Joseph Hopkins

Journal Articles

• 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