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Article ; Online: Identifying Implementation Factors for the Development, Operation, and Sustainment of Ambulatory Care Pharmacy Programs: a Qualitative Study.

Qureshi, Nabeel / Keller, Michelle S

2023 Volume 38, Issue 15, Page(s) 3381–3388

Abstract: Background: Pharmacist-led programs and clinics have been integrated into primary and specialty care clinics in a variety of ways, for example, to improve diabetes outcomes via patient education and counseling. However, factors important to the ... ...

Abstract	Background: Pharmacist-led programs and clinics have been integrated into primary and specialty care clinics in a variety of ways, for example, to improve diabetes outcomes via patient education and counseling. However, factors important to the implementation of different outpatient pharmacy models have not been well elucidated. Objective: To identify provider- and health system-level drivers of implementation and sustainability of pharmacy-led programs in the outpatient setting. Design: Qualitative study of key informants using semi-structured interviews of individuals working in various roles throughout a large health system, including ambulatory clinical pharmacists, pharmacy managers, medical directors and physician leaders, and operations and quality managers. Participants: Key informants (n=19) with leadership roles in pharmacy programs and front-line experience providing integrated pharmacy care were selected purposively and with snowball sampling. Approach: We coded the interviews using a codebook derived from the 2022 Consolidated Framework for Implementation Research (CFIR), which details various internal and external factors important for implementation. Key results: We identified the following themes related to implementing ambulatory care pharmacy programs: (1) pharmacy programs varied in their level of embeddedness in the outpatient clinic, (2) establishing pharmacy program required leadership advocacy and coordination among stakeholders, (3) continued operations required integrated workflows and demonstrated value to the health system and clinicians, and (4) established revenue streams or added indirect value and continued improvement of integration sustained programs over time. Conclusions: External policies and incentives such as new reimbursement codes and quality measurement programs that rely on pharmacy input play a significant role in shaping the design, implementation, and sustainability of health system outpatient pharmacy programs. Ensuring that quality metrics used in value-based contracts or programs demonstrate pharmacy benefits will be critical to supporting and growing pharmacy programs.
MeSH term(s)	Humans ; Ambulatory Care ; Pharmacists ; Pharmacy ; Physicians ; Pharmacies ; Qualitative Research
Language	English
Publishing date	2023-08-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	639008-0
ISSN	1525-1497 ; 0884-8734
ISSN (online)	1525-1497
ISSN	0884-8734
DOI	10.1007/s11606-023-08375-1
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Article ; Online: Associations of Primary Care Provider Burnout with Quality Improvement, Patient Experience Measurement, Clinic Culture, and Job Satisfaction.

Quigley, Denise D / Slaughter, Mary Ellen / Qureshi, Nabeel / Hays, Ron D

Journal of general internal medicine

2024

Abstract: Background: Burnout among providers negatively impacts patient care experiences and safety. Providers at Federally Qualified Health Centers (FQHC) are at high risk for burnout due to high patient volumes; inadequate staffing; and balancing the demands ... ...

Abstract	Background: Burnout among providers negatively impacts patient care experiences and safety. Providers at Federally Qualified Health Centers (FQHC) are at high risk for burnout due to high patient volumes; inadequate staffing; and balancing the demands of patients, families, and team members. Objective: Examine associations of provider burnout with their perspectives on quality improvement (QI), patient experience measurement, clinic culture, and job satisfaction. Design: We conducted a cross-sectional provider survey about their perspectives including the single-item burnout measure. We fit separate regression models, controlling for provider type, gender, being multilingual, and fixed effects for clinic predicting outcome measures from burnout. Participants: Seventy-four providers from 44 clinics in large, urban FQHC (52% response rate; n = 174). Main measures: Survey included a single-item, self-defined burnout measure adapted from the Physician Worklife Survey, and measures from the RAND AMA Study survey, Heath Tracking Physician survey, TransforMed Clinician and Staff Questionnaire, Physician Worklife Survey, Minimizing Errors Maximizing Outcomes survey, and surveys by Friedberg et al. Conclusions: Creating provider-team relationships and environments where providers have the time and space necessary to discuss changes to improve care, ideas are shared, leadership supports QI, and QI is monitored and discussed were related to not being burned out. Reducing time pressures and improving support needed for providers to address the high-need levels of FQHC patients can also decrease burnout. Such leadership and support to improving care may be a separate protective factor against burnout. Research is needed to further examine which aspects of leadership drive down burnout and increase provider involvement in change efforts and improving care.
Language	English
Publishing date	2024-01-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	639008-0
ISSN	1525-1497 ; 0884-8734
ISSN (online)	1525-1497
ISSN	0884-8734
DOI	10.1007/s11606-024-08633-w
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Article ; Online: Are some ways of defining chronic low back pain more indicative of future back pain than others?

