The Experts below are selected from a list of 258 Experts worldwide ranked by ideXlab platform
Ferdinand M. Gerlach - One of the best experts on this subject based on the ideXlab platform.
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Medical Assistant based care management for high risk patients in small primary care practices
Annals of Internal Medicine, 2016Co-Authors: Tobias Freund, Cynthia M. Boyd, Cornelia Mahler, Jochen Gensichen, Antje Erler, Martin Beyer, Matthias Gondan, Justine Rochon, Frank Petersklimm, Ferdinand M. GerlachAbstract:Some observers believe that Medical Assistants in office practice are an underutilized resource. This study examined outpatients with multiple chronic conditions who were likely to be hospitalized ...
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Medical Assistant-Based Care Management for High-Risk Patients in Small Primary Care Practices: A Cluster Randomized Clinical Trial
Annals of internal medicine, 2016Co-Authors: Tobias Freund, Frank Peters-klimm, Cynthia M. Boyd, Cornelia Mahler, Jochen Gensichen, Antje Erler, Martin Beyer, Matthias Gondan, Justine Rochon, Ferdinand M. GerlachAbstract:BACKGROUND: Patients with multiple chronic conditions are at high risk for potentially avoidable hospitalizations, which may be reduced by care coordination and self-management support. Medical Assistants are an increasingly available resource for patient care in primary care practices. OBJECTIVE: To determine whether protocol-based care management delivered by Medical Assistants improves care in patients at high risk for future hospitalization in primary care. DESIGN: Two-year cluster randomized clinical trial. (Current Controlled Trials: ISRCTN56104508). SETTING: 115 primary care practices in Germany. PATIENTS: 2076 patients with type 2 diabetes, chronic obstructive pulmonary disease, or chronic heart failure and a likelihood of hospitalization in the upper quartile of the population, as predicted by an analysis of insurance data. INTERVENTION: Protocol-based care management, including structured assessment, action planning, and monitoring delivered by Medical Assistants, compared with usual care. MEASUREMENTS: All-cause hospitalizations at 12 months (primary outcome) and quality-of-life scores (12-Item Short Form Health Survey [SF-12] and EuroQol instrument [EQ-5D]). RESULTS: Included patients had an average of 4 co-occurring chronic conditions. All-cause hospitalizations did not differ between groups at 12 months (risk ratio [RR], 1.01 [95% CI, 0.87 to 1.18]) and 24 months (RR, 0.98 [CI, 0.85 to 1.12]). Quality of life (differences, 1.16 [CI, 0.24 to 2.08] on SF-12 physical component and 1.68 [CI, 0.60 to 2.77] on SF-12 mental component) and general health (difference on EQ-5D, 0.03 [CI, 0.00 to 0.05]) improved significantly at 24 months. Intervention costs totaled $10 per patient per month. LIMITATION: Small number of primary care practices and low intensity of intervention. CONCLUSION: This low-intensity intervention did not reduce all-cause hospitalizations but showed positive effects on quality of life at reasonable costs in high-risk multimorbid patients. PRIMARY FUNDING SOURCE: AOK Baden-Wurttemberg and AOK Bundesverband.
Sara J. Singer - One of the best experts on this subject based on the ideXlab platform.
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moving violations pairing an illegitimate learning hierarchy with trainee status mobility for acquiring new skills when traditional expertise erodes
Organization Science, 2021Co-Authors: Katherine C Kellogg, Jenna E Myers, Lindsay Gainer, Sara J. SingerAbstract:We explore how members of a community of practice learn new tools and techniques when environmental shifts undermine existing expertise. In our 20-month comparative field study of Medical Assistant...
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Team-based primary care: The Medical Assistant perspective.
