Investment in Primary Care is Crucial

Center director Russ Phillips shares lessons from Rhode Island’s statewide innovation payment model in a recent Health Affairs article. (more…)

Primary Care Collaboration to Improve Diagnosis and Screening for Colorectal Cancer

In a paper recently published by the Joint Commission Journal on Quality and Patient Safety, authors including Dr. Gordy Schiff, Center for Primary Care faculty, highlight findings from a recent Center initiative to improve CRC screening diagnosis across 25 primary care practices. (more…)

Transforming Resident Clinics

One of my first primary care patients as an intern was Mr. S., a 65 year-old fast-talking, salesman-type. He had a deep tan and a strong golf game. On our first meeting, he asked about my favorite Scotch, and told me he drank three glasses of Talisker every evening with a cigar (in addition to a half-pack of cigarettes per day). I listened, energetically nodded my head (we were developing rapport, I thought), and glanced over at the reminders on my computer screen. He was due to have an abdominal aortic aneurysm (AAA) screening ultrasound. I explained the test, and told him I would be in touch with the results.

Negative for an AAA, the report showed an incidental finding of a heterogeneous appearing liver. When the results came back it was late in the evening and I did not know how, or whether, to act upon this finding. UpToDate (Waltham, MA) provided little guidance. So I placed a liver e-consult with my clinical question. Within a few days I received a note in my in-basket from a hepatologist recommending several lab tests to risk-stratify the patient and, if they were negative, to follow-up with a dedicated liver ultrasound in one year. (more…)

Adverse event reporting in children

“…it is sobering to consider how infrequently adverse events and errors are being reported. Not only are we missing many adverse events, but those being reported likely are not perfectly representative of all errors that are occurring.”

 

Read the full article

 
Center faculty member, Gordy Schiff, authored this article, which originally appeared in PLOS Medicine.

The Global Burden of Diagnostic Errors in Primary Care

Center faculty, Gordy Schiff, recently co-authored the below article found in BMJ Quality and Safety.

“In this narrative review, we discuss the global significance, burden and contributory factors related to diagnostic errors in primary care. We synthesize available literature to discuss the types of presenting symptoms and conditions most commonly affected. We then summarize interventions based on available data and suggest next steps to reduce the global burden of diagnostic errors.”

Full article

Health Advancement in Vietnam

Kristen Goodell, Director for Innovation in Medical Education at the Center, spent a week this spring in Ho Chi Minh city working on the Partnership for Health Advancement in Vietnam (HAIVN). This large multi-pronged project is a collaboration between Harvard Medical School, Brigham and Women’s Hospital, and Beth Israel Deaconess Medical Center, as well as the Vietnam Ministry of Health, Hanoi Medical University, and the Ho Chi Minh University of Medicine and Pharmacy. (more…)

Making it easier to remember doctors’ orders

This article originally appeared in MarketPlace.

When my mother was in the hospital recently, I got a closer look than I might have liked at how hard it can be for doctors and patients to communicate. 

Patients rarely feel well. They can be stressed out. They can be on medication, as my mom, who’s being treated for leukemia, is. It makes her thinking fuzzy. When Mom’s doctors stopped by and she wanted to ask a question, she was often thwarted by her own poor memory – unable to come up with the words she was looking for. (more…)

A Chronic Disease Management Student-Faculty Collaborative Practice: Educating Students

This article originally appeared in Academic Medicine.

Clinician educators must inspire future clinicians to practice primary care in a dynamic environment. This need is fueled by burden of chronic disease, an aging population, and an increase of new patients in the wake of health care reform.

The Crimson Care Collaborative, a student-faculty collaborative network at Harvard, aims to expand such educational opportunities and improve patient control of chronic disease.

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The Changing Landscape of Primary Care

The Center’s director, Russ Phillips, recently co-authored a chapter in the Practical Playbook published this October. The Practical Playbook supports increased collaborations between primary care and public health groups by guiding users through stages of integrated population health improvement. Below are some major take-away’s from the chapter, entitled, “The Changing Landscape of Primary Care.” (more…)

Stories of Innovation and Leadership in Primary Care

View stories from the 2015 Primary Care Innovations Conference:

Transforming Care to Improve Patient and Employee Experience
Arshiya Seth, Primary Care Physician at CHA Somerville Hospital, discusses ways to improve the patient and staff experience.

Finding the Person Behind the Patient
Dr. Rose Kakoza of Brigham and Women’s Hospital discusses ways to more effectively work with complex care patients.

Addressing the Mental Health Crisis Among Chinese Immigrants in Boston
Justin Chen, Psychiatrist at Mass General Hospital, discusses approaches for reducing barriers to entry for Chinese Immigrants seeking mental health.

Leaving Neverland: The Transition to Adulthood
Kitty O’Hare, Pediatrician at Brigham and Women’s Hospital, discusses helping patients with chronic medical conditions transition from childhood to adulthood.

Fountain of Richness
Assistant Professor of Medicine at Cambridge Health Alliance, Marie-Louise Jean-Baptiste, discusses using a cooking class to promote health eating and educate Haitian patients with diabetes.

End-of-Life Group Discussions
Nathalie Bloch, primary care physician at Mount Auburn Hospital, Abigail Frydryk, nurse practitioner student at the MGH institute of health professions, and Michael Palizzolo, pre-medical student at the Harvard Extension School, discuss improving end-of-life care.

Experience Based Co-Design: Involving Patients in the Design Effective Healthcare
Allison Blajda and Kelsey Bryckman, both students of the Harvard Chan School of Public Health, discuss their project working with patients on the co-design of their care health.

