JOURNAL OF AMBULATORY CARE MANAGEMENT最新文献

{"title":"Formative Evaluation of a Pharmacist-Led Area Agency on Aging Community Care Transition Initiative: A Qualitative Interview Study From Staff Perspectives.","authors":"Hao-Ping Chiang, Brigid Rowell, Karen B Farris, Nathaniel Bergman, Antoinette B Coe","doi":"10.1097/JAC.0000000000000566","DOIUrl":"10.1097/JAC.0000000000000566","url":null,"abstract":"<p><strong>Objectives: </strong>The Michigan Region VII Area Agency on Aging (AAA) conducted a community care transition initiative (CCTI) for rural, low-income older adults to reduce hospital readmission rates. The AAA CCTI included a community health worker (CHW) home visit, pharmacist telehealth comprehensive medication review, and follow-up after discharge. Our study aimed to conduct a formative evaluation of the AAA CCTI to identify areas for program refinement. Identified strategies for program refinement add to the development, implementation, and evaluation of rural care transition program literature.</p><p><strong>Methods: </strong>We conducted a qualitative study using semistructured interviews with key AAA CCTI informants via Zoom. Qualitative content analysis was used to identify categories related to existing resources, inputs needing adjustment, delivery of planned procedures, suggested procedural changes, and client responses.</p><p><strong>Results: </strong>Five AAA CCTI staff members participated in an interview. The program's resources included AAA reputation, qualified CHWs, and strong external networks. The inputs needing adjustment were funding sustainability, CHW preparation, and the availability of key personnel. The implemented procedures were: CHWs receiving standard training, connecting clients with diverse external resources; an efficient combination of CHW home visits and telehealth pharmacist visits; in-depth CHW home visits; promoting the program to strengthen partnerships; serving older adults at considerable risk of readmission; streamlining recruitment; and person-centered care. The suggested procedure changes included adjusting the follow-up duration and frequency, implementing strategies to improve sustainability, and providing the program to broader populations. Most clients accepted and were satisfied with the program, while a few declined home visits.</p><p><strong>Conclusions: </strong>Our study provided a formative evaluation of the AAA CCTI to inform program refinement. Recommended refinements include adding pharmacist personnel, providing ongoing CHW training, and advocating for pharmacist-led care transitions. Our findings suggest including pharmacist telehealth during CHW home visits, in-person recruitment, and community resource referrals in rural care transition programs.</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":" ","pages":"E243-E256"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unlocking Care: How Telehealth Empowers New Patients to Access More Comprehensive Services at a Tertiary Referral Center.","authors":"Caroline G Olson, Meghan Knoedler, Adrian Keister, Dawn Francis","doi":"10.1097/JAC.0000000000000565","DOIUrl":"10.1097/JAC.0000000000000565","url":null,"abstract":"<p><strong>Objective: </strong>Health care delivery has undergone a shift from in-person visits to more remote consultations via telehealth. Despite the increasing adoption of telehealth for tertiary medical centers' new patient visits, its impact on subsequent in-person health care utilization has not been widely studied. Our objective was to examine differences in health care services used by patients who established care in-person versus those who initiated care remotely via telehealth.</p><p><strong>Methods: </strong>We conducted a retrospective review of all patients who established care at one of our three main Mayo Clinic campuses through either an in-person or telemedicine visit between September 1, 2023, and September 30, 2024. We analyzed aggregate data related to downstream in-person services encompassing diagnostic studies, outpatient procedures, surgical procedures (referred to as \"surgical yield\"), specialist consultations, and follow-up appointments.</p><p><strong>Results: </strong>This study evaluated 252,356 new patient visits, of which 14,915 (5.9%) were performed remotely via telemedicine. Patients who established care in-person had an average of 10.47 subsequent in-person visits. Among patients who initiated care via telemedicine, 62.7% (9,351) later received in-person services, with an average of 16 in-person visits per patient. Surgical yield was higher for patients who started remotely via telehealth and then came on-site, at 29% compared to 16% for those who started with an on-site visit. States bordering the clinic locations had increased percentages of in-person visits compared to states that required patients to travel longer distances.</p><p><strong>Conclusions: </strong>Patients who established care through an initial telemedicine appointment and then came on-site had more downstream encounters and surgical procedures than those who began in-person. This may be due to the ability to efficiently coordinate multiple appointments within a condensed timeframe, optimizing the planning of on-site visits. Additionally, both patients and providers may selectively utilize telemedicine to identify individuals who would derive the greatest benefit from in-person care.