Joseph Hopkins

All Publications

• Association of Coworker Reports About Unprofessional Behavior by Surgeons With Surgical Complications in Their Patients. JAMA surgery Cooper, W. O., Spain, D. A., Guillamondegui, O., Kelz, R. R., Domenico, H. J., Hopkins, J., Sullivan, P., Moore, I. N., Pichert, J. W., Catron, T. F., Webb, L. E., Dmochowski, R. R., Hickson, G. B. 2019

  Abstract

  Importance: For surgical teams, high reliability and optimal performance depend on effective communication, mutual respect, and continuous situational awareness. Surgeons who model unprofessional behaviors may undermine a culture of safety, threaten teamwork, and thereby increase the risk for medical errors and surgical complications.Objective: To test the hypothesis that patients of surgeons with higher numbers of reports from coworkers about unprofessional behaviors are at greater risk for postoperative complications than patients whose surgeons generate fewer coworker reports.Design, Setting, and Participants: This retrospective cohort study assessed data from 2 geographically diverse academic medical centers that participated in the National Surgical Quality Improvement Program (NSQIP) and recorded and acted on electronic reports of safety events from coworkers describing unprofessional behavior by surgeons. Patients included in the NSQIP database who underwent inpatient or outpatient operations at 1 of the 2 participating sites from January 1, 2012, through December 31, 2016, were eligible. Patients were excluded if they were younger than 18 years on the date of the operation or if the attending surgeon had less than 36 months of monitoring for coworker reports preceding the date of the operation. Data were analyzed from August 8, 2018, through April 9, 2019.Exposures: Coworker reports about unprofessional behavior by the surgeon in the 36 months preceding the date of the operation.Main Outcomes and Measures: Postoperative surgical or medical complications, as defined by the NSQIP, within 30 days of the operation.Results: Among 13 653 patients in the cohort (54.0% [7368 ] female; mean [SD] age, 57 [16] years) who underwent operations performed by 202 surgeons (70.8% [143] male), 1583 (11.6%) experienced a complication, including 825 surgical (6.0%) and 1070 medical (7.8%) complications. Patients whose surgeons had more coworker reports were significantly more likely to experience any complication (0 reports, 954 of 8916 [10.7%]; ≥4 reports, 294 of 2087 [14.1%]; P<.001), any surgical complication (0 reports, 516 of 8916 [5.8%]; ≥4 reports, 159 of 2087 [7.6%]; P<.01), or any medical complication (0 reports, 634 of 8916 [7.1%]; ≥4 reports, 196 of 2087 [9.4%]; P<.001). The adjusted complication rate was 14.3% higher for patients whose surgeons had 1 to 3 reports and 11.9% higher for patients whose surgeons had 4 or more reports compared with patients whose surgeons had no coworker reports (P=.05).Conclusions and Relevance: Patients whose surgeons had higher numbers of coworker reports about unprofessional behavior in the 36 months before the patient's operation appeared to be at increased risk of surgical and medical complications. These findings suggest that organizations interested in ensuring optimal patient outcomes should focus on addressing surgeons whose behavior toward other medical professionals may increase patients' risk for adverse outcomes.

  View details for DOI 10.1001/jamasurg.2019.1738

  View details for PubMedID 31215973

• Initiative for prevention and early identification of delirium in medical-surgical units: Lessons learnt in the past five years. The American journal of medicine Rohatgi, N., Weng, Y., Bentley, J., Lansberg, M. G., Shepard, J., Mazur, D., Ahuja, N., Hopkins, J. 2019

