How can people use the results?Health systems can include data on social risks to improve how well measures assess quality of care.

BACKGROUND:Strategies to engage patients to improve and enhance research and clinical care are increasingly being implemented in the United States, yet little is known about best practices for or the impacts of meaningful patient engagement.OBJECTIVE:We describe and reflect on our patient stakeholder groups, engagement framework, experiences, and lessons learned in engaging patients in research, from generating proposal ideas to disseminating findings.SETTING:The ADVANCE (Accelerating Data Value Across a National Community Health Center Network) clinical data research network is the nation's largest clinical dataset on the safety net, with outpatient clinical data from 122 health systems (1109 clinics) in 23 states.RESULTS:Patients stakeholders codeveloped the ADVANCE engagement framework and its implementation in partnership with network leaders. In phase I of ADVANCE, patients were involved with designing studies (input on primary outcome measures and methods) and usability testing (of the patient portal). In phase II, the network is prioritizing research training, dissemination opportunities, an "ambassador" program to pair more experienced patient stakeholders with those less experienced, and evaluation of engagement activities and impacts.DISCUSSION:The ADVANCE framework for patient engagement has successfully involved a diverse group of patients in the design, implementation, and interpretation of comparative effectiveness research. Our experience and framework can be used by other organizations and research networks to support patient engagement activities.

Purpose: Internet-based patient portals are increasingly being implemented throughout health care organizations to enhance health and optimize communication between patients and health professionals. The decision to adopt a patient portal requires careful examination of the advantages and disadvantages of implementation. This study aims to investigate 1 proposed advantage of implementation: alleviating some of the clinical workload faced by employees.Methods: A retrospective time-series analysis of the correlation between the rate of electronic patient-to-provider messages-a common attribute of Internet-based patient portals-and incoming telephone calls. The rate of electronic messages and incoming telephone calls were monitored from February 2009 to June 2014 at 4 economically diverse clinics (a federally qualified health center, a rural health clinic, a community-based clinic, and a university-based clinic) related to 1 university hospital.Results: All 4 clinics showed an increase in the rate of portal use as measured by electronic patient-to-provider messaging during the study period. Electronic patient-to-provider messaging was significantly positively correlated with incoming telephone calls at 2 of the clinics (r = 0.546, P <.001 and r = 0.543, P <.001). The remaining clinics were not significantly correlated but demonstrated a weak positive correlation (r = 0.098, P = .560 and r = 0.069, P = .671).Conclusions: Implementation and increased use of electronic patient-to-provider messaging was associated with increased use of telephone calls in 2 of the study clinics. While practices are increasingly making the decision of whether to implement a patient portal as part of their system of care, it is important that the motivation behind such a change not be based on the idea that it will alleviate clinical workload.

The ADVANCE (Accelerating Data Value Across a National Community Health Center Network) clinical data research network (CDRN) is led by the OCHIN Community Health Information Network in partnership with Health Choice Network and Fenway Health. The ADVANCE CDRN will 'horizontally' integrate outpatient electronic health record data for over one million federally qualified health center patients, and 'vertically' integrate hospital, health plan, and community data for these patients, often under-represented in research studies. Patient investigators, community investigators, and academic investigators with diverse expertise will work together to meet project goals related to data integration, patient engagement and recruitment, and the development of streamlined regulatory policies. By enhancing the data and research infrastructure of participating organizations, the ADVANCE CDRN will serve as a 'community laboratory' for including disadvantaged and vulnerable patients in patient-centered outcomes research that is aligned with the priorities of patients, clinics, and communities in our network.

PURPOSE:To assess the impact of a multicomponent intervention on 30-day hospital readmissions in a group of primary care practices that undertook practice transformation, compared with rates in usual-care practices that admitted patients to the same hospital service.METHODS:Four primary care clinics enhanced patient care coordination with care managers and inpatient care teams, and developed and used hospital readmission reports to monitor readmission rates. Patient readmissions to the hospital were analyzed over a 12-month period from May 2012 through April 2013, among patients who fell into 2 groups. Group 1 patients were those cared for by the primary care clinics that implemented transformation activities and who were admitted to the hospital associated with the practices. Group 2 patients were seen at clinics in the same catchment area that did not undertake any known practice redesign activities (usual care group).RESULTS:A total of 961 patients were included in analyses; 685 (71.3%) were in Group 1, and 276 (28.7%) were in Group 2. Readmissions among Group 1 patients decreased from 27% to 7.1% (P=.02), and readmissions in Group 2 were variable with a nonsignificant trend (P=.53). The unadjusted regression model that compared the interaction between Group 1 and Group 2 patients found a significant difference in readmissions (P=.05).CONCLUSION:Developing a multicomponent intervention appears to have a significant impact on reducing hospital readmissions. Primary care groups seeking to reduce hospital readmissions should consider implementing similar processes.

