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Primary Care Needs a Complete Rebuilding and Not Just More Renovations
No abstract available (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - February 28, 2017 Category: Emergency Medicine Tags: Original Articles Source Type: research

Physician Payment Methods and the Patient-Centered Medical Home: Comment on “A Troubled Asset Relief Program for the Patient-Centered Medical Home”
This commentary analyzes the patient-centered medical home (PCMH) model within a framework of the 8 basic payment methods in health care. PCMHs are firmly within the fee-for-service tradition. Changes to the process and structure of the Resource Based Relative Value Scale, which underlies almost all physician fee schedules, could make PCMHs more financially viable. Of the alternative payment methods being considered, shared savings models are unlikely to transform medical practice whereas capitation models place unrealistic expectations on providers to accept epidemiological risk. Episode payment may strike a feasible bala...
Source: The Journal of Ambulatory Care Management - February 28, 2017 Category: Emergency Medicine Tags: Original Articles Source Type: research

Article Review of a Troubled Asset Relief Program for the Patient-Centered Medical Home by John H. Wasson, MD
No abstract available (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - February 28, 2017 Category: Emergency Medicine Tags: Original Articles Source Type: research

Commentary on “Response to: A Troubled Asset Relief Program for the Patient-Centered Medical Home”: TARP or the New Deal? The Case for Medical Home Repairs
No abstract available (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - February 28, 2017 Category: Emergency Medicine Tags: Original Articles Source Type: research

Commentary on “Rebuild the Patient-Centered Medical Home on a Foundation of Human Needs”
No abstract available (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - February 28, 2017 Category: Emergency Medicine Tags: Original Articles Source Type: research

A Troubled Asset Relief Program for the Patient-Centered Medical Home
This report presents a PCMH-TARP that places patients' interests first. The PCMH-TARP addresses regulatory barriers and greatly simplifies the complexity of the PCMH blueprint. A disruptively renovated PCMH will stand on a foundation of measures that matter to patients. (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - February 28, 2017 Category: Emergency Medicine Tags: Original Articles Source Type: research

From the Editor
No abstract available (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - February 28, 2017 Category: Emergency Medicine Tags: From the Editor Source Type: research

Primary Care Nurse Practitioner Practice Characteristics: Barriers and Opportunities for Interprofessional Teamwork
Developing team-based care models and expanding nurse practitioner (NP) workforce in primary care are recommended by policy makers to meet demand. Little is known how to promote interprofessional teamwork. Using a mixed-methods design, we analyzed qualitative interview and quantitative survey data from primary care NPs to explore practice characteristics important for teamwork. The Interprofessional Teamwork for Health and Social Care Framework guided the study. We identified NP-physician and NP-administration relationships; organizational support and governance; time and space for teamwork; and regulations and economic im...
Source: The Journal of Ambulatory Care Management - December 1, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

Access to Care and Satisfaction Among Health Center Patients With Chronic Conditions
This study examined access to care and satisfaction among health center patients with chronic conditions. Data for this study were obtained from the 2009 Health Center Patient Survey. Dependent variables of interest included 5 measures of access to and satisfaction with care, whereas the main independent variable was number of chronic conditions. Results of bivariate analysis and multiple logistic regressions showed that patients with chronic conditions had significantly higher odds of reporting access barriers than those without chronic conditions. Our results suggested that additional efforts and resources are necessary ...
Source: The Journal of Ambulatory Care Management - December 1, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

Perspectives and Uses of the Electronic Health Record Among US Pediatricians: A National Survey
Little is known about how existing electronic health records (EHRs) influence the practice of pediatric medicine. A total of 808 pediatricians participated in a survey about workflows using the EHR. The EHR was the most commonly used source of initial patient information. Seventy-two percent reported requiring between 2 and 10 minutes to complete an initial review of the EHR. Several moderately severe information barriers were reported regarding the display of information in the EHR. Pediatricians acquire information about new patients from EHRs more often than any other source. EHRs play a critical role in pediatric care ...
Source: The Journal of Ambulatory Care Management - December 1, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

Factors Associated With Electronic Health Record Use Among Nurse Practitioners in the United States
Widespread use of electronic health records (EHRs) among all provider types is foundational to delivery system transformation. Three in 4 nurse practitioners used EHRs in 2012 (76.0%), and 60.3% of nonusers planned to adopt within 18 months. Practice setting, younger age, and colocation with physicians were associated with EHR use. In hospitals and in settings without on-site physicians, EHR use lagged in rural areas. Implementation assistance should be targeted to nonadopters, particularly those who never or infrequently work alongside physicians and those in rural hospitals. Sustained technical assistance with using EHRs...
Source: The Journal of Ambulatory Care Management - December 1, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

Do Years of Experience With Electronic Health Records Matter for Productivity in Community Health Centers?
This study investigated how years of experience with an electronic health record (EHR) related to productivity in community health centers (CHCs). Using data from the 2012 Uniform Data System, we regressed average annual medical visits, weighted for service intensity, as a function of full-time equivalent medical staff controlling for CHC size and location. Physician productivity significantly improved. Although the productivity of all other staff types was not significantly different by years of EHR experience, the trends showed lower productivity among nurses and other medical staff in CHCs with fewer years of EHR experi...
Source: The Journal of Ambulatory Care Management - December 1, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

“Salt in the Wound”: Safety Net Clinician Perspectives on Performance Feedback Derived From EHR Data
Electronic health record (EHR) data can be extracted for calculating performance feedback, but users' perceptions of such feedback impact its effectiveness. Through qualitative analyses, we identified perspectives on barriers and facilitators to the perceived legitimacy of EHR-based performance feedback, in 11 community health centers (CHCs). Providers said such measures rarely accounted for CHC patients' complex lives or for providers' decisions as informed by this complexity, which diminished the measures' perceived validity. Suggestions for improving the perceived validity of performance feedback in CHCs are presented. ...
Source: The Journal of Ambulatory Care Management - December 1, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

Integration of Medical Scribes in the Primary Care Setting: Improving Satisfaction
There are little published data on the use of medical scribes in the primary care setting. We assessed the feasibility of incorporating medical scribes in our ambulatory clinic to support provider documentation in the electronic medical record. In our convenience sampling of patient, provider, and staff perceptions of scribes, we found that patients were comfortable having scribes in the clinic. Overall indicators of patient satisfaction were slightly decreased. Providers found scribe support to be valuable and overall clinician documentation time was reduced by more than 50% using scribes. (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - December 1, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

Leveraging Electronic Health Record Implementation to Facilitate Clinical and Operational Quality Improvement in an Ambulatory Surgical Clinic
We present here the results of a 3-year process improvement. (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - December 1, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research