Patient-centered Health Care Delivery Research Articles

An evaluation of Alberta retina health service delivery in an office setting: a cross-sectional survey of patient experience

BackgroundRetina sub-specialists provide much of the retina related eye care across Canada. In the province of Alberta, 18 retina sub-specialists work across six different offices. The purpose of this study was to assess the quality of care provided by Alberta retina sub-specialists in an office setting by administering a patient satisfaction survey. The results of this survey were provided to the same retina specialists to promote improvements in patient-centered health care delivery.MethodsA cross sectional patient satisfaction survey was performed using a thirty-part questionnaire developed in collaboration with the Physician Learning Program at the University of Alberta. The survey was modelled after other similar patient satisfaction surveys used in other areas of medicine. Patients from ten of the eighteen retina practices in Alberta participated in this survey. Topics of the survey included pre-appointment experience, physician-patient interactions and quality, comments/ feedback and patient demographics.Results214 randomly sampled patients completed the survey from three geographically separate office locations in Calgary and Edmonton. 90% of patients responded that their retina sub-specialist listened adequately and provided quality care in a timely manner. Patients felt that there could be improvements to accessibility to the clinic and reduced wait times, as well as in the pre-operative consent process. Including a more complete explanation of the procedure as well as the potential risks and benefits. Only 51% of patients felt that the risks of a potential surgery had been adequately explained to them. There was a statistically significant association found between overall satisfaction and lower wait times, understanding of procedural risks and time with, listening to and involving the patient in care. There were no correlations found with other demographics such as ethnicity, sex, distance traveled or age.ConclusionsThis patient satisfaction survey provided valuable patient care feedback to the retina sub-specialists of Alberta. The survey results will assist this group to improve the consent process and thereby improve patient centered health care delivery. We would recommend the distribution of this survey or other similar patient satisfaction questionnaire by retina sub-specialists to their patients to improve patient centered care in their clinics.

Provision of contraceptive implants in school-based health centers: A cost-effectiveness analysis

ObjectiveTo evaluate the cost-effectiveness of providing contraceptive implants in school-based health centers (SBHCs) compared to the practice of referring adolescents to non-SBHCs in New York City. Study DesignWe developed a microsimulation model of teen pregnancy to estimate the cost-effectiveness of immediate provision of contraceptive implants at SBHCs over a 3-year time horizon. Model parameters were derived from both a retrospective chart review of patient data and published literature. The model projected the number of pregnancies as well as the total costs for each intervention scenario. The incremental cost-effectiveness ratio was calculated using the public payer perspective, using direct costs only. ResultsThe health care cost of immediate provision of contraceptive implants at SBHCs was projected to be $13,719 per person compared to $13,567 per person for delayed provision at the referral appointment over 3 years. However, immediate provision would prevent 78 more pregnancies per 1000 adolescents over 3 years. The incremental cost-effectiveness ratio for implementing in-school provision was $1940 per additional pregnancy prevented, which was less than the $4206.41 willingness-to-pay threshold. Sensitivity analyses showed that the cost-effectiveness conclusion was robust over a wide range of key model inputs. ConclusionProvision of contraceptive implants in SBHCs compared to non-SBHCs is cost-effective for preventing unintended teen pregnancy. Health care providers and policymakers should consider expanding this model of patient-centered health care delivery to other locations.

The effect of multimorbidity on functional limitations and depression amongst middle-aged and older population in China: a nationwide longitudinal study.

