Author

Mimi Choate

Date

December 2008

Document Type

Thesis

Degree Name

M.P.H.

Department

Dept. of Public Health and Preventive Medicine

Institution

Oregon Health & Science University

Abstract

In 2007 CareOregon implemented a medical home demonstration project called Primary Care Renewal (PCR) in several Portland-area safety-net clinics. The PCR intervention consists of six components: patient-centered care, team care delivery, proactive panel management, open access scheduling, integrated behavioral health, and intentional evaluation and change using PDSA cycles. This mixed-methods study used quantitative methods to evaluate the effect of PCR on provider productivity and qualitative methods to evaluate barriers and successes in implementation of PCR in two family medicine clinics. Pre- and post-intervention panel data was used to create multivariable models analyzing the effect of PCR on total monthly patients seen and total monthly relative value units accumulated by each provider (n=8). This quantitative analysis found that PCR was associated with a non-significant increase in the productivity of the two pilot providers (visits/month p-value=0.458, RVUs/month p-value=0.075). PCR was associated with a downward trend in productivity for six later starting providers (visits/month p-value=0.901, RVUs/month p-value=0.307). Each care team participated in a group interview to discuss barriers and successes in implementing the six components of PCR. This qualitative analysis found distinct differences among the care teams, specifically differences in team knowledge, support, leadership, and teamwork. These findings indicate that a team with these qualities can succeed both in implementing all the PCR components and increasing productivity.

Identifier

doi:10.6083/M44F1NPR

School

School of Medicine

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