Healthc (Amst) - Association of medical home team-based care functions and perceived improvements in patient-centered care at VHA primary care clinics.

Tópicos

{ care(1570) inform(1187) nurs(1089) }
{ age(1611) year(1155) adult(843) }
{ record(1888) medic(1808) patient(1693) }
{ studi(1119) effect(1106) posit(819) }
{ imag(1057) registr(996) error(939) }
{ structur(1116) can(940) graph(676) }
{ survey(1388) particip(1329) question(1065) }
{ treatment(1704) effect(941) patient(846) }
{ clinic(1479) use(1117) guidelin(835) }
{ time(1939) patient(1703) rate(768) }
{ use(2086) technolog(871) perceiv(783) }
{ decis(3086) make(1611) patient(1517) }
{ sequenc(1873) structur(1644) protein(1328) }
{ patient(2315) diseas(1263) diabet(1191) }
{ chang(1828) time(1643) increas(1301) }
{ research(1085) discuss(1038) issu(1018) }
{ model(2656) set(1616) predict(1553) }
{ model(3404) distribut(989) bayesian(671) }
{ can(774) often(719) complex(702) }
{ measur(2081) correl(1212) valu(896) }
{ network(2748) neural(1063) input(814) }
{ studi(2440) review(1878) systemat(933) }
{ assess(1506) score(1403) qualiti(1306) }
{ concept(1167) ontolog(924) domain(897) }
{ control(1307) perform(991) simul(935) }
{ monitor(1329) mobil(1314) devic(1160) }
{ ehr(2073) health(1662) electron(1139) }
{ patient(2837) hospit(1953) medic(668) }
{ medic(1828) order(1363) alert(1069) }
{ intervent(3218) particip(2042) group(1664) }
{ use(1733) differ(960) four(931) }
{ process(1125) use(805) approach(778) }
{ method(2212) result(1239) propos(1039) }
{ imag(1947) propos(1133) code(1026) }
{ data(1737) use(1416) pattern(1282) }
{ inform(2794) health(2639) internet(1427) }
{ system(1976) rule(880) can(841) }
{ bind(1733) structur(1185) ligand(1036) }
{ method(1219) similar(1157) match(930) }
{ featur(3375) classif(2383) classifi(1994) }
{ imag(2830) propos(1344) filter(1198) }
{ imag(2675) segment(2577) method(1081) }
{ take(945) account(800) differ(722) }
{ motion(1329) object(1292) video(1091) }
{ surgeri(1148) surgic(1085) robot(1054) }
{ framework(1458) process(801) describ(734) }
{ problem(2511) optim(1539) algorithm(950) }
{ error(1145) method(1030) estim(1020) }
{ learn(2355) train(1041) set(1003) }
{ algorithm(1844) comput(1787) effici(935) }
{ extract(1171) text(1153) clinic(932) }
{ method(1557) propos(1049) approach(1037) }
{ data(1714) softwar(1251) tool(1186) }
{ design(1359) user(1324) use(1319) }
{ model(2220) cell(1177) simul(1124) }
{ general(901) number(790) one(736) }
{ method(984) reconstruct(947) comput(926) }
{ search(2224) databas(1162) retriev(909) }
{ featur(1941) imag(1645) propos(1176) }
{ case(1353) use(1143) diagnosi(1136) }
{ howev(809) still(633) remain(590) }
{ data(3963) clinic(1234) research(1004) }
{ studi(1410) differ(1259) use(1210) }
{ risk(3053) factor(974) diseas(938) }
{ perform(999) metric(946) measur(919) }
{ system(1050) medic(1026) inform(1018) }
{ import(1318) role(1303) understand(862) }
{ model(2341) predict(2261) use(1141) }
{ visual(1396) interact(850) tool(830) }
{ compound(1573) activ(1297) structur(1058) }
{ perform(1367) use(1326) method(1137) }
{ blood(1257) pressur(1144) flow(957) }
{ spatial(1525) area(1432) region(1030) }
{ health(3367) inform(1360) care(1135) }
{ model(3480) simul(1196) paramet(876) }
{ state(1844) use(1261) util(961) }
{ research(1218) medic(880) student(794) }
{ data(2317) use(1299) case(1017) }
{ signal(2180) analysi(812) frequenc(800) }
{ cost(1906) reduc(1198) effect(832) }
{ group(2977) signific(1463) compar(1072) }
{ sampl(1606) size(1419) use(1276) }
{ gene(2352) biolog(1181) express(1162) }
{ data(3008) multipl(1320) sourc(1022) }
{ first(2504) two(1366) second(1323) }
{ activ(1138) subject(705) human(624) }
{ patient(1821) servic(1111) care(1106) }
{ can(981) present(881) function(850) }
{ analysi(2126) use(1163) compon(1037) }
{ health(1844) social(1437) communiti(874) }
{ high(1669) rate(1365) level(1280) }
{ cancer(2502) breast(956) screen(824) }
{ use(976) code(926) identifi(902) }
{ drug(1928) target(777) effect(648) }
{ result(1111) use(1088) new(759) }
{ implement(1333) system(1263) develop(1122) }
{ estim(2440) model(1874) function(577) }
{ activ(1452) weight(1219) physic(1104) }
{ method(1969) cluster(1462) data(1082) }
{ detect(2391) sensit(1101) algorithm(908) }

Resumo

