Article Figures & Data
Figures
- Figure 1
Ten Building blocks of high-performing primary care.
Additional Files
Supplemental Materials
Building Blocks of Primary Care Assessment
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file, 13 pages
The Article in Brief
The 10 Building Blocks of High-Performing Primary Care
Thomas Bodenheimer , and colleagues
Background A movement is underway to re-engineer primary care practices to help achieve better patient health, improved experience in the health care system, and more affordable costs. This article presents a conceptual model of 10 building blocks of high-performing primary care to assist practices as they transform.
What This Study Found The building blocks include 4 foundational elements--engaged leadership, data-driven improvement, empanelment, and team-based care--that assist the implementation of the other 6 building blocks: patient-team partnership, population management, continuity of care, prompt access to care, comprehensiveness and care coordination, and a template of the future.
Implications
- The authors suggest that, while the building blocks focus on design elements largely under the control of the practice organization, external reforms are needed to support the building blocks--principally a reformed payment model.
Annals Journal Club
Mar/Apr: Building Blocks of High-Performing Primary Care
The Annals of Family Medicine encourages readers to develop a learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club and sharing the results of your discussions in the Annals online discussion for the featured articles. RADICAL is an acronym for Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care and then acting on those discussions.1
HOW IT WORKS
In each issue, the Annals selects an article or articles and provides discussion tips and questions. We encourage you to take a RADICAL approach to these materials and to post a summary of your conversation in our online discussion. (Open the article online and click on "TRACK Comments: Submit a response.") You can find discussion questions and more information online at: http://www.AnnFamMed.org/site/AJC/.
CURRENT SELECTION
Article for Discussion
- Bodenheimer T, Willard-Grace R, Ghorob A, Grumbach K. The 10 building blocks of high-performing primary care. Ann Fam Med. 2014;12(2):166-171.
Discussion Tips
This report uses the authors' experience in practice and in observing high-performing practices around the US to identify elements they believe are associated with high performance in primary care. The article provides a springboard for considering how multiple ingredients can come together to improve practice.
Discussion Questions
- What question is asked by this analysis and why does it matter?
- How does this analysis advance beyond previous research, anecdote, and informal observations on this topic?
- How strong is the observational and analytic approach for answering the question?
- To what degree can the observations be accounted for by:
- How high-performing practices were selected?
- How information was ascertained about the high-performing practices and how they were deemed to be high-performing?
- Preconceptions and blind spots on the part of the authors and the current zeitgeist in which they and we are operating?
- How the observations were synthesized and interpreted?
- The authors' assumptions and the theoretical framework used to guide the assessment?
- What are the main findings?
- What is your judgment about the primacy of the "foundational elements" compared to the other building blocks?
- What is missing?
- Does the analysis do justice to the complex interrelationships among the building blocks?
- How relevant are the high-performing practices to you and your practice? How transferable are the observations and conclusions to your setting?
- What contextual factors are important for interpreting the findings?
- How might this analysis change your practice? Policy? Education? Research?
- What might the intended and unintended consequences be of applying these recommendations on the local and national level?
- Who are the constituencies for the findings, and how might they be engaged in interpreting or using the findings?
- What are the next steps in interpreting or applying the findings?
- What researchable questions remain?
References
- Stange KC, Miller WL, McLellan LA, et al. Annals Journal Club: It's time to get RADICAL. Ann Fam Med. 2006;4(3):196-197.
In this issue
Jump to section
Related Articles
Cited By...
