The COVID-19 pandemic presented significant new needs and challenges for people experiencing homelessness (PEH) and people with substance use disorders (SUDs). In response, program leaders modified existing programs and developed new ones to meet these needs during a unique policy and public health environment. This study aimed to examine how these innovations unfolded and what lessons can be learned from their implementation. We performed in-depth, semi-structured qualitative interviews with key informants (n = 37 informants) from programs serving PEH and addressing substance use created or adapted during the COVID-19 pandemic in the United States (U.S.) and Canada. Informants spanned a wide range of backgrounds, program types, and geographic locations. We completed rapid sequence qualitative analysis using templated summaries for each interview, which we compiled into a summary matrix. We reviewed the summary matrix to identify key topics and develop a code list that was applied to transcripts using line-by-line coding. Results from rapid analysis and line-by-line coding were discussed iteratively to develop and refine key themes. Key informants described innovations including SUD treatment and harm reduction interventions via telemedicine, hotel shelters, and street outreach. Interviews revealed four overarching themes related to innovation implementation: (1) Removal of usual bureaucratic barriers and easing of regulations facilitated action, (2) Individuals stepped up and said, “We’re gonna do it,” (3) Stigma and mixed attitudes about harm reduction impacted the implementation of pandemic innovations, and (4) Innovations in shelter and SUD care delivery for PEH during the COVID-19 pandemic resulted in durable lessons and new program models. A combination of individual action and systemic changes produced new innovations to address the intersecting issues of homelessness and substance use during the COVID-19 pandemic. Lessons from these innovations can inform sustained improvements in SUD care for PEH.

OBJECTIVE:Maternal morbidity and mortality (MMM) rates from drug overdoses have increased, especially among pregnant and postpartum women aged 35-44. However, there is limited understanding of how current toxicology testing practices are implemented in hospital settings and how well they support, or undermine, linkage to care. The goal of the study is to understand variations in toxicology testing use among pregnant and postpartum women, explore hospital- and individual-level differences, and assess outcomes. METHODS:Using the Socio-cultural Framework for the Study of Health Service Disparities (SCF-HSD) we will perform a mixed-methods study to understand testing policies and practices in NY State. Aim 1 will employ multilevel statistical models using New York State Medicaid claims data (2021-2024) to identify predictors of perinatal toxicology testing and characterize hospital-level variation across hospitals. Aim 2 will involve one-on-one interviews with hospital administrators and clinical staff to document and analyze testing policies and practices, capturing diverse perspectives on testing rationales, attitudes, and adherence. Aim 3 will integrate quantitative and qualitative evidence through a mixed-methods design, incorporating perspectives of individuals with lived experience, via focus group sessions to inform and refine hospital policy recommendations. DISCUSSION:Our findings will inform how to improve disparities in toxicology testing for pregnant and postpartum women. Addressing these challenges requires shifting emphasis toward standardized, evidence-based toxicology testing protocols, strengthening pathways to supportive services, and advancing policy reforms that reduce stigma and inequities in care.

Qualitative interviews and focus groups are commonly used methods to elicit participants’ voices in program evaluations. However, the use of these data-gathering methods can fall short of the goal; even with open-ended questions, the protocols guiding and shaping interviews and focus groups heavily reflect the evaluators’ understanding and experience of the program or intervention under consideration and its target population(s). In this paper, we describe three cases that employed a method of inquiry that is underutilized in evaluation but one that we believe holds great potential as a method to enhance interpersonal reflexivity, namely participant-generated photo-elicitation interviewing (PEI). Across three diverse settings and interventions, we readily added participant-generated PEI to our mixed methods evaluations. We found participant-generated PEI to add great value to the evaluations by complementing our other data collection methods, allowing for greater participant voice, challenging evaluators’ assumptions, enhancing dissemination efforts, and fostering our reflexivity.