multimorbidity contributes to a large portion of the disease burden in low- and middle-income countries. However, limited research has been undertaken in China. This study has investigated the prevalence of multimorbidity and the associations of multimorbidity with activities of daily living (ADL), instrumental activities of daily living (IADL) and depression in China. the study participants included 10,055 adults aged 45years and older from three rounds of the China Health and Retirement Longitudinal Study 2011-2015. Random-effects logistic regression models were used to examine the association of multimorbidity with ADL limitation, IADL limitation and mental disease. the prevalence of multimorbidity amongst adults in China aged 45years and older was 62.1% in 2015. The prevalence of multimorbidity was increased with older age, among women, in a higher socio-economic group and in the most deprived regions. Multimorbidity is associated with an increased likelihood of experiencing ADL limitation (adjusted odds ratio [AOR] = 5.738, 95% confidence intervals (CI) = 5.733, 5.744) and IADL limitation (AOR = 2.590, 95% CI = 2.588, 2.592) and depression (AOR = 3.352, 95% CI = 3.350, 3.354). Rural-urban disparities in functional difficulties and depression were also found amongst patients with multimorbidity. the burden of multimorbidity is high in China, particularly amongst the older population. Multimorbidity is associated with higher levels of functional limitations and depression. China healthcare reforms should introduce integrated care models and patient-centred healthcare delivery. The increasing need for reorientation of healthcare resources considering the distribution of multimorbidity and its adverse effect requires more attention from health policymakers in China and other developing countries.

Use of Patient Navigators to Reduce Barriers in Living Donation and Living Donor Transplantation

The transplant community is facing an important and growing crisis in healthcare disparities, which limits the access of vulnerable populations to successful transplant and its most ideal form, living donor transplantation [1–6]. The time is now to implement strategies that facilitate access to timely living donor transplant and relieve the pressure on a burdened deceased donor waiting list. Patient navigation programs have arisen as distinctive model of patient-centered healthcare delivery to overcome existing disparities in access to healthcare. Originally used in oncology [7–9] and gaining momentum across other specialties, navigators function as educators, sponsors, and allies to patients and their potential donors. Similarly, they provide unique insight, context, and valuable feedback to transplant providers who may be insufficiently aware of the challenges faced by the transplant candidates and the potential donors they care for. Ultimately, patient navigators can help decrease the risk of premature transplant process withdrawal, increase the likelihood of work-up completion, demystify living donor misconceptions and misunderstandings, and help maintain engagement of transplant candidates and their donors. While data are still emerging, the future of patient navigation seems promising, particularly as an intervention to help equalize the access to living donor transplantation to the most vulnerable and under-resourced transplant candidates. In this review, we explore the role of patient navigation programs in solid organ transplantation and how they could help reduce the inequities in living donation and living donor transplantation.

Same-Day Patient Consultation and Cochlear Implantation: Innovations in Patient-Centered Health Care Delivery.

To develop and implement a streamlined, patient-centered service delivery model for patients referred for cochlear implantation (CI) at a high-volume academic center. CI candidate adults. CI, implementation of new CI delivery model. Referral-to-surgery time, patient travel burden. Data from 206 adults that underwent CI were used to develop a process map of the initial operational state from referral date to day of surgery (referral-to-surgery time). The initial referral-to-surgery time was 136 days on average, yet the average total work time by all involved providers was 17.6 hours. Prolonged wait times were associated with the following preoperative tasks: appointment scheduling, insurance approval, device ordering and shipment, and surgical scheduling. Patients traveled to the institution on at least two occasions for appointments. A new bundled, patient-centered CI delivery model was developed to address prolonged wait times, travel burden, and process inefficiencies. The new model implemented an interactive electronic medical record, coordinated appointments with same-day surgery, and stocked device inventory to reduce the referral-to-surgery time to 24 days-an improvement of 112 days. In the new model, new patient consultation and surgery were completed in one day, reducing the patient travel burden to the institution. The new CI program demonstrates that delivery innovations can have a substantial impact on measures of patient convenience and experience, and that these results are achievable without new technologies or changes in medical management. With a focus on patient-centered design, health care delivery models can be augmented to increase value for patients.