Health care management review, 2018Co-Authors: Bethany Sheridan, Joanna Veazey Brooks, Antoinette S. Peters, Alyna T. Chien, Meredith B. Rosenthal, Sara J. SingerAbstract:Background Team-based care has the potential to improve primary care quality and efficiency. In this model, Medical Assistants (MAs) take a more central role in patient care and population health management. MAs' traditionally low status may give them a unique view on changing organizational dynamics and teamwork. However, little empirical work exists on how team-based organizational designs affect the experiences of low-status health care workers like MAs. Purposes The aim of this study was to describe how team-based primary care affects the experiences of MAs. A secondary aim was to explore variation in these experiences. Methodology/approach In late 2014, the authors interviewed 30 MAs from nine primary care practices transitioning to team-based care. Interviews addressed job responsibilities, teamwork, implementation, job satisfaction, and learning. Data were analyzed using a thematic networks approach. Interviews also included closed-ended questions about workload and job satisfaction. Results Most MAs reported both a higher workload (73%) and a greater job satisfaction (86%) under team-based primary care. Interview data surfaced four mechanisms for these results, which suggested more fulfilling work and greater respect for the MA role: (a) relationships with colleagues, (b) involvement with patients, (c) sense of control, and (d) sense of efficacy. Facilitators and barriers to these positive changes also emerged. Conclusion Team-based care can provide low-status health care workers with more fulfilling work and strengthen relationships across status lines. The extent of this positive impact may depend on supporting factors at the organization, team, and individual worker levels. Practice implications To maximize the benefits of team-based care, primary care leaders should recognize the larger role that MAs play under this model and support them as increasingly valuable team members. Contingent on organizational conditions, practices may find MAs who are willing to manage the increased workload that often accompanies team-based care.
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team based primary care the Medical Assistant perspective
Academy of Management Proceedings, 2016Co-Authors: Bethany Sheridan, Antoinette S. Peters, Alyna T. Chien, Meredith B. Rosenthal, Joanna Brooks, Sara J. SingerAbstract:Team-based care has the potential to improve quality over traditional models, but little is known about how it affects the primary care professionals who enact it. The Medical Assistant (MA) role s...
Jochen Gensichen - One of the best experts on this subject based on the ideXlab platform.
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effect of a combined brief narrative exposure therapy with case management versus treatment as usual in primary care for patients with traumatic stress sequelae following intensive care medicine study protocol for a multicenter randomized controlled
Trials, 2018Co-Authors: Jochen Gensichen, Susanne Schultz, Christine Adrion, Konrad Schmidt, Maggie Schauer, Daniela Lindemann, Natalia Unruh, Robert P. Kosilek, Antonius Schneider, Martin SchererAbstract:Traumatic events like critical illness and intensive care are threats to life and bodily integrity and pose a risk factor for posttraumatic stress disorder (PTSD). PTSD affects the quality of life and morbidity and may increase health-care costs. Limited access to specialist care results in PTSD patients being treated in primary care settings. Narrative exposure therapy (NET) is based on the principles of cognitive behavioral therapy and has shown positive effects when delivered by health-care professionals other than psychologists. The primary aims of the PICTURE trial (from “PTSD after ICU survival”) are to investigate the effectiveness and applicability of NET adapted for primary care with case management in adults diagnosed with PTSD after intensive care. This is an investigator-initiated, multi-center, primary care-based, randomized controlled two-arm parallel group, observer-blinded superiority trial conducted throughout Germany. In total, 340 adult patients with a total score of at least 20 points on the posttraumatic diagnostic scale (PDS-5) 3 months after receiving intensive care treatment will be equally randomized to two groups: NET combined with case management and improved treatment as usual (iTAU). All primary care physicians (PCPs) involved will be instructed in the diagnosis and treatment of PTSD according to current German guidelines. PCPs in the iTAU group will deliver usual care during three consultations. In the experimental group, PCPs will additionally be trained to deliver an adapted version of NET (three sessions) supported by phone-based case management by a Medical Assistant. At 6 and 12 months after randomization, structured blinded telephone interviews will assess patient-reported outcomes. The primary composite endpoint is the absolute change from baseline at month 6 in PTSD symptom severity measured by the PDS-5 total score, which also incorporates the death of any study patients. Secondary outcomes cover the domains depression, anxiety, disability, health-related quality-of-life, and cost-effectiveness. The principal analysis is by intention to treat. If the superiority of the experimental intervention over usual care can be demonstrated, the combination of brief NET and case management could be a treatment option to relieve PTSD-related symptoms and to improve primary care after intensive care. ClinicalTrials.gov, NCT03315390 . Registered on 10 October 2017. German Clinical Trials Register, DRKS00012589 . Registered on 17 October 2017.