Fountain of Richness

Fountain of Richness

 

Assistant Professor of Medicine at Cambridge Health Alliance, Marie-Louise Jean-Baptiste, discusses using a cooking class to promote health eating and educate Haitian patients with diabetes.

Leaving Neverland: The Transition to Adulthood

Leaving Neverland: The Transition to Adulthood

 

Kitty O’Hare, Director of Transition Medicine for Primary Care, Weitzman Family Young Adult Transition Program, Boston Children’s Hospital, discusses helping patients with chronic medical conditions transition from childhood to adulthood.

Addressing the Mental Health Crisis Among Chinese Immigrants in Boston

Innovative Approaches to Addressing the Mental Health Crisis Among Chinese Immigrants in Boston

 

Justin Chen, Psychiatrist at Mass General Hospital, discusses approaches for reducing barriers to entry for Chinese Immigrants seeking mental health.

Finding the Person Behind the Patient

Finding the Person Behind the Patient: Lessons from an Ambulatory Complex Care Management Team

 

Dr. Rose Kakoza of Brigham and Women’s discusses ways to more effectively work with complex care patients.

Transforming Care to Improve Patient and Employee Experience

Transforming Care to Improve Patient and Employee Experience

 

Arshiya Seth, Primary Care Physician at CHA Somerville Hospital, discusses ways to improve the patient and staff experience.

Lawrence Family Medicine Residency Transition to a Four Year Program

Overall Objective: Development of competencies in all aspects of PCMH in our NCQA Level 3 Family Medicine Center through immersion in and graduated responsibility for management of the medical home.

Goals: To find innovative methods to prepare Family Physicians to “serve as highly effective personal physicians in a high performance health care system.”
Inform whether four years should become the standard length of training in Family Medicine

Download Poster Presentation

Enabling Changemakers: A Primary Care Visioning Group

Problem: House staff feel ill-informed and unable to effect systems change while educated and socialized in an obsolete system.

Objective: Provide a vehicle for education, discussion, and action toward system-level change in primary care.

Intervention: Download Poster Presentation

 

Integrating Pharmacists in Complex Care

Using a Novel Two-Pronged Pharmacy Model in a High-Risk Care Management Program to Address Medication Reconciliation and Access

How do we best integrate and utilize pharmacist and/or pharmacy technicians in complex care?

Objectives:

  1. Improve the quality of medication reconciliation during care transitions
  2. Facilitate medication adherence by identifying high out-of-pocket medication expenses and providing more affordable alternatives.

Download Poster Presenation

 

For more information on this poster , please contact caroline_barnaby@hms.harvard.edu

Transforming Primary Care Practice and Education

This article originally appeared in the Journal of Ambulatory Care Management.

 

What’s the Issue?
AHCs have the ability to succeed in practice transformation and create new models of education that may help the US meet future primary care workforce needs. This raises the question: How will AHCs train our future primary care workforce if they are not able to provide opportunities for trainees to work and learn in transformed practices that mirror practices being created across the country?

Objective:
The objective of this study was to look within teaching practices and identify a transformational medical home framework that can be mirrored by other AHCs. To learn how AHC-based collaboratives transform primary care, a more thorough understanding of their aims and accomplishments was necessary.

Key Findings
Academic health center primary care collaboratives differ significantly from other collaboratives. In addition to confronting the challenges of working in AHCs, academic collaboratives were challenged further by the teaching mission of these practices and the need to accommodate the schedules of trainees, especially those from other health professions.

While more research is necessary to define the optimal change package and resources for AHC primary care practice transformation, the study found that an educational mission provides an important catalyst for these practices to evolve, as educators are inspired to prepare their trainees for practices of the future and residents themselves can serve as change agents. We hope this knowledge can be used for the redesign efforts of other AHCs.

Five things ob-gyns should know about treating survivors of childhood cancer

Recent research shows improvement in long-term survival rates for childhood cancer patients, but also highlights the challenges that remain for many of the almost 400,000 survivors in the United States.  Among these survivors are women facing gynecological health issues from the late effects of their treatment. What follows are several areas of concern that gynecologists and obstetricians should consider when treating women who had cancer as girls. (more…)

Will Medicare’s Chronic Care Management Help Primary Care Survive?

New findings published today in the Annals of Internal Medicine show that primary care practices that add non-physician team members to deliver chronic care management services will see substantial net revenue gains from the new Medicare Chronic Care Management (CCM) program. (more…)

UMass primary care doctors won’t change how they treat high blood pressure before findings of halted NIH clinical trial are published

This article originally appeared in Umass Med Now.

“Dramatic early findings from a major National Institutes of Health study appear to show significant cardiovascular benefits from lowering the recommended systolic blood pressure for adults over age 50 who are at elevated risk for heart disease, but some primary care doctors at UMass Medical School say they are taking a cautionary approach before making any changes with their patients.”

Sanjay Basu, MD, PhD

Sanjay Basu, MD, PhD, is an Assistant Professor of Medicine at Stanford University. He is a primary care physician and epidemiologist focused on the application of mathematical models to chronic disease prevention. Dr. Basu received his undergraduate degree through the computation and systems tracks at MIT, then received a master’s degree in medical anthropology through a Rhodes Scholarship at Oxford before receiving his MD and PhD in epidemiology at Yale University. He completed his medical training through the internal medicine residency program at the University of California in San Francisco, as part of the primary care track at San Francisco General Hospital, then joined Stanford’s Prevention Research Center in September 2012.

Become a Mentor!

Students, are you seeking a mentor in family medicine, internal medicine, or primary care? If so, check out the Center’s mentors in family medicine, med peds, geriatrics, pediatrics, and internal medicine!