Assessment of patient satisfaction and associated factors in an outpatient department at Dangila primary hospital, Awi zone, Northwest Ethiopia, 2018

ABSTRACT Various problems were faced by patients in any hospital outpatient department. But, Patients seek quick and convenient services. Patient satisfaction improves clinical outcomes and patient retention and reduces medical malpractices. Efficient and patient-centered health care delivery is of utmost importance. Thus, patient satisfaction is a very effective indicator to measure the success of health outcomes and plays a key role in improving health service quality and early report of new outbreaks (e.g., Covid-19) or other outbreaks (e,g measles, polio). Objective of this study was to assess patient satisfaction and associated factors on outpatient department, Dangila Primary Hospital, Awi zone, Northwest Ethiopia, 2018. Cross sectional study design was conducted from April 1st to August 31st, 2018. A total of 304 respondents were selected using systematic random sampling. Structured questionnaire was used for data collection. EPI Data version 3.1 and SPSS version 20 were used for data entry and analysis, respectively. Multiple logistic regression was employed to describe associated factors and control potential confounders. Of all 304 participants, 175 (57.6%) were males and 129 (42.4%) were females. About 100 (32.9%) were with age range of 30-39 years. Nearly three-fourth of respondents, 233 (76.6%) were dissatisfied with the queue system to see a doctor. Level of patient satisfaction and waiting time in outpatient department was 48.2% and 48 minutes, respectively. Multivariate logistic regression indicated that satisfaction with courtesy and respect (p=0.013) and satisfaction with confidentiality taken by the examiner during physical examination (p=0.012) were associated factors for patient satisfaction. Patient satisfaction in outpatient department in Dangila primary hospital was lower than regional target. Courtesy and respect and satisfaction with confidentiality taken by the examiner during physical examination were associated factors for patient satisfaction. Outpatient waiting time was less than one hour.

Laboratory quality improvement: Act or perish

The increasingly dominant role of laboratory medicine in clinical decision-making and the simultaneous pressure on cost containment have led to careful evaluation and identification of preventable causes of errors in total testing process of laboratory analyte. The patient-centric health-care delivery system mandates the need to formulate policies and procedures based on international guidelines to minimize errors of laboratory professionals or nonlaboratory operators. The paper summarizes various areas of laboratory that are prone to errors so that the laboratory can redesign the system and make it resistant to errors unknowingly committed by health-care professionals.

Patient reported outcomes in elective laparoscopic cholecystectomy.

Backgrounds/AimsTraditional outcome measures (e.g., length of hospital stay, morbidity, and mortality) are used to determine the quality of care, but these may not be most important to patients. It is unclear which outcomes matter to patients undergoing elective laparoscopic cholecystectomy (ELC). We aim to identify patient-reported outcome measures (PROM) which patients undergoing ELC valued most.MethodsA 45-item questionnaire with Four-point Likert-type questions developed from prior literature review, prospectively administered to patients treated with ELC at a tertiary institution in Singapore.ResultsSeventy-five patients participated. Most essential factors were technical skill and experience level of a surgeon, long-term quality of life (QoL), patient involvement in decision-making, communication skill of a surgeon, cleanliness of the ward environment, and standards of nursing care. Least important factors were hospitalization leave duration, length of hospital stay, a family's opinion of the hospital, and scar cosmesis. Employed patients were more likely to find hospitalization leave duration (p<0.001) and procedure duration (p=0.042) important. Younger patients (p=0.048) and female gender (p=0.003) were more likely to perceive scar cosmesis as important.ConclusionsPatients undergoing ELC value long-term QoL, surgeon technical skill and experience level, patient involvement in decision-making, surgeon communication skill, cleanliness of the ward environment, and nursing care standards. Day-case surgery, medical leave, family opinion of hospital, and scar cosmesis were least important. Understanding what patients value will help guide patient-centric healthcare delivery.

