This chapter looks forward to the next set of chapters in this book which broadly speaking cover ... more This chapter looks forward to the next set of chapters in this book which broadly speaking cover the topic of innovation in public health collaborations. This section of the book provides a concise overview of the types and forms of innovation, the factors driving it, guidance on some of the more successful innovations that are under way, and how to engage in those changes. Innovation does not need to be new as such. It also can be facilitated by new partners, from new perspectives, and using new tools. Not all innovation is effective. The chapter gives an overview of future directions for innovation, which will be covered in one of the chapters in this section.
Objective: Increased demand for quality primary care and value-based payment has prompted interes... more Objective: Increased demand for quality primary care and value-based payment has prompted interest in implementing primary care teams. Evidence-based recommendations for implementing teams will be critical to successful PA participation. This study sought to describe how primary care providers (PCPs) define team membership boundaries and coordinate tasks.Methods: This mixed-methods study included 28 PCPs from a primary care network. We analyzed survey data using descriptive statistics and interview data using content analysis.Results: Ninety-six percent of PCPs reported team membership. Team models fell into one of five categories. The predominant coordination mechanism differed by whether coordination was required in a visit or between visits.Conclusions: Team-based primary care is a strategy for improving access to quality primary care. Most PCPs define team membership based on within-visit task interdependencies. Our findings suggest that team-based interventions can focus on clarifying team membership, increasing interaction between clinicians, and enhancing the electronic health record to facilitate between-visit coordination.
Drawing on the experiences of hundreds of public health and primary care clinicians from across t... more Drawing on the experiences of hundreds of public health and primary care clinicians from across the United States, this book explains why population health is receiving so much attention from policy makers in states and federal agencies, the practical steps that clinicians and public health professionals can take to work together to meet the needs of their community, signs that you are on the right track (or not) and how to sustain successes to the benefit of patients, community members, and the health care and public health teams that care for them.
Drawing on the experiences of hundreds of public health and primary care clinicians from across t... more Drawing on the experiences of hundreds of public health and primary care clinicians from across the United States, this book explains why population health is receiving so much attention from policy makers in states and federal agencies, the practical steps that clinicians and public health professionals can take to work together to meet the needs of their community, signs that you are on the right track (or not) and how to sustain successes to the benefit of patients, community members, and the health care and public health teams that care for them.
Beset with complex reimbursement and regulatory structures, rapidly advancing technology and a po... more Beset with complex reimbursement and regulatory structures, rapidly advancing technology and a population that is growing increasingly older, sicker, and more obese, the U.S. medical environment needs coordinated interdisciplinary teamwork now more than ever.
Over the last few years, this chapter explains, the role of training and the workforce has moved ... more Over the last few years, this chapter explains, the role of training and the workforce has moved from the position of not a primary concern to an important factor in public health issues. Part of the shift was the result of the rapid growth of community partnerships, making the opportunity to include learners more than an isolated possibility. Another was the infrequent presence of learners, training programs, or professional schools in the partnerships, even though many were occurring in the neighborhoods around the professional schools and programs. And a large part was the eagerness of the learners themselves. However, as this next section of chapters will explain, the voice of students and residents in the health improvement process has not yet reached full force.
Chapter 1 provides an introduction to the history and background to a general desire to try to fi... more Chapter 1 provides an introduction to the history and background to a general desire to try to find ways to improve population health through primary care and public health. The first Practical Playbook derived from an internet-based initiative that sought to find, assemble, assess, and share stories of how communities and agencies across the United States were working together to improve health. This text is the second development from that, after the realization that a completely new text was needed that would build on the experiences of the broadening array of sites and sectors and provide a concise set of tools, methods, and examples that support multi-sector partnerships to improve population health. The chapter then outlines the coverage of the rest of the chapters.
Drawing on the experiences of hundreds of public health and primary care clinicians from across t... more Drawing on the experiences of hundreds of public health and primary care clinicians from across the United States, this book explains why population health is receiving so much attention from policy makers in states and federal agencies, the practical steps that clinicians and public health professionals can take to work together to meet the needs of their community, signs that you are on the right track (or not) and how to sustain successes to the benefit of patients, community members, and the health care and public health teams that care for them.
Drawing on the experiences of hundreds of public health and primary care clinicians from across t... more Drawing on the experiences of hundreds of public health and primary care clinicians from across the United States, this book explains why population health is receiving so much attention from policy makers in states and federal agencies, the practical steps that clinicians and public health professionals can take to work together to meet the needs of their community, signs that you are on the right track (or not) and how to sustain successes to the benefit of patients, community members, and the health care and public health teams that care for them.
