The Experts below are selected from a list of 32178 Experts worldwide ranked by ideXlab platform
Benjamin F Crabtree - One of the best experts on this subject based on the ideXlab platform.
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national committee for quality assurance ncqa patient centered Medical Home pcmh recognition is suboptimal even among innovative primary care practices
Journal of the American Board of Family Medicine, 2014Co-Authors: Karissa A Hahn, Martha M Gonzalez, Rebecca S Etz, Benjamin F CrabtreeAbstract:The National Committee for Quality Assurance (NCQA) has promoted Patient-Centered Medical Home (PCMH) recognition among primary care practices since 2008 as a standard indicator of which practices have transformed into Medical Homes. A 40% PCMH adoption rate among a large national cohort of identified practices with innovative staffing (n = 131) calls into question whether the NCQA recognition process is truly transformative and Patient-Centered or simply another certificate to hang on the wall.
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the patient centered Medical Home mental models and practice culture driving the transformation process
Journal of General Internal Medicine, 2013Co-Authors: Peter F Cronholm, Judy A Shea, Rachel M Werner, Michelle Millerday, Jim Tufano, Benjamin F Crabtree, Robert A GabbayAbstract:BACKGROUND The Patient-Centered Medical Home (PCMH) has become a dominant model of primary care re-design. The PCMH model is a departure from more traditional models of healthcare delivery and requires significant transformation to be realized.
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primary care practice transformation is hard work insights from a 15 year developmental program of research
Medical Care, 2011Co-Authors: Benjamin F Crabtree, Paul A Nutting, William L Miller, Carlos Roberto Jaen, Kurt C Stange, Reuben R Mcdaniel, Elizabeth E StewartAbstract:BackgroundSerious shortcomings remain in clinical care in the United States despite widespread use of improvement strategies for enhancing clinical performance based on knowledge transfer approaches. Recent calls to transform primary care practice to a Patient-Centered Medical Home present even grea
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effect of facilitation on practice outcomes in the national demonstration project model of the patient centered Medical Home
Annals of Family Medicine, 2010Co-Authors: Paul A Nutting, Benjamin F Crabtree, Elizabeth E Stewart, William L Miller, Kurt C Stange, Raymond F Palmer, Carlos Roberto JaenAbstract:PURPOSE The objective of this study was to elucidate the effect of facilitation on practice outcomes in the 2-year Patient-Centered Medical Home (PCMH) National Demonstration Project (NDP) intervention, and to describe practices' experience in implementing different components of the NDP model of the PCMH. METHODS Thirty-six family practices were randomized to a facilitated interven- tion group or a self-directed intervention group. We measured 3 practice-level outcomes: (1) the proportion of 39 components of the NDP model that practices implemented, (2) the aggregate patient rating of the practices' PCMH attributes, and (3) the practices' ability to make and sustain change, which we term adap- tive reserve. We used a repeated-measures analysis of variance to test the inter- vention effects. RESULTS By the end of the 2 years of the NDP, practices in both facilitated and self-directed groups had at least 70% of the NDP model components in place. Implementation was relatively harder if the model component affected multiple roles and processes, required coordination across work units, necessitated addi- tional resources and expertise, or challenged the traditional model of primary care. Electronic visits, group visits, team-based care, wellness promotion, and pro- active population management presented the greatest challenges. Controlling for baseline differences and practice size, facilitated practices had greater increases in adaptive reserve (group difference by time, P = .005) and the proportion of NDP model components implemented (group difference by time, P = .02); the latter increased from 42% to 72% in the facilitated group and from 54% to 70% in the self-directed group. Patient ratings of the practices' PCMH attributes did not differ between groups and, in fact, diminished in both of them. CONCLUSIONS Highly motivated practices can implement many components of the PCMH in 2 years, but apparently at a cost of diminishing the patient's expe- rience of care. Intense facilitation increases the number of components imple- mented and improves practices' adaptive reserve. Longer follow-up is needed to assess the sustained and evolving effects of moving independent practices toward PCMHs
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Implementing the Patient-Centered Medical Home: Observation and Description of the National Demonstration Project
The Annals of Family Medicine, 2010Co-Authors: Elizabeth E Stewart, Benjamin F Crabtree, Paul A Nutting, William L Miller, Kurt C Stange, Carlos Roberto JaenAbstract:PURPOSE We provide an overall description of the National Demonstration Proj- ect (NDP) intervention to transform family practices into Patient-Centered Medical Homes. METHODS An independent evaluation team used multiple data sources and methods to describe the design and implementation of the NDP. These included direct observation of the implementation team and project meetings, site visits to practices, depth interviews with practice members and implementation team members, access to practice communications (eg, telephone calls, e-mails), and public domain materials (eg, the NDP Web site).