TRODUCTION: Team-based care is central to the patient-centered medical home (PCMH), but most PCMH evaluations measure team structure exclusively. We assessed team-based care in terms of team structure, process and effectiveness, and the association with improvements in teams abilities to deliver patient-centered care.MATERIAL AND METHODS: We fielded a cross-sectional survey among 913 VA primary care clinics implementing a PCMH model in 2012. The dependent variable was clinic-level respondent-reported improvements in delivery of patient-centered care. Independent variables included three sets of measures: (1) team structure, (2) team process, and (3) team effectiveness. We adjusted for clinic workload and patient comorbidity.RESULTS: 4819 surveys were returned (25% estimated response rate). The highest ratings were for team structure (median of 89% of respondents being assigned to a teamlet, i.e., a PCP working with the same clinical associate, nurse care manager and clerk) and lowest for team process (median of 10% of respondents reporting the lowest level of stress/chaos). In multivariable regression, perceived improvements in patient-centered care were most strongly associated with participatory decision making (?=32, P<0.0001) and history of change in the clinic (?=18, P=0008) (both team processes). A stressful/chaotic clinic environment was associated with higher barriers to patient centered care (?=0.16-0.34, P=<0.0001), and lower improvements in patient-centered care (?=-0.19, P=0.001).CONCLUSIONS: Team process and effectiveness measures, often omitted from PCMH evaluations, had stronger associations with perceived improvements in patient-centered care than team structure measures.IMPLICATIONS: Team process and effectiveness measures may facilitate synthesis of evaluation findings and help identify positive outlier clinics.

Resumo Limpo

troduct teambas care central patientcent medic home pcmh pcmh evalu measur team structur exclus assess teambas care term team structur process effect associ improv team abil deliv patientcent caremateri method field crosssect survey among va primari care clinic implement pcmh model depend variabl cliniclevel respondentreport improv deliveri patientcent care independ variabl includ three set measur team structur team process team effect adjust clinic workload patient comorbidityresult survey return estim respons rate highest rate team structur median respond assign teamlet ie pcp work clinic associ nurs care manag clerk lowest team process median respond report lowest level stresschao multivari regress perceiv improv patientcent care strong associ participatori decis make p histori chang clinic p team process stressfulchaot clinic environ associ higher barrier patient center care p lower improv patientcent care pconclus team process effect measur often omit pcmh evalu stronger associ perceiv improv patientcent care team structur measuresimpl team process effect measur may facilit synthesi evalu find help identifi posit outlier clinic

Resumos Similares

Int J Med Inform - Multi-disciplinary communication networks for skin risk assessment in nursing homes with high IT sophistication. ( 0,899467354729586 )
Healthc (Amst) - When scaling prevention means scaling demand: Voluntary medical male circumcision in Nyanza Province, Kenya. ( 0,876636660637836 )
BMC Med Inform Decis Mak - National survey focusing on the crucial information needs of intensive care charge nurses and intensivists: same goal, different demands. ( 0,867257274930007 )
Int J Med Inform - A model of awareness to enhance our understanding of interprofessional collaborative care delivery and health information system design to support it. ( 0,860451684835203 )
Int J Med Inform - The benefits of introducing electronic health records in residential aged care facilities: a multiple case study. ( 0,855084311512121 )
AMIA Annu Symp Proc - Examining the Multi-level Fit between Work and Technology in a Secure Messaging Implementation. ( 0,851101489444591 )
Int J Med Inform - Using Cognitive Work Analysis to fit decision support tools to nurse managers' work flow. ( 0,850376722379427 )
Int J Med Inform - Use of electronic information systems in nursing management. ( 0,849572515242973 )
Telemed J E Health - Telemonitoring increases patient awareness of health and prompts health-related action: initial evaluation of the TELE-ERA study. ( 0,847318285023045 )
AMIA Annu Symp Proc - Falling through the cracks: information breakdowns in critical care handoff communication. ( 0,847065963012177 )
Int J Med Inform - Going paperless at the emergency department: a socio-technical study of an information system for patient tracking. ( 0,836258409907814 )
