Use of Quality Improvement Strategies Among Small to Medium-Size US Primary Care Practices

PURPOSE Improving primary care quality is a national priority, but little is known about the extent to which small to medium-size practices use quality improvement (QI) strategies to improve care. We examined variations in use of QI strategies among 1,181 small to medium-size primary care practices engaged in a national initiative spanning 12 US states to improve quality of care for heart health and assessed factors associated with those variations. METHODS In this cross-sectional study, practice characteristics were assessed by surveying practice leaders. Practice use of QI strategies was measured by the validated Change Process Capability Questionnaire (CPCQ) Strategies Scale (scores range from −28 to 28, with higher scores indicating more use of QI strategies). Multivariable linear regression was used to examine the association between practice characteristics and the CPCQ strategies score. RESULTS The mean CPCQ strategies score was 9.1 (SD = 12.2). Practices that participated in accountable care organizations and those that had someone in the practice to configure clinical quality reports from electronic health records (EHRs), had produced quality reports, or had discussed clinical quality data during meetings had higher CPCQ strategies scores. Health system–owned practices and those experiencing major disruptive changes, such as implementing a new EHR system or clinician turnover, had lower CPCQ strategies scores. CONCLUSION There is substantial variation in the use of QI strategies among small to medium-size primary care practices across 12 US states. Findings suggest that practices may need external support to strengthen their ability to do QI and to be prepared for new payment and delivery models

Volatile organic compounds as signals in a Plant-Herbivore System: Electrophysiological Responses in Olfactory Sensilla of the Moth Cactoblastis cactorum

The morphological sensillum types on the antennae of male and female Cactoblastis cactorum were visualized by scanning electron microscopy. Electrophysiological recordings were performed for the first time on single olfactory sensilla of C. cactorum. Th

Does Ownership Make a Difference in Primary Care Practice?

Purpose: We assessed differences in structural characteristics, quality improvement processes, and cardiovascular preventive care by ownership type among 989 small to medium primary care practices. Methods: This cross-sectional analysis used electronic health record and survey data collected between September 2015 and April 2017 as part of an evaluation of the EvidenceNOW: Advancing Heart Health in Primary Care Initiative by the Agency for Health Care Research and Quality. We compared physician-owned practices, health system or medical group practices, and Federally Qualified Health Centers (FQHC) by using 15 survey-based practice characteristic measures, 9 survey-based quality improvement process measures, and 4 electronic health record-based cardiovascular disease prevention quality measures, namely, aspirin prescription, blood pressure control, cholesterol management, and smoking cessation support (ABCS). Results: Physician-owned practices were more likely to be solo (45.0% compared with 8.1%, P \u3c .001 for health system practices and 12.8%, P = .009 for FQHCs) and less likely to have experienced a major change (eg, moved to a new location) in the last year (43.1% vs 65.4%, P = .01 and 72.1%, P = .001, respectively). FQHCs reported the highest use of quality improvement processes, followed by health system practices. ABCS performance was similar across ownership type, with the exception of smoking cessation support (51.0% for physician-owned practices vs 67.3%, P = .004 for health system practices and 69.3%, P = .004 for FQHCs). Conclusions: Primary care practice ownership was associated with differences in quality improvement process measures, with FQHCs reporting the highest use of such quality-improvement strategies. ABCS were mostly unrelated to ownership, suggesting a complex path between quality improvement strategies and outcomes

Effect of elevated atmospheric CO2 on oviposition behavior in Manduca sexta moths

Moths can detect changes in environmental carbon dioxide (CO2) with extremely high sensitivity, but the role of CO2 in the biology of these and other insects is not well understood. Although CO2 has been demonstrated to influence egg-laying (oviposition

Miniaturised DBF Communication Modules for Broadband Mobile Satellite Access at Ka-Band

This paper describes the implementation of and measurements on highly integrated transmitter and receiver modules featuring digital beamforming (DBF) at Ka-band frequencies. These modules can be used as building blocks for large receiver or transmitter terminal antennas. After a review of the essential parts of the receiver and transmitter modules like antenna elements, Ka-band frontends, miniaturised interfaces and IF / baseband circuitry, measurement results of one receiver and one transmitter module are presented and discussed

Use of Quality Improvement Strategies Among Small to Medium-Size US Primary Care Practices

Improving primary care quality is a national priority, but little is known about the extent to which small to medium-size practices use quality improvement (QI) strategies to improve care. We examined variations in use of QI strategies among 1,181 small to medium-size primary care practices engaged in a national initiative spanning 12 US states to improve quality of care for heart health and assessed factors associated with those variations

