Multimethod Evaluation of the VA’s Peer-to-Peer Toolkit for Patient-Centered Medical Home Implementation

Luck, Jeff; Bowman, Craig T.; York, Laura; Midboe, Amanda M.; Taylor, Thomas J.; Gale, Rena; Asch, Steven M.

doi:10.1007/s11606-013-2738-0

“…Notably, a common denominator is that interventions are limited to specific medical or technical methods or procedures. Applications of CFIR to more general MIs are rare, but some have been presented; for example, for a reimbursement and benchmarking system [36], a health care delivery redesign project [37], a “patient-aligned toolkit” [38], and primary care leadership [39]. Notably, though, Damschroder et al ([10] (Additional file 4)) argued that even though CFIR is intended for all kinds of innovations, “administrative interventions tend to be more complex and difficult to implement” .…”

Section: Theoretical Backgroundmentioning

confidence: 99%

Value-based healthcare translated: a complementary view of implementation

Colldén

¹

,

Hellström

²

2018

BMC Health Serv Res

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BackgroundInterest in the implementation of various innovations (e.g. medical interventions and organizational approaches) has increased rapidly, and management innovations (MIs) are considered particularly complex to implement. In contrast to a traditional view that innovations are implemented, some scholars have promoted the view that innovations are translated into contexts, a view referred to as translation theory. The aim of this paper is to investigate how a translation theory perspective can inform the Consolidated Framework of Implementation Research (CFIR) to increase understanding of the complex process of putting MIs into practice. The empirical base is a two-year implementation of the MI Value-Based Health Care (VBHC) to a psychiatric department in a large Swedish hospital.MethodsIn this longitudinal case study, a qualitative approach was applied using an insider researcher with unique access to data, who followed the implementation starting in 2015. Data sources includes field notes, documents, and audio recordings of meetings and group reflections which were abridged into an event data file structured by CFIR domains. In a joint analysis, an outsider researcher was added to strengthen the analysis and mitigate potential bias.ResultsTwo themes were identified, for which CFIR did not satisfactorily explain the findings. First, the intervention characteristics (i.e. the content of the MI) were modified along the process and, second, the process did not follow predefined plans. However, the project was still perceived to be successful by internal and external stakeholders.ConclusionsThe paper proposes three ways in which translation theory can inform CFIR when applied to MIs: 1) strength of evidence is not as important for MIs as for medical and technical innovations; 2) adaptability of the MI can be emphasized more strongly, and 3) it can be more fruitful to view implementation as a dynamic process rather than seeing it as a matter of planning and execution. For managers, this implies encouragement to seize the opportunity to translate MIs to fit their organization, rather than to aim to be true to an original concept.

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“…Our study shows that multi-dimensional PCMH based curricular innovations in the WCGME's Internal Medicine residency significantly enhanced THC residents' self-reported KSA by the end of their internship year and that these improvements over baseline were maintained through three Effect of PCMH innovations on patient outcomes, care delivery organizational structure and cost effectiveness have been debated in the literature [19,20,21,22]. Hochman et.…”

Section: Discussionmentioning

confidence: 83%

“…Though earlier small sample studies showed enhanced patient outcomes with the PCMH model [19,20], a recent large study by Friedberg et al [21] showed limited improvement in quality and no improvement in health care utilization or cost effectiveness among multiple practices that adopted this model for three years, suggesting further refinement is necessary in PCMH interventions [21]. Financial sustainability of PCMH interventions in current form is evaluations, direct observation tools, and ACGME reportable milestones outcomes, as well as patient care delivery process and health outcomes, are required before firm inferences can be made from our results.…”

Section: Discussionmentioning

confidence: 99%

Nurturing 21st century physician knowledge, skills and attitudes with medical home innovations: the wright center for graduate medical education teaching health center curriculum experience