- Essential Indicators of Quality in Primary Care Settings: An Evidence-Based, Structured, Expert Approach
- Why does continuity of care with family doctors matter?: Review and qualitative synthesis of patient and physician perspectives
- Intensity of outpatient physician care in the last year of life: a population-based retrospective descriptive study
- Survey protocol for exploring video and phone use in Aotearoa New Zealand general practice: considerations for future telehealth
- Strategies and Factors Associated With Top Performance in Primary Care for Diabetes: Insights From a Mixed Methods Study
- How Comprehensive Medication Management Contributes to Foundational Elements of Primary Care
- Engagement of Small to Medium-Sized Primary Care Practices in Quality Improvement Efforts
- A Taxonomy for External Support for Practice Transformation
- Interdisciplinary Primary Care Team Expertise and Diabetes Care Management
- Patient-centred care delivered by general practitioners: a qualitative investigation of the experiences and perceptions of patients and providers
- The Built Environment for Professionalism
- Care Practices to Promote Patient Engagement in VA Primary Care: Factors Associated With High Performance
- Practice Transformation Support and Patient Engagement to Improve Cardiovascular Care: From EvidenceNOW Southwest (ENSW)
- Evaluation of a learning collaborative to advance team-based care in Federally Qualified Health Centers
- Improving access in a VA primary care clinic using an innovative Panel Retention Tool: a quality improvement report
- Association of physician payment model and team-based care with timely access in primary care: a population-based cross-sectional study
- Patient and primary care physician characteristics associated with billing incentives for chronic diseases in British Columbia: a retrospective cohort study
- Complex programme evaluation of a 'new care model vanguard: a shared commitment to quality improvement in an integrated health and care context
- Evaluating the implementation of collaborative teams in community family practice using the Primary Care Assessment Tool
- Features of U.S. Primary Care Physicians and Their Practices Associated with Advance Care Planning Conversations
- Attachment to primary care and team-based primary care: Retrospective cohort study of people who experienced imprisonment in Ontario
- Primary health care performance: a scoping review of the current state of measurement in Africa
- HIGH-PERFORMING PRIMARY CARE RESIDENCY CLINICS: A COLLABORATION
- Connecting People With Multimorbidity to Interprofessional Teams Using Telemedicine
- A Longitudinal Study of Trends in Burnout During Primary Care Transformation
- A Randomized Trial of External Practice Support to Improve Cardiovascular Risk Factors in Primary Care
- Primary Care Practices' Implementation of Patient-Team Partnership: Findings from EvidenceNOW Southwest
- Engaging primary care physicians in care coordination for patients with complex medical conditions
- Burnout and Health Care Workforce Turnover
- Shared vision for primary care delivery and research in Canada and the United States: Highlights from the cross-border symposium
- Recruiting Primary Care Practices for Research: Reflections and Reminders
- Practice-based Research Network (PBRN) Engagement: 20+ Years and Counting
- How health care may modify the effects of illness determinants on population outcomes: the Leicester SEARCH conceptual framework for primary care
- Improving the quality of health care in Canada
- The influence of patient-clinician ethnocultural and language concordance on continuity and quality of care: a cross-sectional analysis
- Alternative Payment Models and Team-Based Care
- Processes that influence the evolution of family health teams
- Roles and Functions of Community Health Workers in Primary Care
- Association of the Social Determinants of Health With Quality of Primary Care
- Identification of physicians providing comprehensive primary care in Ontario: a retrospective analysis using linked administrative data
- The Patient-Centered Medical Home (PCMH) Framing Typology for Understanding the Structure, Function, and Outcomes of PCMHs
- Team-based primary care with integrated mental health is associated with higher quality of care, lower usage and lower payments received by the delivery system
- Building a Sustainable Primary Care Workforce: Where Do We Go from Here?
- Increased Health Information Technology Adoption and Use Among Small Primary Care Physician Practices Over Time: A National Cohort Study
- Integrating Social And Medical Data To Improve Population Health: Opportunities And Barriers
- "A Paradox Persists When the Paradigm Is Wrong": Pisacano Scholars' Reflections from the Inaugural Starfield Summit
- Association Between Physician Teamwork and Health System Outcomes After Coronary Artery Bypass Grafting
- Perspectives of Primary Care Providers Toward Palliative Care for Their Patients
- Care Coordination and Population Management Services Are More Prevalent in Large Practices and Patient-centered Medical Homes
- Toward evidence-based policy
- Family Medicine Panel Size with Care Teams: Impact on Quality
- A Primary Care Panel Size of 2500 Is neither Accurate nor Reasonable
- Processes of patient-centred care in Family Health Teams: a qualitative study
- Achieving Value in Primary Care: The Primary Care Value Model
- Perspectives in Primary Care: A Conceptual Framework and Path for Integrating Social Determinants of Health Into Primary Care Practice
- Teamlets in Primary Care: Enhancing the Patient and Clinician Experience
- Large Independent Primary Care Medical Groups
- Longitudinal evaluation of physician payment reform and team-based care for chronic disease management and prevention
- Perspectives in Primary Care: The Foundational Urgent Importance of a Shared Primary Care Data Model
- Only One Third of Family Physicians Can Estimate Their Patient Panel Size
- Patient Empanelment: The Importance of Understanding Who Is at Home in the Medical Home
- Health Is Primary: Family Medicine for America's Health
- On-the-Ground Wisdom About Care Integration
- In This Issue: Building Blocks for Improving Practice