Delivery Of High-value Care Research Articles

Alternative payment models in Dutch hospital care: what works, how, why and under what circumstances? Protocol for a realist evaluation study

IntroductionThe predominant provider payment models in healthcare, particularly fee-for-service, hinder the delivery of high-value care and can encourage healthcare providers to prioritise the volume of care over the value of...

Maryland's Integration of Public Health and Primary Care During the COVID-19 Pandemic: Case Study and Lessons Learned.

The Maryland Primary Care Program is a statewide advanced primary care program that works directly with practices to transform healthcare delivery by managing chronic disease, preventing unnecessary hospital utilization, and integrating with the public health system. The Maryland Primary Care Program has demonstrated how linking the public health system to primary care practices, paired with strategic financial and resource investments in primary care, can enable the delivery of high-value care and reduce acute hospital utilization. Such a system is especially prudent when responding to crises. Throughout the COVID-19 pandemic, the Maryland Primary Care Program was able to capitalize on existing infrastructure to quickly engage primary care in a robust pandemic response. Successes of this relationship included early and consistent communication channels, as well as coordinated resource distribution. In particular, this partnership allowed primary care providers, the most trusted source of healthcare in patients' lives, to directly provide patients with health information and vaccines. Now comprising more than 500 practices, this vaccine program uses data-driven reports to facilitate intentional vaccine outreach. The program has enabled a more equitable vaccine distribution system, resulting in over 400,000 vaccines administered in Maryland counties. The effectiveness of Maryland's integrated response indicates that partnerships between public health and primary care will result in an effective response in future times of crisis.

Reducing Overuse by Healthcare Systems: A Positive Deviance Analysis.

Healthcare in the USA is increasingly delivered by large healthcare systems that include one or more hospitals and associated outpatient practices. It is unclear what role healthcare systems play in driving or preventing overutilization of healthcare services in the USA. To learn how high-value healthcare systems avoid overuse of services DESIGN: We identified "positive deviant" health systems using a previously constructed Overuse Index. These systems have much lower-than-average overuse of healthcare services. We confirmed that these health systems also delivered high-quality care. We conducted semi-structured interviews with executive leaders of these systems to validate a published framework for understanding drivers of overuse. Leaders at select healthcare systems in the USA. None APPROACH: We developed an interview guide and conducted semi-structured interviews. We iteratively developed a code book. Paired reviewers coded and reconciled each interview. We analyzed the interviews by applying constant comparative techniques. We mapped the emergent themes to provide the first empirical data to support a previously developed theoretical framework. We interviewed 15 leaders from 10 diverse healthcare systems. Consistent with important domains from the overuse framework, themes from our study support the role of clinicians and patients in avoiding overuse. The leaders described how they create a culture of professional practice and how they modify clinicians' attitudes to facilitate high-value practices. They also described how their patients view healthcare consumption and the characteristics of their patient populations allowed them to practice high-value medicine. They described the role of quality metrics, insurance plan ownership, and alternative payment model participation as encouraging avoidance of overuse. Our qualitative analysis of positive deviant health systems supports the framework that is in the published literature, although health system leaders also described their financial structures as another important factor for reducing overuse and encouraging high-value care delivery.

Association of Maryland Global Budget Revenue With Spending and Outcomes Related to Surgical Care for Medicare Beneficiaries With Cancer