  Abstract

  BACKGROUND: Delirium is an acute change in mental status affecting 10-64% of hospitalized patients, and may be preventable in 30-40% cases. In October 2013, a task force for delirium prevention and early identification in medical-surgical units was formed at our hospital. We studied if our standardized protocol prevented delirium among high-risk patients.METHODS: We studied 105,455 patient encounters between November 2013 and January 2018. Since November 2013, there has been ongoing education to decrease deliriogenic medications use. Since 2014, nurses screen all patients for presence or absence of delirium using confusion assessment method (CAM). Since 2015, nurses additionally screen all patients for risk of delirium. In 2015, a physician order set for delirium was created. Non-pharmacological measures are implemented for high-risk or CAM positive patients.RESULTS: 98.8% of patient encounters had CAM screening, and 99.6% had delirium risk screening. Since 2013, odds of opiate use decreased by 5.0% per year (P<0.001), and odds of benzodiazepines use decreased by 8.0% per year (P<0.001). There was no change in anticholinergics use. In the adjusted analysis, since 2015, odds of delirium decreased by 25.3% per year among high-risk patients (N=21,465; P<0.001). Among high-risk patients or those diagnosed with delirium (N=22,121), estimated LOS decreased by 0.13days per year (P<0.001), odds of inpatient mortality decreased by 16.0% per year (P=0.011), and odds of discharge to nursing home decreased by 17.1% per year (P<0.001).CONCLUSION: With high clinician engagement and simplified workflows, our delirium initiative has shown sustained results.

  View details for DOI 10.1016/j.amjmed.2019.05.035

  View details for PubMedID 31228413

• Patient vs provider perspectives of 30-day hospital readmissions. BMJ open quality Smeraglio, A., Heidenreich, P. A., Krishnan, G., Hopkins, J., Chen, J., Shieh, L. 2019; 8 (1): e000264

  Abstract

  Objective: To compare patients' and providers' views on contributors to 30-day hospital readmissions.Design: Analysis of a qualitative interview survey between 18 May-30 June 2015.Setting: Interviews were conducted during the 30-day readmission hospitalisation at a single tertiary care academic hospital.Participants: We conducted 178 interviews of readmitted patients.Measures: We queried opinions of what factors patients believed contributed to their rehospitalisation and compared this with the perspective of the index admission provider. The primary outcome was the view that the readmission was preventable. A review by a RN (nurse) case manager also provided an assessment based on patient report, provider report and chart review.Results: Patients were more likely to view a readmission as preventable compared with physicians (p<0.0001). Patients identified system issues (defined as factors controlled by the hospital discharge process) as contributors to their readmission in 58% (103/178) of cases while providers identified system issues as the contributor to a patients' readmission in 2% (2/101) of cases. Patients with poor functional status were more likely to feel the cause of their readmission was due to system issues than patients with better functional status (p=0.03). A RN case manager review determined that in 48% (86/178) of cases the system had some amount of contribution to a patient's readmission. There was no significant difference in belief that the readmission was preventable between the RN case manager and the patient (p=0.47).Conclusions: Readmitted patients often feel that the hospital system contributed to their readmission. Providers did not recognise patient and RN case manager identified issues as contributors to hospital readmissions.

  View details for PubMedID 30687798

• Patterns of Disrespectful Physician Behavior at an Academic Medical Center: Implications for Training, Prevention, and Remediation. Academic medicine : journal of the Association of American Medical Colleges Hopkins, J., Hedlin, H., Weinacker, A., Desai, M. 2018

  Abstract

  PURPOSE: Physician disrespectful behavior affects quality of care, patient safety, and collaborative clinical team function. Evidence defining the demographics, ethnography, and epidemiology of disrespectful behavior is lacking.METHOD: The authors conducted a retrospective analysis of reports of disrespectful physician behavior at Stanford Hospital and Clinics from March 2011 through February 2015. Events were stratified by role, gender, specialty, and location in the hospital or clinics where the event occurred. Event rate ratios were estimated using a multivariable negative binomial regression model. Correlation of rates of faculty and trainees in the same specialty were assessed.RESULTS: One-hundred-ninety-nine events concerned faculty; 160 concerned trainees. Events were concentrated among a small number of physicians in both groups. The rates of faculty and trainee events within the same specialty were highly correlated (Spearman's rho: 0.90; P < .001). Male physicians had an adjusted event rate 1.86 (95% CI = 1.33 - 2.60; P < .001) times that of females. Procedural physicians were 3.67 times (95% CI = 2.63 - 5.13; P < .001) more likely to have a disrespectful behavior event than non-procedural physicians when adjusting for other covariates. Most common location for faculty was the operating rooms (69 events, 34%); for trainees, the medical/surgical units (43 events, 27%).CONCLUSIONS: Patterns of physician disrespectful behavior differed by role, gender, specialty, and location. Rates among faculty and trainees of the same specialty were highly correlated. These patterns can be used to create more focused education and training for specific physician groups and individualized remediation interventions.

