Background: Central to the "medical home" concept is the premise that the delivery of effective primary care requires a fundamental shift in relationships among practice members and between practice members and patients. Primary care practices can potentially increase their capacity to deliver effective care through knowledge management (KM), a process of sharing and making existing knowledge available or by developing new knowledge among practice members and patients. KM affects performance by influencing work relationships to enhance learning, decision making, and task execution.
Purpose: We extend our previous work to further characterize, describe, and contrast how primary care practices exhibit KM and explain why KM deserves attention in medical home redesign initiatives.
Methodology: Case studies were conducted, drawn from two higher and lower performing practices, which were purposely selected based on disease management, prevention, and productivity measures from an improvement trial. Observations of operations, clinical encounters, meetings, and interviews with office members and patients were transcribed and coded independently using a KM template developed from a previous secondary analysis. Face-to-face discussions resolved coding differences among research team members. Confirmation of findings was sought from practice participants.
Findings: Practices manifested varying degrees of KM effectiveness through six interdependent processes and multiple overlapping tools. Social tools, such as face-to-face-communication for sharing and developing knowledge, were often more effective than were expensive technical tools such as an electronic medical record. Tool use was tailored for specific outcomes, interacted with each other, and leveraged by other organizational capacities. Practices with effective KM were more open to adopting and sustaining new ways of functioning, ways reflecting attributes of a medical home.
Practice Implications: Knowledge management differences occur within and between practices and can explain differences in performance. By relying more on social tools rather than costly, high-tech investment, KM leverages primary care's relationship-centered strength, facilitating practice redesign as a medical home.
A. John Orzano, MD, MPH, New Hampshire Dartmouth Family Medicine Residency, Concord. E-mail: firstname.lastname@example.org.
Claire R. McInerney, PhD, is Associate Professor, School of Communication, Information and Library Studies, Rutgers, The State University of New Jersey, New Brunswick.
Reuben R. McDaniel Jr., EdD, is Professor, Department of Information, Risk and Operations Management, McCombs School of Business, The University of Texas at Austin.
Abigail Meese, MS, is Graduate Student, School of Communication, Information and Library Studies, Rutgers, The State University of New Jersey, New Brunswick.
Bibi Alajmi, MS, is Graduate Student, School of Communication, Information and Library Studies, Rutgers, The State University of New Jersey, New Brunswick.
Stewart M. Mohr, PhD, is Lecturer, School of Communication, Information and Library Studies, Rutgers, The State University of New Jersey, New Brunswick.
Alfred F. Tallia, MD, MPH, is Professor, Department of Family Medicine, Research Division, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Somerset; Cancer Institute of New Jersey, New Brunswick; and Center for Research in Family Medicine and Primary Care, New Brunswick.
This study was supported by the Agency for Healthcare Research and Quality (K08 HS14018) and the National Heart, Lung, and Blood Institute (R01 HL070800). This study was presented at the 35th Annual North American Primary Care Research Group, October 21-23, 2007. The authors have no conflict of interests.