Kevin A Dorrance

Walter Reed National Military Medical Center, Washington, Washington, D.C., United States

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Publications (10)28.61 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Psychologists played a crucial role in the successful implementation of integrated behavioral health care services in Department of Defense (DoD) primary care clinics. On the front lines of policy development, training programs, clinical care, and program evaluations, psychologists successfully promoted integrated care as a core component of the DoD patient-centered medical home. We review the development of integrated care and discuss the roles of psychologists in the DoD to provide an exemplar of the impact psychologists can have on the implementation and sustainment of integrated care. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    American Psychologist 01/2014; 69(4):388-98. · 6.87 Impact Factor
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    ABSTRACT: Patient-centered medical homes (PCMHs) are intended to actively provide effective care by physician-led teams, where patients take a leading role and responsibility. To determine whether the Walter Reed PCMH has reduced costs while at least maintaining if not improving access to and quality of care, and to determine whether access, quality, and cost impacts differ by chronic condition status. This study conducted a retrospective analysis using a patient-level utilization database to determine the impact of the Walter Reed PCMH on utilization and cost metrics, and a survey of enrollees in the Walter Reed PCMH to address access to care and quality of care. Outcome measures: Inpatient and outpatient utilization, per member per quarter costs, Healthcare Effectiveness Data and Information Set metrics, and composite measures for access, patient satisfaction, provider communication, and customer service are included. Costs were 11% lower for those with chronic conditions compared to 7% lower for those without. Since treating patients with chronic conditions is 4 times more costly than treating patients without such conditions, the vast majority of dollar savings are attributable to chronic care. Results suggest focusing first on patients with chronic conditions given the greater potential for early gains.
    Military medicine 02/2013; 178(2):135-41. · 0.77 Impact Factor
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    ABSTRACT: This case study describes the Military Health System's (MHS) patient-centered medical home (PCMH) initiative and how it is being delivered across the MHS by the Army, Navy, and Air Force. The MHS, an integrated delivery model that includes both military treatment facilities and civilian providers and health care institutions, is transforming its primary care platforms from the traditional acute, episodic system to the PCMH model of care to maximize patient experience, satisfaction, health care quality, and readiness and to control cost growth. Preliminary performance measures are analyzed to assess the impact of PCMH implementation on the core primary care processes of the MHS. This study also discusses lessons learned and recommendations for improving health care performance through the PCMH care model.
    Military medicine 02/2013; 178(2):146-52. · 0.77 Impact Factor
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    ABSTRACT: This study describes and categorizes the cultural frictions and conflicts within a successfully implemented Internal Medicine Patient-Centered Medical Home (PCMH) clinic at the National Naval Medical Center, and provides lessons learned for combating these concerns. A semistructured interview protocol was developed, focusing on unique tenets of the PCMH, benefits of the model, and perceived obstacles to practicing medicine within this delivery system. The interviews included questions regarding efforts to foster team cohesion and impediments within the PCMH, as well as unique influences of the larger organization and the patient population, and lingering concerns about threats to the PCMH's viability. Cultural tensions were revealed in four areas: perceived competing values within PCMH, individual resistance to PCMH values, within-team conflicts threatening the acculturation of PCMH values, and threats to the culture from external stakeholders. Recommendations for addressing these areas include values clarification and empowerment, training for socialization, realistic job previews, selective personnel retention, team building and conflict resolution mechanisms, and increased senior managerial support.
    Military medicine 02/2013; 178(2):153-8. · 0.77 Impact Factor
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    ABSTRACT: The Patient Protection and Affordable Care Act recently passed into law is poised to profoundly affect the provision of medical care in the United States. In today's environment, the foundation for most ongoing comparative effectiveness research is financial claims data. However, there is an alternative that possesses much richer data. That alternative, uniquely positioned to serve as a test system for national health reform efforts, is the Department of Defense Military Health System. This article describes how to leverage the Military Health System and provide effective solutions to current health care reform challenges in the United States.
    Military medicine 02/2013; 178(2):142-5. · 0.77 Impact Factor