  View details for DOI 10.1097/ACM.0000000000002126

  View details for PubMedID 29319539

• A long-term follow-up of a physician leadership program. Journal of health organization and management Fassiotto, M., Maldonado, Y., Hopkins, J. 2018; 32 (1): 56–68

  Abstract

  Purpose Physician leadership programs serve to develop individual capabilities and to affect organizational outcomes. Evaluations of such programs often focus solely on short-term increases in individual capabilities. The purpose of this paper is to assess long-term individual and organizational outcomes of the Stanford Leadership Development Program. Design/methodology/approach There are three data sources for this mixed-methods study: a follow-up survey in 2013-2014 of program participants ( n=131) and matched (control) non-participants ( n=82) from the 2006 to 2011 program years; promotion and retention data; and qualitative in-person interview data. The authors analyzed survey data across leadership knowledge, skills, and attitudes as well as leadership titles held, following program participation using Pearson's χ2 test of independence. Using logistic regression, the authors analyzed promotion and retention among participants and non-participants. Finally, the authors applied both a grounded theory approach and qualitative content analysis to analyze interview data. Findings Program participants rated higher than non-participants across 25 of 30 items measuring leadership knowledge, skills, and attitudes, and were more likely to hold regional/national leadership titles and to have gained in leadership since program participation. Asian program participants were significantly more likely than Asian non-participants to have been promoted, and women participants were less likely to have left the institution than non-participants. Finally, qualitative interviews revealed the long-term impact of leadership learning and networking, as well as the enduring, sustained impact on the organization of projects undertaken during the program. Originality/value This study is unique in its long-term and comprehensive mixed-methods nature of evaluation to assess individual and organizational impact of a physician leadership program.

  View details for PubMedID 29508671

• Use of Unsolicited Patient Observations to Identify Surgeons With Increased Risk for Postoperative Complications. JAMA surgery Cooper, W. O., Guillamondegui, O., Hines, O. J., Hultman, C. S., Kelz, R. R., Shen, P., Spain, D. A., Sweeney, J. F., Moore, I. N., Hopkins, J., Horowitz, I. R., Howerton, R. M., Meredith, J. W., Spell, N. O., Sullivan, P., Domenico, H. J., Pichert, J. W., Catron, T. F., Webb, L. E., Dmochowski, R. R., Karrass, J., Hickson, G. B. 2017

  Abstract

  Unsolicited patient observations are associated with risk of medical malpractice claims. Because lawsuits may be triggered by an unexpected adverse outcome superimposed on a strained patient-physician relationship, a question remains as to whether behaviors that generate patient dissatisfaction might also contribute to the genesis of adverse outcomes themselves.To examine whether patients of surgeons with a history of higher numbers of unsolicited patient observations are at greater risk for postoperative complications than patients whose surgeons generate fewer such unsolicited patient observations.This retrospective cohort study used data from 7 academic medical centers participating in the National Surgical Quality Improvement Program and the Vanderbilt Patient Advocacy Reporting System from January 1, 2011, to December 31, 2013. Patients older than 18 years included in the National Surgical Quality Improvement Program who underwent inpatient or outpatient operations at 1 of the participating sites during the study period were included. Patients were excluded if the attending surgeon had less than 24 months of data in the Vanderbilt Patient Advocacy Reporting System preceding the date of the operation. Data analysis was conducted from June 1, 2015, to October 20, 2016.Unsolicited patient observations for the patient's surgeon in the 24 months preceding the date of the operation.Postoperative surgical or medical complications as defined by the National Surgical Quality Improvement Program within 30 days of the operation of interest.Among the 32 125 patients in the cohort (13 230 men, 18 895 women; mean [SD] age, 55.8 [15.8] years), 3501 (10.9%) experienced a complication, including 1754 (5.5%) surgical and 2422 (7.5%) medical complications. Prior unsolicited patient observations for a surgeon were significantly associated with the risk of a patient having any complication (odds ratio, 1.0063; 95% CI, 1.0004-1.0123; P = .03), any surgical complication (odds ratio, 1.0104; 95% CI, 1.0022-1.0186; P = .01), any medical complication (odds ratio, 1.0079; 95% CI, 1.0009-1.0148; P = .03), and being readmitted (odds ratio, 1.0088, 95% CI, 1.0024-1.0151; P = .007). The adjusted rate of complications was 13.9% higher for patients whose surgeon was in the highest quartile of unsolicited patient observations compared with patients whose surgeon was in the lowest quartile.Patients whose surgeons have large numbers of unsolicited patient observations in the 24 months prior to the patient's operation are at increased risk of surgical and medical complications. Efforts to promote patient safety and address risk of malpractice claims should continue to focus on surgeons' ability to communicate respectfully and effectively with patients and other medical professionals.