Clinical Relevance of Routine Monitoring of Patient-reported Outcomes Versus Clinician-reported Outcomes in Oncology

The National Cancer Institute Common Terminology Criteria for Adverse Events classification is the standard classification used by the physicians in oncology for reporting adverse events. This classification has evolved over the last years according to the emergence of new therapies. Reporting symptoms, quality of life (QoL) and toxicities via patient-reported outcomes (PROs) in clinical practice is not yet a standard of care, nevertheless many studies have been conducted recently to assess feasibility and impact of routine monitoring of PROs, which should enable for better management of toxicities and earlier detection of disease progression in a more patient-centered health care delivery system. The aim of this article was to discuss the advantages and limitations of both approaches, clinicians-reported outcomes and PROs. Growing evidence supports that the routine collection of PROs leads to improvement of QoL and overall survival of cancer patients.

Developing Sexual and Reproductive Health Educational Resources for Young Women with Cystic Fibrosis: A Structured Approach to Stakeholder Engagement.

Stakeholder engagement, specifically integration of patient and family perspectives about what matters, is increasingly recognized as a critical component of patient-centered healthcare delivery. This study describes a structured approach to and evaluation of stakeholder engagement in the development of novel sexual and reproductive health (SRH) educational resources for adolescent and young adult (AYA) women with cystic fibrosis (CF). Key stakeholders participated in a systematic series of steps to iteratively develop and adapt patient educational resources. Process measures (stakeholder recruitment, composition, co-learning, and transparency) and proximal outcomes of stakeholder involvement (impact on the development process and satisfaction) were measured via recorded stakeholder recommendations and a stakeholder survey. Seventeen stakeholders participated in seven group and two patient-only conference calls. The majority of stakeholders understood their roles, had their expectations met or exceeded, and were satisfied with the frequency and quality of engagement in the project. All stakeholders in attendance provided multiple concrete recommen-dations during the development process. Stakeholders explored the motivations of AYA women with CF related to SRH and agreed that the ideal resource should be online. After reviewing the design of existing resources, stakeholders decided by consensus to partner with a pre-existing young women's health website and created 11 CF-specific SRH guides. This study illuminates a path for a formal process of stakeholder engagement and evaluation in educational resource development centered on the SRH care needs of AYA women with CF. Similar systematic, planned processes could be extended to other populations and aspects of healthcare.

A patient-derived conceptual framework of lung cancer care priorities.

206 Background: Patient-centric healthcare delivery, where patients are the ultimate decision-makers, warrants care evaluated based on patient priorities. A heterogeneous lung cancer patient population fosters variation in care priorities. This study identified care concept domains in a wholly patient-driven manner. Methods: Group concept mapping was used to assess priorities among patients invited from the PatientsLikeMe online community aged ≥18, US residents, and self-reporting lung cancer. In Phase I, 26 patients generated ideas based on the focus prompt: “ What do you want to achieve when it comes to the treatment you are receiving or are considering receiving for your lung cancer?”. 78 ideas were generated over 2 weeks. Supplementation from literature, editing for relatability, independence, and consistency yielded 78 concepts. In Phase II 67 patients used CSGlobalMax® (Concept Systems, 2018) to rate the concepts for importance (1 = not important to 5 = very important); 64 of which grouped and named the ideas into categories of unrestricted size. Multidimensional scaling and hierarchical cluster analysis generated visual maps, average importance, and categorized concept domains. Domains were compared across all patients and by treatment experience (≤1 or &gt; 1 systemic regimens) and stage at diagnosis. Results: Patients were female (78%), white (93%), and mean age of 62 (SD 8.9). 93% reported non-small cell lung cancer, 70% reported Stage III or IV diagnosis, and 58% were classified as early in treatment experience. 11 unique domains were visually represented. In order of average importance the domains were: managing lifestyle (4.52), care team quality, active participation in treatment, treatment goals, treatment options, side effects, social well-being, physical well-being, future options, fulfillment in daily living, and supportive environment (4.01). There was strong correlation between treatment subgroups (r = 0.89), although relative importance of domains shifted. Generalizability is limited. Conclusions: In this patient-driven research approach, patients developed the focus prompt, generated ideas, and structured concepts. The unique domains may help evaluate care value in patient-centric healthcare delivery.