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    ABSTRACT: Context specificity, or the variation in a participant's performance from one case, or situation, to the next, is a recognized problem in medical education. However, studies have not explored the potential reasons for context specificity in experts using the lens of situated cognition and cognitive load theories (CLT). Using these theories, we explored the influence of selected contextual factors on clinical reasoning performance in internal medicine experts. We constructed and validated a series of videotapes portraying different chief complaints for three common diagnoses seen in internal medicine. Using the situated cognition framework, we modified selected contextual factors--patient, encounter, and/or physician--in each videotape. Following each videotape, participants completed a post-encounter form (PEF) and a think-aloud protocol. A survey estimating recent exposure from their practice to the correct videotape diagnoses was also completed. The time given to complete the PEF was randomly varied with each videotape. Qualitative utterances from the think-aloud procedure were converted to numeric measures of cognitive load. Survey and cognitive load measures were correlated with PEF performance. Pearson correlations were used to assess relations between the independent variables (cognitive load, survey of experience, contextual factors modified) and PEF performance. To further explore context specificity, analysis of covariance (ANCOVA) was used to assess differences in PEF scores, by diagnosis, after controlling for time. Low correlations between PEF sections, both across diagnoses and within each diagnosis, were observed (r values ranged from -.63 to .60). Limiting the time to complete the PEF impacted PEF performance (r = .2 to .4). Context specificity was further substantiated by demonstrating significant differences on most PEF section scores with a diagnosis (ANCOVA). Cognitive load measures were negatively correlated with PEF scores. The presence of selected contextual factors appeared to influence diagnostic more than therapeutic reasoning (r = -.2 to -.38). Contextual factors appear to impact expert physician performance. The impact observed is consistent with situated cognition and CLT's predictions. These findings have potential implications for educational theory and clinical practice.
    Advances in Health Sciences Education 04/2011; 17(1):65-79. · 2.06 Impact Factor
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    Annals of internal medicine 10/2008; 149(6):437-9. · 13.98 Impact Factor
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    ABSTRACT: Shortages in primary care careers such as internal medicine are projected in the future. Conducting research is an explicit requirement for graduate medical education and interest in research is growing in undergraduate medical education. We hypothesized that a medical student research initiative could increase student research productivity and foster mentoring relationships with internists. We compared the number of medical student presentations, awards, and peer-reviewed publications before and after a brief research initiative at a single institution and recorded comments from student participants; data collected before the initiative were retrospective, and data after the initiative were collected prospectively. Mann-Whitney U was used for statistical analysis. Twenty-seven students participated in our workshop initiative during the study period (2000-2005). Eighteen (67%) subsequently had presentations, research awards, and/or publications during the study period. Mann-Whitney U testing of groups (all pre-initiative Uniformed Services University students and initiative participants) showed a statistically significant increase in regional presentations (p = .003), research awards (p = .01), and publications (p = .02) after the research initiative. Student comments not only revealed research mentoring benefits but also commented on receiving career counseling advice from mentors. Our study findings support the feasibility of this initiative as well as produced significant outcomes in terms of quantified research productivity and student mentoring.
    Teaching and Learning in Medicine 04/2008; 20(2):163-7. · 0.94 Impact Factor
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    ABSTRACT: For more than a decade, primary care residency training programs have struggled to attract graduates of U.S. medical schools. Internal medicine (IM) interest groups (IMIGs) have been widely instituted to foster student interest in careers in IM. Residents can participate in many IMIG activities. Studies have not assessed the benefits gained by resident participants in such groups. A questionnaire was sent to residents at two IM residency training programs that contribute to IMIG activities at one medical school. Both participating and nonparticipating residents were included. The questionnaire was completed by 44 of 58 IM residents (76% response rate; 25 participants and 19 nonparticipants). Free-text advantages reported were teaching (n=6), mentoring (n=8), and leadership (n=5) opportunities, staying current in IM (n=3), encouraging students to enter IM (n=6), and improving resident morale (n=6). Likert-scale responses were higher for participants than for nonparticipants for all questions; nonparticipants also reported that involvement in IMIG activities is beneficial for residents. Statistically significant results were seen for questions regarding the following: improves resident morale, fosters leadership opportunities, is a valuable experience, and feeling qualified to participate. Residents perceive that participation in an IMIG confers significant benefit, providing additional justification for conducting these interest groups.
    Military medicine 03/2007; 172(2):210-3. · 0.77 Impact Factor
  • Southern Medical Journal 08/2006; 99(7):780-1. · 0.92 Impact Factor

Publication Stats

28 Citations
28.61 Total Impact Points

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Institutions

  • 2013
    • Walter Reed National Military Medical Center
      Washington, Washington, D.C., United States
  • 2008
    • Uniformed Services University of the Health Sciences
      • Department of Medicine
      Bethesda, MD, United States