L I Solberg

....

..In this study, we hypothesized that adults age 65 and over receive lower quality diabetes care than adults age 45-64 years old...

..The purpose of this article is to produce a relatively simple conceptual framework for guiding and studying practice improvement...

....

..This retrospective survey of women with fibroids, a benign condition with multiple treatment options, sought to evaluate the extent to which this was measurable and true...

..It is important to know whether medical groups have quality improvement (QI) priorities, approaches, activities, and congruence that will allow them to achieve major improvements in quality of care...

..Little is known about current physician-patient interactions regarding smoking cessation when a prescription is given for cessation medications...

....

....

..There is limited evidence about how to ensure that patients are helped to make informed medical care decisions...

..To improve this for tobacco cessation, we measured differences in the frequency of receiving and filling cessation medication prescriptions by race, ethnicity, age, language preference, health insurance, and pregnancy...

..We wanted to test whether improvements in care quality were correlated with changes in the Chronic Care Model (CCM) in a large medical group that attempted to implement the CCM...

..Most attention has focused on T1 translation studies (bench to bedside) with considerable uncertainty about how to enhance T2 (effectiveness trials) and especially T3 (implementation studies)...

..We wanted to identify differences between diabetic patients who smoke and those who do not smoke to design more effective strategies to improve their diabetes care and encourage smoking cessation...

....

..Therefore, the electronic medical record database of a large medical group in Minnesota was used to demonstrate the potential value of that approach to accomplish those goals...

..The problem is that there are few examples of such systems in real clinical practices. This article describes the main components of such a systematic approach...

....

..To demonstrate that one physician can dramatically improve care of diabetes patients by taking a systems approach and getting support from leaders and other team members...

..It was concluded that any organization striving to greatly improve the quality of its healthcare delivery should consider these factors when planning improvement initiatives...

..They have been successfully used to describe care quality changes for these patients over time. This starter set for the 6 IOM aims should be tested and expanded by others...

..To compare smoking-cessation interest and behaviors in younger and older smokers to develop better smoking-cessation strategies for younger smokers...

..This study was designed to develop a standardized rating for the clinically preventable burden and cost effectiveness of complying with that recommendation that would allow comparisons across many recommended services...

..97, 0.95, and 0.95. This approach is feasible and necessary for those wanting to use administrative data for case identification for performance measurement or quality improvement...

..To determine whether a questionnaire that assesses the presence of practice systems is associated with clinical performance rates for diabetes care...

..A study was conducted to test whether patient reports of medical errors via surveys could produce sufficiently accurate information to be used as a measure of patient safety...

..To describe a new survey tool for assessing medical group capability to improve care and to test the relationship between survey scores and other factors among 41 medical groups...

..31, P = .05). Thus, practice systems overall and several domains of the Chronic Care Model appear to be associated with higher quality care for depression. This questionnaire may help practices identify particular systems to improve...

..To study physician-smoker interactions around the receipt of smoking cessation medication prescriptions to better understand the low rates of reported assistance and follow-up...

..We studied one such group to determine the organizational and cultural attributes that seem related to its achievements in care quality...

..We wanted to determine whether a major improvement in access to primary care during 2000 was associated with changes in the quality of care for patients with depression...

..S. health care system. This rigorous qualitative evaluation of transformational change for patient access in one large multispecialty group practice identifies the major issues facing organizations addressing the IOM challenge...

..It is unclear whether methodological differences in sample size, survey methods, and analysis approach significantly affect the ability to accurately monitor tobacco control activities and to make rate comparisons...

..We tested the hypothesis that the introduction of coverage for smoking-cessation pharmacotherapy by the health plans covering most of the population in one region would increase physician use of 5A's...

....

..Previous studies of nonresponders have not assessed the effects of nonresponse on the accuracy of clinician behavior measurements. Knowledge of these effects is critical to both research and quality improvement...

....

..Although new strategies for managing depression in primary care (e.g., nurse telephone calls, collaborative care) have been shown to be effective, no models are available for their systematic implementation in the "real world."..

..This study sought to learn whether these studies and reviews have recognized the importance of systems thinking and organizational change for implementation...

....

..We tested whether patients who seek care very early in their illness differ from those who seek care later and whether they might require a different approach to care...

....

..Although there has been enormous interest in continuous quality improvement (CQI) as a measure to improve health care, this enthusiasm is based largely on its apparent success in business rather than formal evaluations in health care...

..Do low-SES adult patients visiting private primary care clinics differ from higher SES adult patients in their need for eight preventive services or in receiving either a recommendation for or the needed services?..

..We identify measures of emergency department (ED) and hospital workflow that would be of value in understanding, monitoring, and managing crowding...

....

....

..In any other industry, that would be the case, especially the key questions about the financial viability of both the transformation of traditional practices and sustainability of the new care model...

..Studying variation among clinics could help us to understand the extent of system use in practice...

..We conclude that among primary care clinics recognized as high-level medical homes, the instrument used to assess medical home characteristics cannot differentiate their quality...

....

..To understand the process, outcomes, and patient satisfaction of usual primary care for patients given a diagnostic code for depression...

