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J Ambulatory Care Manage Vol. 37, No. 2, pp. 96–99 C 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright 

Special Issue on Primary Care Practice-Based Research Networks Insights on Innovative Strategies for Harnessing Health Information Technology to Help Individuals, Teams Rebecca Roper, MS, MPH Abstract: This issue of the Journal highlights the problem-solving perspectives of primary care practices, including practice-based research networks. Informed, dedicated primary care teams are seeking incremental insight on how to use health information technology to support holistic enhancements in primary care, including how health information technology can support individual patients and how it can support care teams. Practice-based research networks comprise groups of primary care clinicians, their diversified practice teams, and skilled researchers, all of whom work together to answer community-based health care questions, seek practical solutions, and translate research findings into practice. Key words: Expanded Chronic Care Model, health information technology, patient-centered medical home, patient engagement, practice-based research networks, quality Improvement, team-based care

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NFORMED, dedicated primary care teams are seeking incremental insight on how to use health information technology (IT) to support holistic enhancements in primary care, including how health IT can support individual patients and how it can support care teams. The roles of the clinical care team are

Author Affiliation: Practice-Based Research Network Initiative, Agency for Healthcare Research and Quality, Rockville, Maryland. The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining to this article. The opinions expressed in this article are the author’s and do not necessarily represent the positions of the Department of Health and Human Services. Correspondence: Rebecca Roper, MS, MPH, PracticeBased Research Network Initiative, Agency for Healthcare Research and Quality, Room 6000, 540 Gaither Rd, Rockville, MD 20850 ([email protected]). DOI: 10.1097/JAC.0000000000000030

evolving. Patients’ expectations of themselves and their care providers are changing. The point of care is extending beyond the traditional office visit. Integration of evidencebased services and personalized care is being realized through iterative advancements. Insights are sought on how the technological infrastructure can support the information needs of the primary care team and their patients. This issue of the Journal highlights the problem-solving perspectives of primary care practices, including practice-based research networks (PBRNs), which comprise groups of primary care clinicians, their diversified practice teams, and skilled researchers, all of whom work together to answer communitybased health care questions, seek practical solutions, and translate research findings into practice. The Agency for Healthcare Research and Quality (AHRQ) works with the PBRNs to promote practice-based research, to improve the organization and delivery of primary care,

96 Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

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Primary Care Practice-Based Research Networks to accelerate quality improvement in primary care practices, and to stimulate innovation, as reflected in this issue. Practice-based research networks articulate real-world challenges in the delivery of primary care and test plausible changes in various aspects of health IT. In the pursuit of research and quality improvement, PBRNs often involve the diversified members of the clinical team and, when possible, engage patients, their families, and a new type of quality improvement professional, practice facilitators (see the Practice Facilitation pages of the Patient-Centered Medical Home [PCMH] Resource Center at http://pcmh.ahrq.gov and http://www.ahrq.gov/professionals/preventi on-chronic-care/improve/system/pfhandboo k/index.html). This issue complements other PBRN-based articles, including a few by Nagykaldi et al, which appear in the January-March issue of Journal of Ambulatory Care Management. Collectively, these articles clearly identify gaps and challenges. Yet, their shared finding is that health IT can be used to engage patients and members of the clinical care team effectively.

TEAM-BASED CARE Given the numerous expectations placed on primary care practices, it is helpful to note that many are using their wit and wherewithal to transform distantly possible wishes into plausible practices. The Expanded Chronic Care Model purposefully links the Care Model with the central elements of the PCMH. It has 6 core elements: health systems, delivery system design, decision support, clinical information systems, self-management support, and community resources and policies (Barr et al., 2003). Application of community resources, to support prevention and management services, is integral to realizing the desired shift to a health care system that promotes wellbeing through communication and accountability. By strengthening Expanded Chronic Care Model aspects of care delivery, patients are activated and the primary care team is

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poised to be both proactive and reactive to the needs of the patients. The pilot study of Richman et al, among team members in safety-net PBRN practices in a PCMH configuration, sought their preferences for content and format for care coordination communications by clinicians. Both nurses and physicians found e-mail communication by case managers and care managers to be central to care coordination; yet, the preferences for content varied across types of managers. Although not conducted in a PBRN, Hall et al provide real-world examples of the breadth of approaches that can be pursued in PCMH accreditation. These findings emphasize the diversity of how health IT can be used to develop and strengthen PCMH core components and the importance of characterizing that usage when assessing effectiveness of a PCMH configuration.

PATIENT ENGAGEMENT Self-management support is an evolving strategy to empower patients and caregivers alike, by promoting and delivering education and communication to increase patients’ skills to cope with the burden of chronic illness. For example, the snapshot by Fiks et al provides a kaleidoscope of vested partners’ perspectives and information needs, which are reflected in a promising patient-informed, shared decision approach through an electronic medical record portal that supports improved self-management of asthma by pediatric patients. Ratanawongsa et al present an intriguing proof-of-concept study that demonstrated the technical feasibility of implementing multilanguage automated telephone self-management support services to coach English-, Spanish-, and Cantonese-speaking patients on how to manage their diabetes. For primary care teams interested in learning more about the what, why, and how of providing selfmanagement support to patients, AHRQ’s library of self-management support resources is found at www.orau.gov/ahrq.

