J Am Board Fam Med
-
Primary care practice-based research networks (PBRNs) are critical laboratories for generating evidence from real-world settings, including studying natural experiments. Primary care's response to the novel coronavirus-19 (COVID-19) pandemic is arguably the most impactful natural experiment in our lifetime. EVALUATING THE IMPACT OF COVID-19: We briefly describe the OCHIN PBRN of community health centers (CHCs), its partnership with implementation scientists, and how we are leveraging this infrastructure and expertise to create a rapid research response evaluating how CHCs across the country responded to the COVID-19 pandemic. COVID-19 RESEARCH ROADMAP: Our research agenda focuses on asking: How has care delivery in CHCs changed due to COVID-19? What impact has COVID-19 had on the delivery of preventive services in CHCs? Which PBRN services (e.g., data surveillance, training, evidence synthesis) are most impactful to real-world practices? What decision-making strategies were used in the PBRN and its practices to make real-time changes in response to the pandemic? What critical factors in successfully and sustainably transforming primary care are illuminated by pandemic-driven changes? ⋯ PBRNs enable real-world evaluation of practice change and natural experiments, and thus are ideal laboratories for implementation science research. We present a real-time example of how a PBRN Implementation Laboratory activated a response to study a historic natural experiment, to help other PBRNs charting a course through this pandemic.
-
Quality Improvement has gone from practice by practice piecework to an industry driven by expertise that lies within corporate offices rather than within patient care. Using for her 20 years of experience leading and teaching quality improvement as a lens, the author makes the case for quality improvement teams to ensure a key role for clinicians and direct care staff who are closest to the patients and the improvements that need to be made.
-
Randomized Controlled Trial
Patient, Clinician, and Communication Factors Associated with Colorectal Cancer Screening.
Screening for colorectal cancer is beneficial. Yet, screening remains suboptimal, and underserved populations are at greater risk for not being appropriately screened. Although many barriers to screening are understood, less is known about how the decision-making process on whether to receive colonoscopy or stool testing influences screening. ⋯ Having a long-term relationship with a primary care clinician and sharing decisions may be key drivers to ensure evidence-based preventive care for underserved populations.
-
Prior research has documented disparities in asthma outcomes between Latino children and non-Hispanic whites, but little research directly examines the care provided to Latino children over time in clinical settings. ⋯ In a multi-state network of clinics, Latino children were less likely to have their asthma entered on their problem list the first day it was noted than non-Hispanic white children, but otherwise did not receive inferior care to non-Hispanic white children in other measures. Further research can examine other parts of the asthma care continuum to better understand asthma disparities.
-
In the 50 years since the American Board of Family Medicine (ABFM) was established, the United States has gone from a shared perspective that high-quality care was being routinely delivered to becoming aware of the significant and pervasive problems with quality. Efforts to stimulate improved quality have included public reporting, pay for performance, and value-based purchasing. In addition, maintenance of certification, systematic reviews of research, practice guidelines, electronic health records, and quality improvement programs have offered support for different dimensions of quality. ⋯ The focus on financial incentives as a primary tool for motivating improvement may not be productive and there is little evidence from research that quality varies with payment or incentives. Quality is a systems issue and requires system solutions. The ABFM has had a long commitment to assessing quality and has an opportunity to lead the way in reimagining quality measurement and assessment.