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Effect of a combined brief narrative exposure therapy with case management versus treatment as usual in primary care for patients with traumatic stress sequelae following intensive care medicine: study protocol for a multicenter randomized controlled
BMC, 2018Co-Authors: Jochen Gensichen, Susanne Schultz, Christine Adrion, Konrad Schmidt, Maggie Schauer, Daniela Lindemann, Natalia Unruh, Robert P. Kosilek, Antonius Schneider, Martin SchererAbstract:Abstract Background Traumatic events like critical illness and intensive care are threats to life and bodily integrity and pose a risk factor for posttraumatic stress disorder (PTSD). PTSD affects the quality of life and morbidity and may increase health-care costs. Limited access to specialist care results in PTSD patients being treated in primary care settings. Narrative exposure therapy (NET) is based on the principles of cognitive behavioral therapy and has shown positive effects when delivered by health-care professionals other than psychologists. The primary aims of the PICTURE trial (from “PTSD after ICU survival”) are to investigate the effectiveness and applicability of NET adapted for primary care with case management in adults diagnosed with PTSD after intensive care. Methods/design This is an investigator-initiated, multi-center, primary care-based, randomized controlled two-arm parallel group, observer-blinded superiority trial conducted throughout Germany. In total, 340 adult patients with a total score of at least 20 points on the posttraumatic diagnostic scale (PDS-5) 3 months after receiving intensive care treatment will be equally randomized to two groups: NET combined with case management and improved treatment as usual (iTAU). All primary care physicians (PCPs) involved will be instructed in the diagnosis and treatment of PTSD according to current German guidelines. PCPs in the iTAU group will deliver usual care during three consultations. In the experimental group, PCPs will additionally be trained to deliver an adapted version of NET (three sessions) supported by phone-based case management by a Medical Assistant. At 6 and 12 months after randomization, structured blinded telephone interviews will assess patient-reported outcomes. The primary composite endpoint is the absolute change from baseline at month 6 in PTSD symptom severity measured by the PDS-5 total score, which also incorporates the death of any study patients. Secondary outcomes cover the domains depression, anxiety, disability, health-related quality-of-life, and cost-effectiveness. The principal analysis is by intention to treat. Discussion If the superiority of the experimental intervention over usual care can be demonstrated, the combination of brief NET and case management could be a treatment option to relieve PTSD-related symptoms and to improve primary care after intensive care. Trial registration ClinicalTrials.gov, NCT03315390. Registered on 10 October 2017. German Clinical Trials Register, DRKS00012589. Registered on 17 October 2017
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Medical Assistant based care management for high risk patients in small primary care practices
Annals of Internal Medicine, 2016Co-Authors: Tobias Freund, Cynthia M. Boyd, Cornelia Mahler, Jochen Gensichen, Antje Erler, Martin Beyer, Matthias Gondan, Justine Rochon, Frank Petersklimm, Ferdinand M. GerlachAbstract:Some observers believe that Medical Assistants in office practice are an underutilized resource. This study examined outpatients with multiple chronic conditions who were likely to be hospitalized ...
