Family medicine practices face increasing demands to enhance efficiency and quality of care. Current solutions propose major practice redesign and investment in sophisticated technology. Knowledge management (KM) is a process that increases the capacity of a practice to deliver effective care by finding and sharing information and knowledge among practice members or by developing new knowledge for use by the practice. Our preliminary research in family medicine practices has suggested improved patient outcomes with greater and more effective KM. Research in other organizational settings has suggested that KM can be facilitated by certain organizational characteristics.
To identify those organizational characteristics within a family medicine practice that management can effect to enhance KM.
We performed a cross-sectional secondary analysis of second-year data from 13 community family medicine practices participating in a practice improvement project. Practice KM, leaderships' promotion of participatory decision making, existence of activities supportive of human resource processes, and effective communication were derived from clinician's, nurses', and staff's responses to a survey eliciting responses on practice organizational characteristics. Hierarchical linear modeling examined relationships between individual practice members' perception of KM and organizational characteristics of the practice, controlling for practice covariates (solo-group, electronic medical record use, and perception of a chaotic practice environment) and staff-level covariates (gender, age, and role).
Practices with greater participatory decision making and human resources' processes and effective communication significantly (p < .019, p < .0001, and p < .004) increased odds of reporting satisfactory KM (odds ratio = 2.48, 95% confidence interval = 1.32-4.65; odds ratio = 10.84, 95% confidence interval = 4.04-29.12; and odds ratio = 4.95, 95% confidence interval = 2.02-12.16). The sizes of these effects were not substantially changed even when practice members perceived their practice environment as more chaotic.
Steps to facilitate KM should be considered when evaluating more intensive and costly organizational solutions for enhancing family medicine practice performance.
"" Evidently, developing knowledge relies on social tools. Articulating tacit knowledge to explicit manifests through collective reflection (Orzano et al., 2008A), 'huddles' or brief team meetings (Orzano et al., 2008B) and dialogical exchange (Quinlan, 2009). Still, eHealth technologies, like decision support systems, active directories and portals, facilitate dynamic interaction among clinical practitioners. "
[Show abstract][Hide abstract] ABSTRACT: Objetivos: El propósito principal de esta investigación es conocer tanto la eficacia como los límites que presentan los sistemas de información científica , respecto a la coordinación y continuidad entre la investigación clínica y la atención primaria, es decir, la aplicación de los resultados de la investigación a la práctica asistencial. Para conseguirlo, el segundo propósito es evaluar las tendencias en las publicaciones durante el período comprendido desde 2002 a 2007. Métodos: Se realizó una búsqueda documental combinada de ensayos clínicos y guías de práctica clínica con una estrategia basada en texto libre. Se utilizaron las bases de datos Web of Knowledge (WOK) y Scopus. Resultados: Se seleccionaron 6433 artículos en WOK, en los que participaron 26756 autores, escribiendo en 1233 revistas. 45 % de las publicaciones procedieron de la Unión Europea (Reino Unido, Holanda, Alemania, España, Italia y Francia en cabeza), el 44.6 % de los USA y el 17.1 % de Canadá. En la evolución de la transferencia de la investigación a la práctica clínica medida por el número anual de artículos sobre guías publicados destacan los años 2004 (15%) y 2007 (17.6%). Conclusiones: La tarea de inventariar el potencial de conocimiento aportado por los ensayos y guías a la práctica de la atención primaria es poco frecuente. Este resultado puede ser debido a que las enfermedades más comunes sean las menos estudiadas.
[Show abstract][Hide abstract] ABSTRACT: Central to the "medical home" concept is the premise that the delivery of effective primary care requires a fundamental shift in relationships among practice members and between practice members and patients. Primary care practices can potentially increase their capacity to deliver effective care through knowledge management (KM), a process of sharing and making existing knowledge available or by developing new knowledge among practice members and patients. KM affects performance by influencing work relationships to enhance learning, decision making, and task execution.
We extend our previous work to further characterize, describe, and contrast how primary care practices exhibit KM and explain why KM deserves attention in medical home redesign initiatives.
Case studies were conducted, drawn from two higher and lower performing practices, which were purposely selected based on disease management, prevention, and productivity measures from an improvement trial. Observations of operations, clinical encounters, meetings, and interviews with office members and patients were transcribed and coded independently using a KM template developed from a previous secondary analysis. Face-to-face discussions resolved coding differences among research team members. Confirmation of findings was sought from practice participants.
Practices manifested varying degrees of KM effectiveness through six interdependent processes and multiple overlapping tools. Social tools, such as face-to-face-communication for sharing and developing knowledge, were often more effective than were expensive technical tools such as an electronic medical record. Tool use was tailored for specific outcomes, interacted with each other, and leveraged by other organizational capacities. Practices with effective KM were more open to adopting and sustaining new ways of functioning, ways reflecting attributes of a medical home.
Knowledge management differences occur within and between practices and can explain differences in performance. By relying more on social tools rather than costly, high-tech investment, KM leverages primary care's relationship-centered strength, facilitating practice redesign as a medical home.
Health care management review 06/2009; 34(3):224-33. DOI:10.1097/HMR.0b013e31819c42fc · 1.30 Impact Factor
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