In 2014, Maryland initiated the global budget revenue (GBR) model, placing caps on total hospital expenditures across all care sites. The GBR program aims to reduce unnecessary utilization while maintaining or improving care quality. To date, there has been limited examination of program effects on cancer care. To compare changes in spending, clinical outcomes, and acute care utilization through 4 years of the GBR program among Medicare beneficiaries who undergo cancer-directed surgery in Maryland vs matched control states. Drawing from a matched pool of hospitals in Maryland (n = 35) and 24 control states with a similar timing of Medicaid expansion (n = 101), we identified Medicare beneficiaries from Maryland and control states who underwent any cancer-directed surgery from 2011 through 2018. Using difference-in-differences analysis, we compared changes in outcomes from before (2011-2013) to after (2015-2018) GBR implementation between patients treated in Maryland and control states. We also performed a subgroup analysis among patients who underwent major surgical procedures that are usually performed in the inpatient setting (cystectomy, esophagectomy, gastrectomy, colorectal resection, nephrectomy, pancreatectomy, and lung resection). Thirty-day episode spending, mortality, readmissions, and emergency department (ED) visits. Relative to Medicare beneficiaries undergoing cancer surgery in control states (n = 4737; 3323 [70.1%] female; 571 [12.1%] dual-eligible; mean [SD] age 74.9 [6.5] years), patients in Maryland (n = 20 320; 14 068 [69.2%] female; 1705 [8.4%] dual-eligible; mean [SD] age 74.9 [6.5] years) had a statistically significant reduction of 2.2 percentage points (95% CI, -4.3 to -0.1) in the 30-day readmission rate. We found no statistically significant changes in 30-day spending, mortality, or ED visits. We report no significant results in the subgroup analysis of patients undergoing major surgical procedures. Global budget revenue was not associated with changes in expenditures, ED utilization, or clinical outcomes after cancer-directed surgery through 4 years. There was a modest decline in 30-day readmissions. Specialty-specific definitions of care quality and better alignment across the entire care delivery value chain (ie, physician incentives) may be strategies that could improve delivery of high-value care for beneficiaries undergoing cancer surgery.

Improving Transitions of Care: Designing a Blockchain Application for Patient Identity Management

Background: The current healthcare ecosystem in the United States is plagued by inefficiencies in transitions of patient care between healthcare providers due in large part to a lack of interoperability among the many electronic medical record (EMR) systems that exist today. Both providers and patients experience significant frustration due to the negative effects of increased costs, unnecessary administrative burden, and duplication of services that occur because of data fragmentation in the system. Blockchain technology provides a solution to mitigate or eliminate these gaps by allowing for healthcare information exchange that is distributed, auditable, immutable, and respectful of patient autonomy. Our multidisciplinary team identified key tasks required for a transition of care to design and develop a blockchain application, MediLinker, that served as a patient-centric identity management system to address the issues of data fragmentation ultimately allowing for the delivery of high value care.   Methods: The MediLinker application was evaluated for its ability to accomplish various key tasks needed for a successful transition of patient care in an outpatient setting. Our team created twenty unique patient use cases covering a diversity of medical needs and social circumstances that were played out by participants who were asked to perform various tasks as they received case across a simulated healthcare ecosystem composed of four clinics, a research institution, and other ancillary public services. Tasks included, but were not limited to, clinic enrollment, verification of identity, medication reconciliation, sharing insurance and billing information, and updating demographic information. With this iteration of MediLinker, we specifically focused on the functionality of Guardianship and patient revocation of healthcare information. Additionally, throughout the simulation we surveyed participant perceptions regarding the use of MediLinker and blockchain technology to better ascertain comfortability and usability of the application.   Results: Quantitative evaluation of simulation results revealed that MediLinker was able to successfully accomplish all seven clinical scenarios tested across the twenty patient use cases. MediLinker successfully achieved its goal of patient-centered interoperability as participants transitioned their simulated healthcare data, including COVID-19 vaccination status and current medications, across the four clinic sites and research institution. In addition to completing all key tasks designated, all eligible participants were able to enroll with and subsequently revoke data access with our simulated research site. A high degree of data accuracy was noted with most errors occurring due to inaccurate data entry from user input. Our qualitative analysis of user perceptions indicated that comfortability and trust with blockchain technology, such as MediLinker, grew with increased education and exposure to such technology.   Conclusion: The ubiquitous problem of data fragmentation in our current healthcare ecosystem has placed considerable strain on providers and patients alike. Blockchain applications for health identity management, such as MediLinker, provide a viable solution to stem the inefficiencies that exist today. The interoperability that MediLinker provided across our simulated healthcare system has the potential to improve transitions of care by sharing key aspects of healthcare information in a timely, secure, and patent-centric fashion allowing for the delivery of consistent personalized high-value care. Blockchain technologies appear to face similar challenges to widespread adoption as other novel interventions, namely recognition, trust, and usability. Further development and scaling are required for such technology to realize its full potential in the real-world and transform the practice of modern healthcare.