Qureshi, Nabeel / Hays, Ron D / Herman, Patricia M

Pain medicine (Malden, Mass.)

2023 Volume 25, Issue 2, Page(s) 160–162

MeSH term(s)	Humans ; Low Back Pain/diagnosis ; Back Pain ; Chronic Pain/diagnosis
Language	English
Publishing date	2023-09-29
Publishing country	England
Document type	Journal Article
ZDB-ID	2015903-1
ISSN	1526-4637 ; 1526-2375
ISSN (online)	1526-4637
ISSN	1526-2375
DOI	10.1093/pm/pnad135
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Article ; Online: Associations between days spent at home and patient-reported outcomes among frail older adults.

Gotanda, Hiroshi / Qureshi, Nabeel / Nuckols, Teryl / Tsugawa, Yusuke

Journal of the American Geriatrics Society

2023 Volume 71, Issue 9, Page(s) 2983–2986

MeSH term(s)	Humans ; Aged ; Frail Elderly ; Geriatric Assessment ; Exercise Therapy ; Patient Reported Outcome Measures
Language	English
Publishing date	2023-04-19
Publishing country	United States
Document type	Letter ; Research Support, N.I.H., Extramural
ZDB-ID	80363-7
ISSN	1532-5415 ; 0002-8614
ISSN (online)	1532-5415
ISSN	0002-8614
DOI	10.1111/jgs.18384
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Article ; Online: Cumulative Update of a Systematic Overview Evaluating Interventions Addressing Polypharmacy.

Keller, Michelle S / Qureshi, Nabeel / Mays, Allison M / Sarkisian, Catherine A / Pevnick, Joshua M

JAMA network open

2024 Volume 7, Issue 1, Page(s) e2350963

Abstract: Importance: Polypharmacy is associated with mortality, falls, hospitalizations, and functional and cognitive decline. The study of polypharmacy-related interventions has increased substantially, prompting the need for an updated, more focused systematic ...

Abstract	Importance: Polypharmacy is associated with mortality, falls, hospitalizations, and functional and cognitive decline. The study of polypharmacy-related interventions has increased substantially, prompting the need for an updated, more focused systematic overview. Objective: To systematically evaluate and summarize evidence across multiple systematic reviews (SRs) examining interventions addressing polypharmacy. Evidence review: A search was conducted of MEDLINE, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects for articles published from January 2017-October 2022, as well as those identified in a previous overview (January 2004-February 2017). Systematic reviews were included regardless of study design, setting, or outcome. The evidence was summarized by 4 categories: (1) medication-related process outcomes (eg, potentially inappropriate medication [PIM] and potential prescribing omission reductions), (2) clinical and functional outcomes, (3) health care use and economic outcomes, and (4) acceptability of the intervention. Findings: Fourteen SRs were identified (3 from the previous overview), 7 of which included meta-analyses, representing 179 unique published studies. Nine SRs examined medication-related process outcomes (low to very low evidence quality). Systematic reviews using pooled analyses found significant reductions in the number of PIMs, potential prescribing omissions, and total number of medications, and improvements in medication appropriateness. Twelve SRs examined clinical and functional outcomes (very low to moderate evidence quality). Five SRs examined mortality; all mortality meta-analyses were null, but studies with longer follow-up periods found greater reductions in mortality. Five SRs examined falls incidence; results were predominantly null save for a meta-analysis in which PIMs were discontinued. Of the 8 SRs examining quality of life, most (7) found predominantly null effects. Ten SRs examined hospitalizations and readmissions (very low to moderate evidence quality) and 4 examined emergency department visits (very low to low evidence quality). One SR found significant reductions in hospitalizations and readmissions among higher-intensity medication reviews with face-to-face patient components. Another meta-analysis found a null effect. Of the 7 SRs without meta-analyses for hospitalizations and readmissions, all had predominantly null results. Two of 4 SRs found reductions in emergency department visits. Two SRs examined acceptability (very low evidence quality), finding wide variation in the adoption of polypharmacy-related interventions. Conclusions and relevance: This updated systematic overview noted little evidence of an association between polypharmacy-related interventions and reduced important clinical and health care use outcomes. More evidence is needed regarding which interventions are most useful and which populations would benefit most.
MeSH term(s)	Humans ; COVID-19 ; Polypharmacy ; Quality of Life ; Systematic Reviews as Topic
Language	English
Publishing date	2024-01-02
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2023.50963
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Article ; Online: Mapping of the PROMIS global health measure to the PROPr in the United States.

Hays, Ron D / Herman, Patricia M / Qureshi, Nabeel / Rodriguez, Anthony / Edelen, Maria Orlando

Journal of patient-reported outcomes

2024 Volume 8, Issue 1, Page(s) 5

Abstract: Background: The Patient-Reported Outcomes Measurement and Information System (PROMIS®) global health items (global-10) yield physical and mental health scale scores and the PROMIS-Preference (PROPr) scoring system estimated from PROMIS domain scores (e ... ...

