J Am Board Fam Med
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Two key advancements in improving the quality of primary care have been practice-based research networks (PBRNs) and Project Extension for Community Health care Outcomes (ECHO). PBRNs advance quality through research and transformation projects, often using practice facilitation. Project ECHO uses case-based telementoring to support community clinicians to deliver best-practice care. ⋯ We describe the synergy between ORPRN projects and ECHO programs using 3 examples: tobacco cessation, chronic pain and opioid prescribing, and diabetes management. We highlight challenges and opportunities in these examples, beginning with their development, their implementation, and their ultimate alignment, despite varied funding streams and timelines. We believe that incorporating the OEN within ORPRN has been a success for both PBRN research and Project ECHO programs, allowing us to better support primary care practices across the state.
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Observational Study
Impact of Physician-Pharmacist Collaboration on Diabetes Outcomes and Health Care Use.
To evaluate the impact of physician-pharmacist collaboration for disease-state management on diabetes outcomes in primary care by comparing outcomes between physician-managed care and pharmacist collaborative care. ⋯ The collaboration of pharmacists and physicians in the primary care setting is associated with improved diabetes outcomes and substantially reduces costs related to decreased health care use.
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The Healthier Together study aimed to implement and evaluate a sustainable, rural community-based patient outreach model for preventive care provided through primary care practices located in 3 rural counties in Oklahoma. Community-based wellness coordinators (WCs) working with primary care practitioners, county health departments, local hospitals, and health information exchange (HIE) networks helped residents receive high-priority evidence-based preventive services. ⋯ Although health care is under-resourced and segmented in many rural counties, when stakeholder partnerships are established, they may be able to achieve and economically sustain community-wide health improvement by creating a win-win situation for all partners.
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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.
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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.