Objective Despite increasing incidence of genital gender-affirming surgery (GGAS), there is no systematic method of evaluating patient perspectives. The objective of this study is to elucidate transgender and non-binary patient perspectives on gender-affirming phalloplasty/metoidioplasty via structured focus groups and determine convergent themes as the first step towards the development of a GGAS patient-reported outcome measure.Design We conducted a systematic qualitative study using a thematic content analysis of four focus groups from April 2021 to April 2022 comprising 8 patients undergoing phalloplasty/metoidioplasty and 10 patients post-phalloplasty/metoidioplasty. Focus groups were hosted virtually and recorded and transcribed. Discussions were guided by participant input and focused on goals, experiences, outcomes, satisfaction, and quality of life.Setting This volunteer but purposive sample of patients was recruited directly in clinic, via email, and via social media at NYU Langone Health (primary site), Callen-Lorde Community Health Center (New York, New York, USA) and the San Francisco Community Health Center.Participants We conducted focus groups with 18 patients before/after undergoing gender-affirming phalloplasty/metoidioplasty.Primary and secondary outcome measurements and statistical analysis Transcripts were uploaded into ATLAS.ti, a qualitative data analysis software that facilitates coding for thematic content analysis. We performed deductive and inductive coding to identify the themes that were clustered into overarching domains.Results The mean duration of focus groups was 81.5 min. Seven themes and 19 subthemes were constructed. The major themes were (1) goals, expectations, and priorities before/after surgery; (2) sexual function; (3) urinary function; (4) peer support; (5) decision-making; (6) mental health and quality of life; and (7) gender dysphoria. Of the major themes, those determined before the study included themes 1–3 and 6–7. Limitations include small sample size and bias in patient selection.Conclusions We conducted focus groups with 18 patients before/after undergoing gender-affirming phalloplasty/metoidioplasty. Mental health, quality of life, functional, and aesthetic outcomes are all critical to patients. Phalloplasty/metoidioplasty impact numerous aspects of patients’ lives. Experiential components of the surgical process, mental health, and quality of life are important metrics to consider in addition to functional and aesthetic outcomes.

Despite progress to define primary care practice transformation models, there remain gaps in translating evidence-based guidelines into routine clinical care. Primary care providers (MD, DO, NP, PA) and researchers need tools to assess modifiable factors that improve practice performance to inform practice transformation efforts. We aimed to develop a pragmatic tool for assessing practice-level primary care structures and processes that are associated with better care quality and clinical outcomes. We generated 314 candidate items for the Tool for Advancing Practice Performance (TAPP) using data from a comprehensive literature review, Delphi study, and qualitative interviews with high-performing practices. We used empirical criteria and expert review to eliminate redundancy and improve clarity via removing and retaining items. The retained items were formatted into a survey tool, and we further revised the tool based on feedback elicited from cognitive interviews and pilot testing with primary care providers and staff. The final candidate pool comprised 126 items after refinement and expert review. For the survey tool, we adapted and developed survey questions for each of the 126 items. Eight cognitive interview participants reviewed the tool and provided feedback on its content and language. Based on this feedback, we eliminated 13 items because they were poorly or incorrectly understood by participants, resulting in a 113-item tool. Fifteen participants pilot tested the tool and no additional items were eliminated. The TAPP is a novel, low-burden tool that researchers and primary care providers can use to identify areas for improvement at the practice-level. Practices and health systems could use the TAPP to assess their own performance and identify gaps in their structures and processes, and practice networks and health systems can use the tool to assess structures and processes at individual clinics, track this information over time, and evaluate its relationship to care quality and clinical outcomes.

OBJECTIVES:This study compared the performance of and patient preference for New York City Health and Hospital's (NYC H + H) social needs screener to 2 widely used screeners, a version of the Accountable Health Communities screener and the WellRx screener, that include the same core domains of social needs. METHODS:Two NYC H + H primary care clinics provided data for analysis. A convenience sample completed 1 of the 2 other screeners during May-June 2024, in addition to the NYC H + H screener. Analyses compared rates of needs detected and number of needs identified as well as patient preference. RESULTS:The H + H screener performed similarly to both alternate screeners in identifying patients with social needs, (κ = 0.7, P < .001 and κ = 0.6, P < .001). The number of positive items identified by each screener was virtually identical. Patients preferred the H + H screener to the alternates, but differences were not statistically significant. CONCLUSIONS:Despite differences in question phrasing and response options, all 3 screeners performed similarly.