  View details for DOI 10.1001/jamasurg.2016.5703

  View details for PubMedID 28199477

• Designing a physician leadership development program based on effective models of physician education. Health care management review Hopkins, J., Fassiotto, M., Ku, M. C., Mammo, D., Valantine, H. 2017

  Abstract

  Because of modern challenges in quality, safety, patient centeredness, and cost, health care is evolving to adopt leadership practices of highly effective organizations. Traditional physician training includes little focus on developing leadership skills, which necessitates further training to achieve the potential of collaborative management.The aim of this study was to design a leadership program using established models for continuing medical education and to assess its impact on participants' knowledge, skills, attitudes, and performance.The program, delivered over 9 months, addressed leadership topics and was designed around a framework based on how physicians learn new clinical skills, using multiple experiential learning methods, including a leadership active learning project. The program was evaluated using Kirkpatrick's assessment levels: reaction to the program, learning, changes in behavior, and results. Four cohorts are evaluated (2008-2011).Reaction: The program was rated highly by participants (mean = 4.5 of 5). Learning: Significant improvements were reported in knowledge, skills, and attitudes surrounding leadership competencies. Behavior: The majority (80%-100%) of participants reported plans to use learned leadership skills in their work. Improved team leadership behaviors were shown by increased engagement of project team members.All participants completed a team project during the program, adding value to the institution.Results support the hypothesis that learning approaches known to be effective for other types of physician education are successful when applied to leadership development training. Across all four assessment levels, the program was effective in improving leadership competencies essential to meeting the complex needs of the changing health care system.Developing in-house programs that fit the framework established for continuing medical education can increase physician leadership competencies and add value to health care institutions. Active learning projects provide opportunities to practice leadership skills addressing real word problems.

  View details for DOI 10.1097/HMR.0000000000000146

  View details for PubMedID 28157830

• Surgical Comanagement by Hospitalists Improves Patient Outcomes: A Propensity Score Analysis. Annals of surgery Rohatgi, N., Loftus, P., Grujic, O., Cullen, M., Hopkins, J., Ahuja, N. 2016; 264 (2): 275-282

  Abstract

  The aim of the study was to examine the impact of a surgical comanagement (SCM) hospitalist program on patient outcomes at an academic institution.Prior studies may have underestimated the impact of SCM due to methodological shortcomings.This is a retrospective study utilizing a propensity score-weighted intervention (n = 16,930) and control group (n = 3695). Patients were admitted between January 2009 to July 2012 (pre-SCM) and September 2012 to September 2013 (post-SCM) to Orthopedic or Neurosurgery at our institution. Using propensity score methods, linear regression, and a difference-in-difference approach, we estimated changes in outcomes between pre and post periods, while adjusting for confounding patient characteristics.The SCM intervention was associated with a significant differential decrease in the proportion of patients with at least 1 medical complication [odds ratio (OR) 0.86; 95% confidence interval (CI), 0.74-0.96; P = 0.008), the proportion of patients with length of stay at least 5 days (OR 0.75; 95% CI, 0.67-0.84; P < 0.001), 30-day readmission rate for medical cause (OR 0.67; 95% CI, 0.52-0.81; P < 0.001), and the proportion of patients with at least 2 medical consultants (OR 0.55; 95% CI, 0.49-0.63; P < 0.001). There was no significant change in patient satisfaction (OR 1.08; 95% CI, 0.87-1.33; P = 0.507). We estimated average savings of $2642 to $4303 per patient in the post-SCM group. The overall provider satisfaction with SCM was 88.3%.The SCM intervention reduces medical complications, length of stay, 30-day readmissions, number of consultants, and cost of care.

