RESUMEN
PURPOSE: We examined quality, satisfaction, financial, and productivity outcomes associated with implementation of Care by Design (CBD), the University of Utah's version of the patient-centered medical home. METHODS: We measured the implementation of individual elements of CBD using a combination of observation, chart audit, and collection of data from operational reports. We assessed correlations between level of implementation of each element and measures of quality, patient and clinician satisfaction, financial performance, and efficiency. RESULTS: Team function elements had positive correlations (P ≤.05) with 6 quality measures, 4 patient satisfaction measure, and 3 clinician satisfaction measures. Continuity elements had positive correlations with 2 satisfaction measures and 1 quality measure. Clinician continuity was the key driver in the composite element of appropriate access. Unexpected findings included the negative correlation of use of templated questionnaires with 3 patient satisfaction measures. Trade-offs were observed for performance of blood draws in the examination room and the efficiency of visits, with some positive and some negative correlations depending on the outcome. CONCLUSIONS: Elements related to care teams and continuity appear to be key elements of CBD as they influence all 3 CBD organizing principles: appropriate access, care teams, and planned care. These relationships, as well as unexpected, unfavorable ones, require further study and refined analyses to identify causal associations.
Asunto(s)
Satisfacción del Paciente , Atención Dirigida al Paciente/organización & administración , Atención Primaria de Salud/organización & administración , Calidad de la Atención de Salud , Empleos Relacionados con Salud , Redes Comunitarias/organización & administración , Continuidad de la Atención al Paciente , Accesibilidad a los Servicios de Salud , Investigación sobre Servicios de Salud , Humanos , Satisfacción en el Trabajo , Grupo de Atención al Paciente , Atención Dirigida al Paciente/economía , Médicos de Atención Primaria/psicología , Atención Primaria de Salud/economíaAsunto(s)
Colonoscopía , Neoplasias Colorrectales/diagnóstico , Tamizaje Masivo , Aceptación de la Atención de Salud , Negativa del Paciente al Tratamiento , Intervalos de Confianza , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Retrospectivos , Factores de Riesgo , UtahRESUMEN
This quality improvement project was designed to improve rates of referral for colonoscopy screening in the Utah Health Research Network, University of Utah Community Clinics. This study was conducted between October 2004 and June 2007 with the main intervention being a clinic workflow modification using computerized screening reminders embedded in the electronic medical record (EMR). The intervention led to sustained improvement, largely driven by the performance of two network clinics. This study demonstrates that a robust EMR, with decision prompts, accompanied by clinic workflow changes and feedback to providers, can lead to sustained change in the rates of colonoscopy referral.