Reducing Low-Value Care: Uncertainty as Crucial Cross-Cutting Theme Comment on "Key Factors That Promote Low-Value Care: Views of Experts From the United States, Canada, and the Netherlands".

Low-value care is increasingly recognized as a global problem that places strain on healthcare systems and has no quick fix. Verkerk et al have identified key factors promoting low-value care on a national level, proposed strategies to address these and create a healthcare system facilitating delivery of high-value care. In this commentary, we reflect on the results of Verkerk et al and argue that uncertainty has a crucial role when it comes to reducing low-value care. This uncertainty is reflected in lack of a shared view between stakeholders, with clear criteria and thresholds on what constitutes low-value care, and as cross-cutting theme related to the key factors identified. We suggest to work on such a shared view of low-value care and - different from implementation efforts - to explicitly address uncertainty and its driving cognitive biases grounded in human decision-making psychology, to reduce low-value care.

Improving Transitions of Care: Designing a Blockchain Application for Patient Identity Management.

The current healthcare ecosystem in the United States is plagued by inefficiencies in transitions of patient care between healthcare providers due in large part to a lack of interoperability among the many electronic medical record (EMR) systems that exist today. Both providers and patients experience significant frustration due to the negative effects of increased costs, unnecessary administrative burden, and duplication of services that occur because of data fragmentation in the system. Blockchain technology provides a potential solution to mitigate or eliminate these gaps by allowing for exchange of healthcare information that is distributed, auditable, immutable, and respectful of patient autonomy. Our multidisciplinary team identified key tasks required for a transition of care to design and develop a blockchain application, MediLinker, which served as a patient-centric identity management system to address issues of data fragmentation ultimately aiding in the delivery of high-value care services. The MediLinker application was evaluated for its ability to accomplish various key tasks needed for a successful transition of patient care in an outpatient setting. Our team created 20 unique patient use cases covering a diversity of medical needs and social circumstances that were played out by participants who were asked to perform various tasks as they received case across a simulated healthcare ecosystem composed of four clinics, a research institution, and other ancillary public services. Tasks included, but were not limited to, clinic enrollment, verification of identity, medication reconciliation, sharing insurance and billing information, and updating demographic information. With this iteration of MediLinker, we specifically focused on the functionality of digital guardianship and patient revocation of healthcare information. In addition, throughout the simulation, we surveyed participant perceptions regarding the use of MediLinker and blockchain technology to better ascertain comfortability and usability of the application. Quantitative evaluation of simulation results revealed that MediLinker was able to successfully accomplish all seven clinical scenarios tested across the 20 patient use cases. MediLinker successfully achieved its goal of patient-centered interoperability as participants transitioned their simulated healthcare data, including COVID-19 vaccination status and current medications, across the four clinic sites and research institution. In addition to completing all key tasks designated, all eligible participants were able to enroll with and subsequently revoke data access with our simulated research site. MediLinker had a low data-entry error rate, with most errors occurring due to work-flow vulnerabilities. Our qualitative analysis of user perceptions indicated that comfortability and trust with blockchain technology, such as MediLinker, grew with increased education and exposure to such technology. The ubiquitous problem of data fragmentation in our current healthcare ecosystem has placed considerable strain on providers and patients alike. Blockchain applications for health identity management, such as MediLinker, provide a viable solution to stem the inefficiencies that exist today. The interoperability that MediLinker provided across our simulated healthcare system has the potential to improve transitions of care by sharing key aspects of healthcare information in a timely, secure, and patent-centric fashion allowing for the delivery of consistent and personalized high value care. Blockchain technologies appear to face similar challenges to widespread adoption as other novel interventions, namely recognition, trust, and usability. Further development and scaling are required for such technology to realize its full potential in the real world and transform the practice of modern health care.

