Stoeckle Center research initiatives focus on evaluating educational programs, tools and interventions to identify best clinical practices and the most effective ways to involve patients and families in shared decision-making.
Stoeckle Center research initiatives focus on evaluating educational programs, tools and interventions to identify best clinical practices and the most effective ways to involve patients and families in shared decision-making. We are in the process of evaluating several innovative programs and interventions, including:
- Various methods of shared decision-making in adult and pediatric primary care practices;
- Methods for sharing information and coordinating care among patients and families;
- Courses and seminars designed to improve doctor-patient communication;
- Management of patients with challenging conditions and diverse backgrounds;
- New models of reimbursement for primary care services that encourage quality improvement in primary care and improved doctor-patient communication;
- The study of how clinical teams function best in the primary care setting, and how patients prefer to interact with their primary care team; and
- The use of information technology to support the doctor-patient relationship in adult and pediatric practices.
Improving Decision Making in Primary Care
The Foundation for Informed Medical Decision Making is providing funding to the Stoeckle Center to help support the implementation and evaluation of a shared decision-making pilot project in primary care practices at MGH. The Center is collaborating with Dartmouth Hitchcock Medical Center, the University of North Carolina, and the University of California-San Diego. (Read more about this project in our "Innovations" section.)
Identifying Best Practices in Primary Care
An anonymous MGH donor sponsored a needs assessment and study of best practices in primary care in academic health centers and large group practices to help the Center identify innovative, robust strategies to improve physician and patient satisfaction with office practices.
The needs assessment helped us gain a deeper understanding of what our current patients need and want from the delivery system. We gained new insights into factors leading to patient loyalty to primary care practices, sources of satisfaction and dissatisfaction with care, perceptions of quality of care and service in MGH primary care practices, and factors that influence patients to get their primary care outside of MGH.
The benchmarking component of the study identified innovative strategies that are currently in place in other academic health centers and community-based practices that could be considered for adoption at MGH. These innovative strategies focused on the following categories:
- Advanced Access Scheduling
- Comprehensive Health Assessment
- Patient-Centered Information Technology
- Prescribed Health Information
The CAHPS Study
The CAHPS program began in 1995 and is funded and managed by the Agency for Healthcare Research and Quality (AHRQ). Susan Edgman-Levitan, PA, from the Stoeckle Center and Paul Cleary, PhD, from the Department of Health Care Policy at Harvard Medical School, have led the Harvard CAHPS team since its inception.
The term CAHPS refers to a comprehensive and evolving family of surveys that ask patients to evaluate the interpersonal aspects of health care. CAHPS surveys probe those aspects of care for which patients are the best or only source of information, as well as those that patients have identified as being important. CAHPS surveys are similar to patient satisfaction surveys but not the same. CAHPS surveys go beyond rating providers and health plans by asking patients to report on their experiences with health care services. CAHPS initially stood for the Consumer Assessment of Health Plans Study, but as the products have evolved beyond health plans, the acronym now stands alone as a registered brand name.
Beginning in 2003 and ending in 2004, the study's Harvard CAHPS team conducted a quality improvement collaborative learning project with group practices in Minnesota to learn how to improve service in those areas measured by the CAHPS survey. The Harvard CAHPS team and the Stoeckle Center will offer a similar program to practices in Massachusetts, and is working with the American Board of Medical Specialties and the American Board of Internal Medicine to develop a CAHPS survey that will be used in the maintenance of board certification for physicians.
The Harvard CAHPS team also will work together with the Massachusetts Health Quality Partnership to conduct a quality improvement learning collaborative that will be open to Partners and MGH primary care practices. The collaborative will focus on improving both the patient and clinician's experience with primary care and will involve nationally recognized faculty.
The Centers for Medicare and Medicaid Services has provided funding for the Harvard CAHPS team to update the CAHPS Improvement Guide and distribute the publication in both a web-based and print format. The Guide is being used by health plans and group practices around the country to improve the patient's experience of care.
In the future we hope to expand the Stoeckle Center Fellowship Program to provide funding for young primary care doctors, nurses, other clinicians and social scientists to pursue research and novel projects within primary care. This program provides tomorrow's innovators with valuable insight into primary care improvement, and is designed to create a core group of clinicians and researchers who will advance the mission of the Stoeckle Center throughout their careers.