SANTANA – Smart Antenna Terminal for Broadband Mobile Satellite Communications at Ka-Band

Smart antennas employing Digital BeamForming (DBF) at Ka-band frequencies will be key elements for the next generation of broadband satellite communication systems. This frequency band offers high bandwidth, whereas DBF provides a high degree of system flexibility. Scope of the two-phase project Smart Antenna Terminal (SANTANA) is the development of advanced satellite communication terminals for mobile segments (e.g. aircrafts). The antenna consists of an Rx (20 GHz) and a separate Tx (30 GHz) array. In order to realise high gain DBF arrays, the Tx/Rx antennas are composed of 4x4 array modules which are used as basic building blocks. After a short introduction explaining the background and vision of the SANTANA project, a general system overview on the terminal-antenna concept will be given, followed by the presentation of measurement results. After that, the focus will be on novel concepts of an improved terminal architecture which is currently developed in the second project phase: • An enhanced RF-to-antenna interconnect design, which enables separate testing of RF- and antenna structures before integration and allows for a new architecture to enhance the thermal management. • An improved Rx-antenna element and feeding structure. • A new Tx antenna layout, based on a LTCC multilayer structure, featuring hybrid couplers, shielding cavities and a calibration network. An outlook on the fixed and mobile tests of a system, composed of 4 basic building blocks for high data rate planned to be carried out in 2006 will conclude this contribution

Does Ownership Make a Difference in Primary Care Practice?

PURPOSE: We assessed differences in structural characteristics, quality improvement processes, and cardiovascular preventive care by ownership type among 989 small to medium primary care practices. METHODS: This cross-sectional analysis used electronic health record and survey data collected between September 2015 and April 2017 as part of an evaluation of the EvidenceNOW: Advancing Heart Health in Primary Care Initiative by the Agency for Health Care Research and Quality. We compared physician-owned practices, health system or medical group practices, and Federally Qualified Health Centers (FQHC) by using 15 survey-based practice characteristic measures, 9 survey-based quality improvement process measures, and 4 electronic health record-based cardiovascular disease prevention quality measures, namely, aspirin prescription, blood pressure control, cholesterol management, and smoking cessation support (ABCS). RESULTS: Physician-owned practices were more likely to be solo (45.0% compared with 8.1%, CONCLUSIONS: Primary care practice ownership was associated with differences in quality improvement process measures, with FQHCs reporting the highest use of such quality-improvement strategies. ABCS were mostly unrelated to ownership, suggesting a complex path between quality improvement strategies and outcomes

A national evaluation of a dissemination and implementation initiative to enhance primary care practice capacity and improve cardiovascular disease care: the ESCALATES study protocol.

BACKGROUND: The Agency for Healthcare Research and Quality (AHRQ) launched the EvidenceNOW Initiative to rapidly disseminate and implement evidence-based cardiovascular disease (CVD) preventive care in smaller primary care practices. AHRQ funded eight grantees (seven regional Cooperatives and one independent national evaluation) to participate in EvidenceNOW. The national evaluation examines quality improvement efforts and outcomes for more than 1500 small primary care practices (restricted to those with fewer than ten physicians per clinic). Examples of external support include practice facilitation, expert consultation, performance feedback, and educational materials and activities. This paper describes the study protocol for the EvidenceNOW national evaluation, which is called Evaluating System Change to Advance Learning and Take Evidence to Scale (ESCALATES). METHODS: This prospective observational study will examine the portfolio of EvidenceNOW Cooperatives using both qualitative and quantitative data. Qualitative data include: online implementation diaries, observation and interviews at Cooperatives and practices, and systematic assessment of context from the perspective of Cooperative team members. Quantitative data include: practice-level performance on clinical quality measures (aspirin prescribing, blood pressure and cholesterol control, and smoking cessation; ABCS) collected by Cooperatives from electronic health records (EHRs); practice and practice member surveys to assess practice capacity and other organizational and structural characteristics; and systematic tracking of intervention delivery. Quantitative, qualitative, and mixed methods analyses will be conducted to examine how Cooperatives organize to provide external support to practices, to compare effectiveness of the dissemination and implementation approaches they implement, and to examine how regional variations and other organization and contextual factors influence implementation and effectiveness. DISCUSSION: ESCALATES is a national evaluation of an ambitious large-scale dissemination and implementation effort focused on transforming smaller primary care practices. Insights will help to inform the design of national health care practice extension systems aimed at supporting practice transformation efforts in the USA. CLINICAL TRIAL REGISTRATION: NCT02560428 (09/21/15)