A data integration platform for patient-centered e-healthcare and clinical decision support

The proliferation of disconnected information systems accumulating increasing volumes of heterogeneous data is a formidable challenge in the healthcare domain. It is necessary to address this challenge as the entire domain gradually transitions into e-healthcare and patient-centered healthcare delivery models. The lack of data integration at systems level prohibits clinicians from building a comprehensive understanding of the patient condition and further deprives patients of developing a holistic awareness of their medical conditions. In this paper, we propose an open data integration platform for patient, clinical, medical and historical data siloed across multiple health information systems. As an open platform, it can accommodate and integrate further heterogeneous data sources such as data streams generated by wearable IoT devices. As an integration platform, it facilitates the centralization of data assets. This centralization empowers every stakeholder in a patient-centered care setting to actively participate in decision-making. A range of analytics and reporting solutions, such as data warehouse, interactive dashboards, and predictive analytics tools, can be deployed upon this open data integration platform. The proposed platform is currently being adapted and implemented to address patient-centered healthcare and clinical decision support requirements in a sports injury clinic at a not-for-profit private hospital in Melbourne, Australia. Use Case based demonstration of the platform’s suitability for holistic information management, decision support, and predictive analytics justify its role in the advancement of e-healthcare.

Using Patient-Reported Outcome Measures for Quality Improvement in Clinical Genetics: an Exploratory Study

International advocacy of patient-centred healthcare delivery has led to emphasis on the (re)design and evaluation of healthcare processes and outcomes from a patient perspective. Patient-reported outcome measures (PROMs) have significant potential to inform such attempts. However there is limited understanding of the processes by which this can be achieved. This exploratory study followed attempts to utilise two different PROMs measures to support service quality improvement in clinical genetics. PROMs used were the Genetic Counseling Outcome Scale (GCOS-24), a well-validated clinical genetics-specific PROM and Euroqol (EQ-5D), a generic PROM favoured by the UK National Institute for Health and Excellence (NICE). Both of these PROMs enable pre/post intervention comparison. A service audit tool was also used, premised on a patient-reported experience measure. In addition, the study draws on interviews with clinical staff to identify challenges associated with the use of PROMs (response rate, data collection, analysis). Benefits are also explored and include the provision of insight into patients’ needs; complementing clinical judgement; identification of needs being met, evidencing the benefit of services provided; prompting consideration of areas requiring attention; and encouraging professional development.

Bridging the Gap between Population Needs and Barriers into Onsite Clinic Use

Providing occupational care in worksite clinics has been a common service offered by employers specifically among companies with high incidence of hazardous events. In recent years, onsite clinics have expanded their services to non-occupational care. Various types of employers such as universities have started providing care to employees and their dependents through onsite clinics. The purpose of this pilot study is to assess health claim data of a self-insured public university to identify patient-population factors, such as demographic and health conditions, that may influence the utilization of health services offered by the onsite clinic. Common health services and health conditions were compared for patients using onsite clinic and for patients that choose to use offsite providers. Potential hypotheses based on the presented descriptive comparisons are proposed to further distinguish population health needs and potential barriers on onsite clinic usage. Preliminary findings and methodology in this pilot study can help improve healthcare services provided by onsite clinics and lead to more patient-centered healthcare delivery.