Cost assessment of allergy procedures to improve high-value care implementation.

Background: Oral challenges and desensitizations are regularly performed by allergy/immunology physicians. However, there is limited research that has evaluated their cost-effectiveness and overall health-care-related value. Objective: The objective was to analyze the costs of oral challenges and desensitizations by clinician type (including allergy/immunology physicians, other physicians, and certified registered nurse practitioners [CRNP] and physician assistants [PA]), and by geographic distribution in the United States. Methods: By using a de-identified commercial database of medical encounters, we identified all claims for outpatient oral challenges and desensitizations in 2017 and grouped them separately by clinician type and by U.S. Census region. We used analysis of variance to test for cost differences between these two groupings. Results: Allergy/immunology physicians performed the majority of oral challenges (74.36%) with a mean cost of $161, significantly less than that of other physicians ($280). Allergy/immunology physicians also performed the majority of desensitizations (84.48%) with a mean cost of $335, significantly higher than that of CRNPs/PAs ($280); other physicians were reimbursed significantly more than both groups ($410). By geographic region, the mean costs of oral challenges in the Northeast ($212) and the West ($210) were significantly higher than those of other regions, whereas the mean cost of desensitizations was significantly highest in the West ($381). Conclusion: Allergy/immunology physicians and CRNPs/PAs cost the least with respect to oral challenges, whereas CRNPs/PAs cost the least with respect to desensitizations. The Northeast and the West regions provided the highest cost for oral challenges, whereas the West was most expensive in terms of desensitizations. Further knowledge and examination of these reimbursement patterns are crucial in understanding their relative value and the impact on delivery of high-value care.

340 Simultaneous Preservation of Language and Executive Function in the Dominant Hemisphere

INTRODUCTION: Although awake brain mapping is the gold-standard for the preservation of neurological function in patients with tumors in eloquent regions, it is resource-intensive, costly, and exposes patients to additional perioperative risks. Therefore, the tasks used to map out the brain should be carefully selected and limited to cognitive processes that will be permanently impaired if those brain regions are violated. Impairments in language and executive function are common after tumor resection and are associated with decreased survival. However, mapping of each of those functions separately is often infeasible and antithetical to the delivery of high-value care. METHODS: Each participant underwent awake craniotomy with intraoperative mapping using a single lexical retrieval task. Linear mixed-effects modeling was used to assess for a return to preoperative functional levels in language and executive function at preoperative, two days postoperative, and greater than one-month postoperative intervals. RESULTS: Participants had lesions in regions that placed them at risk for long-term functional impairments including the perisylvian language network and anterior cingulate gyrus. In the immediate postoperative setting, participants had substantial declines in language and overall executive function performance. However, at longer (i.e., >1 month) testing intervals, performance on both domains returned to baseline levels. Longitudinal changes in picture naming performance were predictive of changes in a measure of executive function that indexes cognitive flexibility. CONCLUSION: In patients undergoing resection of brain tissue in the dominant hemisphere, separate mapping of language and executive functions may not be necessary so long as a task that reliably recruits both is implemented during awake brain mapping.

Clinical Redesign: An Innovative Approach to Leading Change at an Academic Healthcare System.