BACKGROUND AND OBJECTIVES: Oregon Health & Science University Family Medicine implemented a balanced scorecard within our clinics that embraces the inherent tensions between care quality, financial productivity, and operational efficiency. This data-driven performance improvement process involved: (1) consensus-building around specific indicators to be measured, (2) developing and refining the balanced scorecard, and (3) using the balanced scorecard in the quality improvement process. Developing and implementing the balanced scorecard stimulated an important culture shift among clinics; practice members now actively use data to recognize successes, understand emerging problems, and make changes in response to these problems. Our experience shows how Patient-centered Medical Homes can be enhanced through use of information technology and evidence-based tools that support improved decision making and performance and help practices develop into learning organizations.

Pharmacists can play an important role in improving the continuity of medication management for hospitalized patients.1,2 Interventions, including medication reconciliation at the time of admission and discharge, may help to reduce hospital readmissions and even patient mortality.3–5 However, evidence to date is conflicting, and more data are needed. In July 2007, a new pharmacist position was added to the family medicine inpatient service (FMIS) at Oregon Health and Science University (OHSU) hospital to provide more proactive pharmacy services (i.e., medication reconciliation, resolution of drug and dosing issues, medication discharge counseling and follow-up) for patients admitted to that service. The position was staffed by two pharmacy faculty members from the Oregon State University College of Pharmacy who shared a schedule of alternating six-week blocks on hospital service. The pharmacist and two students rounded with the FMIS five or six days per week. Activities included medication reconciliation on newly admitted patients, inpatient medication management, and discharge reconciliation with both primary providers and outpatient pharmacies as appropriate. Hospital staff pharmacists at OHSU continued their traditional role of reviewing medication orders for all admitted patients during the period of study.

(Fam Med 2009;41(4):237-9.) Our need to serve as leaders is intertwined with our need to care for our patients. This is the theme of what follows. Occasionally, you experience something that reinforces the challenging path that you chose to take to be involved in medicine. For some, these experiences occur more frequently than for others, yet they need to occur to continue to motivate and support us, especially in challenging times. At the same time, all of us are involved in organizations where decisions are being made that have the potential of undermining our ability to care for patients, and teach, the way we want and the way we should. In environments like this, leadership matters, as does our ability to advocate for our patients’ needs. I would like to share an experience that has helped to reinvigorate me, not because it is unique but because it is not. It is Sabrina’s story. If we take a moment to reflect on what we are experiencing as clinicians and teachers, we are better prepared to handle the challenges of our leadership roles. First, the context. At my institution, like yours, decisions are being made every day that have the potential of shaking our confidence in our commitment to our organization. We are facing job cuts that are affecting those on the front line, as well as those in management. Bordering on unrealistic, we are being asked to dramatically increase productivity, and decrease costs, while improving patient satisfaction. Commitments and agreements are being broken on a daily basis.

Evidence-Based Medicine in Primary Care: An Overview Did We Learn Evidence-Based Medicine in Medical School? Some Common Medical Myths Dimensions of Evidence Strategies for Finding Evidence Critical Appraisal of the Literature: How to Assess an Article and Still Enjoy Life Applying a Meta-Analysis to Daily Clinical Practice Using Outcomes to Improve Quality of Research and Quality of Care Understanding the Choices That Patients Make Assessing Accuracy of Diagnostic and Screening Tests Evaluating Evidence from a Decision Analysis Weighing the Economic Evidence: Guidelines for Critical Assessment of Cost-Effectiveness Analyses Cost-Effectiveness of Primary Care Clinical Guidelines: A Strategy for Translating Evidence into Practice Use of Balance Sheets in Developing Clinical Guidelines Summarizing Evidence for Clinical Use Computer Aids to Clinical Practice Information at the Point-of-Care: Answering Clinical Questions Epilogue Evidence-Based Medicine Glossary

Play it safe when documenting E/M services: Keep your medical students' documentation out of patient chart notes.