Int J Med Inform - Managing variations from surgical care plans: challenges for coordination. ( 0,834416617100984 )
Telemed J E Health - Task-technology fit of video telehealth for nurses in an outpatient clinic setting. ( 0,832361201850966 )
Int J Med Inform - The impact of medical record technologies on collaboration in emergency medicine. ( 0,82880442179665 )
J Biomed Inform - Bridging gaps in handoffs: a continuity of care based approach. ( 0,827878463858587 )
J Am Med Inform Assoc - Intensive care unit nurses' information needs and recommendations for integrated displays to improve nurses' situation awareness. ( 0,825130376302914 )
BMC Med Inform Decis Mak - Successful implementation of new technologies in nursing care: a questionnaire survey of nurse-users. ( 0,823472841278396 )
J Am Med Inform Assoc - The impact of PACS on clinician work practices in the intensive care unit: a systematic review of the literature. ( 0,820228827568354 )
Int J Med Inform - Perceptions of urgency: defining the gap between what physicians and nurses perceive to be an urgent issue. ( 0,81755656926967 )
Healthc (Amst) - Flexible implementation and integration of new team members to support patient-centered care. ( 0,812964855603584 )
Int J Med Inform - Evaluation of the national nursing model and four nursing documentation systems in Finland--lessons learned and directions for the future. ( 0,806212735260046 )
Telemed J E Health - Implementing home blood glucose and blood pressure telemonitoring in primary care practices for patients with diabetes: lessons learned. ( 0,803726210123012 )
Int J Med Inform - Effect of a nursing information system on the quality of information processing in nursing: An evaluation study using the HIS-monitor instrument. ( 0,799669453281031 )
Perspect Health Inf Manag - Assessment of success on the RHIA certification examination: a comparison of baccalaureate program graduates and postbaccalaureate certificate program graduates. ( 0,795471571538734 )
Inform Health Soc Care - Information practices of health care professionals related to patient discharge from hospital. ( 0,795389672942984 )
AMIA Annu Symp Proc - Development of a nursing handoff tool: a web-based application to enhance patient safety. ( 0,793287406987262 )
AMIA Annu Symp Proc - A Framework for Incorporating Patient Preferences to Deliver Participatory Medicine via Interdisciplinary Healthcare Teams. ( 0,793053770337659 )
J Am Med Inform Assoc - Challenges to nurses' efforts of retrieving, documenting, and communicating patient care information. ( 0,7925091679452 )
AMIA Annu Symp Proc - Describing the Clinical Communication Space through a Model of Common Ground: 'you don't know what you don't know'. ( 0,791760416351915 )
BMC Med Inform Decis Mak - Improving the effectiveness of electronic health record-based referral processes. ( 0,790150171795816 )
J Am Med Inform Assoc - The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals. ( 0,786316380721227 )
AMIA Annu Symp Proc - Coordination of care for complex pediatric patients: perspectives from providers and parents. ( 0,78399724467501 )
Int J Med Inform - Can technology change the work of nurses? Evaluation of a drug monitoring system for ambulatory chronic disease patients. ( 0,783725011664318 )
AMIA Annu Symp Proc - Clinical Workflow Observations to Identify Opportunities for Nurse, Physicians and Patients to Share a Patient-centered Plan of Care. ( 0,77725496270453 )
J. Med. Internet Res. - An evaluation of the use of smartphones to communicate between clinicians: a mixed-methods study. ( 0,774247094002266 )
Health Informatics J - Using integrated bio-physiotherapy informatics in home health-care settings: A qualitative analysis of a point-of-care decision support system. ( 0,77413830469946 )
Int J Med Inform - Lost in translation: the challenges of seamless integration in nursing practices. ( 0,773424314556756 )
Int J Med Inform - Different usage of the same oncology information system in two hospitals in Sydney--lessons go beyond the initial introduction. ( 0,772071104844165 )
Int J Med Inform - Guidelines for maternal and neonatal point of care: needs of and attitudes towards a computerized clinical decision support system in rural Burkina Faso. ( 0,770915650485856 )
BMC Med Inform Decis Mak - Qualitative evaluation of a diabetes electronic decision support tool: views of users. ( 0,770548703880621 )
J Med Syst - Understanding critical barriers to implementing a clinical information system in a nursing home through the lens of a socio-technical perspective. ( 0,764276297976922 )