Thomas-Hemak

¹

,

Shantha

²

,

Gollamudi

³

et al. 2014

Preprint

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Purpose: Effect of patient centered medical home (PCMH) curriculum interventions on residents’ self-reported and demonstrated knowledge, skills and attitudes (KSA) in PCMH competency arenas is lacking in the literature. This study aimed to assess impact of PCMH curricular innovations on Internal Medicine residents’ self-reported KSA. Method: Twenty four (24) Internal Medicine residents - 12 Traditional (TR) track and 12 Teaching Health Center (THC) track - began training in academic year (AY) 2011 at the Wright Center for Graduate Medical Education (WCGME). They were followed through AY2013 covering three years of training. PCMH curricular innovations were applied beginning July 2011 until May 2012 focally to THC residents. These curricular innovations were spread program wide in May 2012. Semi-annual validated PCMH Clinician Assessments assessing PCMH competencies based on self-reported KSA were started in AY2011 and completed by all residents. Results: Mean self-reported KSA scores of TR residents were similar to THC residents at baseline for all PCMH competencies. In May 2012, mean scores of THC residents were significantly higher than 2011 and graduating 2009 TR residents for most PCMH competencies. After program wide implementation of PCMH innovations, mean scores of 2011 and 2010 TR residents for all PCMH competencies improved and most equalized to those of 2011 THC residents. Globally improved PCMH competency scores of 2011 THC and TR residents were maintained through May 2014, with majority of improvements above baseline reaching statistical significance. Conclusions: PCMH curricular innovations inspired by HRSA’s Teaching Health Center funded residency program expansion quickly and consistently improved Internal Medicine residents’ self-reported KSA of PCMH competencies and improvements were sustained.

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“…Our study shows that multi-dimensional PCMH based curricular innovations in the WCGME's Effect of PCMH innovations on patient outcomes, care delivery organizational structure and cost effectiveness have been debated in the literature [19,20,21,22]. Hochman et.…”

Section: Discussionmentioning

confidence: 95%

Nurturing 21st century physician knowledge, skills and attitudes with medical home innovations: the wright center for graduate medical education teaching health center curriculum experience

Thomas-Hemak

¹

,

Shantha

²

,

Gollamudi

³

et al. 2014

Preprint

View full text Add to dashboard Cite

Purpose: Effect of patient centered medical home (PCMH) curriculum interventions on residents’ self-reported and demonstrated knowledge, skills and attitudes (KSA) in PCMH competency arenas is lacking in the literature. This study aimed to assess impact of PCMH curricular innovations on Internal Medicine residents’ self-reported KSA. Method: Twenty four (24) Internal Medicine residents - 12 Traditional (TR) track and 12 Teaching Health Center (THC) track - began training in academic year (AY) 2011 at the Wright Center for Graduate Medical Education (WCGME). They were followed through AY2013 covering three years of training. PCMH curricular innovations were applied beginning July 2011 until May 2012 focally to THC residents. These curricular innovations were spread program wide in May 2012. Semi-annual validated PCMH Clinician Assessments assessing PCMH competencies based on self-reported KSA were started in AY2011 and completed by all residents. Results: Mean self-reported KSA scores of TR residents were similar to THC residents at baseline for all PCMH competencies. In May 2012, mean scores of THC residents were significantly higher than 2011 and graduating 2009 TR residents for most PCMH competencies. After program wide implementation of PCMH innovations, mean scores of 2011 and 2010 TR residents for all PCMH competencies improved and most equalized to those of 2011 THC residents. Globally improved PCMH competency scores of 2011 THC and TR residents were maintained through May 2014, with majority of improvements above baseline reaching statistical significance. Conclusions: PCMH curricular innovations inspired by HRSA’s Teaching Health Center funded residency program expansion quickly and consistently improved Internal Medicine residents’ self-reported KSA of PCMH competencies and improvements were sustained.

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Multimethod Evaluation of the VA’s Peer-to-Peer Toolkit for Patient-Centered Medical Home Implementation

Cited by 26 publications

References 16 publications

Value-based healthcare translated: a complementary view of implementation

Value-based healthcare translated: a complementary view of implementation

Nurturing 21st century physician knowledge, skills and attitudes with medical home innovations: the wright center for graduate medical education teaching health center curriculum experience

Nurturing 21st century physician knowledge, skills and attitudes with medical home innovations: the wright center for graduate medical education teaching health center curriculum experience

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