During infectious disease epidemics, accurate diagnostic testing is key to rapidly identify and treat cases, and mitigate transmission. When a novel pathogen is involved, building testing capacity and scaling testing services at the local level can present major challenges to healthcare systems, public health agencies, and laboratories. This mixed methods study examined lessons learned from the scale-up of SARS-CoV-2 testing services in New York City (NYC), as a core part of NYC’s Test Trace program. Using quantitative and geospatial analyses, the authors assessed program success at maximizing reach, equity, and timeliness of SARS-CoV-2 diagnostic testing services across NYC neighborhoods. Qualitative analysis of key informant interviews elucidated key decisions, facilitators, and barriers involved in the scale-up of SARS-CoV-2 testing services. A major early facilitator was the ability to establish working relationships with private sector vendors and contractors to rapidly procure and manufacture necessary supplies locally. NYC residents were, on average, less than 25 min away from free SARS-CoV-2 diagnostic testing services by public transport, and services were successfully directed to most neighborhoods with the highest transmission rates, with only one notable exception. A key feature was to direct mobile testing vans and rapid antigen testing services to areas based on real-time neighborhood transmission data. Municipal leaders should prioritize fortifying supply chains, establish cross-sectoral partnerships to support and extend testing services, plan for continuous testing and validation of assays, ensure open communication feedback loops with CBO partners, and maintain infrastructure to support mobile services during infectious disease emergencies.

On June 1, 2020, NYC Health + Hospitals, in partnership with the NYC Department of Health and Mental Hygiene, other city agencies, and a large network of community partners, launched the New York City Test Trace (T2) COVID-19 response program to identify and isolate cases, reduce transmission through contact tracing, and provide support to residents during isolation or quarantine periods. In this paper, we describe lessons learned with respect to planning and implementation of case notification and contact tracing. Our findings are based on extensive document review and analysis of 74 key informant interviews with T2 leadership and frontline staff, cases, and contacts conducted between January and September 2022. Interviews elicited respondent background, history of program development, program leadership and structure, goals of the program, program evolution, staffing, data systems, elements of community engagement, trust with community, program reach, timeliness, equity, general barriers and challenges, general facilitators and best practices, and recommendations/improvement for the program. Facilitators and barriers revealed in the interviews primarily revolved around hiring and managing staff, data and technology, and quality of interactions with the public. Based on these facilitators and barriers, we identify suggestions to support effective planning and response for future case notification and contact tracing programs, including recommendations for planning during latent periods, case management and data systems, and processes for outreach to cases and contacts.

BackgroundDespite proliferation of acute-care interventions to initiate medications for opioid use disorder (MOUD), significant challenges remain to supporting care continuity following discharge. Research is needed to inform effective hospital strategies to support patient transitions to ongoing MOUD in the community.ObjectiveTo inform a taxonomy of care transition strategies to support MOUD continuity from hospital to community-based settings and assess their perceived impact and feasibility among experts in the field.DesignA modified Delphi consensus process through three rounds of electronic surveys.ParticipantsExperts in hospital-based opioid use disorder (OUD) treatment, care transitions, and hospital-based addiction treatment.Main MeasuresDelphi participants rated the impact and feasibility of 14 OUD care transition strategies derived from a review of the scientific literature on a scale from 1 to 9 over three survey rounds. Panelists were invited to suggest additional care transition strategies. Agreement level was calculated based on proportion of ratings within three points of the median.Key ResultsForty-five of 71 invited panelists participated in the survey. Agreement on impact was strong for 12 items and moderate for 10. Agreement on feasibility was strong for 11 items, moderate for 7, and poor for 4. Strategies with highest ratings on impact and feasibility included initiation of MOUD in-hospital and provision of buprenorphine prescriptions or medications before discharge. All original 14 strategies and 8 additional strategies proposed by panelists were considered medium- or high-impact and were incorporated into a final taxonomy of 22 OUD care transition strategies.ConclusionsOur study established expert consensus on impactful and feasible hospital strategies to support OUD care transitions from the hospital to community-based MOUD treatment, an area with little empirical research thus far. It is the hope that this taxonomy serves as a stepping-stone for future evaluations and clinical practice implementation toward improved MOUD continuity and health outcomes.