Although much attention has been focused on finding ways to identify medical errors and thereby r... more Although much attention has been focused on finding ways to identify medical errors and thereby reduce harm in hospital settings, few efforts have been directed at these issues in ambulatory settings. Duke University's Department of Community and Family Medicine has developed and implemented a practical, voluntary reporting system with classification and tracking of types of errors. Initially created in the Family Medicine Center, this system is now used in all of the department's wide variety of clinical operations. By reporting errors, analyzing error patterns, and addressing them, the clinical practices have become better able to identify faulty systems and error-prone areas and to change processes to prevent future errors.
A major contributor to shortfalls in delivery of recommended health care services is lack of phys... more A major contributor to shortfalls in delivery of recommended health care services is lack of physician time. On the basis of recommendations from national clinical care guidelines for preventive services and chronic disease management, and including the time needed for acute concerns, sufficiently addressing the needs of a standard patient panel of 2,500 would require 21.7 hours per day. The problem of insufficient time indicates that primary care requires broad, fundamental changes. The creation of primary care teams that include members such as physician assistants, nurse practitioners, dietitians, health educators, and lay coaches is important to meeting patients' primary care needs.
Carolina Digital Repository (University of North Carolina at Chapel Hill), 2012
Community engagement (CE) and community-engaged research (CEnR) are increasingly viewed as the ke... more Community engagement (CE) and community-engaged research (CEnR) are increasingly viewed as the keystone to translational medicine and improving the health of the nation. In this article, the authors seek to assist academic health centers (AHCs) in learning how to better engage with their communities and build a CEnR agenda by suggesting five steps: defining community and identify partners; learning the etiquette of community engagement; building a sustainable network of CEnR researchers; recognizing that CEnR will require the development of new methodologies; and improving translation and dissemination plans. Health disparities that lead to uneven access to and quality of care as well as high costs will persist without a CEnR agenda that finds answers to both medical and public health questions. One of the biggest barriers toward a national CEnR agenda, however, are the historical structures and processes of an AHC-including the complexities of how institutional review boards operate, accounting practices and indirect funding policies, and tenure and promotion paths. Changing institutional culture starts with the leadership and commitment of top decision-makers in an institution. By aligning the motivations and goals of their researchers, clinicians, and community members into a vision of a healthier population, AHC Correspondence should be addressed to Ms. Cook,
This chapter looks forward to the next set of chapters in this book which broadly speaking cover ... more This chapter looks forward to the next set of chapters in this book which broadly speaking cover the topic of innovation in public health collaborations. This section of the book provides a concise overview of the types and forms of innovation, the factors driving it, guidance on some of the more successful innovations that are under way, and how to engage in those changes. Innovation does not need to be new as such. It also can be facilitated by new partners, from new perspectives, and using new tools. Not all innovation is effective. The chapter gives an overview of future directions for innovation, which will be covered in one of the chapters in this section.
Objective: Increased demand for quality primary care and value-based payment has prompted interes... more Objective: Increased demand for quality primary care and value-based payment has prompted interest in implementing primary care teams. Evidence-based recommendations for implementing teams will be critical to successful PA participation. This study sought to describe how primary care providers (PCPs) define team membership boundaries and coordinate tasks.Methods: This mixed-methods study included 28 PCPs from a primary care network. We analyzed survey data using descriptive statistics and interview data using content analysis.Results: Ninety-six percent of PCPs reported team membership. Team models fell into one of five categories. The predominant coordination mechanism differed by whether coordination was required in a visit or between visits.Conclusions: Team-based primary care is a strategy for improving access to quality primary care. Most PCPs define team membership based on within-visit task interdependencies. Our findings suggest that team-based interventions can focus on clarifying team membership, increasing interaction between clinicians, and enhancing the electronic health record to facilitate between-visit coordination.
Drawing on the experiences of hundreds of public health and primary care clinicians from across t... more Drawing on the experiences of hundreds of public health and primary care clinicians from across the United States, this book explains why population health is receiving so much attention from policy makers in states and federal agencies, the practical steps that clinicians and public health professionals can take to work together to meet the needs of their community, signs that you are on the right track (or not) and how to sustain successes to the benefit of patients, community members, and the health care and public health teams that care for them.
Drawing on the experiences of hundreds of public health and primary care clinicians from across t... more Drawing on the experiences of hundreds of public health and primary care clinicians from across the United States, this book explains why population health is receiving so much attention from policy makers in states and federal agencies, the practical steps that clinicians and public health professionals can take to work together to meet the needs of their community, signs that you are on the right track (or not) and how to sustain successes to the benefit of patients, community members, and the health care and public health teams that care for them.