J Am Med Inform Assoc - Computerized provider documentation: findings and implications of a multisite study of clinicians and administrators. ( 0,764270809940122 )
BMC Med Inform Decis Mak - Quality of prenatal and maternal care: bridging the know-do gap (QUALMAT study): an electronic clinical decision support system for rural Sub-Saharan Africa. ( 0,764139004499702 )
Health Informatics J - The coordination hub: Toward patient-centered and collaborative care processes. ( 0,759199203668108 )
Int J Med Inform - Does the introduction of an electronic nursing documentation system in a nursing home reduce time on documentation for the nursing staff? ( 0,759199203668108 )
BMC Med Inform Decis Mak - Participatory eHealth development to support nurses in antimicrobial stewardship. ( 0,756633885963981 )
J Am Med Inform Assoc - Patient-centered care requires a patient-oriented workflow model. ( 0,753703693606195 )
Appl Clin Inform - Usability characteristics of self-administered computer-assisted interviewing in the emergency department: factors affecting ease of use, efficiency, and entry error. ( 0,751756465557054 )
AMIA Annu Symp Proc - To talk or not to talk: exploring culturally diverse patients' health information communication choices. ( 0,748714663727505 )
Healthc (Amst) - Implementing a patient centered medical home in the Veterans health administration: Perspectives of primary care providers. ( 0,743367408806632 )
Int J Med Inform - Nurses' experiences of using an interactive tailored patient assessment tool one year past implementation. ( 0,740581267519431 )
J Telemed Telecare - Mobile computing and the quality of home care nursing practice. ( 0,739115794108762 )
BMC Med Inform Decis Mak - Validation of the Work Observation Method By Activity Timing (WOMBAT) method of conducting time-motion observations in critical care settings: an observational study. ( 0,738077318012767 )
J. Med. Internet Res. - Aligning medication reconciliation and secure messaging: qualitative study of primary care providers' perspectives. ( 0,736495742955278 )
J. Med. Internet Res. - Experiences of multidisciplinary development team members during user-centered design of telecare products and services: a qualitative study. ( 0,736389674224196 )
Int J Med Inform - Evaluation of a comprehensive EHR based on the DeLone and McLean model for IS success: approach, results, and success factors. ( 0,735819686929061 )
Healthc (Amst) - The EFECT framework for interprofessional education in the patient centered medical home. ( 0,732568296611244 )
Telemed J E Health - Communication strategies and timeliness of response to life critical telemetry alarms. ( 0,731827882005924 )
Int J Med Inform - Organizational routines, innovation, and flexibility: the application of narrative networks to dynamic workflow. ( 0,731628658286668 )
Inform Health Soc Care - Patients' contribution to the development of a web-based plan for integrated care - a participatory design study. ( 0,73021545153621 )
Appl Clin Inform - Advice for Decision Makers Based on an Electronic Health Record Evaluation at a Program for All-inclusive Care for Elders Site. ( 0,729158442869696 )
AMIA Annu Symp Proc - A mixed methods approach for measuring the impact of delivery-centric interventions on clinician workflow. ( 0,728822520315569 )
Int J Med Inform - Barriers and facilitators to the use of computer-based intensive insulin therapy. ( 0,728128696613272 )
J Biomed Inform - Informing the design of clinical decision support services for evaluation of children with minor blunt head trauma in the emergency department: a sociotechnical analysis. ( 0,727576441861201 )
Int J Med Inform - Does e-pain plan improve management of sickle cell disease associated vaso-occlusive pain crisis? a mixed methods evaluation. ( 0,725907312687681 )
Health Info Libr J - Information needs of clinicians and non-clinicians in the Emergency Department: a qualitative study. ( 0,722565444438351 )
J Biomed Inform - Proclets in healthcare. ( 0,72119816427526 )
BMC Med Inform Decis Mak - The role of ICT in supporting disruptive innovation: a multi-site qualitative study of nurse practitioners in emergency departments. ( 0,720874573045553 )
Int J Med Inform - The effects of EMR deployment on doctors' work practices: a qualitative study in the emergency department of a teaching hospital. ( 0,720555056414476 )