SUMMARY Goal: We characterized the core elements of a clinical redesign program (CRDP) to represent both a team and a methodology to rapidly improve outcomes important to patients and hospitals (e.g., length of stay, unnecessary care, and cost). Unique features of our CRDP included a clinician lead, engagement from senior leadership, formal project management, and rapid cycle implementation. We aimed to examine the effectiveness of this strategy across three different project examples. Methods: Using an observational pre–post study design, we compared the patient-level data for three representative projects applying the core elements of the CRDP: (1) optimizing telemetry utilization, (2) creating a high flow nasal cannula protocol in the pediatric intensive care unit, and (3) standardizing care for patients with chronic obstructive pulmonary disease and pneumonia. Principal Findings: The primary metrics for all three projects were a project-specific clinical outcome and cost per case. Telemetry utilization was reduced from a peak of 26.0% to 19.6% with a $1,075 reduction in cost per case. Creation of a high flow nasal cannula protocol led to a decrease in median pediatric intensive care unit length of stay from 77.3 to 75.8 hours with a $2,020 decrease in cost per case. Decreasing variation of care for patients with chronic obstructive pulmonary disease and pneumonia diagnoses led to a $371 decrease in cost per case. Applications to Practice: The CRDP adds to existing clinical quality improvement models using a structured process for a 90-day rapid cycle project turnaround. In addition, the CRDP incorporates project management and defined team members for the completion and sustainability of projects. The CRDP also facilitates the scalable translation of projects from local to systemwide and incorporates tracking of clinical and financial outcomes through interval internal auditing. These elements provide prioritization, resource allocation, and expertise for improved patient care and high-value care delivery. The CRDP can be adapted for other contexts to lead and foster momentum and drive rapid and successful completion of clinical improvement projects.

Population Health Trends in the Delivery of High Value Care for Knee Osteoarthritis

Osteoarthritis (OA) of the knee is a common and disabling condition that represents around 20% of the global burden of musculoskeletal disease with a lifetime risk estimated at 13%-26%. The escalation in cases is associated with a rise in ageing and obese populations. OA of the knee is also now recognized as a multi-faceted problem affecting not only an individual's physical health but their psychological and social wellbeing. Thus, a condition-focused, whole person approach that encompasses a range of treatment strategies is critical to managing populations with this condition in order to achieve value – an improvement in health outcomes benefiting patients relative to cost. Comprehensive models focused on delivering high value care for knee osteoarthritis that aim to meet the preferences, values, and needs of patient populations with this condition have been developed at The Muskuloskeletal Institute at the University of Texas at Austin, Dell Medical School, and the Joint Health Program, at Duke University Health System. Both programs strive to address the risk factors underlined in this chapter via multi-disciplinary teams and multi-modal approaches that are highly coordinated, continuous over time and between visits, and designed around the patient's needs toward a common goal of value. In this article we discuss the population level impact and health trends associated with knee osteoarthritis, alongside the design, delivery, and impact of these comprehensive models of care delivery.

Patient-centered care in musculoskeletal practice: Key elements to support clinicians to focus on the person

Musculoskeletal rehabilitation, including physiotherapy, needs to move towards a broader biopsychosocial understanding of musculoskeletal conditions and the delivery of high-value care for people with persistent pain conditions, in which a patient-centered approach is a key feature. However, it has been reported that clinicians experience difficulties with integrating patient-centered care principles into their clinical practice. Based on a focused symposium about patient-centered care for patients with musculoskeletal conditions, held during the online 2021 World Physiotherapy Congress, the purpose of this article is to share key elements of the content of this symposium with a wider audience, aimed at enabling clinicians to enhance patient-centeredness in their current practice. These key elements include establishing meaningful connections, deciding together and self-management support. Moreover, challenges on patient-centered care in low/middle income countries will be discussed and recommendations to implement patient-centered care in clinical practice will be provided.

PMS23 Preferences of Patients with Rheumatoid Arthritis Are Diverse and Changeable

Rheumatoid arthritis affects 1.5 million adults in the U.S. and results in inflammation causing pain, joint damage, and loss of function. The course of the disease is highly dynamic and individualized, and yet clinicians and patients rarely discuss treatment preferences during clinical care which means many patients struggle with adherence to therapy. To assist in the delivery of high-value care, the objective of this study was to determine patient treatment preferences related to pain, joint damage, physical changes and fatigue, and whether preferences changed over time.

