Improving System Integration: The Art and Science of Engaging Small Community Practices in Health System Innovation.

Pauline Pariser,Elizabeth Lockhart,Laura Pus,Howard Abrams,Noah Ivers,Ian Stanaitis,G Ross Baker,Gillian Hawker

doi:10.1155/2016/5926303

Abstract

This paper focuses on successful engagement strategies in recruiting and retaining primary care physicians (PCPs) in a quality improvement project, as perceived by family physicians in small practices. Sustained physician engagement is critical for quality improvement (QI) aiming to enhance health system integration. Although there is ample literature on engaging physicians in hospital or team-based practice, few reports describe factors influencing engagement of community-based providers practicing with limited administrative support. The PCPs we describe participated in SCOPE: Seamless Care Optimizing the Patient Experience, a QI project designed to support their care of complex patients and reduce both emergency department (ED) visits and inpatient admissions. SCOPE outcome measures will inform subsequent papers. All the 30 participating PCPs completed surveys assessing perceptions regarding the importance of specific engagement strategies. Project team acknowledgement that primary care is challenging and new access to patient resources were the most important factors in generating initial interest in SCOPE. The opportunity to improve patient care via integration with other providers was most important in their commitment to participate, and a positive experience with project personnel was most important in their continued engagement. Our experience suggests that such providers respond well to personalized, repeated, and targeted engagement strategies.

Highlights

IntroductionIn recruitment and engagement of community physicians we emphasize their grassroots involvement to both inform and iteratively improve the key elements of the project [3]
A high degree of physician engagement is key in successful quality improvement projects aiming to improve health care integration and reduce emergency department (ED) visits and hospital readmissions for individuals with chronic conditions who account for the majority of health care costs [1,2,3,4,5,6,7]
In 2012, we identified a group of community-based primary care physicians (PCPs), unaffiliated with any hospital to whom we offered SCOPE resources: a multifaceted intervention that includes access to a nurse navigator, community care resource coordinator, general internal medicine, and online access to hospital-based patient results (Figure 1)

Summary

Introduction

In recruitment and engagement of community physicians we emphasize their grassroots involvement to both inform and iteratively improve the key elements of the project [3]. Health care integration has more in common with virtual vertical integration as we sought to establish a clinical network rather than absorb free-standing PCPs into formal organizations [9]. These PCPs have virtual access to services via a centrally coordinated hub and are included in codesigning and developing a shared set of guidelines and protocols [10]

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Methods

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Discussion

Conclusion