J Am Board Fam Med
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Little is known about incorporating community data into clinical care. This study sought to understand the clinical associations of cold spots (census tracts with worse income, education, and composite deprivation). ⋯ Living in cold spots is associated with worse chronic conditions and quality for some screening tests. Practices can use neighborhood data to allocate resources and identify those at risk for poor outcomes.
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Health technology solutions are too often implemented without a true understanding of the system-level problem they seek to address, resulting in excessive costs, poor adoption, ineffectiveness, and ultimately failure. Before implementing or adopting health care innovations, stakeholders should complete a thorough assessment to ensure effectiveness and value. In this article, we describe how to evaluate the impact of a health technology innovation through the 4 dimensions of care outlined by the Quadruple Aim Framework, using our experience with the Champlain Building Access to Specialists through eConsultation (BASE) eConsult service as a case example. ⋯ The eConsult service has been widely adopted in our region and is currently expanding to new jurisdictions across Canada. However, although we successfully demonstrated eConsult's impact on patient experience, provider satisfaction, and reducing costs, we met several challenges in evaluating its impact on population health. More work is needed to evaluate eConsult's impact on key population health metrics (eg, mortality, morbidity, and system use). Efforts to conduct such evaluations are underway.
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The potential of implementation research in understanding strategies for changing practice is undermined by poor reporting, leaving readers unable to replicate such strategies and unclear whether they apply in the context of their practice. These challenges are particularly pertinent in the complex, diverse world of primary care. ⋯ Other requirements are full descriptions of context, strategies and interventions (and how the strategies were adopted or adapted), and evaluation methods, which will require flexible interpretation of journal limit constraints or innovative approaches to supplementary information. The choice is between accepting the unsatisfactory status quo or adopting strategies to improve reporting with a view to optimizing the potential of implementation research to advance primary care.
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Dissemination and Implementation Science (DIS) is a growing research field that seeks to inform how evidence-based interventions can be successfully adopted, implemented, and maintained in health care delivery and community settings. In this article, an overview of DIS and how it has contributed to primary care delivery improvement, future opportunities for its use, and DIS resources for learning are described. Case examples are provided to illustrate how DIS can be used to solve the complex implementation and dissemination problems that emerge in primary care. Finally, recommendations are made to guide the use of DIS to inform and drive improvements in primary care delivery.
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Ambulatory Antibiotic Stewardship through a Human Factors Engineering Approach: A Systematic Review.
In the United States, most antibiotics are prescribed in ambulatory settings. Human factors engineering, which explores interactions between people and the place where they work, has successfully improved quality of care. However, human factors engineering models have not been explored to frame what is known about ambulatory antibiotic stewardship (AS) interventions and barriers and facilitators to their implementation. ⋯ A human factors engineering approach suggests that investigating the role of the clinic's processes or physical layout or external pressures' role in antibiotic prescribing may be a promising way to improve ambulatory AS.