Ian Nelligan

All Publications

• Impact of a Family Medicine Minor Procedure Service on Cost of Care for a Health Plan. Family medicine Nelligan, I., Montacute, T., Browne, M., Lin, S. 2020; 52 (6): 417–21

  Abstract

  BACKGROUND AND OBJECTIVES: Academic medical centers (AMC) are among some of the most expensive places to provide care. One way to cut costs is by decreasing unnecessary referrals to specialists for procedures that can be provided by well-trained primary care physicians. Our goal is to measure the financial impact of an office-based minor procedure service driven entirely by family physicians.METHODS: We examined claims data for procedures performed on patients insured under our AMC's home-grown accountable care organization-style health plan (Stanford Health Care Alliance [SHCA]). Descriptive statistics was used to compare the volume and cost of procedures performed by family medicine (FM) versus specialty care (SC). We preformed a subanalysis of SC procedures to explore the degree to which consultation and facility fees increased costs for SC. We used mathematical modeling to estimate the impact on cost of care if procedures were shifted from SC to FM and to calculate a return on investment (ROI).RESULTS: Our data set examined 6,974 outpatient procedures performed on SHCA patients from 2016-2018 at a cost of $5,263,720 to SHCA. FM performed 6% of procedures at an average cost of $236 per procedure, while SC performed 94% of procedures at an average cost of $787 per procedure. FM saved money for all 12 types of skin, musculoskeletal, and reproductive procedures assessed; the average saved per procedure was $551. This represents a 70% cost savings. ROI was 2.33; for every $1 spent on FM procedures, SHCA saved $2.33.CONCLUSION: A family medicine minor procedure service significantly lowered health spending at our AMC.

  View details for DOI 10.22454/FamMed.2020.334308

  View details for PubMedID 32520375

• Impact of Scribes on Physician Satisfaction, Patient Satisfaction, and Charting Efficiency: A Randomized Controlled Trial. Annals of family medicine Gidwani, R., Nguyen, C., Kofoed, A., Carragee, C., Rydel, T., Nelligan, I., Sattler, A., Mahoney, M., Lin, S. 2017; 15 (5): 427–33

  Abstract

  Scribes are increasingly being used in clinical practice despite a lack of high-quality evidence regarding their effects. Our objective was to evaluate the effect of medical scribes on physician satisfaction, patient satisfaction, and charting efficiency.We conducted a randomized controlled trial in which physicians in an academic family medicine clinic were randomized to 1 week with a scribe then 1 week without a scribe for the course of 1 year. Scribes drafted all relevant documentation, which was reviewed by the physician before attestation and signing. In encounters without a scribe, the physician performed all charting duties. Our outcomes were physician satisfaction, measured by a 5-item instrument that included physicians' perceptions of chart quality and chart accuracy; patient satisfaction, measured by a 6-item instrument; and charting efficiency, measured by time to chart close.Scribes improved all aspects of physician satisfaction, including overall satisfaction with clinic (OR = 10.75), having enough face time with patients (OR = 3.71), time spent charting (OR = 86.09), chart quality (OR = 7.25), and chart accuracy (OR = 4.61) (all P values <.001). Scribes had no effect on patient satisfaction. Scribes increased the proportion of charts that were closed within 48 hours (OR =1.18, P =.028).To our knowledge, we have conducted the first randomized controlled trial of scribes. We found that scribes produced significant improvements in overall physician satisfaction, satisfaction with chart quality and accuracy, and charting efficiency without detracting from patient satisfaction. Scribes appear to be a promising strategy to improve health care efficiency and reduce physician burnout.