Beset with complex reimbursement and regulatory structures, rapidly advancing technology and a po... more Beset with complex reimbursement and regulatory structures, rapidly advancing technology and a population that is growing increasingly older, sicker, and more obese, the U.S. medical environment needs coordinated interdisciplinary teamwork now more than ever.
Over the last few years, this chapter explains, the role of training and the workforce has moved ... more Over the last few years, this chapter explains, the role of training and the workforce has moved from the position of not a primary concern to an important factor in public health issues. Part of the shift was the result of the rapid growth of community partnerships, making the opportunity to include learners more than an isolated possibility. Another was the infrequent presence of learners, training programs, or professional schools in the partnerships, even though many were occurring in the neighborhoods around the professional schools and programs. And a large part was the eagerness of the learners themselves. However, as this next section of chapters will explain, the voice of students and residents in the health improvement process has not yet reached full force.
Chapter 1 provides an introduction to the history and background to a general desire to try to fi... more Chapter 1 provides an introduction to the history and background to a general desire to try to find ways to improve population health through primary care and public health. The first Practical Playbook derived from an internet-based initiative that sought to find, assemble, assess, and share stories of how communities and agencies across the United States were working together to improve health. This text is the second development from that, after the realization that a completely new text was needed that would build on the experiences of the broadening array of sites and sectors and provide a concise set of tools, methods, and examples that support multi-sector partnerships to improve population health. The chapter then outlines the coverage of the rest of the chapters.
Drawing on the experiences of hundreds of public health and primary care clinicians from across t... more Drawing on the experiences of hundreds of public health and primary care clinicians from across the United States, this book explains why population health is receiving so much attention from policy makers in states and federal agencies, the practical steps that clinicians and public health professionals can take to work together to meet the needs of their community, signs that you are on the right track (or not) and how to sustain successes to the benefit of patients, community members, and the health care and public health teams that care for them.
Drawing on the experiences of hundreds of public health and primary care clinicians from across t... more Drawing on the experiences of hundreds of public health and primary care clinicians from across the United States, this book explains why population health is receiving so much attention from policy makers in states and federal agencies, the practical steps that clinicians and public health professionals can take to work together to meet the needs of their community, signs that you are on the right track (or not) and how to sustain successes to the benefit of patients, community members, and the health care and public health teams that care for them.
Although much attention has been focused on finding ways to identify medical errors and thereby r... more Although much attention has been focused on finding ways to identify medical errors and thereby reduce harm in hospital settings, few efforts have been directed at these issues in ambulatory settings. Duke University's Department of Community and Family Medicine has developed and implemented a practical, voluntary reporting system with classification and tracking of types of errors. Initially created in the Family Medicine Center, this system is now used in all of the department's wide variety of clinical operations. By reporting errors, analyzing error patterns, and addressing them, the clinical practices have become better able to identify faulty systems and error-prone areas and to change processes to prevent future errors.
A major contributor to shortfalls in delivery of recommended health care services is lack of phys... more A major contributor to shortfalls in delivery of recommended health care services is lack of physician time. On the basis of recommendations from national clinical care guidelines for preventive services and chronic disease management, and including the time needed for acute concerns, sufficiently addressing the needs of a standard patient panel of 2,500 would require 21.7 hours per day. The problem of insufficient time indicates that primary care requires broad, fundamental changes. The creation of primary care teams that include members such as physician assistants, nurse practitioners, dietitians, health educators, and lay coaches is important to meeting patients' primary care needs.
Carolina Digital Repository (University of North Carolina at Chapel Hill), 2012
Community engagement (CE) and community-engaged research (CEnR) are increasingly viewed as the ke... more Community engagement (CE) and community-engaged research (CEnR) are increasingly viewed as the keystone to translational medicine and improving the health of the nation. In this article, the authors seek to assist academic health centers (AHCs) in learning how to better engage with their communities and build a CEnR agenda by suggesting five steps: defining community and identify partners; learning the etiquette of community engagement; building a sustainable network of CEnR researchers; recognizing that CEnR will require the development of new methodologies; and improving translation and dissemination plans. Health disparities that lead to uneven access to and quality of care as well as high costs will persist without a CEnR agenda that finds answers to both medical and public health questions. One of the biggest barriers toward a national CEnR agenda, however, are the historical structures and processes of an AHC-including the complexities of how institutional review boards operate, accounting practices and indirect funding policies, and tenure and promotion paths. Changing institutional culture starts with the leadership and commitment of top decision-makers in an institution. By aligning the motivations and goals of their researchers, clinicians, and community members into a vision of a healthier population, AHC Correspondence should be addressed to Ms. Cook,
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