Research ArticleOriginal Research

Practice Transformation Under the University of Colorado’s Primary Care Redesign Model

Peter Chabot Smith, Corey Lyon, Aimee F. English and Colleen Conry
The Annals of Family Medicine August 2019, 17 (Suppl 1) S24-S32; DOI: https://doi.org/10.1370/afm.2424

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Patient access: total and new patient appointments, pilot practice vs wave 2 practice.

    PCR = Primary Care Redesign.

    Note: Vertical lines mark formal start of PCR for each practice. Dashed lines represent the mean before February 2015. Shaded areas represent ±3σ upper and lower control limits.

  • Figure 2
    Figure 2

    Clinical quality metrics: hypertension control, pilot practice vs wave 2 practice.

    PCR = Primary Care Redesign.

    Note: Vertical lines mark formal start of PCR for each practice. Dashed lines represent the mean before February 2015. Shaded areas represent ±3σ upper and lower control limits.

  • Figure 3
    Figure 3
    Figure 3

    Experience: pilot practice clinician and staff experience by domain.

    aNegatively worded items were reverse coded so higher values are desirable for all items including burnout. UCHealth began measuring staff burnout in November 2016.

    Note: All questions except that for burnout used 5-point Likert scales for level of endorsement (not at all, slightly, somewhat, mostly, completely) or agreement (strongly disagree, disagree, neither agree nor disagree, agree, strongly agree).

  • Figure 4
    Figure 4

    Burnout: pilot practice clinician and staff burnout vs MA availability.

    C = clinician; MA = medical assistant; S = staff.

    Note: Left axis/bars represent burnout. Staff burnout (marked S) was first evaluated in November 2016. Solid bars indicate not burned out; textured bars indicate burned out. Right axis/dotted line represents MA actual/expected minutes per month. January 2015 represents the clinician baseline before go-live.

Tables

  • Table 1

    Definitions of Measures Used to Evaluate the PCR Model

    Measure (Source)Definition
    Access (EHR schedule data)
     Total patient appointmentsTotal office visits scheduled per month
     New patient appointmentsTotal office visits scheduled with new patients per month
     New patient appointments within 2 daysNumber of new patient visits that are scheduled within 2 business days of initial request to schedule
    Clinical quality metrics (discrete EHR data)
     Hypertension controlPercentage of patients aged 18-85 years with hypertension on problem list with a blood pressure at last visit <140/90 mm Hg
     Colorectal cancer screeningPercentage of patients aged 50-75 years with completed appropriate colorectal screening (colonoscopy, flexible sigmoidoscopy, FOBT)
     Retinal examination (diabetes process measure)Percentage of patients aged 18-75 years with diabetes on problem list with a completed documented retina examination in the last 13 months
     Foot examination (diabetes process measure)Percentage of patients aged 18-75 years with diabetes on problem list with a documented mono-filament examination in the last 13 months
     Nephropathy screening (diabetes process measure)Percentage of patients aged 18-75 years with diabetes on problem list with a completed documented uro-microalbumin test in the last 13 months or with an ACE or ARB on the active medication list
     Diabetes: blood pressure controlPercentage of patients aged 18-75 years with diabetes on problem list with a blood pressure at last visit <140/90 mm Hg
    HbA1c >9%Percentage of patients aged 18-75 years with diabetes on problem list with last HbA1c of >9%
    Staffing (hospital human resources data)
     MA availabilityTotal hours all MAs logged in Kronos system per month divided by total expected hours when practice is fully staffed
     Staff hours per visitTotal hours all staff logged in to Kronos system per month divided by all visits with a schedule status of “arrived” per month

    • ACE = angiotensin-converting enzyme inhibitor; ARB = angiotensin receptor blocker; EHR = electronic health record; FOBT = fecal occult blood testing; HbA1c = glycated hemoglobin; MA = medical assistant; PCR = Primary Care Redesign.

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