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Implementation of a novel linkage of primary care electronic medical record data with hospital data in South Eastern Ontario [Big data]

Annals of Family Medicine

Context: Currently, primary care data, community data, and hospital data are not linked in Ontario, resulting in a disconnect in continuity of care. We demonstrated the capacity to implement data-drive QI approaches to support patient care across health care sectors using the novel merged datasets.

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Exploring Primary Care Provider eConsult Utilization Trends [Health care services, delivery, and financing]

Annals of Family Medicine

Objective: To determine how primary care providers (PCP) utilize the eConsult platform. It includes templated eConsult exchange data extracted from the electronic health record. Setting or Dataset: CUSOM and University Hospital. Intervention/Instrument: eConsult platform and electronic health record.

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Electronic Health Record Use and Patient-Centredness [Education and training]

Annals of Family Medicine

Context: Large-scale electronic health record (EHR) programs have reported a number of issues to their implementation in primary care including physician patient-centredness and clinical performance. Setting: An academic primary care clinic based in a hospital.

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Maryland's Primary Care Program: incremental progress or breakthrough?

The Health Policy Exchange

Our residency, formerly a collaboration with Providence Hospital, is now known as the Medstar Health/Georgetown-Washington Hospital Center Family Medicine Residency Program. MDPCP promises to narrow the primary care-subspecialist reimbursement gap and provide opportunities to improve patient care in the short term.

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Transitional Care Management care team impact on no-show rates to hospital discharge appointments [Patient education/adherence]

Annals of Family Medicine

Context: The Transitional Care Management (TCM) clinic visit is a uniquely billed visit type to review a recently discharged patient’s hospital course, reconcile medications, and continue ongoing workup. Intervention: A team was created with an attending physician, care coordinators, and front office staff.

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Evaluation of a pre-consultation tool for older adults in primary care: Results from a randomized controlled trial [Geriatrics]

Annals of Family Medicine

Context: Pre-consultation questionnaires designed to provide rapid assessments of the physical, social, mental and cognitive health of older adults may support effective primary care management and improved patient outcomes for this population. Study Design and Analysis: Multi-center, 1:1 individually randomized trial design.

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Personalized medicine in a community health system: the Endeavor Health experience [Dissemination and implementation research]

Annals of Family Medicine

Successful implementation required the development of a scalable family history collection tool, the Genetic and Wellness Assessment (GWA) and Breast Health Assessment (BHA) tools; integrated pharmacogenomics programming; educational programming; electronic medical record integration; and robust clinical decision support tools.

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