Abstract	Background: The Patient-Reported Outcomes Measurement and Information System (PROMIS®) global health items (global-10) yield physical and mental health scale scores and the PROMIS-Preference (PROPr) scoring system estimated from PROMIS domain scores (e.g., PROMIS-29 + 2) produces a single score anchored by 0 (dead or as bad as being dead) to 1 (full health). A link between the PROMIS global-10 and the PROPr is needed. Methods: The PROMIS-29 + 2 and the PROMIS global-10 were administered to 4102 adults in the Ipsos KnowledgePanel in 2022. The median age was 52 (range 18-94), 50% were female, 70% were non-Hispanic White, and 64% were married or living with a partner. The highest level of education completed for 26% of the sample was a high school degree or general education diploma and 44% worked full-time. We estimated correlations of the PROPr with the PROMIS global health items and the global physical and mental health scales. We examined the adjusted R Results: Product-moment correlations between the PROMIS global health items and the PROPr ranged from 0.50 to 0.63. The PROMIS global physical health and mental health scale scores correlated 0.74 and 0.60, respectively, with the PROPr. The adjusted R Conclusions: Regression equations provide a reasonably accurate estimate of the PROPr preference-based score from the PROMIS global health items or scales for group-level comparisons. These estimates facilitate cost-effectiveness research and meta-analyses. The estimated PROPr scores are not accurate enough for individual-level applications. Future evaluations of the prediction equations are needed.
MeSH term(s)	Adult ; Female ; Humans ; Male ; Middle Aged ; Educational Status ; Global Health ; Marriage ; Mental Health ; Patient Reported Outcome Measures ; United States ; Adolescent ; Young Adult ; Aged ; Aged, 80 and over
Language	English
Publishing date	2024-01-10
Publishing country	Germany
Document type	Journal Article
ISSN	2509-8020
ISSN (online)	2509-8020
DOI	10.1186/s41687-023-00677-6
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Article ; Online: Is Primary Care Patient Experience Associated with Provider-Patient Language Concordance and Use of Interpreters for Spanish-preferring Patients: A Systematic Literature Review.

Quigley, Denise D / Qureshi, Nabeel / Predmore, Zachary / Diaz, Yareliz / Hays, Ron D

Journal of racial and ethnic health disparities

2024

Abstract: Background: Healthcare provided by a bilingual provider or with the assistance of an interpreter improves care quality; however, their associations with patient experience are unknown. We reviewed associations of patient experience with provider-patient ...

Abstract	Background: Healthcare provided by a bilingual provider or with the assistance of an interpreter improves care quality; however, their associations with patient experience are unknown. We reviewed associations of patient experience with provider-patient language concordance (LC) and use of interpreters for Spanish-preferring patients. Method: We reviewed articles from academic databases 2005-2023 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Joanna Briggs Institute Checklists to rate study quality. We reviewed 217 (of 2193) articles, yielding 17 for inclusion. Results: Of the 17 included articles, most articles focused on primary (n = 6 studies) or pediatric care (n = 5). All were cross-sectional, collecting data by self-administered surveys (n = 7) or interviews (n = 4). Most assessed the relationship between LC or interpreter use and patient experience by cross-sectional associations (n = 13). Two compared subgroups, and two provided descriptive insights into the conversational content (provider-interpreter-patient). None evaluated interventions, so evidence on effective strategies is lacking. LC for Spanish-preferring patients was a mix of null findings (n = 4) and associations with better patient experience (n = 3) (e.g., receiving diet/exercise counseling and better provider communication). Evidence on interpreter use indicated better (n = 2), worse (n = 2), and no association (n = 2) with patient experience. Associations between Spanish-language preference and patient experience were not significant (n = 5) or indicated worse experience (n = 4) (e.g., long waits, problems getting appointments, and not understanding nurses). Conclusion: LC is associated with better patient experience. Using interpreters is associated with better patient experience but only with high-quality interpreters. Strategies are needed to eliminate disparities and enhance communication for all Spanish-preferring primary care patients, whether with a bilingual provider or an interpreter.
Language	English
Publishing date	2024-03-05
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2760524-3
ISSN	2196-8837 ; 2197-3792
ISSN (online)	2196-8837
ISSN	2197-3792
DOI	10.1007/s40615-024-01951-z
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Article: Identifying Strategies for Strengthening the Health Care Workforce in the Commonwealth of Virginia.

Andrew, Megan / Briscombe, Brian / Vardavas, Raffaele / Wolters, Nazia / Qureshi, Nabeel / Nham, Wilson / Abir, Mahshid

Rand health quarterly

2024 Volume 11, Issue 2, Page(s) 1

Abstract: Like the United States as a whole, Virginia faces a significant shortage of health care workers in nursing, primary care, and behavioral health. If current trends persist, these shortages will increase across Virginia. The authors of this study identify ... ...