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Medical Assistant-Based Care Management for High-Risk Patients in Small Primary Care Practices: A Cluster Randomized Clinical Trial
Annals of internal medicine, 2016Co-Authors: Tobias Freund, Frank Peters-klimm, Cynthia M. Boyd, Cornelia Mahler, Jochen Gensichen, Antje Erler, Martin Beyer, Matthias Gondan, Justine Rochon, Ferdinand M. GerlachAbstract:BACKGROUND: Patients with multiple chronic conditions are at high risk for potentially avoidable hospitalizations, which may be reduced by care coordination and self-management support. Medical Assistants are an increasingly available resource for patient care in primary care practices. OBJECTIVE: To determine whether protocol-based care management delivered by Medical Assistants improves care in patients at high risk for future hospitalization in primary care. DESIGN: Two-year cluster randomized clinical trial. (Current Controlled Trials: ISRCTN56104508). SETTING: 115 primary care practices in Germany. PATIENTS: 2076 patients with type 2 diabetes, chronic obstructive pulmonary disease, or chronic heart failure and a likelihood of hospitalization in the upper quartile of the population, as predicted by an analysis of insurance data. INTERVENTION: Protocol-based care management, including structured assessment, action planning, and monitoring delivered by Medical Assistants, compared with usual care. MEASUREMENTS: All-cause hospitalizations at 12 months (primary outcome) and quality-of-life scores (12-Item Short Form Health Survey [SF-12] and EuroQol instrument [EQ-5D]). RESULTS: Included patients had an average of 4 co-occurring chronic conditions. All-cause hospitalizations did not differ between groups at 12 months (risk ratio [RR], 1.01 [95% CI, 0.87 to 1.18]) and 24 months (RR, 0.98 [CI, 0.85 to 1.12]). Quality of life (differences, 1.16 [CI, 0.24 to 2.08] on SF-12 physical component and 1.68 [CI, 0.60 to 2.77] on SF-12 mental component) and general health (difference on EQ-5D, 0.03 [CI, 0.00 to 0.05]) improved significantly at 24 months. Intervention costs totaled $10 per patient per month. LIMITATION: Small number of primary care practices and low intensity of intervention. CONCLUSION: This low-intensity intervention did not reduce all-cause hospitalizations but showed positive effects on quality of life at reasonable costs in high-risk multimorbid patients. PRIMARY FUNDING SOURCE: AOK Baden-Wurttemberg and AOK Bundesverband.
Tobias Freund - One of the best experts on this subject based on the ideXlab platform.
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Medical Assistant based care management for high risk patients in small primary care practices
Annals of Internal Medicine, 2016Co-Authors: Tobias Freund, Cynthia M. Boyd, Cornelia Mahler, Jochen Gensichen, Antje Erler, Martin Beyer, Matthias Gondan, Justine Rochon, Frank Petersklimm, Ferdinand M. GerlachAbstract:Some observers believe that Medical Assistants in office practice are an underutilized resource. This study examined outpatients with multiple chronic conditions who were likely to be hospitalized ...
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Medical Assistant-Based Care Management for High-Risk Patients in Small Primary Care Practices: A Cluster Randomized Clinical Trial
Annals of internal medicine, 2016Co-Authors: Tobias Freund, Frank Peters-klimm, Cynthia M. Boyd, Cornelia Mahler, Jochen Gensichen, Antje Erler, Martin Beyer, Matthias Gondan, Justine Rochon, Ferdinand M. GerlachAbstract:BACKGROUND: Patients with multiple chronic conditions are at high risk for potentially avoidable hospitalizations, which may be reduced by care coordination and self-management support. Medical Assistants are an increasingly available resource for patient care in primary care practices. OBJECTIVE: To determine whether protocol-based care management delivered by Medical Assistants improves care in patients at high risk for future hospitalization in primary care. DESIGN: Two-year cluster randomized clinical trial. (Current Controlled Trials: ISRCTN56104508). SETTING: 115 primary care practices in Germany. PATIENTS: 2076 patients with type 2 diabetes, chronic obstructive pulmonary disease, or chronic heart failure and a likelihood of hospitalization in the upper quartile of the population, as predicted by an analysis of insurance data. INTERVENTION: Protocol-based care management, including structured assessment, action planning, and monitoring delivered by Medical Assistants, compared with usual care. MEASUREMENTS: All-cause hospitalizations at 12 months (primary outcome) and quality-of-life scores (12-Item Short Form Health Survey [SF-12] and EuroQol instrument [EQ-5D]). RESULTS: Included patients had an average of 4 co-occurring chronic conditions. All-cause hospitalizations did not differ between groups at 12 months (risk ratio [RR], 1.01 [95% CI, 0.87 to 1.18]) and 24 months (RR, 0.98 [CI, 0.85 to 1.12]). Quality of life (differences, 1.16 [CI, 0.24 to 2.08] on SF-12 physical component and 1.68 [CI, 0.60 to 2.77] on SF-12 mental component) and general health (difference on EQ-5D, 0.03 [CI, 0.00 to 0.05]) improved significantly at 24 months. Intervention costs totaled $10 per patient per month. LIMITATION: Small number of primary care practices and low intensity of intervention. CONCLUSION: This low-intensity intervention did not reduce all-cause hospitalizations but showed positive effects on quality of life at reasonable costs in high-risk multimorbid patients. PRIMARY FUNDING SOURCE: AOK Baden-Wurttemberg and AOK Bundesverband.