Context: Multiple tools to assess primary care quality exist but none have been rigorously developed and validated. Objective: To develop and establish reliability of a tool to assess primary care structures (e.g., care team makeup) and processes (e.g., care coordination) that are associated with better quality and patient outcomes. Study Design and Analysis: We generated a list of 314 candidate items for the Tool for Advancing Practice Performance (TAPP) based on data from a scoping review, Delphi study, and qualitative interviews with high-performing primary care practices. We refined this list using criteria for removing/retaining items and expert review for redundancy and clarity. We developed the tool and revised it based on feedback from cognitive interviews and pilot testing with primary care providers and staff (e.g., lead clinician, practice manager). The final tool was administered to 401 primary care practices from December 2021 to March 2022. We considered three scoring methods: two different unidimensional factor analysis models and a simple total summed score. A subset of practices completed the tool a second time; these data were used to assess test-retest reliability by calculating an intraclass correlation and Cohen's Weighted Kappa. Setting or Dataset: United States Population Studied: Primary care practices varying in size, ownership type, and patient population served Intervention/Instrument: TAPP Outcome Measures: TAPP scores Results: After expert review, 8 cognitive interviews, and 15 pilot tests, the tool consisted of 113 items organized into 8 domains related to primary care practice (e.g., reduce clinical risk factors, expand access to care). The final tool was completed by 259 practices across 26 states (64.6% response rate). There was moderate to high internal consistency within most domains. The scores from the factor analysis models and the simple total summed score were highly correlated (r>0.97). For test-retest reliability, we found moderate to high reliability for the 8 domains and high reliability for the simple total summed score across the 51 practices that completed a second survey. Conclusions: The TAPP is a novel, low-burden tool consisting of 113 items to assess primary care structures and processes. Since the simple total summed score was highly correlated with the more complex factor scores, it may be a suitable replacement and thus, we recommend a total score to those who wish to use this tool.

Context: Many tools measuring the overall quality of primary care exist but none have established predictive validity with respect to care quality and patient outcomes. Objective: To establish the predictive validity of the Tool for Advancing Practice Performance (TAPP), a new, rigorously developed, low-burden practice-level survey for assessing primary care structures (e.g., use of electronic health records) and processes (e.g., panel management). Study Design and Analysis: We invited a national sample of 401 primary care practices to complete the TAPP survey from December 2021 to March 2022. We obtained electronic health records (EHR) data reflecting 6 quality of care and 2 clinical outcome measures; each measure reflects the proportion of patients receiving the appropriate care or with a good clinical outcome. Overall primary care performance was assessed as the average of the 8 measures. We used linear regression analysis to assess the relationship between TAPP scores and outcomes data. Setting or Dataset: United States Population Studied: 247 practices had complete TAPP and EHR outcomes data. These practices varied in size, ownership type, and patient population served. Intervention/Instrument: TAPP Outcome Measures: Use of statin therapy, use of aspirin/antiplatelet for ischemic vascular disease, documentation of BMI with follow-up for obesity, screening and follow-up for depression, screening for breast cancer, screening and referral for smoking, blood pressure control, HbA1c control Results: The total TAPP score was positively associated with the overall performance measure. For a one-point increase on the overall survey score, which reflected the difference between the worst and best possible survey score, there was an increase of 0.24 on the overall performance score (95% CI: 0.16 – 0.32, p<.001). The total TAPP score was positively associated with 3 of the quality-of-care measures (breast cancer screening, p<.001; depression screening and follow-up, p<.001; smoking screening and referral, p<.001). Adjusting for percentage of patient caseloads enrolled in Medicaid or non-white did not affect the associations appreciably. Conclusions: The TAPP is a rigorously developed, low-burden tool consisting of 113 items for assessing practice-level primary care structures and processes. It is the first such tool to predict primary care practice performance as measured by quality of care and clinical outcomes.

Purpose: The purpose of the study was to examine differences among adult patients with diabetes who receive care through a telementoring model versus care at an academic specialty clinic on guideline-recommended diabetes care and self-management behaviors. Methods: Endocrinology-focused Extension for Community Healthcare Outcomes (ECHO Endo) patients completed surveys assessing demographics, access to care, health care quality, and self-management behaviors at enrollment and 1 year after program enrollment. Diabetes Comprehensive Care Center (DCCC) patients completed surveys at comparable time points. Results: At baseline, ECHO patients were less likely than DCCC patients to identify English as their primary language, have postsecondary education, and private insurance. One year postenrollment, ECHO patients visited their usual source of diabetic care more frequently. There were no differences in A1C testing or feet checking by health care professionals, but ECHO patients were less likely to report eye exams and smoking status assessment. ECHO and DCCC patients did not differ in consumption of high-fat foods and soda, physical activity, or home feet checks. ECHO patients were less likely to space carbohydrates evenly and test glucose levels and more likely to have smoked cigarettes. Conclusions: Endo ECHO is a suitable alternative to specialty care for patients in underserved communities with restricted access to specialty care. Results support the value of the Project ECHO telementoring model in addressing barriers to high-quality care for underserved communities.