  View details for PubMedID 28893812

• Creating the medical school of the future through incremental curricular transformation: the Stanford Healthcare Innovations and Experiential Learning Directive (SHIELD) EDUCATION FOR PRIMARY CARE Lin, S., Osborn, K., Sattler, A., Nelligan, I., Svec, D., Aaronson, A., Schillinger, E. 2017; 28 (3): 180–84

  View details for DOI 10.1080/14739879.2016.1259965

  View details for Web of Science ID 000441840100011

• An assessment of implementation of CommunityOriented Primary Care in Kenyan family medicine postgraduate medical education programmes. African journal of primary health care & family medicine Nelligan, I. J., Shabani, J., Taché, S., Mohamoud, G., Mahoney, M. 2016; 8 (1): e1-e4

  Abstract

  Family medicine postgraduate programmes in Kenya are examining the benefits of Community-Oriented Primary Care (COPC) curriculum, as a method to train residents in population-based approaches to health care delivery. Whilst COPC is an established part of family medicine training in the United States, little is known about its application in Kenya. We sought to conduct a qualitative study to explore the development and implementation of COPC curriculum in the first two family medicine postgraduate programmes in Kenya.Semi-structured interviews of COPC educators, practitioners, and academic stakeholders and focus groups of postgraduate students were conducted with COPC educators, practitioners and academic stakeholders in two family medicine postgraduate programmes in Kenya. Discussions were transcribed, inductively coded and thematically analysed.Two focus groups with eight family medicine postgraduate students and interviews with five faculty members at two universities were conducted. Two broad themes emerged from the analysis: expected learning outcomes and important community-based enablers. Three learning outcomes were (1) making a community diagnosis, (2) understanding social determinants of health and (3) training in participatory research. Three community-based enablers for sustainability of COPC were (1) partnerships with community health workers, (2) community empowerment and engagement and (3) institutional financial support.Our findings illustrate the expected learning outcomes and important communitybased enablers associated with the successful implementation of COPC projects in Kenya and will help to inform future curriculum development in Kenya.

  View details for DOI 10.4102/phcfm.v8i1.1064

  View details for PubMedID 28155322

  View details for PubMedCentralID PMC5153406

• Creating the medical school of the future through incremental curricular transformation: the Stanford Healthcare Innovations and Experiential Learning Directive (SHIELD). Education for primary care : an official publication of the Association of Course Organisers, National Association of GP Tutors, World Organisation of Family Doctors Lin, S., Osborn, K., Sattler, A., Nelligan, I., Svec, D., Aaronson, A., Schillinger, E. 2016: 1-5

  View details for PubMedID 27892817

• Are Kenyan healthcare workers willing to receive the pandemic influenza vaccine? Results from a cross-sectional survey of healthcare workers in Kenya about knowledge, attitudes and practices concerning infection with and vaccination against 2009 pandemic influenza A (H1N1), 2010 VACCINE Oria, P. A., Matini, W., Nelligan, I., Emukule, G., Scherzer, M., Oyier, B., Ochieng, H. N., Hooper, L., Kanyuga, A., Muthoka, P., Morales, K. F., Nzioka, C., Breiman, R. F., Katz, M. A. 2011; 29 (19): 3617-3622

  Abstract

  Over 1200 cases of 2009 pandemic influenza A H1N1 (pH1N1) have been identified in Kenya since the first case in June 2009. In April 2010 the Kenyan government launched a program to immunize high-risk groups and healthcare workers (HCWs) with pH1N1 vaccines donated by the World Health Organization. To characterize HCWs' knowledge, attitudes and practices regarding pH1N1 vaccination, we conducted a quantitative and qualitative survey in 20 healthcare facilities across Kenya between January 11 and 26, 2010. Of 659 HCWs interviewed, 55% thought there was a vaccine against pH1N1, and 89% indicated that they would receive pH1N1 vaccine if it became available. In focus group discussions, many HCWs said that pH1N1 virus infection did not cause severe disease in Kenyans and questioned the need for vaccination. However, most were willing to accept vaccination if they had adequate information on safety and efficacy. In order for the influenza vaccination campaign to be successful, HCWs must understand that pH1N1 can cause severe disease in Kenyans, that pH1N1 vaccination can prevent HCWs from transmitting influenza to their patients, and that the vaccine has been widely used globally with few recognized adverse events.

  View details for DOI 10.1016/j.vaccine.2011.01.063

  View details for Web of Science ID 000291072400014

  View details for PubMedID 21296117