Ethical pause as a framework for high-value care of hospitalized COVID-19 patients

Caring for hospitalized patients with COVID-19 raises ethical dilemmas in which clinicians must weigh the unknown value of an intervention against the unknown risk of viral transmission. Current guidelines for delivering high-value care in the time of the COVID-19 pandemic do not directly address ethical dilemmas that arise from the unique concerns of individual patients. We propose an “ethical pause” in which clinicians address ethical dilemmas by taking time to ask three questions that invoke the major bioethical principles of beneficence, nonmaleficence, and distributive justice: will this intervention help my patient? Could this intervention harm my patient? Could this intervention harm or help others? Using two exemplar cases, we demonstrate how the process of deliberately asking and answering structured ethical questions is a mindful problem-solving strategy that facilitates delivery of high-value care.

Imagining a world without low-value services: progress, barriers, and the path forward.

Low-value services are a major problem in the US health care system. We believe that the coronavirus disease 2019 pandemic's unprecedented impact on the health system, and society writ large, offers an opportunity to reshape the conversation and incentives around low-value services. This article explores current barriers to and opportunities for accelerating progress toward high-value care delivery. We examine how financial and nonfinancial incentives, uncertainty in clinical decision-making, and insufficient partnering with patients and families contribute to the delivery of low-value care. We then explore potential solutions, including making it easier for clinicians to forgo low-value services and providing them with actionable information to make those decisions, expanding payer efforts to develop "value report cards," developing measures that map the adverse health and economic effects of low-value services, and training clinicians and health care leaders to engage in conversations with patients about the personal medical, financial, and psychological harms of low-valueservices.

Commentary: Improving the Sustainability of Healthcare in Canada through Physician-Engaged Delivery System Reforms.

Increasing private healthcare financing has been suggested as a solution toward improving healthcare quality and access within the Canadian healthcare system. However, Lee et al. (2021) find no evidence that increasing private financing would address the challenges faced by Canadian healthcare. We suggest turning our focus away from reforms that solely increase private healthcare financing and toward evidence-based delivery-system reforms to address both quality and sustainability. We present examples and supporting evidence of the effectiveness of patient-, physician-, organization- and system-level strategies. Changes should engage physicians and be implemented across Canada to facilitate a cultural shift toward experimentation and high-value care delivery.

Improving Medical Students' OSCE Performance in Telehealth: The Effects of a Telephone Medicine Curriculum.

To report on the implementation of a telephone medicine curriculum as part of the core clerkship in pediatrics for students at Johns Hopkins University School of Medicine and evaluate the curriculum's effect on student performance on a telephone medicine case as part of a required objective structured clinical exam (OSCE). Using a prospective cohort design with a convenience sample of third-year medical students during the 2016-2017 and 2017-2018 academic years, the authors compared the OSCE scores of students assigned to the curriculum with both historical and concurrent control groups of students who had not received the curriculum. Additionally, the authors compared the costs of the recommended testing by students in each group using the 2018 Centers for Medicare and Medicaid Services Clinical Laboratory Fee Schedule. Students assigned to the telephone medicine curriculum (students in the intervention group) had a significantly higher mean overall score on the simulated OSCE telephone medicine case compared with the students in the control groups who did not receive the curriculum (the mean score for students in the intervention group was 7.38 vs 6.92 for students in the control groups, P = .02). Additionally, the intervention group had statistically significantly lower costs for their recommended testing compared with the control groups (the median value for tests ordered by students in the intervention group was $27.91 vs $51.23 for students in the control groups, P = .03). Implementing a dedicated telephone medicine curriculum for medical students improves their overall performance and delivery of high-value care via telephone medicine as part of an OSCE. Medical educators should pursue ongoing research into effective methods for teaching medical students and residents how to navigate digital encounters.

