Evaluating the cost of NP-led vs. GP-led primary care in British Columbia.

In 2020, British Columbia (BC) opened four pilot Nurse Practitioner Primary Care Clinics (NP-PCCs) to improve primary care access. The aim of this economic evaluation is to compare the average cost of care provided by Nurse Practitioners (NPs) working in BC's NP-PCCs to what it would have cost the government to have physicians provide equivalent care. Comparisons were made to both the Fee-For-Service (FFS) model and BC's new Longitudinal Family Physician (LFP) model. The analyses relied on administrative data, mostly from the Medical Services Plan (MSP) and Chronic Disease Registry (CDR) via BC's Health Data Platform. Results show the cost of NPs providing care in the NP-PCCs is slightly lower than what it would cost to provide similar care in medical clinics staffed by physicians paid through the LFP model. This suggests that the NP-PCC model is an efficient approach to increase accessibility to primary care services in BC and should be considered for expansion across the province.

Pre-post analysis of the impact of British Columbia nurse practitioner primary care clinics on patient health and care experience.

OBJECTIVE: This study aims to evaluate the impact of a primary care nurse practitioner (NP)-led clinic model piloted in British Columbia (Canada) on patients' health and care experience. DESIGN: The study relies on a quasi-experimental longitudinal design based on a pre-and-post survey of patients receiving care in NP-led clinics. The prerostering survey (T0) was focused on patients' health status and care experiences preceding being rostered to the NP clinic. One year later, patients were asked to complete a similar survey (T1) focused on the care experiences with the NP clinic. SETTING: To solve recurring problems related to poor primary care accessibility, British Columbia opened four pilot NP-led clinics in 2020. Each clinic has the equivalent of approximately six full-time NPs, four other clinicians plus support staff. Clinics are located in four cities ranging from urban to suburban. PARTICIPANTS: Recruitment was conducted by the clinic's clerical staff or by their care provider. A total of 437 usable T0 surveys and 254 matched and usable T1 surveys were collected. PRIMARY OUTCOME MEASURES: The survey instrument was focused on five core dimensions of patients' primary care experience (accessibility, continuity, comprehensiveness, responsiveness and outcomes of care) as well as on the SF-12 Short-form Health Survey. RESULTS: Scores for all dimensions of patients' primary care experience increased significantly: accessibility (T0=5.9, T1=7.9, p<0.001), continuity (T0=5.5, T1=8.8, p<0.001), comprehensiveness (T0=5.6, T1=8.4, p<0.001), responsiveness (T0=7.2, T1=9.5, p<0.001), outcomes of care (T0=5.0, T1=8.3, p<0.001). SF-12 Physical health T-scores also rose significantly (T0=44.8, T1=47.6, p<0.001) but no changes we found in the mental health T scores (T0=45.8, T1=46.3 p=0.709). CONCLUSIONS: Our results suggest that the NP-led primary care model studied here likely constitutes an effective approach to improve primary care accessibility and quality.

Design, delivery, and evaluation of a knowledge translation intervention for multi-stakeholders.

BACKGROUND: Knowledge translation (KT) is a key competency for trainees (graduate students and post-doctoral fellows), the new generation of researchers who must learn how to synthesize, disseminate, exchange, and ethically apply knowledge to improve patient and health system services, products, and outcomes. KT training is a key enabler to support KT competency development. Yet, there is a dearth of research on the design, delivery, and evaluation of KT training for trainees. METHODS: The study applied a QUAN(qual) mixed methods approach with an embedded experimental model design. A heart and lung patient was also recruited to participate as a partner and researcher in the study. A multi-faceted KT intervention for trainees was designed, delivered, and evaluated. Data were collected using surveys and focus groups. Quantitative data were analyzed using descriptive and inferential statistics in R Studio and MS Excel. Qualitative data were analyzed in NVivo using thematic analysis. RESULTS: Participation in each KT intervention varied, with 8-42 participants attending KT webinars, 61 attendees in the Three Minute Thesis (3MT) Competition Heat, and 31 participants in the Patient & Public Forum. In total, 27 trainees and 4 faculty participated in at least one of the KT webinars. Trainee participants reported satisfaction, as well as statistically significant increases in 10/13 KT competencies after receiving one or more components of the KT intervention. Additionally, participating faculty, patients, and the public were satisfied with the intervention components they participated in. Several challenges and facilitators were also identified to improve the KT intervention. CONCLUSIONS: The KT intervention is a promising initiative that can be adopted and adapted across various post-secondary settings to support trainees' competency development in KT. This evaluation demonstrates that trainees will respond to opportunities for KT training and that capacity for KT competencies can be advanced through a multi-faceted intervention that involves trainees, faculty, patients, and health system collaborators in its design and delivery. This evaluation study contributes the design and results of a novel KT intervention for multi-stakeholders. TRIAL REGISTRATION: N/A.

The role of artificial intelligence in learning and professional development for healthcare professionals.

This article discusses the emerging role of Artificial Intelligence (AI) in the learning and professional development of healthcare professionals. It provides a brief history of AI, current and past applications in healthcare education and training, and discusses why and how health leaders can revolutionize education system practices using AI in healthcare education. It also discusses potential implications of AI on human educators like clinical educators and provides recommendations for health leaders to support the application of AI in the learning and professional development of healthcare professionals.

Evaluating a post-implementation electronic medical record training intervention for diabetes management in primary care.