  View details for DOI 10.1097/SLA.0000000000001629

  View details for PubMedID 26764873

• Improving and sustaining a reduction in iatrogenic pneumothorax through a multifaceted quality-improvement approach. Journal of hospital medicine Shieh, L., Go, M., Gessner, D., Chen, J. H., Hopkins, J., Maggio, P. 2015; 10 (9): 599-607

  Abstract

  The Agency for Healthcare Research and Quality has adopted iatrogenic pneumothorax (IAP) as a Patient Safety Indicator. In 2006, in response to a low performance ranking for IAP rate from the University Healthsystem Consortium (UHC), the authors established a multidisciplinary team to reduce our institution's IAP rate. Root-cause analysis found that subclavian insertion of central venous catheterization (CVC) was the most common procedure associated with IAP OBJECTIVE: Our short-term goal was a 50% reduction of both CVC-associated and all-cause IAP rates within 18 months, with long-term goals of sustained reduction.Observational study.Academic tertiary care hospital.Consecutive inpatients from 2006 to 2014.Our multifaceted intervention included: (1) clinical and documentation standards based on evidence, (2) cognitive aids, (3) simulation training, (4) purchase and deployment of ultrasound equipment, and (5) feedback to clinical services.CVC-associated IAP, all-cause IAP rate.We achieved both a short-term (years 2006 to 2008) and long-term (years 2006 to 2008-2014) reduction in our CVC-associated and all-cause IAP rates. Our short-term reduction in our CVC-associated IAP was 53% (P = 0.088), and our long-term reduction was 85% (P < 0.0001). Our short-term reduction in the all-cause IAP rate was 26% (P < 0.0001), and our long-term reduction was 61% (P < 0.0001).A multidisciplinary team, focused on evidence, patient safety, and standardization, can use a set of multifaceted interventions to sustainably improve patient outcomes for several years after implementation. Our hospital was in the highest performance UHC quartile for all-cause IAP in 2012 to 2014. Journal of Hospital Medicine 2015. © 2015 Society of Hospital Medicine.

  View details for DOI 10.1002/jhm.2388

  View details for PubMedID 26041246

• Improving and sustaining a reduction in iatrogenic pneumothorax through a multifaceted quality-improvement approach JOURNAL OF HOSPITAL MEDICINE Shieh, L., Go, M., Gessner, D., Chen, J. H., Hopkins, J., Maggio, P. 2015; 10 (9): 599-607

  Abstract

  The Agency for Healthcare Research and Quality has adopted iatrogenic pneumothorax (IAP) as a Patient Safety Indicator. In 2006, in response to a low performance ranking for IAP rate from the University Healthsystem Consortium (UHC), the authors established a multidisciplinary team to reduce our institution's IAP rate. Root-cause analysis found that subclavian insertion of central venous catheterization (CVC) was the most common procedure associated with IAP OBJECTIVE: Our short-term goal was a 50% reduction of both CVC-associated and all-cause IAP rates within 18 months, with long-term goals of sustained reduction.Observational study.Academic tertiary care hospital.Consecutive inpatients from 2006 to 2014.Our multifaceted intervention included: (1) clinical and documentation standards based on evidence, (2) cognitive aids, (3) simulation training, (4) purchase and deployment of ultrasound equipment, and (5) feedback to clinical services.CVC-associated IAP, all-cause IAP rate.We achieved both a short-term (years 2006 to 2008) and long-term (years 2006 to 2008-2014) reduction in our CVC-associated and all-cause IAP rates. Our short-term reduction in our CVC-associated IAP was 53% (P = 0.088), and our long-term reduction was 85% (P < 0.0001). Our short-term reduction in the all-cause IAP rate was 26% (P < 0.0001), and our long-term reduction was 61% (P < 0.0001).A multidisciplinary team, focused on evidence, patient safety, and standardization, can use a set of multifaceted interventions to sustainably improve patient outcomes for several years after implementation. Our hospital was in the highest performance UHC quartile for all-cause IAP in 2012 to 2014. Journal of Hospital Medicine 2015. © 2015 Society of Hospital Medicine.