Healthc (Amst) - Doubling down: Lessons learned from building a new electronic health record as part of primary care practice redesign. ( 0,720327309322328 )
Int J Med Inform - Health information exchange interventions can enhance quality and continuity of HIV care. ( 0,719989244710977 )
BMC Med Inform Decis Mak - Staff experiences within the implementation of computer-based nursing records in residential aged care facilities: a systematic review and synthesis of qualitative research. ( 0,71917219820237 )
Appl Clin Inform - Insight into the sharing of medical images: physician, other health care providers, and staff experience in a variety of medical settings. ( 0,718937348316573 )
Appl Clin Inform - CAH to CAH: EHR implementation advice to critical access hospitals from peer experts and other key informants. ( 0,717761857597577 )
Int J Med Inform - The importance of the verbal shift handover report: a multi-site case study. ( 0,712616499689066 )
Telemed J E Health - A pilot trial of telephone-based collaborative care management for PTSD among Iraq/Afghanistan war veterans. ( 0,712399115880901 )
Inform Health Soc Care - Information exchange between registered nurses and district nurses during the discharge planning process: cross-sectional analysis of survey data. ( 0,709228018214706 )
Methods Inf Med - Real-time feedback on nonverbal clinical communication. Theoretical framework and clinician acceptance of ambient visual design. ( 0,708727547570527 )
J Telemed Telecare - Telehealth in palliative care in the UK: a review of the evidence. ( 0,708563611837086 )
Inform Health Soc Care - 'The web is not enough, it's a base'--an explorative study of what needs a web-based support system for young carers must meet. ( 0,703869630479612 )
Telemed J E Health - Home telehealth: facilitators, barriers, and impact of nurse support among high-risk dialysis patients. ( 0,702020408733285 )
Health Informatics J - Accessibility, usability, and usefulness of a Web-based clinical decision support tool to enhance provider-patient communication around Self-management TO Prevent (STOP) Stroke. ( 0,701492181145582 )
Int J Med Inform - Using ORA to explore the relationship of nursing unit communication to patient safety and quality outcomes. ( 0,701323210921336 )
BMC Med Inform Decis Mak - A qualitative evaluation of general practitioners' views on protocol-driven eReferral in Scotland. ( 0,695403266731592 )
BMC Med Inform Decis Mak - The status of IT service management in health care - ITIL? in selected European countries. ( 0,694989333426157 )
BMC Med Inform Decis Mak - What is needed to implement a computer-assisted health risk assessment tool? An exploratory concept mapping study. ( 0,694861465141637 )
Med Decis Making - Impact of Diabetes E-Consults on Outpatient Clinic Workflow. ( 0,694680445333417 )
Inform Health Soc Care - Team climate and attitudes toward information and communication technology among nurses on acute psychiatric wards. ( 0,69412565207063 )
J Med Syst - Advanced nurse-patient communication system. ( 0,694063257655919 )
Int J Med Inform - Organisational influences on nurses' use of clinical decision support systems. ( 0,692381978698313 )
Int J Med Inform - CareCoor: augmenting the coordination of cooperative home care work. ( 0,691383543887497 )
Appl Clin Inform - An evaluation of the usability of a computerized decision support system for nursing homes. ( 0,689805931314245 )
AMIA Annu Symp Proc - Support for contextual control in primary care: a qualitative analysis. ( 0,688027404024127 )
Appl Clin Inform - Clinician preferences for verbal communication compared to EHR documentation in the ICU. ( 0,685732256453378 )
J Am Med Inform Assoc - Towards public health decision support: a systematic review of bidirectional communication approaches. ( 0,685541342796385 )
BMC Med Inform Decis Mak - A study of clinical and information management processes in the surgical pre-assessment clinic. ( 0,683793537115981 )
J Med Syst - Data envelopment analysis model for the appraisal and relative performance evaluation of nurses at an intensive care unit. ( 0,683115955596138 )
Int J Med Inform - Using a sociotechnical framework to understand adaptations in health IT implementation. ( 0,682666540684387 )
J Innov Health Inform - Using information to deliver safer care: a mixed-methods study exploring general practitioners' information needs in North West London primary care. ( 0,681739422338546 )
Int J Med Inform - Supporting medical communication for older patients with a shared touch-screen computer. ( 0,680058374645154 )