Preparing Trainees to Deliver High-Value and Cost-Conscious Care in Hematology.

Despite national-level directives to reduce healthcare waste and promote high-value care (HVC), clinical educators struggle to equip trainees with the knowledge and skills needed to practice value-based care. In this review, we analyze ongoing efforts in graduate medical education (GME) to enhance trainee competence in delivery of high-value and cost-conscious care. Surveys of residents and program directors have shown that while many training programs want to offer formal training in high-value care delivery, few succeed. Although several studies suggest that trainees model stewardship behaviors after clinical preceptors, there remains a shortage of faculty role models skilled in providing HVC. Preparing future hematologist-oncologists to provide cost-conscious care will require significant cultural change at the institutional and program levels and will depend heavily on the development of skilled clinical role models.

National Osteoarthritis Strategy brief report: Living well with osteoarthritis.

Recommended first-line management oflower limb osteoarthritis (OA) includes support for self-management, exercise and weight loss. However, many Australians with OA do not receive these. A National Osteoarthritis Strategy (the Strategy) was developed to outline a national plan to achieve optimal health outcomes for people at risk of, or with, OA. The aim of this article is to identify priorities for action for Australians living with OA. The Strategy was developed in consultation with a leadership group, thematic working groups, an implementation advisory committee, multisectoral stakeholders and the public. Two priorities were identified by the 'living well with OA' working group: 1) support primary care practitioners in the delivery of high-value care to Australians with OA, and 2) enhance the uptake of high-value care by Australians with OA. Evidence-informed strategies and implementation plans were developed through consultation to address these priorities.

Implementing high value back pain care in private physiotherapy in Australia: A qualitative evaluation of physiotherapists who participated in an “implementation to innovation” system

ABSTRACT Objectives: Many barriers exist to delivering high-value care for people with low back pain (LBP). We have developed a multistrategy implementation system to overcome these barriers. Here we describe a qualitative evaluation of the experiences of private-sector physiotherapists implementing the system. Design: PRISM (Practice-based innovation and implementation system) is an iterative clinician-as-scientist implementation program, tailored here for acute and subacute LBP. PRISM integrates strategies from behavioral change, implementation, and educational science fields. Semistructured interviews, group discussion forums, and electronic questionnaires were used to collect data at multiple time points that were then analyzed using an interpretative descriptive approach. Participants: Six physiotherapists (purposive sample) practicing in private practice physiotherapy clinics in the Adelaide region, South Australia, were enrolled in the study. Interventions: Interventions included an educational pain science and care workshop incorporating self-regulated learning principles, a co-planned clinical pathway, an electronic decision support tool, development and support of a community of practice, case study simulations, audit and feedback, and collaborative problem solving and innovation for physiotherapists. Results: Participants’ experiences and perceptions centered around five themes: (1) knowledge and skills training; (2) networking and mentoring; (3) a clear clinical pathway; (4) practical tools; and (5) data feedback. Participants appraised the implementation process positively but identified patient receptiveness as a challenge at times. Suggestions for improvement included streamlining/automating data collection forms and processes and providing more simulation opportunities. Conclusions: PRISM appears to be a promising approach to overcoming several barriers that prevent people with back pain from receiving high-value care. It consolidates and increases pain science knowledge and increases physiotherapist confidence in delivering high-value care. It appears to legitimize some current practices, enhance clinical reasoning and communication skills, extend knowledge in line with contemporary pain science, and facilitate the application of a biopsychosocial management approach. The high-level acceptance by participants provides a foundation for further research to test outcomes and delivery in different settings. Contribution of the article A quality improvement intervention designed to improve delivery of high-value care was well received by private practice physiotherapists. Physiotherapists particularly valued using experiential learning to improve fluency in communicating with, and educating patients about, contemporary pain science. A structured clinical pathway and tools guided physiotherapists on the basic elements of necessary care and allowed them to concentrate on higher levels of decision making and communication with patients.