Teaching Principles of Patient-Centered Care During Radiology Residency

Patient-centered healthcare delivery has become increasingly established as a cornerstone of quality medical care, but teaching these principles in a radiology residency setting is often difficult and ineffective in a traditional lecture format. We developed a novel educational session in which actual patient letters about a healthcare provider are used to facilitate a case-based discussion of key principles of patient-centered care. A novel patient letter-facilitated, case-based session was conducted at two different university-based teaching institutions. Prior to the educational session, patient letters introducing the principles of patient-centered care were distributed to residents for review. During the session, radiology-specific cases were discussed in the context of the principles introduced by the letters. A post-session survey was administered to evaluate the efficacy and usefulness of the session. Forty-six of the 61 session attendees (75%) completed the post session survey. Most respondents (93%) preferred this case-based, interactive session to a typical didactic session. A majority of the residents indicated that both the patient letters (64%) and radiology specific cases (73%) helped them think differently about how they interact with patients. They indicated that the session enhanced their understanding of professionalism (3.7 out of 5.0 [95% CI 3.4-4.0]) and increased their motivation to become more patient-centered (3.0 out of 4.0 [95% CI 2.8-3.3]). Our findings suggest that patient letter-facilitated, case-based sessions may influence resident attitudes regarding the principles of patient-centered care and may help to increase resident motivation to become more patient-centered in their own practice.

Patient Experience Assessment is a Requisite for Quality Evaluation: A Discussion of the In-Center Hemodialysis Consumer Assessment of Health Care Providers and Systems (ICH CAHPS) Survey.

Patient experience surveys provide a critical and unique perspective on the quality of patient-centered healthcare delivery. These surveys provide a mechanism to systematically express patients' voice on topics valued by patients to make decisions about choices in care. They also provide an assessment to healthcare organizations about their service that cannot be obtained from any other source. Regulatory agencies have mandated the assessment of patients' experience as part of healthcare value based purchasing programs and weighted the results to account for up to 30% of the total scoring. This is a testimony to the accepted importance of this metric as a fundamental assessment of quality. After more than a decade of rigorous research, there is a significant body of growing evidence supporting specifically the validity and use of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, including a version specific to in-center hemodialysis (ICH CAHPS). This review will focus on the ICH CAHPS survey including a review of its development, content, administration, and also a discussion of common criticisms. Although it is suggested that the survey assesses activities and experiences that are not modifiable by the healthcare organization (or the dialysis facility in our case) emerging evidence suggests otherwise. Dialysis providers have an exclusive opportunity to lead the advancement of understanding the implications and serviceability of the evaluation of the patient experience in health care.

Abstract TP293: Radial Access for Neurovascular Procedures-Patient Preference and Outcomes

Introduction: Radial access for neurovascular procedures is rarely performed or even considered. There is increasing evidence from the interventional cardiology literature that radial access is associated with lower costs, lower incidence of myocardial infarction, stroke, decreased major access site complications, and even decreased mortality. Roadblocks for adopting or considering radial access for neurovascular procedures includes physician bias, physician training, and limitations in technology/devices. As we move towards a patient centered health care delivery, patient preference and complication rates should be considered. The 2 goals of this poster presentation are to provide a simplified approach to performing radial access for neurovascular and to present data on patient preference and outcomes for radial access. Hypothesis: Radial access for neuro interventional procedures is preferred by patients over traditional femoral access and can be performed with a high degree of technical success and low rates of complications. Methods: Over a two-year period, 25 patients that had undergone conventional femoral angiography and presented for repeat angiography or subsequent neurovascular intervention were offered radial access. By including only patients that had undergone both femoral and radial access, we felt that this would provide the best comparison between the 2 techniques. Patient assessment survey included: Preference for femoral versus radial, degree of stress between the 2 procedures, degree of pain during and post-procedurally, any immediate/delayed complications, recovery time and ambulation time. Results: There was 100% patient preference for radial access and no minor (hematoma or pseudoaneurysm) or major access site complications (bleeding requiring transfusion, pseudoaneurysm requiring intervention, arteriovenous fistula, delayed occlusion). Conclusion: Radial access was preferred by patients over femoral access for neurovascular procedures and associated with low complications and high technical success.