  View details for DOI 10.1002/jhm.2388

  View details for Web of Science ID 000360836000007

• Creating a Patient Complaint Capture and Resolution Process to Incorporate Best Practices for Patient-Centered Representation. Joint Commission journal on quality and patient safety / Joint Commission Resources Levin, C. M., Hopkins, J. 2014; 40 (11): 484-412

  Abstract

  A growing body of evidence suggests that patient (including family) feedback can provide compelling opportunities for developing risk management and quality improvement strategies, as well as improving customer satisfaction. The Patient Representative Department (PRD) at Stanford Health Care (SHC) (Stanford, California) created a streamlined patient complaint capture and resolution process to improve the capture of patient complaints and grievances from multiple parts of the organization and manage them in a centralized database.In March 2008 the PRD rolled out a data management system for tracking patient complaints and generating reports to SHC leadership, and SHC needed to modify and address its data input procedures. A reevaluation of the overall work flow showed it to be complex, with over-lapping and redundant steps, and to lack standard processes and actions. Best-practice changes were implemented: (1) leadership engagement, (2) increased capture of complaints, (3) centralized data and reporting, (4) improved average response times to patient grievances and complaints, and (5) improved service recovery. Standard work flows were created for each category of complaint linked to specific actions.Complaints captured increased from 20 to 270 per month. Links to a specific physician rose from 16%-36% to more than 80%. In addition, 68% of high-complaint physicians improved. With improved work flows, responses to patients expressing concerns met a requirement of less than seven days.Standardized work flows for managing complaints and grievances, centralized data management and clear leadership accountability can improve responsiveness to patients, capture incidents more consistently, and meet regulatory and accreditation requirements.

  View details for PubMedID 26111366

• Assigning a team-based pager for on-call physicians reduces paging errors in a large academic hospital. Joint Commission journal on quality and patient safety / Joint Commission Resources Shieh, L., Chi, J., Kulik, C., Momeni, A., Shelton, A., DePorte, C., Hopkins, J. 2014; 40 (2): 77-82

  Abstract

  As complexity of care of hospitalized patients has increased, the need for communication and collaboration among members of the team caring for the patient has become increasingly important. This often takes the form of a nurse's need to contact a patient's physician to discuss some aspect of care and modify treatment plans. Errors in communication delay care and can pose risk to patients. This report describes the successful implementation of a standardized team-based paging system at an academic center. Results showed a substantial improvement in nurses' perceptions of knowing how to contact the correct physician when discussion of the patient's care is needed. This improvement was found across multiple medical and surgical specialties and was particularly effective for services with the greatest communication problems.

  View details for PubMedID 24716330

• PAGING EFFECTIVENESS: A MODEL FOR PAGER COMMUNICATION AT A LARGE ACADEMIC MEDICAL CENTER Chi, J., Shieh, L., Hopkins, J. SPRINGER. 2011: S552

  View details for Web of Science ID 000208812703224

• Improving and sustaining core measure performance through effective accountability of clinical microsystems in an academic medical center. Joint Commission journal on quality and patient safety / Joint Commission Resources Pardini-Kiely, K., Greenlee, E., Hopkins, J., Szaflarski, N. L., Tabb, K. 2010; 36 (9): 387-398

