J Am Board Fam Med
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Healthcare is in need of improvement. It harms too often, costs too much, learns and improves too slowly, and burns out its workforce. Large healthcare systems (HCS) have an important role in influencing the quality and value of care. ⋯ Clinical teams often rely on local QI efforts to improve care at the delivery site. At the same time, managers and executives focus on a centralized, system-wide approach, generally focused on externally reported metrics. We propose that a hybrid of the 2 most popular healthcare QI approaches, local QI and centralized QI, might be the best method for achieving and sustaining quality care across a wide variety of conditions.
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There are many words for what physicians commonly refer to as Somatoform Disorder. However, none is particularly patient-centered; to greater or lesser extent, they are all framed by medical jargon. ⋯ Using examples from practice, the author notes how PRESSS combines simplicity, ambiguity, and directness in one non-stigmatizing, patient-focused word. Combined with a patient-centered manner of communication, the use of PRESSS can help create the kind of shared therapeutic presence that is so important when attending to patients who experience the bothersome, unrelenting symptoms these conditions suggest.
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Randomized Controlled Trial
Successful Trial of Practice Facilitation for Plan, Do, Study, Act Quality Improvement.
Practice facilitation (PF) is a promising but relatively new intervention supporting data-driven practice change. There is a need to better detail research-based facilitation methods, which must balance intervention fidelity and time restrictions with the flexibility required for the intervention. As part of a multi-level 4-armed cluster randomized clinical trial (RCT), 32 rural primary care practices received PF for 1 year. We evaluated the feasibility of having facilitators guide practices to perform 4 key driver domain activities, implemented as Plan-Do-Study-Act (PDSA) cycles, to better understand facilitation "exposure." We describe the intervention and activity length such that our experiences may be useful to other PF research efforts. ⋯ In this trial, it was feasible for PFs to engage practices in at least 4 Key Driver quality improvement activities within 1 year, which will inform PF methods and protocol development in future trials.