OBJECTIVE: This study evaluated the potential for electronic medical record (EMR) video tutorials to improve diabetes (type 1 and 2) care processes by primary care physicians (PCP) using OSCAR EMR. DESIGN: A QUAN(qual) mixed methods approach with an embedded design was used for the overall research study. EMR video tutorials were developed based on the chronic care model (CCM), value-adding EMR use, best practice guidelines for designing software video tutorials and clinician-led EMR training. RESULTS: In total, 18 PCPs from British Columbia, Canada, participated in the study. The video EMR intervention elicited a statistically significant increase in EMR advanced feature use for diabetes care, with a large effect size (ie, F(1,51)=6.808, p<0.001, partial η2=0.286). CONCLUSION: This small-scale efficacy study demonstrates the potential of CCM-based EMR video tutorials to improve EMR use for chronic diseases, such as diabetes. A larger-scale effectiveness study with a control group is needed to further validate the study findings and determine their generalisability. The demonstrated efficacy of the intervention suggests that EMR video tutorials may be a cost-effective, sustainable and scalable strategy for supporting EMR optimisation and the continuous learning and development of PCPs. Health informatics practitioners may develop video tutorials for their respective EMR/electronic health record software based on theory and best practices for video tutorial design. For patients, EMR video tutorials may lead to improved tracking of processes of care for diabetes, and potentially other chronic conditions.

Evidence-Based Usability Principles for Safe Computerized Provider Order Entry (CPOE) Interface Design.

There is a dearth of evidence-based tools to design the safest Computerized Provider Order Entry (CPOE) system possible. An evidence-based list of usability principles for the design of the CPOE interface was developed following a literature review, and validated with the Chief Medical Information Officer and CPOE team at Island Health. The list includes 11 usability principles that can be used to inform ongoing CPOE interface design and evaluation efforts to improve patient safety.

Educational approaches for improving physicians' use of health information technology.

The benefits of Health Information Technology (HIT) depend on the way they are being used. Education and training are often needed to move from basic to advanced, value-adding, use. In this article, we describe three educational approaches that can help in achieving this goal: "productive failure," video tutorials, and simulation. We describe the rationale behind these approaches, their strengths, and limitations and illustrate their application, respectively, to three problems associated with the use of HIT in clinical practice: improving data quality within Electronic Medical Records (EMRs) at the point of data entry, use of advanced EMR features for chronic disease management, and impact of the EMR on patient-clinician communication. We conclude that, while these approaches are promising, there is a need for innovation and diversity of educational approaches to address use of advanced HIT features, identified challenges with HIT, and usage in context-as well as for rigorous evaluation.

Realizing Quality & Experience Benefits Through EHR Adoption & Use: A Conceptual Model.

A conceptual model of EHR adoption and use is presented, which details the components necessary to realize both quality and experience benefits. The model was developed based on a review of the conceptual and theoretical frameworks related to technology adoption/use and quality in health care. It includes 42 constructs, six key constructs, three antecedents, four moderator variables, and two key benefit areas (i.e., quality and experience) at the micro, meso, and macro levels. The model has been operationalized through identification of over 130 metrics for measuring the constructs. The model may be used to inform planning, decision-making, and evaluation of EHR implementations and benefits realization. It is recommended that the EAU model be further tested.

A Conceptual Model for Increasing Use of Electronic Medical Records by Primary Care Physicians Through End-User Support.

A conceptual model for exploring the relationship between end-user support (EUS) and electronic medical record (EMR) use by primary care physicians is presented. The model was developed following a review of conceptual and theoretical frameworks related to technology adoption/use and EUS. The model includes (a) one core construct (facilitating conditions), (b) four antecedents and one postcedent of facilitating conditions, and (c) four moderators. EMR use behaviour is the key outcome of the model. The proposed conceptual model should be tested. The model may be used to inform planning and decision-making for EMR implementations to increase EMR use for benefits realization.

A Knowledge Translation Project on Best Practices in End-of-life Care.

This is a knowledge translation project to promote the uptake of best practices in end-of-life (EOL) care within the primary care setting in British Columbia (BC) through the use of tools embedded into electronic medical records (EMRs). The knowledge-to-action model is used to engage primary care providers in co-designing, adopting and evaluating the EOL care toolkit built for 3 EMRs. The toolkit has a set of EMR-specific data entry templates, query/report functions and access to additional downloadable resources. It is based on the EOL learning module designed and offered by the BC General Practice Services Committee's Practice Support Program to improve EOL care by primary care providers in the province. Our web-based distribution method allows providers to download and install the toolkit then take part to evaluate its use and impact. Initial feedback from phases 1-3 (of 4) has been favorable and has led to iterative improvements.

Applying the clinical adoption framework to evaluate the impact of an ambulatory electronic medical record.

This paper describes the application of the Clinical Adoption (CA) Framework to evaluate the impact of a recently deployed electronic medical record (EMR) in a Canadian healthcare organization. The CA Framework dimensions evaluated were EMR quality, use and net benefits at the micro level; and people, organization and implementation at the meso level. The study involved clinical and support staff from two ambulatory care clinics, and managers and technical staff from the organization. A number of issues were identified at both levels of the CA Framework that had affected EMR adoption in the two clinics. Some perceived benefits in care coordination and efficiency were reported despite challenges that arose from early deployment decisions. There were five lessons that could be applied to other ambulatory care settings. The CA Framework has proved useful in making sense of ways that EMR can add value to the organization.

Evaluating the adoption of e-prescribing in primary care.

The purpose of this study was to examine the adoption of e-prescribing by primary care physicians in Central Vancouver Island. To accomplish this, a multi-method study design was used to compare the ideal state of e-prescribing (desired e-prescribing features in an electronic medical record [EMR]) with the possible state (what the EMR offers) and current state (what physicians are using in practice). The authors found that recruited physicians are using most of the e-prescribing and EMR features available. However, there are several gaps between the ideal, possible and current states of e-prescribing. The authors address the identified gaps through physician-level, policy-related and technology-related recommendations to improve the adoption, design and development of e-prescribing features.