  Abstract

  Evidence-based performance measures, known as core measures, have been established by The Joint Commission to improve the quality of care for patient populations, such as those with acute myocardial infarction (AMI), heart failure, and community-acquired pneumonia (CAP), as well as to improve the quality of surgical care--the Surgical Care Improvement Project (SCIP) measures. Hospital administrators have traditionally held academic and community physicians and hospital clinicians accountable for integrating the core measures into daily practice. Such efforts have often led to suboptimal results because of the belief that the "organization" (macrosystem) is the appropriate level at which to work to improve quality. Stanford Hospital and Clinics (Stanford, California) has instead held leaders of clinical microsystems--the clinical units where care is provided--accountable to improve performance on the core measures. The strategic approaches taken for this initiative include engagement of the hospital's board of directors; clear assignment of accountability among interdisciplinary care teams to drive the change; implementation of a unit-based medical director program; transparency of core measure performance at the microsystem, mesosystem, and macrosystem levels; and concurrent monitoring with rapid feedback of results.In 2007, the first year of this initiative, the 24-metric composite compliance score for all four core measures increased from 64% to 82%. The composite score was sustained at a minimum of 90% during 2009 and Quarter 1 of 2010.Holding clinical microsystems accountable for improving unit performance proved beneficial to macrosystem performance of the Joint Commission core measures.

  View details for PubMedID 20873671

• Accountability of Unit-Based Teams Leads to Improved and Sustained Performance of Core Measures Am J Medical Quality Pardini-Kiely K, Greelet E, Hopkins J 2009; 24 (Suppl): 34S-35S
• A new instrument to measure appropriateness of services in primary care INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE Thom, D. H., Kravitz, R. L., Kelly-Reif, S., Sprinkle, R. V., Hopkins, J. R., Rubenstein, L. V. 2004; 16 (2): 133-140

  Abstract

  To develop a new instrument for judging the appropriateness of three key services (new prescription, diagnostic test, and referral) as delivered in primary care outpatient visits.Candidate items were generated by a seven-member expert panel, using a five-step nominal technique, for each of three service categories in primary care: new prescriptions, diagnostic tests, and referrals. Expert panelists and a convenience sample of 95 community-based primary care physicians ranked items for (i) importance and (ii) feasibility of ascertaining from a typical office chart record. Resulting items were used to construct a measure of appropriateness using principals of structured implicit review. Two physician reviewers used this measure to judge the appropriateness of 421 services from 160 outpatient visits.Primary care practices in a staff model health maintenance organization and a large preferred provider network.Inter-rater agreement was measured using intraclass correlation coefficient (ICC) and kappa statistic.For overall appropriateness, the ICC and kappa were 0.52 and 0.44 for new medication, 0.35 and 0.32 for diagnostic test, and 0.40 and 0.41 for referral, respectively. Only 3% of services were judged to be inappropriate by either reviewer. The proportion of services judged to be less than definitely appropriate by one or both reviewers was 56% for new medication, 31% for diagnostic test, and 22% for referral.This new measure of appropriateness of primary care services has fair inter-rater agreement for new medications and referrals, similar to appropriateness measures of other general services, but poor agreement for diagnostic tests. It may be useful as a tool to assess the appropriateness of common primary care services in studies of health care quality, but is not suitable for evaluating performance of individual physicians.

  View details for DOI 10.1093/intqhc/mzh029

  View details for Web of Science ID 000220614500003

  View details for PubMedID 15051707

• The Midpeninsula Health Service: action research using small primary care groups to provide evidence-based medicine that empowers patients while continuously improving quality and lowering costs. Medical care Goldberg, H. I., Rund, D. A., Hopkins, J. R. 2002; 40 (4): II32-9

  Abstract

  A Joint Planning Committee Report was issued in 1974 exploring how Stanford University might itself provide primary care to students, faculty, employees and their dependents at low cost. The report called for the creation of a health maintenance organization owned by its subscribers in affiliation with Stanford Medical Center. However, because the report was dismissed by the dean of the School of Medicine as being unworkable, the Midpeninsula Health Service (MHS) began operating as an unaffiliated, nonprofit health plan in downtown Palo Alto in January 1976. The MHS's planning, early operation, move to the Stanford campus, financial viability and ultimate fate are examined as an example of action research in health care.Source documents were examined by the authors, a founding MHS board member and its two inaugural medical directors, in compiling a 30-year organizational history.The MHS was remarkably prescient in its early use of small primary care groups that included midlevel practitioners, the principles of evidence-based medicine, the participation of patients in self-care activities, and a commitment to the continuous monitoring and improvement of quality. Imputed annualized costs of care were 30% lower than contemporary fee-for-service care and 20% lower than that of Kaiser, with no discernible difference in health outcomes.Action research methods can be useful in identifying and testing potential solutions to vexing problems in health care delivery.