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JOURNAL OF AMBULATORY CARE MANAGEMENT/APRIL–JUNE 2014

ACCESS TO CARE Health IT can be harnessed to support a continuum of care both within and adjunct to the office visit. The pilot study of Wu et al demonstrates that the automated telephonic assessment is a widely available technology that can be used successfully to extend and prioritize screening for depression among diabetic patients receiving care through a federally qualified health care center. DeVoe et al provide insights on how to harness IT to reach uninsured children and mitigate their losing health insurance coverage. These findings provide insights that have the potential to be translated to other settings and populations, as the Affordable Care Act seeks to expand and sustain increased access to health care through wider availability of health insurance. Chung et al demonstrate that patients’ access to their primary care providers and their enrollment in a personal health care record are indicators for the receipt of recommended chronic care management and preventive services. The project also reveals the difficulties in measuring performance of process quality measures so that these measures are closely and clearly related to the clinical outcomes they seek to support.

DATA COLLECTION TO SUPPORT QUALITY IMPROVEMENT The snapshot by Cole et al addresses the fundamental challenges of uniform data collection across practices with diversified priorities and health IT functionality and provides general guidance on how to pursue individualized solutions to address the diversity in data collection made to be actionable within a given care setting. Litvin and Ornstein explore the practicalities of translating evidence-based guidelines for the treatment and management of chronic kidney disease to develop reliable quality indicators from data collected in an electronic health record–supported ambulatory system, which could support ongoing assessment and pursuit of evidence-based care.

The article by Lipman et al highlights the diversity of quality improvement activities being pursued through PBRNs and the emerging facility and desire for PBRNs to engage in rapidlearning activities and learning communities, supported by AHRQ-sponsored collaborations of learning networks. Ward presents lessons learned from an interactive, all-payer, quality measurement web-based reporting system. Informed by the prioritized information needs of primary care clinicians and reporting requirements for certification as PCMH and ACO, this project illustrates how a holistic approach to quality measurement reporting can be pursued. The set of quality measures promotes action at the provider level, quality improvement efforts at the practice level, and demonstration of capacity for team-based care. The fact that primary care providers have an annual bonus based upon their performance in these reported measures reflects the extent of their trust in the validity of the measures to represent quality of care provided. 2014, 15-year anniversary for AHRQ support of PBRNs In 2014, AHRQ celebrates 15 years of supporting the primary care PBRN community. The current registered community consists of 151 PBRNs (http://pbrn.ahrq.gov/ pbrn-registry) that serve 55 million patients. Over time, the configurations of individual networks and the collaboration among and across PBRNs continue to evolve, seeking to build on the culture of caring and communication both within and across PBRNs. Just under one-third of the primary care practices affiliated with registered PBRNs report a PCMH designation. The AHRQ-sponsored PCMH Resource Center Web site offers reference materials and other types of guidance for researchers, evaluators, health care decision makers, and the increasing numbers of primary care practices, including PBRNaffiliated practices, that increasingly are engaged in the transformation to the PCMH (http://www.pcmh.ahrq.gov). In addition, more than one-third of the registered networks are members of one of the 8 PBRN Centers of Primary

Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

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Primary Care Practice-Based Research Networks Care Practice-Based Research and Learning (http://www.ahrq.gov/professionals/ systems/primary-care/rescenters.html). Each of these centers was established in 2012 with 5-year grants from the AHRQ. These centers have a minimum of 120 member practices, and several centers have more than 500 practices. Each center has a rich cadre of senior researchers who serve as leaders across diversified areas of research and technological advancement. They join other members of the PBRN community that serve as active members of the evolving PBRN learning communities, supporting learning both among their members and more broadly through AHRQ-sponsored Web conferences and other activities, such as the AHRQ-supported PBRN conferences, including the North American Primary Care Research Group’s 2-day PBRN conference to be held in Bethesda, Maryland, June 30-July 1, 2014. The PBRN community appreciates Drs. Goldfield and Wasson’s invitation to primary care PBRNs to share their experiences and evaluations of how to harness health IT to improve health care quality in this special issue of the Journal. We invite you to continue these conversations through AHRQ-sponsored Web conferences and learning communities. These include AHRQ’s multimodality Innovations Exchange (http:// www.innovations.ahrq.gov) and AHRQ’s pro-

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gressive health IT community (http://www. healthit.ahrq.gov), both of which are particularly relevant to the primary care community. Join the conversation among PBRNs PBRN listserv members are part of an active or prospective community. They receive a biweekly digest and other announcements of interest, are able to reach out directly to members of the PBRN community, participate in learning communities that are wrestling with contemporary challenges and strategies for conducting research and other quality improvement enterprises in the primary care settings, and participate in monthly continuing medical-education-earning National Web conferences. If you are a member of a registered PBRN, simply e-mail the AHRQ PBRN Resource Center ([email protected]) with the subject “Please add me to the PBRN listserv.” National Web Conference, 2:00-3:30 pm, EST, April 29, 2014 Harnessing Health Information Technology to Help Individuals, Teams: Practical Insights from the Journal of Ambulatory Care Management, PBRN issue, April-June 2014. Presentations will be made by Drs DeVoe, Ratanawongsa, Masi, Wasson, and others. Register for this Web conference at http: //pbrn.ahrq.gov/events

REFERENCE Barr, V. J., Robinson, S., Marin-Link, B., Underhill, L., Dotts, A., Ravensdale, D., . . . Salivaras, S. (2003). The Expanded Chronic Care Model: An integration of

concepts and strategies from population health promotion and Chronic Care Model. Hospital Quarterly, 7(1), 73–82.

Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

Special issue on primary care practice-based research networks: insights on innovative strategies for harnessing health information technology to help individuals, teams.

This issue of the Journal highlights the problem-solving perspectives of primary care practices, including practice-based research networks. Informed,...
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