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Assessing stressful life events in large-scale epidemiologic studies is challenged by the need to measure potential stressful events in a reasonably comprehensible manner balanced with burden on participants and research staff. The aim of this paper was to create a short form of the Crisis in Family Systems-Revised (CRISYS-R) plus 17 acculturation items, a measure that captures contemporary life stressors across 11 domains. Latent class analysis (LCA) was used to segment the sample of 884 women from the PRogramming of Intergenerational Stress Mechanisms (PRISM) study experiencing different patterns of exposure to stressful events and identify items from each domain that best discriminate between individuals with different patterns of stressful-event exposures (high vs. low stress exposure). The results from the LCA, in conjunction with the expert opinions provided by the original developers of the CRISYS, yielded a 24-item item short form (CRISYS-SF) with at least one question from each of the original domains. Scores on the 24-item CRISYS-SF had high correlations with scores on the 80-item CRISYS., Author(s): Phillip Sherlock [sup.1] , Madeleine U. Shalowitz [sup.2] , Carolyn Berry [sup.3] , David Cella [sup.1] , Courtney K. Blackwell [sup.1] , Whitney Cowell [sup.4] , Karen M. Reyes [...]

Care management (CM) is a promising team-based, patient-centered approach "designed to assist patients and their support systems in managing medical conditions more effectively." As little is known about its implementation, this article describes CM implementation and associated lessons from 12 Agency for Healthcare Research and Quality-sponsored projects. Two rounds of data collection resulted in project-specific narratives that were analyzed using an iterative approach analogous to framework analysis. Informants also participated as coauthors. Variation emerged across practices and over time regarding CM services provided, personnel delivering these services, target populations, and setting(s). Successful implementation was characterized by resource availability (both monetary and nonmonetary), identifying as well as training employees with the right technical expertise and interpersonal skills, and embedding CM within practices. Our findings facilitate future context-specific implementation of CM within medical homes. They also inform the development of medical home recognition programs that anticipate and allow for contextual variation.

PURPOSE Small independent primary care practices (SIPs) often lack the resources to implement system changes. HealthyHearts NYC, funded through the EvidenceNOW initiative of the Agency for Healthcare Research and Quality, studied the effectiveness of practice facilitation to improve cardiovascular disease-related care in 257 SIPs. We sought to understand SIP clinicians' perspectives on the benefits of practice facilitation. METHODS We conducted in-depth interviews with 19 SIP clinicians enrolled in HealthyHearts NYC. Interviews were transcribed and coded using deductive and inductive approaches. To understand whether the perceived benefits of practice facilitation differ based on the availability of internal staff for quality improvement (QI), we compared themes pertaining to benefits between practices with 3 or fewer office staff vs more than 3 office staff. RESULTS Clinicians perceived 2 main benefits of practice facilitation. First, facilitators served as a connection to the external health care environment for SIPs, often through teaching and information sharing. Second, facilitators provided electronic health record (EHR)/data expertise, often by teaching functionality and completing technical assistance and tasks. SIPs with more than 3 office staff felt that facilitators provided benefits primarily through teaching, whereas SIPs with 3 or fewer staff felt that facilitators also provided hands-on support. At the intersections of these benefits, there emerged 3 central practice facilitation benefits: (1) creating awareness of quality gaps, (2) connecting practices to information, resources, and strategies, and (3) optimizing the EHR for QI goals. CONCLUSIONS SIP clinicians perceived practice facilitation to be an important resource for connecting their practice to the external health care environment and resources, and helping their practice build QI capacity through teaching, hands-on support, and EHR-driven solutions. Key words: primary care; practice transformation; practice facilitation; organizational change; professional practice; physician perspective; small independent primary care practices; qualitative research; health information technology; practice-based research, INTRODUCTION Small independent primary care practices (SIPs), defined as those with 5 or fewer clinicians, provide primary care for a substantial proportion of the US population, (1) yet the number [...]

This article shares insights and reflections from an experience funding and evaluating the Healthy Neighborhoods Initiative, a $22 million, six-year, place-based effort by two grantmaking foundations across nine diverse communities in New York state. An external, mixed methods evaluation provided feedback to the funders on achievements, challenges, and learnings. Local partnership structures building on existing relationships and those that had or could quickly build trust of key actors and community residents were more effective at sustaining strategic activities and engagement. While working at the community level had many benefits, it was difficult to leverage strategies to create policy changes at the city or state level. [ABSTRACT FROM AUTHOR]

Synchronous home-based telemedicine for primary care experienced growth during the coronavirus disease 2019 pandemic. A review was conducted on the evidence reporting on the feasibility of synchronous telemedicine implementation within primary care, barriers and facilitators to implementation and use, patient characteristics associated with use or nonuse, and quality and cost/revenue-related outcomes. Initial database searches yielded 1,527 articles, of which 22 studies fulfilled the inclusion criteria. Synchronous telemedicine was considered appropriate for visits not requiring a physical examination. Benefits included decreased travel and wait times, and improved access to care. For certain services, visit quality was comparable to in-person care, and patient and provider satisfaction was high. Facilitators included proper technology, training, and reimbursement policies that created payment parity between telemedicine and in-person care. Barriers included technological issues, such as low technical literacy and poor internet connectivity among certain patient populations, and communication barriers for patients requiring translators or additional resources to communicate. [ABSTRACT FROM AUTHOR]

Survey responses from 120 British local governments that achieved the Investors in People (IiP) standard for training and development indicated that most found some benefits from the award; a number of barriers were identified. Results of this and other studies suggest that it is unclear how effective IiP is for improving business performance or enhancing change management. (Contains 24 references.) (SK)

Study of 394 physicians graduating in 1989 from six New York medical schools found that certain residency-training factors had sustained effects on physician behavior in caring for AIDS (acquired immune deficiency syndrome) patients, but not on the number of patients treated. Determinants of treatment practice included residency environment, faculty characteristics, cynicism about patient care, social biases, and AIDS-related attitudes. (Author/MSE)

In 2004, the American Medical Association (AMA) approved the Performance Improvement (PI) educational process as a strategy for improving patient care. (1) Through this process, clinicians earn AMA Physician's Recognition [...]