Practice Transformation Under the University of Colorado's Primary Care Redesign Model

Increasing the ratio of MAs to clinicians and expanding the roles of the MAs improved access, quality of care, and clinician experience without increasing overhead. James W. Mold, MD, MPH

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PURPOSE:

We compared the transformation experience of 2 family medicine practices that implemented the Primary Care Redesign (PCR) team-based model to improve access, quality, and experience without increasing cost. The University of Colorado's A.F. Williams Family Medicine clinic (pilot practice) implemented the model in February 2015, and a smaller, community-based practice (wave 2 practice) did so 2 years later, in February 2017.

METHODS:

The PCR model increased the ratio of medical assistants to clinicians from about 1:2 to 2.5:1 while expanding the role of the medical assistants, through enhanced rooming procedures, in-room support (eg, scribing), postclinician wrap-up, and in-basket assistance. We assessed access, clinical quality metrics, staffing costs, and clinician and staff experience and burnout for at least 7 months before and 42 months after the intervention.

RESULTS:

In the pilot practice, compared with preimplementation, there were improvements in total appointments and rates of hypertension control, colorectal cancer screening, and most diabetic quality metrics. In the wave 2 practice, total appointments increased slightly when clinicians were added pre-PCR and then increased substantially after implementation; initially variable hypertension control improved rapidly after implementation. The wave 2 practice's colorectal cancer screening improved gradually, then accelerated postimplementation, while diabetic metrics initially remained stable or declined, then improved postimplementation. New patient appointments began to increase for both practices in late 2015, but grew faster in the pilot practice under PCR. Over time, all experiential domains improved for clinicians; most remained stable for staff. Clinician burnout was reduced by at least one-half in both practices except during low staffing periods, which also adversely affected staff. After a ramp-up period, the number of staff hours per visit remained stable.

CONCLUSIONS:

The PCR model is associated with simultaneous improvements in quality, access, and clinician experience, as well as reductions in burnout, while maintaining staffing costs.

Author/s:

Smith, P.C., Lyon, C., English, A.F., Conry, C.

Adapting Screening, Brief Intervention, and Referral to Treatment for Alcohol and Drugs to Culturally Diverse Clinical Populations

Jeffrey Wilson — Wed, 02 Jan 2019 14:20:26 +0000

Date Added:

January 2, 2019

Journal/Publication:

Journal of Addiction Medicine

Publisher:

American Society of Addiction Medicine

Publication Date:

September 1, 2015

Issue:

Volume:

Pages:

343-351

URL:

Adapting Screening, Brief Intervention, and Referral to Treatment for Alcohol and Drugs to Culturally Diverse Clinical Populations

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1097/ADM.0000000000000150

Keywords

alcohol

alcoholism

SBIRT

PMID (1):

26428359

MeSH

community health services

substance-related disorders

alcoholism

alcohol drinking

motivational interviewing

This is a systematic review that provides guidance regarding use of the SBIRT process in culturally diverse patient populations.

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OBJECTIVES:

To review the literature on the screening, brief intervention, and referral to treatment (SBIRT) approach to alcohol and drug use with racial and ethnic subgroups in the United States and to develop recommendations for culturally competent SBIRT practice.

METHODS:

Articles reporting on the use of SBIRT components (screening, brief intervention, referral to treatment) for alcohol and drug use were identified through a comprehensive literature search of PubMed from 1995 to 2015.

RESULTS:

A synthesis of the published literature on racial and ethnic considerations regarding SBIRT components (including motivational interviewing techniques) was created using evidence-based findings. Recommendations on culturally competent use of SBIRT with specific ethnic groups are also described.

CONCLUSIONS:

On the basis of the literature reviewed, SBIRT offers a useful set of tools to help reduce risky or problematic substance use. Special attention to validated screeners, appropriate use of language/literacy, trust building, and incorporation of patient and community health care preferences may enhance SBIRT acceptability and effectiveness.

PRACTICE IMPLICATIONS:

Providers should consider the implications of previous research when adapting SBIRT for diverse populations, and use validated screening and brief intervention methods. The accompanying case illustration provides additional information relevant to clinical practice.

Author/s:

Manuel, Jennifer K., Satre, Derek D., Tsoh, Janice, Moreno-John, Gina, Ramos, Jacqueline S., McCance-Katz, Elinore F., Satterfield, Jason M.