OBJECTIVES/GOALS: Primary care practices struggle to identify which combination of care structures and processes need to be implemented to improve practice performance and subsequently, patient outcomes. The goal of this study is to develop and validate a tool to assess care structures and processes that are associated with better quality and patient outcomes. METHODS/STUDY POPULATION: Data from a scoping review, Delphi study, and qualitative interviews with high-performing primary care practices contributed to the development and content validation of the Tool for Advancing Practice Performance (TAPP). From these sources we identified 314 items representing care structures (e.g., care team makeup, use of electronic health records) and processes (e.g., care coordination, panel management). We developed criteria for deleting and rescuing items and received input from our expert panel to refine the pool of items. We eliminated items that were redundant and lacked clarity/specificity. The tool was further modified based on feedback from cognitive interviewing and pilot testing with practice managers, quality improvement leaders, and physicians from primary care practices. RESULTS/ANTICIPATED RESULTS: The pool of 314 items was winnowed to 188 after applying criteria for deleting and rescuing items. During the expert review, 70 items were eliminated and 8 new items were added, resulting in a working tool of 126 items. We conducted eight cognitive interviews with the 126-item tool and received feedback on the content, item structure, and language, which led to the elimination of 13 items that were poorly or incorrectly understood by respondents. We also modified the language of 23 items for clarity. After cognitive interviewing, the resulting tool comprised 113 items. Fifteen practices piloted the tool and no additional items were eliminated. We modified the instructions for completing the tool and resolved technical issues related to online administration. DISCUSSION/SIGNIFICANCE: TAPP is a novel tool for assessing care structures and processes that are associated with better quality and patient outcomes in primary care settings. The tool can be used by researchers and primary care clinicians to identify areas for improvement in practice performance and patient outcomes related to chronic disease prevention and management.

Synchronous home-based telemedicine for primary care experienced growth during the coronavirus disease 2019 pandemic. A review was conducted on the evidence reporting on the feasibility of synchronous telemedicine implementation within primary care, barriers and facilitators to implementation and use, patient characteristics associated with use or nonuse, and quality and cost/revenue-related outcomes. Initial database searches yielded 1,527 articles, of which 22 studies fulfilled the inclusion criteria. Synchronous telemedicine was considered appropriate for visits not requiring a physical examination. Benefits included decreased travel and wait times, and improved access to care. For certain services, visit quality was comparable to in-person care, and patient and provider satisfaction was high. Facilitators included proper technology, training, and reimbursement policies that created payment parity between telemedicine and in-person care. Barriers included technological issues, such as low technical literacy and poor internet connectivity among certain patient populations, and communication barriers for patients requiring translators or additional resources to communicate.

there no systematic evaluation of for transgender populations undergoing genital gender-af fi rming surgery (GGAS) e vaginoplasty, phalloplasty, and metoidioplasty e nor are there validated patient reported outcome measures (PROMs). PROMs elicit un fi ltered patient feedback and empower patient-centered care. The scarcity of GGAS PROMs may negatively impact shared decision-making, which may adversely impact outcomes. The objective of this study is to elicit perspectives of transgender patients undergoing GGAS through a community based participatory research approach. METHODS: We recruited transgender patients undergoing GGAS from January-May 2021 for participation in virtual focus groups in partnership with LGBTQ community health centers (Table We used guides developed with the patient community and qualitative research experts to lead discussions, focusing on patient experiences and expectations. Discussions were transcribed, coded, and analyzed using inductive and deductive coding to identify common themes, focusing on quotations coded with decision-making and/or patient- surgeon relationship . RESULTS: We 9 total focus groups, with 3-6 participants per group (Table analysis revealed divergent outcome expectations between and and not all met. one very ciary, for

Synchronous home-based telemedicine for primary care experienced growth during the coronavirus disease 2019 pandemic. A review was conducted on the evidence reporting on the feasibility of synchronous telemedicine implementation within primary care, barriers and facilitators to implementation and use, patient characteristics associated with use or nonuse, and quality and cost/revenue-related outcomes. Initial database searches yielded 1,527 articles, of which 22 studies fulfilled the inclusion criteria. Synchronous telemedicine was considered appropriate for visits not requiring a physical examination. Benefits included decreased travel and wait times, and improved access to care. For certain services, visit quality was comparable to in-person care, and patient and provider satisfaction was high. Facilitators included proper technology, training, and reimbursement policies that created payment parity between telemedicine and in-person care. Barriers included technological issues, such as low technical literacy and poor internet connectivity among certain patient populations, and communication barriers for patients requiring translators or additional resources to communicate.