..The purpose of this study was to measure the attitudes, activities, and organizational cultures concerning Continuous Quality Improvement in a group of Midwestern primary care clinics...

..Expectations for large and rapid change are probably unrealistic...

..The thematic analysis identified four factors that appear to be important in implementing a CQI process in a clinic setting: awareness, momentum, ownership, and communication...

..Three questions were addressed: How does change in the health care environment affect a quality improvement (QI) process? How does clinic organization influence a QI process? and What is the impact of a QI process on clinic organization?..

..Thematic analytic methods were used to identify themes in the contextual data...

..This study tests the hypothesis that a managed care organization (MCO) can help its contracted private primary care clinics to develop such systems...

..Further studies are needed to test whether greater efforts to make smokers aware of insurance benefits or adding other types of cessation support might lead to any beneficial effects...

..Most of these problems can be attributed to an absence of depression care systems in primary care practice. We collected information from a group of practices to assess the need for and acceptability of such systems...

..Effective clinic-based, smoking-cessation activities are not widely implemented...

..To determine whether depression is treated differently in older and younger patients in primary care clinics...

..To describe the types of practice system tools that medical groups use for depression care, and to compare these with the tools used for care of other chronic conditions...

..Advanced access and productivity-based pay may be effective ways to address the challenges of timeliness, efficiency, and patient centeredness identified by the Institute of Medicine...

..One large health care organization that tried to implement the CCM in primary care provided an opportunity to study these issues...

..CONCLUSION: This study identifies the most valuable clinical preventive services that can be offered in medical practice and should help decision-makers select which services to emphasize...

..Payers and health plans are encouraging shorter hospital stays after routine vaginal delivery...

..This study is among the first to use electronic medical record (EMR) data to examine differences in tobacco use associated with acculturation among various population groups...

..7 billion, or 0.2 percent of U.S. personal health care spending. These findings suggest that policy makers should pursue options that move the nation toward greater use of proven preventive services...

..We wanted to measure how frequently adolescents who are insured either through private insurance or government programs have preventive vs nonpreventive care visits...

..4%) and outpatient ($1282/person, 3.5%) costs among patients with 11 or more prescriptions suggesting higher functioning PCMHs may lead to reduced costs among the most complex and costly patients...

....

..It has not been tested in prioritizing community interventions and other health care services but should provide a useful starting point for designing priority-setting efforts in those areas...

..We sought to determine whether the educational backgrounds of young adult smokers (aged 18 to 24 years) affect their cessation attitudes or behaviors in ways that could be used to improve smoking interventions...

..The results varied by gender and amount smoked. In addition, the variables associated with quitting in a multivariate logistic regression model included older age and using more than 30 days of medication...

....

..It also addresses repeated counseling because the literature has focused on single episodes of treatment, while in reality that is neither desirable nor likely...

..To test the hypothesis that patient readiness to change (RTC) predicts future changes in glycemic control in adults with diabetes...

....

..This article evaluates the impact of introducing routine use of smoking status as a vital sign on clinician cessation support in a primary care setting...

..Although other variations of this approach might be tested, we suspect that it might be more useful to test innovative ways to influence the factors we identified as being most strongly predictive of lack of successful quitting...

..To assess the impact of a quality improvement (QI) intervention on the quality of diabetes care at primary care clinics...

....

..The study analyzes the effect of an advanced access program on quality of diabetes care...

....

..To examine whether depressive symptoms are associated with achievement of recommended goals for control of glucose, lipids, and blood pressure among patients with diabetes...

..To assess the impact of organizational features and improvement strategies of primary care clinics on health care costs of adults with diabetes...

..Although evidence-based national guidelines for tobacco-dependence treatment have been available since 1996, translating these guidelines into clinical practice is challenging...

....

....

..The goal of the conceptual model is to provide a practical framework on which an organized research, policy, and operations management agenda can be based to alleviate ED crowding...

..To describe the systems strategies used to reduce failures in delivery of breast and cervical cancer screening services in HMOs with high performance rates for these services...

..Interventions that are based on understanding the four key elements and their interrelationships can yield sustainable quality improvements in primary care practice...

..To test whether a mailing describing new coverage for smoking cessation medications increases benefit knowledge, utilization, and quitting...

..This report should be useful to those who want to understand additional detail about how the ranking was developed or who want to adapt the methods for their own purposes...

..CONCLUSIONS: Colorectal cancer screening is a high-impact, cost-effective service used by less than half of persons aged 50 and older...

..The purpose of this study was to assess the impact of baseline A1c, cardiovascular disease, and depression on subsequent health care costs among adults with diabetes...

..There is little information on the extent of compliance with the guideline's treatment model described by the "5A's" (Ask, Advise, Assess, Assist, Arrange)...

..Further research is needed to determine whether, and to what extent, this failure to monitor patients is associated with adverse clinical outcomes...

..Finally, by conducting the study in cooperation with those who pay for and deliver the care, the project will demonstrate a new approach to research-practice partnerships. ..

..Finally, by conducting the study in cooperation with those who pay for and deliver the care, the project will demonstrate a new approach to research-practice partnerships. ..