Eugene C Rich - One of the best experts on this subject based on the ideXlab platform.
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using evidence to inform policy developing a policy relevant research agenda for the patient centered Medical Home
Journal of General Internal Medicine, 2010Co-Authors: Bruce E Landon, James M Gill, Richard C Antonelli, Eugene C RichAbstract:Amidst the debate about health care reform, there appears to be near unanimity around the fact that a reformed US health care system requires at its foundation a robust system of primary care. The Patient-Centered Medical Home (PCMH) has emerged as the leading strategy around which primary care will be redesigned.1 The core principles of the PCMH model build upon the core concepts of primary care as defined by Starfield2 and the Institute of Medicine3, and include a whole person orientation with care that is accessible, coordinated, comprehensive, and continuous over time.
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prospects for rebuilding primary care using the patient centered Medical Home
Health Affairs, 2010Co-Authors: Bruce E Landon, James M Gill, Richard C Antonelli, Eugene C RichAbstract:Existing research suggests that models of enhanced primary care lead to health care systems with better performance. What the research does not show is whether such an approach is feasible or likely to be effective within the U.S. health care system. Many commentators have adopted the model of the Patient-Centered Medical Home as policy shorthand to address the reinvention of primary care in the United States. We analyze potential barriers to implementing the Medical Home model for policy makers and practitioners. Among others, these include developing new payment models, as well as the need for up-front funding to assemble the personnel and infrastructure required by an enhanced non-visit-based primary care practice and methods to facilitate transformation of existing practices to functioning Medical Homes.
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us approaches to physician payment the deconstruction of primary care
Mathematica Policy Research Reports, 2010Co-Authors: Robert A Berenson, Eugene C RichAbstract:This paper addresses why the three dominant alternatives to compensating physicians (fee-for-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the Patient-Centered Medical Home and the relevance of payment reforms, such as pay-for-performance and episodes/bundling.
Neil Korsen - One of the best experts on this subject based on the ideXlab platform.
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the development of joint principles integrating behavioral health care into the patient centered Medical Home
Families Systems & Health, 2014Co-Authors: Mac Baird, Alexander Blount, Stacy Brungardt, Perry Dickinson, Allen J Dietrich, Ted Epperly, Larry A Green, Douglas E Henley, Rodger Kessler, Neil KorsenAbstract:The world of primary care was galvanized in 2007 by the publication of the Joint Principles of The Patient-Centered Medical Home (PCMH) that spells out the fundamental features of a primary health care setting in which a team of clinicians offers accessible first-contact primary care.[1][1] This
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joint principles integrating behavioral health care into the patient centered Medical Home
Annals of Family Medicine, 2014Co-Authors: Mac Baird, Alexander Blount, Stacy Brungardt, Perry Dickinson, Allen J Dietrich, Ted Epperly, Larry A Green, Douglas E Henley, Rodger Kessler, Neil KorsenAbstract:The Patient-Centered Medical Home (PCMH) is an innovative, improved, and evolving approach to providing primary care that has gained broad acceptance in the United States. The Joint Principles of the PCMH, formulated and endorsed in February 2007, are sound and describe the ideal toward which we
Elizabeth E Stewart - One of the best experts on this subject based on the ideXlab platform.
