 1 or more chronic illnesses are more or less likely to receive recommended preventive services is unclear and an important public health and health care system issue. We addressed this issue in a large national practice-based research network (PBRN) that maintains a longitudinal database d...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1502
更新日期:2013-07-01 00:00:00
abstract::The exposure to unethical and unprofessional behavior is thought to play a major role in the declining empathy experienced by medical students during their training. We reflect on the reasons why medical schools are tolerant of unethical behavior of faculty. First, there are barriers to reporting unprofessional behavi...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1763
更新日期:2015-03-01 00:00:00
abstract::Modern medical care is a 2-edged sword. Technical advances have improved our ability to diagnosis and treat disease, but they can also create a frightening, painful and bewildering environment for the patient seeking care. In this essay, the author shares his recent encounter with a life-threatening disease, emphasizi...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.93
更新日期:2004-03-01 00:00:00
abstract:PURPOSE:Multimorbidity is associated with adverse outcomes, yet research on the determinants of its incidence is lacking. We investigated which sociodemographic, health, and individual lifestyle (eg, physical activity, smoking behavior, body mass index) characteristics predict new cases of multimorbidity. METHODS:We u...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2271
更新日期:2018-07-01 00:00:00
abstract:PURPOSE:Self-harm is a public health problem that requires a better understanding of mortality risk. We undertook a study to examine premature mortality in a nationally representative cohort of primary care patients who had harmed themselves. METHODS:During 2001-2013, a total of 385 general practices in England contri...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2054
更新日期:2017-05-01 00:00:00
abstract:PURPOSE:The purpose of this study was to determine the relationship between the number of patients under a primary care physician's care (panel size) and primary care quality indicators. METHODS:We conducted a cross-sectional, population-based study of fee-for-service and capitated interprofessional and non-interprofe...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1864
更新日期:2016-01-01 00:00:00
abstract:BACKGROUND:Clinicians are faced with a plethora of guidelines. To rate guidelines, they can select from a number of evaluation tools, most of which are long and difficult to apply. The goal of this project was to develop a simple, easy-to-use checklist for clinicians to use to identify trustworthy, relevant, and useful...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2119
更新日期:2017-09-01 00:00:00
abstract:PURPOSE:Few studies have tested the hypothesis that children with sensory disabilities such as deafness may be at increased risk of injuries. To test this hypothesis, this study compared rates of emergency department or hospital treatment for injury among Medicaid-insured South Carolina children with and without a diag...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.740
更新日期:2007-11-01 00:00:00
abstract:PURPOSE:Traditionally first-void urine specimens are used to test for Chlamydia trachomatis. In contrast, midstream urine specimens are traditionally recommended for microscopy and culture of presumptive bacterial urinary tract infections. The ability to test for both C trachomatis and urinary tract infection on a sing...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1323
更新日期:2012-01-01 00:00:00
abstract:PURPOSE:In this study, we aimed to assess (1) the agreement between patient self-reports and general practitioner (GP) reports of the chronic conditions affecting the patients and (2) the agreement between patients and GPs on health priorities in a primary care setting. METHOD:Patients were recruited in the Parisian a...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2444
更新日期:2019-09-01 00:00:00