Search

Context Over three years, 50 Oregon clinical practices and a staff of researchers screened 24,828 patients for social needs as part of the Accountable Health Communities Model supported by the Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services. Screening took place within clinics, by telephone, and by text. Objective To compare the rate of screening completion using three administration methodologies: in-person in clinical settings, by telephone, and by text. Study Design and Analysis This observational study aimed to understand the effectiveness of the three approaches to screening. Clinical sites selected their administration methodology, and data were collected on the number of surveys offered and completed by patients. Analysis was conducted using the statistics software package R. Sites 50 clinical sites across the State of Oregon Population Studied Medicaid and Medicare members Setting For clinic-based screening, subjects were screened onsite in a clinical setting. Telephone and text screening were conducted using the patients' cellular phone numbers. Intervention/Instrument The data collection tool is the Accountable Health Communities Health- Related Social Needs Screening Tool which includes questions on living situation, food, transportation, utilities, interpersonal safety, income, sex, race, ethnicity, and educational attainment. Outcome Measures The proportion of patients completing the screening via each of the 3 methodologies. Results Of the 15,657 patients offered a screening in a clinic 70% completed the screening. Of the 17,970 patients offered screening over the telephone 47% completed the screening, however only 24% of telephone calls were answered. Finally, of the 9,182 patients who viewed the offer of screening in a text 68% completed the screening, however only 7% of texts were opened. In person and telephone screening administration took similar amounts of time. Texting took the least amount of time to administer at only seconds a text. Conclusions Screening in the clinical setting offered the highest response rate, however, clinics found it challenging to fit screening into their workflows. Telephone and text screening, while less effective, might be considered as part of a multi-modal approach to screening for social needs., Presenters Anne King, MBA, Zoe Major-McDowall, Zoe Rothberg, Cullen Conway, MPH, Lisa [...]

PURPOSE We conducted a randomized controlled trial to compare the effectiveness of adding various forms of enhanced external support to practice facilitation on primary care practices' clinical quality measure (CQM) performance. METHODS Primary care practices across Washington, Oregon, and Idaho were eligible if they had fewer than 10 full-time clinicians. Practices were randomized to practice facilitation only, practice facilitation and shared learning, practice facilitation and educational outreach visits, or practice facilitation and both shared learning and educational outreach visits. All practices received up to 15 months of support. The primary outcome was the CQM for blood pressure control. Secondary outcomes were CQMs for appropriate aspirin therapy and smoking screening and cessation. Analyses followed an intention-to-treat approach. RESULTS Of 259 practices recruited, 209 agreed to be randomized. Only 42% of those offered educational outreach visits and 27% offered shared learning participated in these enhanced supports. CQM performance improved within each study arm for all 3 cardiovascular disease CQMs. After adjusting for differences between study arms, CQM improvements in the 3 enhanced practice support arms of the study did not differ significantly from those seen in practices that received practice facilitation alone (omnibus P = .40 for blood pressure CQM). Practices randomized to receive both educational outreach visits and shared learning, however, were more likely to achieve a blood pressure performance goal in 70% of patients compared with those randomized to practice facilitation alone (relative risk = 2.09; 95% CI, 1.16-3.76). CONCLUSIONS Although we found no significant differences in CQM performance across study arms, the ability of a practice to reach a target level of performance may be enhanced by adding both educational outreach visits and shared learning to practice facilitation. Key words: primary health care; cardiovascular disease; quality improvement; chronic illness; prevention; health promotion; quantitative methods; health services; organizational change; practice-based research, INTRODUCTION Past efforts to transform primary care have included practice redesign based on medical home principles and adoption of electronic health records. (1-4) More recently, primary care practices face increasing [...]