  View details for PubMedID 12064579

• Financial incentives for ambulatory care performance improvement. Joint Commission journal on quality improvement Hopkins, J. R. 1999; 25 (5): 223-238

  Abstract

  Measuring and improving the quality of care while curtailing costs are essential objectives in capitated care. As patient care moves from the hospital to outpatient settings, quality management resources must be shifted to ambulatory care process improvement. The Quality Improvement and Efficiency Financial Incentives Program at Stanford University Medical Center was adopted to increase quality improvement efforts and contain costs. THE INCENTIVE PROGRAM: Each department's budget for care of capitated patients was reduced by 5% from the previous year. Return of a reserve fund (10% of payments for specialty care) required completion of substantive quality improvement projects and containing costs. Successful departments were also eligible for bonus funds. Implementation strategies included endorsement by clinical leaders, physician education, use of administrative data to identify project topics and support measurement of quality and cost variables, project templates and time lines, and the availability of clinical quality managers with special expertise in clinical process improvement.Eight of 13 clinical departments developed and implemented 19 ambulatory quality improvement projects to varying degrees. Success in the program was roughly correlated with the potential impact of the incentive on revenues and the status of the lead person selected by the department to spearhead their efforts. Only 5 departments achieved their cost containment goals.Financial incentives are one method of encouraging physicians to use clinical process improvement methods. Endorsement by clinical leaders and selection of realistic beginning projects enhance chances for success. The capitated population has attributes that make it an attractive focus for initial quality improvement efforts.

  View details for PubMedID 10340207

• Drug therapy: the impact of managed care. Advances in pharmacology (San Diego, Calif.) Hopkins, J., Siu, S., Cawley, M., Rudd, P. 1998; 44: 1-32

  View details for PubMedID 9547883

• An interdisciplinary teaching program in geriatrics for physician's assistants J. Allied Health Stark R, Hopkins J, et. al. 1984; 13: 280-287
• Multidisciplinary geriatrics training using elders as consultants and community senior resources as classrooms Gerontology and Geriatric Education Yeo G, Hopkins, JR, et. al. 1982; 2: 227-232
• FAMILY-PRACTICE RESIDENCY GRADUATES AS FACULTY MEMBERS JOURNAL OF FAMILY PRACTICE Hopkins, J. R., Green, W. M. 1978; 6 (4): 823-826

  Abstract

  The demand for teachers of family practice is being met in part by recent residency graduates. The background of these individuals would not predict that they would become teachers, and a major role adaptation is required of them. Yet a number of factors lead them to elect to become faculty members. They possess several qualities different from faculty members coming from practice backgrounds and are, therefore, able to make unique contributions. A combination of recent graduates and practice-experienced faculty members may represent the ideal mix for the further development of academic family practice.

  View details for Web of Science ID A1978EV43000014

  View details for PubMedID 641466

• EXPERIENCE OF FAMILY-PRACTICE RESIDENTS AS ATHLETIC TEAM PHYSICIANS JOURNAL OF FAMILY PRACTICE Hopkins, J. R., Parker, C. E. 1978; 7 (3): 519-525

  Abstract

  Providing exposure for family practice residence to all aspects of community medicine is a common goal of training programs. The Antelope Valley Hospital Medical Center Family Practice Program has initiated an innovative project which involves residents serving as team physicians for local college athletic teams. This provides a valuable opportunity for residents to learn skills they can be expected to need in their future practice. The team physician's role offers educational potential for family practice residents through experience with acute orthopedic problems as well as the preventive and psychological aspects of sports medicine. This role also serves as an example of physician responsibility for health-related activities in the acommunity.

  View details for Web of Science ID A1978FR49000009

  View details for PubMedID 690584

• PROTEIN BINDING OF CALCIUM AND STRONTIUM IN GUINEA PIG MATERNAL AND FETAL BLOOD PLASMA AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY Twardock, A. R., KUO, E. Y., AUSTIN, M. K., Hopkins, J. R. 1971; 110 (7): 1008-?

  View details for Web of Science ID A1971J978900020

  View details for PubMedID 5558962