</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":" ","pages":"E214-E220"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Veterans Health Administration Intensive Primary Care in Optimizing Medication Regimens: A Qualitative Study of Patient and Provider Perspectives.","authors":"Emily P Wong, Marian Katz, Susan Stockdale, Evelyn T Chang, Karleen F Giannitrapani, Jean Yoon","doi":"10.1097/JAC.0000000000000561","DOIUrl":"10.1097/JAC.0000000000000561","url":null,"abstract":"<p><strong>Objective: </strong>To identify actionable steps from a Veterans Health Administration (VA) Intensive Primary Care (IPC) pilot in five VA sites that primary care teams and health care systems can take to optimize medication regimens in high-risk patients, many of whom have polypharmacy and poor medication adherence.</p><p><strong>Methods: </strong>We conducted semi-structured, qualitative interviews between 2014 and 2018 with 27 IPC providers and 16 IPC patients. Interviews were analyzed using inductive and deductive approaches to thematic analysis.</p><p><strong>Results: </strong>Patient respondents were an average of 67 years old and more likely to be male (94%), divorced (44%), Black (50%), hypertensive (88%), and have two or more comorbidities (81%). IPC patients and providers described IPC as helping to identify and/or address specific medication adherence barriers that were not adequately understood or addressed in usual primary care. IPC providers' greater understanding of adherence barriers allowed them to optimize patient medication regimens, closing the gap between care provided and patient needs. IPC program elements that enabled care improvements included interdisciplinary care teams, care team accessibility, home visits, and close provider-patient relationships.</p><p><strong>Conclusions: </strong>Primary care teams can adopt some IPC program elements to help patients optimize medication regimens, such as greater involvement of extended team members, increasing accessibility of care teams through telephone and secure messaging, utilizing home visits for assessment of patients' needs, and developing strong provider-patient relationships.</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":" ","pages":"E231-E242"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Journal of Ambulatory Care Management Thanks Our Reviewers.","authors":"","doi":"10.1097/JAC.0000000000000571","DOIUrl":"10.1097/JAC.0000000000000571","url":null,"abstract":"","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":" ","pages":"E177"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Women's Experiences With Telemedicine: Predictors of Satisfaction in Ambulatory Care.","authors":"Mona Polavarapu, Sara Shihab, Samuel T Savitz, Amy E Glasgow, Suneela Vegunta","doi":"10.1097/JAC.0000000000000563","DOIUrl":"10.1097/JAC.0000000000000563","url":null,"abstract":"<p><strong>Background: </strong>Telemedicine use has expanded rapidly across ambulatory care. Satisfaction with telemedicine services has been associated with social determinants of health (SDOH) such as socioeconomic status, ethnicity, and employment status. However, little is known about gender-specific patterns in patient experience. This study examined how demographic and SDOH are associated with telehealth satisfaction among women.</p><p><strong>Methods: </strong>A cross-sectional analysis was conducted using data from female patients who completed standardized post-telehealth surveys within the Mayo Clinic Health Care System between March 2020 and December 15, 2023. Logistic regression was used to evaluate the association between patient satisfaction and the following demographics and SDOH: age, race, ethnicity, marital status, Elixhauser score, mental health diagnosis, stress risk, financial risk, transportation risk, food insecurity risk, primary language, and physical activity risk.</p><p><strong>Results: </strong>Among 51,512 female patients, higher age was associated with less satisfaction with \"ease of scheduling appointment\" and \"ease of contacting clinic,\" but was associated with significantly higher satisfaction for other measures, including \"care practitioners' efforts to include\" and \"recommending healthcare office.\" A high Elixhauser score was associated with lower satisfaction with \"how well the audio and video connections worked.\"</p><p><strong>Conclusion and action steps: </strong>A higher Elixhauser score and older age emerged as key factors associated with telehealth satisfaction among women. Targeted efforts to support patients with complex health needs and those requiring enhanced care coordination may improve satisfaction and equity in ambulatory telemedicine.</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":" ","pages":"E221-E230"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implications of Artificial Intelligence for Administrative and Management Roles Among Allied Health Occupations.","authors":"Shahida Shahrir, Susan M Skillman, Bianca K Frogner","doi":"10.1097/JAC.0000000000000569","DOIUrl":"10.1097/JAC.0000000000000569","url":null,"abstract":"<p><strong>Objective: </strong>This study explored how artificial intelligence (AI) technologies support the nondiagnosing/nontreatment roles of allied health workers, examining challenges and risks AI may pose for the workforce and highlighting areas for expansion as AI use grows.</p><p><strong>Methods: </strong>We conducted 12 interviews with 14 key informants familiar with specific allied health occupations and how AI has been incorporated into their roles. Themes and gaps identified from peer-reviewed and gray literature informed our semi-structured interview guide. We used rapid content analysis to summarize findings from interviews around the following tasks: transcription, medical coding/billing, translation/interpretation, scheduling, communication, and data collection/management. We also summarized findings around ensuring AI literacy.