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off the hamster wheel qualitative evaluation of a payment linked patient centered Medical Home pcmh pilot
Milbank Quarterly, 2012Co-Authors: Asaf Bitton, Gregory R Schwartz, Elizabeth E Stewart, Daniel E Henderson, Carol A Keohane, David W Bates, Gordon D SchiffAbstract:Context: Many primary care practices are moving toward the Patient-Centered Medical Home (PCMH) model and increasingly are offering payment incentives linked to PCMH changes. Despite widespread acceptance of general PCMH concepts, there is still a pressing need to examine carefully and critically what transformation means for primary care practices and their patients and the experience of undergoing such change in a practice. Methods: We used a qualitative case study approach to explore the underlying dynamics of change at five practices participating in PCMH transformation efforts linked to payment reform. The evaluation consisted of structured site visits, interviews, observations, and artifact reviews followed by a structured review of transcripts and documents for patterns, themes, and insights related to PCMH implementation. Findings:Wedescribeboththedetailedcomponentsofeachpractice’stransformation efforts and a grounded taxonomy of eight insights stemming from the experiences of these Medical Homes. We identified specific contextual factors related to wide variations in change tactics. We also observed widely varying
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primary care practice transformation is hard work insights from a 15 year developmental program of research
Medical Care, 2011Co-Authors: Benjamin F Crabtree, Paul A Nutting, William L Miller, Carlos Roberto Jaen, Kurt C Stange, Reuben R Mcdaniel, Elizabeth E StewartAbstract:BackgroundSerious shortcomings remain in clinical care in the United States despite widespread use of improvement strategies for enhancing clinical performance based on knowledge transfer approaches. Recent calls to transform primary care practice to a Patient-Centered Medical Home present even grea
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effect of facilitation on practice outcomes in the national demonstration project model of the patient centered Medical Home
Annals of Family Medicine, 2010Co-Authors: Paul A Nutting, Benjamin F Crabtree, Elizabeth E Stewart, William L Miller, Kurt C Stange, Raymond F Palmer, Carlos Roberto JaenAbstract:PURPOSE The objective of this study was to elucidate the effect of facilitation on practice outcomes in the 2-year Patient-Centered Medical Home (PCMH) National Demonstration Project (NDP) intervention, and to describe practices' experience in implementing different components of the NDP model of the PCMH. METHODS Thirty-six family practices were randomized to a facilitated interven- tion group or a self-directed intervention group. We measured 3 practice-level outcomes: (1) the proportion of 39 components of the NDP model that practices implemented, (2) the aggregate patient rating of the practices' PCMH attributes, and (3) the practices' ability to make and sustain change, which we term adap- tive reserve. We used a repeated-measures analysis of variance to test the inter- vention effects. RESULTS By the end of the 2 years of the NDP, practices in both facilitated and self-directed groups had at least 70% of the NDP model components in place. Implementation was relatively harder if the model component affected multiple roles and processes, required coordination across work units, necessitated addi- tional resources and expertise, or challenged the traditional model of primary care. Electronic visits, group visits, team-based care, wellness promotion, and pro- active population management presented the greatest challenges. Controlling for baseline differences and practice size, facilitated practices had greater increases in adaptive reserve (group difference by time, P = .005) and the proportion of NDP model components implemented (group difference by time, P = .02); the latter increased from 42% to 72% in the facilitated group and from 54% to 70% in the self-directed group. Patient ratings of the practices' PCMH attributes did not differ between groups and, in fact, diminished in both of them. CONCLUSIONS Highly motivated practices can implement many components of the PCMH in 2 years, but apparently at a cost of diminishing the patient's expe- rience of care. Intense facilitation increases the number of components imple- mented and improves practices' adaptive reserve. Longer follow-up is needed to assess the sustained and evolving effects of moving independent practices toward PCMHs
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Implementing the Patient-Centered Medical Home: Observation and Description of the National Demonstration Project
The Annals of Family Medicine, 2010Co-Authors: Elizabeth E Stewart, Benjamin F Crabtree, Paul A Nutting, William L Miller, Kurt C Stange, Carlos Roberto JaenAbstract:PURPOSE We provide an overall description of the National Demonstration Proj- ect (NDP) intervention to transform family practices into Patient-Centered Medical Homes. METHODS An independent evaluation team used multiple data sources and methods to describe the design and implementation of the NDP. These included direct observation of the implementation team and project meetings, site visits to practices, depth interviews with practice members and implementation team members, access to practice communications (eg, telephone calls, e-mails), and public domain materials (eg, the NDP Web site).
