2015 News & Events

Our newest initiative:  Healthy Hearts Northwest
The U.S. Agency for Healthcare Research and Quality (AHRQ) has funded the MacColl Center for three years to lead one of seven regional partnerships throughout the nation both to improve heart health among patients in primary care practices and to increase the capability of these practices to improve the quality of care they deliver.

With partners Qualis Health, the Oregon Rural Practice Research Network (ORPRN) at the Oregon Health & Science University (OHSU), and the Institute of Translational Health Sciences, on May 1st our team started inviting small- and medium-sized primary-care practices in Washington, Oregon, and Idaho to participate in Healthy Hearts Northwest: Improving Practice Together.

The project goal is to enroll 320 primary care practices: 150 in Washington, 130 in Oregon, and 40 in Idaho.  Clinics that participate will receive at least 15 months of practice support, technical assistance for health information technology, coaching in quality improvement, and chances to participate in workshops to build quality improvement competencies. The project will use practice facilitation, the IHI improvement model, and data management to improve patients’ measures of heart health.

“Healthy Hearts Northwest is an unprecedented opportunity for primary care to prove to the nation that we can make a difference in cardiovascular health at a scale never before tested,” said the principal investigator of Health Hearts Northwest, Michael Parchman. “Practices that participate will receive resources, support, and a ‘roadmap’ to build their capacity to really do quality improvement well.”

AF4Q Issue Brief: Emerging Primary Care Tends and Implications for Practice Support Programs
In this white paper, MacColl Center Director Michael Parchman and his co-authors summarize seven current trends in providing sustainable primary care practices support. These include: complexity, care coordination, hospital and health systems acquisition of primary care practices, EHR adoption, workforce changes, payment reform, and patient empowerment. Three successful practice support programs are profiled.

LEAP "Team Guide" for Transforming Primary Care
Primary care practices across the United States are finding that creating more effective practice teams is the key to becoming a patient-centered medical home, improving patients’ health, and increasing productivity. The Improving Primary Care Team Guide ("Team Guide") is a free, publicly available online resource for primary care practices that:

  • Provides hands-on tools and resources that are actionable and measureable
  • Is appropriate for practices at any stage of development
  • Includes modules that enable practices to easily pinpoint relevant topics and areas of interest

The Team Guide presents practical advice, case studies, and tools from 31 exemplary primary care practices across the country that have markedly improved care, efficiency, and job satisfaction by transforming to a team-based approach. For the last three years, with funding from the Robert Wood Johnson Foundation, the PCT-LEAP team has identified, studied, and engaged these practices to develop the lessons contained in the Team Guide.

Lessons from the Safety Net:  Medical Care Supplement
We are pleased to announce the special November 2014 supplement to the journal Medical Care which describes the progress and lessons learned from our Safety Net Medical Home Initiative (SNMHI).

The MacColl Center team co-led with Qualis Health the largest and most rigorous initiative to date to spread the medical home model to safety net practices. Supported by The Commonwealth Fund, this five-year, 65-site, multi-state effort demonstrated a replicable, sustainable implementation model to transform primary care safety net practices into patient-centered medical homes that have benchmark performance in quality, efficiency, and patient experience.

The SNMHI taught us much about caring for Medicaid and other low-income patients, and it produced a library of tested implementation guides and tools to improve primary care practice—in the safety net and beyond. All materials are publicly available and free of cost.

Integrating behavioral health into the medical home
The MacColl Center and Qualis Health are pleased to announce the publication of the Safety Net Medical Home Initiative Behavioral Health Integration Implementation Guide and accompanying tools and resources, a component of the SNMHI's Patient-Centered Medical Home transformation resource library.

What is "behavioral health integration"?  There are many different models and approaches to integrated care. An integrated care team differs from a typical primary care team in the ways the medical and behavioral health providers interact, as well as the addition of specific functions into primary care. Whatever model or approach is taken, the goal remains the same: to develop processes and systems that identify patients in need of behavioral health care and monitor them to ensure their treatments are effective and are having the desired effect (e.g., reduced depression symptoms).

Released in October 2014, the Behavioral Health Integration Implementation Guide is free and publicly available.


PCT-LEAP featured in RWJF Human Capital Bbog
The MacColl LEAP team is working on the online primary care Guide set for for release this fall.  The Robert Wood Johnson Foundation recently featured "The Role of Primary Care Providers in Changing the Culture of Care in Communities" in its online blog.

ACIC-P now available to measure care in correctional healthcare systems
The absence of a validated instrument to direct quality improvement efforts in correctional healthcare systems provided the motivation for Emily Wang, MD, MAS and her team at Yale University to adapt the Assessment of Chronic Illness Care (ACIC). The Assessing Chronic Illness Care- Prison instrument (ACIC-P) was adapted from the original instrument through cognitive interviews of correctional healthcare providers for use in prison systems. ACIC-P assesses how well prison healthcare systems are providing chronic illness care in each of the six components of the Chronic Care Model and includes unique questions on discharge planning and the role of correctional officers in the delivery of care.

The team at Yale has administered the ACIC-P in two prison healthcare systems and are currently analyzing the results of that survey.

Blood pressure control study shows promise in measuring CCM effect on patient blood pressure outcomes
An analysis published in March 2014 examines the role of home monitoring, communication with pharmacists, medication intensification, medication adherence and lifestyle factors in contributing to the effectiveness of an intervention to improve blood pressure control in patients with uncontrolled essential hypertension.   The intervention was delivered over a secure patient website, and used the PACIC survey to assess overall fidelity to the Chronic Care Model.

“Home blood pressure monitoring, secure electronic messaging and medication intensification for improving hypertension control: a mediation analysis” found that web-based pharmacist case management improved blood pressure  control .  The improved outcomes  were accounted for in part through home blood pressure monitoring, e-communication with providers and associated medication intensification, with the entire effect accounted for through communications outside the office via secure messaging.

 “We wanted to see if patients’ perceptions of their care matched the elements of the Chronic Care Model”, explains Group Health Research Institute Associate Investigator and study lead author James Ralston, MD MPH.  “This study demonstrates the sensitivity to change of the PACIC instrument in an intervention using the Chronic Care Model.”

"Assessing Patient and Practice Member Perspectives When Evaluating Quality"
After the Chronic Care Model has been implemented, is it possible to compare patient and provider team views on quality of care?  A new study provides the first published report exploring this question by administering the Assessment of Chronic Illness Care (ACIC) and Patient Assessment of Chronic Illness Care (PACIC) scales in 39 primary care settings.

Health care settings where elements of the Chronic Care Model have been implemented are likely to have prepared, proactive practice teams, and informed, engaged patients who become active members of their health care teams and accept shared responsibility for their chronic illness care.  However, little is known as to whether primary care teams’ perceptions of how well they have implemented the CCM corresponds with their patients’ own experience of chronic illness care.  Improving patient experiences of care is a priority within the National Quality Strategy as reflected in recent multi-payer initiatives that include the use of patient experience results in determining provider payment

Commenting on "Alignment of patient and primary care practice member perspectives of chronic illness care: a cross-sectional analysis", co-author Michael Parchman said:  “We did this study to see if patients’ experiences of chronic illness care align with what clinicians and staff say about the type of chronic illness care they are able to deliver.”

Study findings show the ACIC and PACIC provide complementary but relatively unique assessments of how well clinical services are aligned with the CCM.