Problem: Academic medical centers (AMCs) need new approaches to delivering higher-quality care at lower costs, and engaging trainees in the work of high-functioning primary care practices.
Approach: In 2012, the Harvard Medical School Center for Primary Care, in partnership with with local AMCs, established an Academic Innovations Collaborative (AIC) with the goal of transforming primary care education and practice. This novel two-year learning collaborative consisted of hospital- and community-based primary care teaching practices, committed to building highly functional teams, managing populations, and engaging patients. The AIC built on models developed by Qualis Health and the Institute for Healthcare Improvement, optimized for the local AMC context. Foundational elements included leadership engagement and development, application of rapid-cycle process improvement, and the creation of teams to care for defined patient populations. Nineteen practices across six AMCs participated, with nearly 260,000 patients and 450 resident learners. The collaborative offered three 1.5-day learning sessions each year featuring shared learning, practice coaches, and improvement measures, along with monthly data reporting, webinars, and site visits.
Outcomes: Validated self-reports by transformation teams showed that practices made substantial improvement across all areas of change. Important factors for success included leadership development, practice-level resources, and engaging patients and trainees.
Next Steps: The AIC model shows promise as a path for AMCs to catalyze health system transformation through primary care improvement. In addition to further evaluating the impact of practice transformation, expansion will require support from AMCs and payers, and the application of similar approaches on a broader scale.
Dr. Bitton is associate physician and assistant professor of medicine, Division of General Medicine, Brigham and Women’s Hospital, and faculty lead for transformation strategy and design, Center for Primary Care, Harvard Medical School, Boston, Massachusetts.
Dr. Ellner is associate physician and assistant professor of medicine, Division of Global Health Equity, Brigham and Women’s Hospital, and codirector, Center for Primary Care, Harvard Medical School, Boston, Massachusetts.
Dr. Pabo is a postgraduate year 3 resident, Brigham and Women’s Hospital, and clinical fellow in medicine, Harvard Medical School, Boston, Massachusetts.
Dr. Stout is vice president of patient centered medical home development, Cambridge Health Alliance, instructor in medicine, and director, Academic Innovations Collaborative Leadership Academy, Center for Primary Care, Harvard Medical School, Boston, Massachusetts.
Dr. Sugarman is president and CEO, Qualis Health and Clinical Professor, Departments of Family Medicine and Epidemiology, University of Washington, Seattle, Washington.
Ms. Sevin is director, Institute for Healthcare Improvement, Cambridge, Massachusetts.
Dr. Goodell is director, Innovation in Medical Education, and clinical instructor, Population Medicine, Center for Primary Care, Harvard Medical School, Boston, Massachusetts.
Ms. Bassett is executive director, Center for Primary Care, Harvard Medical School, Boston, Massachusetts.
Dr. Phillips is director, Center for Primary Care, and William S. Applebaum Professor of Medicine and Professor of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.
The authors have informed the journal that they agree that Drs. Bitton and Ellner have completed the intellectual and other work associated with the first author.
Funding/Support: Funding was provided through a philanthropic gift from an anonymous donor to Harvard Medical School with matching commitments from the following six participating Harvard Medical School–affiliated academic medical centers: Beth Israel Deaconess Medical Center; Brigham & Women’s Hospital; Cambridge Health Alliance; Boston Children’s Hospital; Mount Auburn Hospital; and Massachusetts General Hospital.
Other disclosures: None reported.
Ethical approval: The institutional review board at the Harvard School of Public Health approved all research methods.
Previous presentations: Workshop, Society of General Internal Medicine Annual Meeting, April 24–27, 2013, Denver, Colorado.
Correspondence should be addressed to Dr. Phillips, Center for Primary Care, 635 Huntington Ave., 2nd Floor, Boston, MA 02115; telephone: (617) 432-2222; e-mail: Russell_Phillips@hms.harvard.edu.