Rachel Willardgrace - One of the best experts on this subject based on the ideXlab platform.
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team configurations efficiency and family physician burnout
Journal of the American Board of Family Medicine, 2020Co-Authors: Mingliang Dai, Rachel Willardgrace, Michael K Magill, Margae Knox, Samantha A Larson, Kevin Grumbach, Lars E PetersonAbstract:Introduction: The delivery of team-based care relies on team structure and teamwork. Little is known about the landscape of team configurations in family medicine practices in the United States. Teamwork between diverse team members likely impacts both performance and physician well-being. We examined team configuration and teamwork and whether they are associated with family physician (FP) well-being. Methods: We used data from practice demographic questionnaires completed by FPs who registered for the American Board of Family Medicine Family Medicine Certification Examination in 2017 and 2018. We grouped 14 types of health care professionals into Medical Assistant (MA)/nurse, nurse practitioner (NP)/physician Assistant (PA), and specialist, and we characterized 3 common team configurations. We used FPs9 subjective ratings to measure perceived teamwork efficiency and a validated single-item measure to identify FPs who were burned out. Results: Among 2575 FPs in our sample, 22% worked collaboratively with MA/nurse only; 40% with MA/nurse and NP/PA or specialist; and 38% with MA/nurse, NP/PA, and specialist. The distribution of perceived teamwork efficiency was not statistically different across team configurations. In teams with greater perceived teamwork efficiency, FPs were less likely to be burned out. For FPs working with expansive teams, optimal perceived teamwork efficiency was associated with significantly reduced odds of burnout after controlling for practice and physician characteristics. Conclusion: Most FPs practice in multidisciplinary teams. Regardless of the team structure, FPs who perceived their teams as having greater efficiency were less likely to be burned out. We found that optimal perceived teamwork efficiency was associated with significantly reduced odds of burnout for FPs in all types of team configurations. Improving teamwork efficiency may be an effective strategy for practice organizations to support not only team functioning but also physician well-being.
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the effectiveness of Medical Assistant health coaching for low income patients with uncontrolled diabetes hypertension and hyperlipidemia protocol for a randomized controlled trial and baseline characteristics of the study population
BMC Family Practice, 2013Co-Authors: Rachel Willardgrace, Denise Devore, Ellen H Chen, Danielle Hessler, Thomas Bodenheimer, David H ThomAbstract:Many patients with chronic disease do not reach goals for management of their conditions. Self-management support provided by Medical Assistant health coaches within the clinical setting may help to improve clinical outcomes, but most studies to date lack statistical power or methodological rigor. Barriers to large scale implementation of the Medical Assistant coach model include lack of clinician buy-in and the absence of a business model that will make Medical Assistant health coaching sustainable. This study will add to the evidence base by determining the effectiveness of health coaching by Medical Assistants on clinical outcomes and patient self-management, by assessing the impact of health coaching on the clinician experience, and by examining the costs and potential savings of health coaching. This randomized controlled trial will evaluate the effectiveness of clinic-based Medical Assistant health coaches to improve clinical outcomes and self-management skills among low-income patients with uncontrolled type 2 diabetes, hypertension, or hyperlipidemia. A total of 441 patients from two San Francisco primary care clinics have been enrolled and randomized to receive a health coach (n = 224) or usual care (n = 217). Patients participating in the health coaching group will receive coaching for 12 months from Medical Assistants trained as health coaches. The primary outcome is a change in hemoglobin A1c, systolic blood pressure, or LDL cholesterol among patients with uncontrolled diabetes, hypertension and hyperlipidemia, respectively. Self-management behaviors, perceptions of the health care team and clinician, BMI, and chronic disease self-efficacy will be measured at baseline and after 12 months. Clinician experience is being assessed through surveys and qualitative interviews. Cost and utilization data will be analyzed through cost-predictive models. Medical Assistants are an untapped resource to provide self-management support for patients with uncontrolled chronic disease. Having successfully completed recruitment, this study is uniquely poised to assess the effectiveness of the Medical Assistant health coaching model, to describe barriers and facilitators to implementation, and to develop a business case for sustainability. ClinicalTrials.gov identifier NCT-01220336