</p><p><strong>Results: </strong>Allied health occupations (typically considered occupations other than physicians, nurses, and dentists) not directly involved in patient diagnosis and treatment have varying levels of interaction with AI. Positive descriptions of AI use in these allied health roles included situations where workforce demand exceeds supply and where AI can be deployed for some routine administrative tasks and may improve job satisfaction by allowing the workforce to focus on more complex and rewarding tasks. AI use was also described positively where it contributed to increased efficiency, for example, in facilitating communications. Because AI can produce biased or erroneous results, cautions about its applications included needing additional staff time to monitor outcomes and avoid negative impacts on patient safety and an organization's operations. Education that contributes to AI literacy across the health workforce is considered critical for its appropriate use.</p><p><strong>Conclusions: </strong>To date, most allied health workers' jobs with administrative/management roles have not been at risk of replacement by AI. AI's rapidly expanding use, however, combined with the ongoing impacts of provider burnout and financial pressures on health systems, could incentivize increased interest in using AI to compensate for a downsized workforce, including many allied health occupations.</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":" ","pages":"E257-E267"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transforming Outpatient Patient Flow: A COVID-19 Driven Quality Improvement Initiative for an Outpatient Model of Care.","authors":"Louisa Tam","doi":"10.1097/JAC.0000000000000564","DOIUrl":"10.1097/JAC.0000000000000564","url":null,"abstract":"<p><strong>Objective: </strong>The COVID-19 pandemic profoundly disrupted outpatient services with challenges including cancellations and delays in consultations, diagnostics, and surgeries. The Acute Hand Program at Trillium Health Partners examined the pandemic's impact as a catalyst for improving an outpatient model of care.</p><p><strong>Methods: </strong>In 2020, the Acute Hand Program redesigned its care model. This multiyear, quality improvement plan included seven change initiatives ranging from physical space reconfiguration to workflow, admission and discharge criteria revisions, and leveraging community resources.</p><p><strong>Results: </strong>The change initiatives revealed: (1) standardized appointment blocks increased capacity with 4.3% more treatment visits, (2) leaner admission criteria and scheduling consistently eliminated the waitlist to zero referrals per month, (3) length of stay benchmark compliance increased by 18% within 1 year of introducing the new model of care, (4) Quick DASH functional outcome scores remained high, with 94% of patients meeting the benchmark of no more than mild functional difficulty, and (5) overall patient satisfaction increased by 0.5%, with the most notable increase of 5% to 99% in the domain of quality of care.</p><p><strong>Conclusions: </strong>Developing an outpatient model of care by optimizing physical resources, streamlining clinical processes, using data-driven decision-making, and leveraging community resources enables effective response to crises and ensures quality care and long-term sustainability.</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":" ","pages":"E185-E198"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The EDUCATE Framework: A Practical Approach to Building Efficient and Effective Multidisciplinary Clinics in Ambulatory Care.","authors":"Sani M Roy, Amy Trejo, Marie-Eve Robinson, Molly Regelmann, Kari Lipscomb, Tara Allen, Karen Regan, Amy Vito, Matthew Dzurik, Paul Thornton, Shanlee M Davis","doi":"10.1097/JAC.0000000000000568","DOIUrl":"10.1097/JAC.0000000000000568","url":null,"abstract":"<p><strong>Objective: </strong>Multidisciplinary clinics (MDCs) aim to provide streamlined, coordinated care and better clinical outcomes for patients requiring access to multiple specialists with unique expertise. Despite broad endorsement in clinical guidelines, no generalizable framework exists for MDC development.</p><p><strong>Methods: </strong>Drawing on published principles of collaborative care, pediatric-specific considerations, and the authors' collective experience, we propose a seven-step framework (EDUCATE) for establishing effective MDCs: Envision the MDC, Develop the team, Undertake the business proposal, Consolidate support, Activate operations, Team-build/educate/engage, and Expand the mission.</p><p><strong>Results: </strong>The framework was implemented in a pediatric MDC for Prader-Willi syndrome, with measurable improvements in patient access, care coordination, and family experience.</p><p><strong>Conclusions: </strong>The EDUCATE framework provides a structured, replicable process for building sustainable MDCs in ambulatory care settings.</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":" ","pages":"E199-E213"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Waiting Room.","authors":"Tarek Zieneldien","doi":"10.1097/JAC.0000000000000562","DOIUrl":"10.1097/JAC.0000000000000562","url":null,"abstract":"","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":" ","pages":"E268"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Signals of Strain: A Paradigm Shift in Ambulatory Access.","authors":"Elizabeth W Woodcock, Marc P DiFazio, Angela J Lamb","doi":"10.1097/JAC.0000000000000567","DOIUrl":"10.1097/JAC.0000000000000567","url":null,"abstract":"","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":" ","pages":"E178-E184"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}