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journey to the patient centered Medical Home a qualitative analysis of the experiences of practices in the national demonstration project
Annals of Family Medicine, 2010Co-Authors: Paul A Nutting, Benjamin F Crabtree, Elizabeth E Stewart, William L Miller, Kurt C Stange, Carlos Roberto JaenAbstract:PURPOSE We describe the experience of practices in transitioning toward Patient-Centered Medical Homes (PCMHs) in the National Demonstration Project (NDP). METHODS The NDP was launched in June 2006 as the first national test of a model of the PCMH in a diverse sample of 36 family practices, randomized to facilitated and self-directed intervention groups. An independent evaluation team used a multimethod evaluation strategy, analyzing data from direct observation, depth interviews, e-mail streams, Medical records, and patient and practice surveys. The evaluation team reviewed data from all practices as they became available and produced interim summaries. Four 2- to 3-day evaluation team retreats were held during which case summaries of all practices were discussed and patterns were described. RESULTS The 6 themes that emerged from the data reflect major shifts in individual and practice roles and identities, as well as changes in practices’ management strategies. The themes are (1) practice adaptive reserve is critical to managing change, (2) developmental pathways to success vary considerably by practice, (3) motivation of key practice members is critical, (4) the larger system can help or hinder, (5) practice transformation is more than a series of changes and requires shifts in roles and mental models, and (6) practice change is enabled by the multiple roles that facilitators play. CONCLUSIONS Transformation to a PCMH requires more than a sequence of discrete changes. The practice transformation process may be fostered by promoting adaptive reserve and local control of the developmental pathway.
Eric C Schneider - One of the best experts on this subject based on the ideXlab platform.
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effect of a multipayer patient centered Medical Home on health care utilization and quality the rhode island chronic care sustainability initiative pilot program
JAMA Internal Medicine, 2013Co-Authors: Meredith B Rosenthal, Mark W Friedberg, Sara J Singer, Diana Eastman, Zhonghe Li, Eric C SchneiderAbstract:Importance The Patient-Centered Medical Home is advocated to reduce health care costs and improve the quality of care. Objective To evaluate the effects of the pilot program of a multipayer Patient-Centered Medical Home on health care utilization and quality. Design An interrupted time series design with propensity score–matched comparison practices, including multipayer claims data from 2 years before (October 1, 2006–September 30, 2008) and 2 years after (October 1, 2008–September 30, 2010) the launch of the pilot program. Uptake of the intervention was measured with audit data from the National Committee for Quality Assurance Patient-Centered Medical Home recognition process. Setting Five independent primary care practices and 3 private insurers in the Rhode Island Chronic Care Sustainability Initiative. Participants Patients in 5 pilot and 34 comparison practices. Interventions Financial support, care managers, and technical assistance for quality improvement and practice transformation. Main Outcomes and Measures Hospital admissions, emergency department visits, and 6 process measures of quality of care (3 for diabetes mellitus and 3 for colon, breast, and cervical cancer screening). Results The mean National Committee for Quality Assurance recognition scores of the pilot practices increased from 42 to 90 points of a possible 100 points. The pilot and comparison practices had statistically indistinguishable baseline patient characteristics and practice patterns, except for higher numbers of attributed member months per year in the pilot practices (31 130 per practice vs 14 779, P = .01) and lower rates of cervical cancer screening in the comparison practices. Although estimates of the emergency department visits and inpatient admissions of patients in the pilot practices trended toward lower utilization, the only significant difference was a lower rate of ambulatory care sensitive emergency department visits in the pilot practices. The Chronic Care Sustainability Initiative pilot program was associated with a reduction in ambulatory care–sensitive emergency department visits of approximately 0.8 per 1000 member months or approximately 11.6% compared with the baseline rate of 6.9 for emergency department visits per 1000 member months ( P = .002). No significant improvements were found in any of the quality measures. Conclusion and Relevance After 2 years, a pilot program of a Patient-Centered Medical Home was associated with substantial improvements in Medical Home recognition scores and a significant reduction in ambulatory care sensitive emergency department visits. Although not achieving significance, there were downward trends in emergency department visits and inpatient admissions.
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readiness for the patient centered Medical Home structural capabilities of massachusetts primary care practices
Journal of General Internal Medicine, 2009Co-Authors: Mark W Friedberg, Eric C Schneider, Dana Gelb Safran, Kathryn L Coltin, Marguerite DresserAbstract:Background The Patient-Centered Medical Home (PCMH), a popular model for primary care reorganization, includes several structural capabilities intended to enhance quality of care. The extent to which different types of primary care practices have adopted these capabilities has not been previously studied.