Patient-centered Health Care Delivery Uniting MTM, EHRs and Patients: Opportunities for Pharmacists

Objective: To describe a patient-centered approach to health care delivery for chronically ill patients that emphasizes incorporation of HIT-driven Medication Therapy Management with Electronic Health Records. Summary: Health care delivery for patients with chronic conditions is often ineffective and costly. A consolidated approach is needed, and there has never been a more opportune time for pharmacists to implement improvements through HIT-driven Medication Therapy Management (MTM) incorporating Electronic Health Records. The primary role of the MTM provider is to identify and resolve barriers in treatment before the health and welfare of the patient are adversely affected. The proposed approach incorporates MTM services and Electronic Health Records and would help to achieve optimal drug therapy and address deficiencies in treatment for patients with chronic illnesses to improve quality of life. The EHR will be considered to be the centerpiece of health care delivery with the potential to improve patient safety, productivity, and data retrieval. The EHR will likely be the focal point of all patient encounters in the future, and the major access point of patient information for pharmacists in a variety of clinical settings. Conclusion: Current healthcare initiatives that promote MTM services and the use of Health Information Technology such as Electronic Health Records can improve on patient monitoring and favorably impact the prognosis for the patients with chronic illnesses.

Telemedicine for the elderly- opportunities are increasing, critical factors have to be tackled!

An autonomous life and quality .of life are essential objectives for the use of telemedicine among the elderly population. To make aging in place possible the elderly peoples' homes have to be embedded in an integrated health and aged care system. In addition to this, it is necessary to create coproduction with the patients and their relatives. However, to meet those targets it is required to achieve enormous rethinking and widely acceptance of telemedicine among all health care professionals. Medical institutions have to undergo vast changes towards a patient-centered health care delivery and an increased intersectoral and interdisciplinary collaboration. Political will for fair and just allocation processes is essential to avoid a potential digital divide among the population, e.g. for socioeconomic disadvantaged population groups or people living in rural areas. Therefore,flanking preparing measures and continuous support through easily accessible contact persons are essential. According adaptations of financial models and an extension of health insurance benefits will be necessary.

Return on investment in electronic health records in primary care practices: a mixed-methods study.

BackgroundThe use of electronic health records (EHR) in clinical settings is considered pivotal to a patient-centered health care delivery system. However, uncertainty in cost recovery from EHR investments remains a significant concern in primary care practices.ObjectiveGuided by the question of “When implemented in primary care practices, what will be the return on investment (ROI) from an EHR implementation?”, the objectives of this study are two-fold: (1) to assess ROI from EHR in primary care practices and (2) to identify principal factors affecting the realization of positive ROI from EHR. We used a break-even point, that is, the time required to achieve cost recovery from an EHR investment, as an ROI indicator of an EHR investment.MethodsGiven the complexity exhibited by most EHR implementation projects, this study adopted a retrospective mixed-method research approach, particularly a multiphase study design approach. For this study, data were collected from community-based primary care clinics using EHR systems.ResultsWe collected data from 17 primary care clinics using EHR systems. Our data show that the sampled primary care clinics recovered their EHR investments within an average period of 10 months (95% CI 6.2-17.4 months), seeing more patients with an average increase of 27% in the active-patients-to-clinician-FTE (full time equivalent) ratio and an average increase of 10% in the active-patients-to-clinical-support-staff-FTE ratio after an EHR implementation. Our analysis suggests, with a 95% confidence level, that the increase in the number of active patients (P=.006), the increase in the active-patients-to-clinician-FTE ratio (P<.001), and the increase in the clinic net revenue (P<.001) are positively associated with the EHR implementation, likely contributing substantially to an average break-even point of 10 months.ConclusionsWe found that primary care clinics can realize a positive ROI with EHR. Our analysis of the variances in the time required to achieve cost recovery from EHR investments suggests that a positive ROI does not appear automatically upon implementing an EHR and that a clinic’s ability to leverage EHR for process changes seems to play a role. Policies that provide support to help primary care practices successfully make EHR-enabled changes, such as support of clinic workflow optimization with an EHR system, could facilitate the realization of positive ROI from EHR in primary care practices.