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The settings included general practice clinics (n=18), specialized care units (n=14), and emergency and ambulatory units (n=3). Of the 1,907 records retrieved, 35 studies met the inclusion criteria.
Clinical microsystem greenbooks full#
Independent reviewers screened abstracts, read full texts, extracted data from the included studies, and appraised methodological quality assessments. This study was conducted in order to provide a critical appraisal and synthesize the best available evidence on the impact of implementing clinical microsystem (CMS) on quality of care and safety of the health care delivery.Ī comprehensive and systematic search of six electronic databases, from 1998 to 2018, was conducted to identify empirical literature published in both English and French, evaluating the impact of implementing CMS in healthcare settings.
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In this study, a Microsystem team developed a model to provide key components of care coordination to support PCMH practice redesign at a large community health center.įaced with the increased expectations on the quality and safety of health care delivery systems, a number of stakeholders are increasingly looking for more efficient ways to deliver care. The nurse in this new role spent 276 minutes over two days of observation engaged in direct care coordination work while two nurses at the comparison site spent only 94 minutes and 149 minutes, respectively, over the same time period.Ĭonclusion: Engaging front line staff is an effective way for organizations to make changes in delivery systems, improve quality and spread innovations. The nurse care coordinator in this new role managed 335 patients over a nine-month study period. The intervention emphasized patient self-management, independent nursing visits, and hospital and emergency room transition support. Results: The Microsystem team developed and implemented a new nurse care coordination model for their site. Nurses in a non-participating site with similar characteristics served as a comparison group. Intervention uptake and impact on workflow was tracked by direct observation of nurses and by measuring volume of nursing visits and virtual contacts. Methods: A Clinical Microsystem team, supported by an improvement coach, met weekly for one year to develop and test a new nurse staffing model in a large Federally Qualified Health Center. We used a Microsystem team to develop an effective model to integrate nurse care coordinators into a busy primary care center. Clinical Microsystems are frontline teams of healthcare staff that, when engaged in quality improvement, can make important contributions towards practice redesign. Implementing care coordination in primary care is challenging and requires changes in roles, staffing, and culture. Objective: Care coordination is a core competency for primary care nurses and an essential element of the Patient Centered Medical Home (PCMH) model.