Abstract	Like the United States as a whole, Virginia faces a significant shortage of health care workers in nursing, primary care, and behavioral health. If current trends persist, these shortages will increase across Virginia. The authors of this study identify interventions that can help the Virginia Health Workforce Development Authority (VHWDA) address these health care workforce shortages. To accomplish this goal, they applied an analytic framework to existing or potential interventions for retaining, recruiting, and improving the structural efficiency of the nursing, primary care, and behavioral health workforces in Virginia. In this study, they highlight which interventions VHWDA should prioritize based on its desired outcomes and policy goals.
Language	English
Publishing date	2024-03-04
Publishing country	United States
Document type	Journal Article
ISSN	2162-8254
ISSN	2162-8254
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Article ; Online: Reasons Primary Care Practices Chose Patient Experience Surveys During Patient-Centered Medical Home Transformation.

Quigley, Denise D / Qureshi, Nabeel / Hays, Ron D

The Journal of ambulatory care management

2022 Volume 46, Issue 1, Page(s) 34–44

Abstract: Patient-centered medical home takes years to attain. Fifteen-to-eighteen percent of US primary care practices in 2008-2017 sought or maintained patient-centered medical home recognition. We conducted interviews with a stratified-random sample of 105 of ... ...

Abstract	Patient-centered medical home takes years to attain. Fifteen-to-eighteen percent of US primary care practices in 2008-2017 sought or maintained patient-centered medical home recognition. We conducted interviews with a stratified-random sample of 105 of these practices to determine why patient experience surveys were chosen. Fifty-one were using a Consumer Assessment of Healthcare Providers and Systems survey and 53 administering another patient survey. The 3 most common reasons were (1) to compare performance against other practices, which requires systematically collected data across large numbers of practices (ie, the Consumer Assessment of Healthcare Providers and Systems survey), (2) participation in an external patient-centered medical home program, and (3) survey administration cost. Leaders invested in a second patient survey for quality improvement needs.
MeSH term(s)	Humans ; Patient-Centered Care ; Quality Improvement ; Health Personnel ; Patient Outcome Assessment
Language	English
Publishing date	2022-10-08
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	198845-1
ISSN	1550-3267 ; 0148-9917
ISSN (online)	1550-3267
ISSN	0148-9917
DOI	10.1097/JAC.0000000000000442
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Article ; Online: How Well Do Seven Self-Report Measures Represent Underlying Back Pain Impact?

Hays, Ron D / Herman, Patricia M / Qureshi, Nabeel / Rodriguez, Anthony / Edelen, Maria Orlando

Pain management nursing : official journal of the American Society of Pain Management Nurses

2023 Volume 25, Issue 1, Page(s) e1–e7

Abstract: Background: The extent to which different measures of back pain impact represent an underlying common factor has implications for decisions about which one to use in studies of pain management and estimating one score from others.: Aims: To determine ...

Abstract	Background: The extent to which different measures of back pain impact represent an underlying common factor has implications for decisions about which one to use in studies of pain management and estimating one score from others. Aims: To determine if different self-report back pain impact measures represent an underlying pain latent variable and estimate associations with it. Method: Seven pain impact measures completed by Amazon Mechanical Turk adults are used to estimate internal consistency reliability and associations: Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), short form of the Örebro Musculoskeletal Pain Questionnaire (OMPQ), Subgroups for Targeted Treatment (STarT) Back Tool, the Graded Chronic Pain Scale (GCPS) disability score, PEG (Pain intensity, interference with Enjoyment of life, interference with General activity), and Impact Stratification Score (ISS). Results: The sample of 1,874 adults with back pain had an average age of 41 and 52% were female. Sixteen percent were Hispanic, 7% non-Hispanic Black, 5% non-Hispanic Asian, and 71% non-Hispanic White. Internal consistency reliability estimates ranged from 0.710 (OMPQ) to 0.923 (GCPS). Correlations among the measures ranged from 0.609 (RMDQ with OMPQ) to 0.812 (PEG with GCPS). Standardized factor loadings on the pain latent variable ranged from 0.782 (RMDQ) to 0.870 (ISS). Conclusions: Scores of each measure can be estimated from the others for use in research.
MeSH term(s)	Adult ; Humans ; Female ; Male ; Self Report ; Low Back Pain ; Reproducibility of Results ; Disability Evaluation ; Back Pain ; Surveys and Questionnaires ; Chronic Pain ; Musculoskeletal Pain
Language	English
Publishing date	2023-08-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2213260-0
ISSN	1532-8635 ; 1524-9042
ISSN (online)	1532-8635
ISSN	1524-9042
DOI	10.1016/j.pmn.2023.07.008
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