BACKGROUND:Studies specifically focused on patients' perspectives on telemedicine visits in primary and behavioral health care are fairly limited and have often focused on highly selected populations or used overall satisfaction surveys.OBJECTIVE:To examine patient perspectives on the shift to telemedicine, the remote delivery of health care via the use of electronic information and communications technology, in primary and behavioral health care in Federally Qualified Health Centers (FQHCs) during COVID-19.DESIGN:Semi-structured interviews were conducted using video conference with patients and caregivers between October and December 2020.PARTICIPANTS:Providers from 6 FQHCs nominated participants. Eighteen patients and caregivers were interviewed: 6 patients with only primary care visits; 5 with only behavioral health visits; 3 with both primary care and behavioral health visits; and 4 caregivers of children with pediatric visits.APPROACH:Using a protocol-driven, rapid qualitative methodology, we analyzed the interview data and assessed the quality of care, benefits and challenges of telemedicine, and use of telemedicine post-pandemic.KEY RESULTS:Respondents broadly supported the option of home-based synchronous telemedicine visits in primary and behavioral health care. Nearly all respondents appreciated remote visits, largely because such visits provided a safe option during the pandemic. Patients were generally satisfied with telemedicine and believed the quality of visits to be similar to in-person visits, especially when delivered by a provider with whom they had established rapport. Although most respondents planned to return to mostly in-person visits when considered safe to do so, they remained supportive of the continued option for remote visits as remote care addresses some of the typical barriers faced by low-income patients.CONCLUSIONS:Addressing digital literacy challenges, enhancing remote visit privacy, and improving practice workflows will help ensure equitable access to all patients as we move to a new post-COVID-19 "normal" marked by increased reliance on telemedicine and technology.

Transgender and non-binary (TGNB) individuals often experience gender dysphoria. TGNB individuals with gender dysphoria may undergo genital gender-affirming surgery including vaginoplasty, phalloplasty, or metoidioplasty so that their genitourinary anatomy is congruent with their experienced gender. Given decreasing social stigma and increasing coverage from private and public payers, there has been a rapid increase in genital gender-affirming surgery in the past few years. As the incidence of genital gender-affirming surgery increases, a concurrent increase in the development and utilization of patient reported outcome measurement tools is critical. To date, there is no systematic way to assess and measure patients’ perspectives on their surgeries nor is there a validated measure to capture patient reported outcomes for TGNB individuals undergoing genital gender-affirming surgery. Without a systematic way to assess and measure patients’ perspectives on their care, there may be fragmentation of care. This fragmentation may result in challenges to ensure patients’ goals are at the forefront of shared- decision making. As we aim to increase access to surgical care for TGNB individuals, it is important to ensure this care is patient-centered and high-quality. The development of patient-reported outcomes for patients undergoing genital gender-affirming surgery is the first step in ensuring high quality patient-centered care. Herein, we discuss the critical need for development of validated patient reported outcome measures for transgender and non-binary patients undergoing genital reconstruction. We also propose a model of patient-engaged patient reported outcome measure development.

BACKGROUND:Guidelines for managing and preventing chronic disease tend to be well-known. Yet, translation of this evidence into practice is inconsistent. We identify a combination of factors that are connected to guideline concordant delivery of evidence-informed chronic disease care in primary care.METHODS:Cross-sectional observational study; purposively selected 22 practices to vary on size, ownership and geographic location, using National Quality Forum metrics to ensure practices had a ≥ 70% quality level for at least 2 of the following: aspirin use in high-risk individuals, blood pressure control, cholesterol and diabetes management. Interviewed 2 professionals (eg, medical director, practice manager) per practice (n = 44) to understand staffing and clinical operations. Analyzed data using an iterative and inductive approach.RESULTS:Community Health Centers (CHCs) employed interdisciplinary clinical teams that included a variety of professionals as compared with hospital-health systems (HHS) and clinician-owned practices. Despite this difference, practice members consistently reported a number of functions that may be connected to clinical chronic care quality, including: having engaged leadership; a culture of teamwork; engaging in team-based care; using data to inform quality improvement; empaneling patients; and managing the care of patient panels, with a focus on continuity and comprehensiveness, as well as having a commitment to the community.CONCLUSIONS:There are mutable organizational attributes connected-guideline concordant chronic disease care in primary care. Research and policy reform are needed to promote and study how to achieve widespread adoption of these functions and organizational attributes that may be central to achieving equity and improving chronic disease prevention.