Annals of Family Medicine

New Journal Feature Spotlights Practice Innovations

May 09, 2017 02:12 pm Michael Laff

Given the importance of primary care and the changes being made in this era of payment reform, practice innovation has become essential.

[Hand holding up a lightbulb in front of a chalkboard]

That's why the latest issue of Annals of Family Medicine launches a new feature, Innovations in Primary Care,( with brief articles that describe practice-based innovations and close with takeaway lessons.

In the May/June issue, the innovations feature offers seven profiles of transformative practice initiatives. The articles, each one page in length, highlight new approaches that are making a difference on the ground in primary care and in its partnerships with subspecialists and other care providers.

"Each article describes an innovation from the front lines of primary care, how it works, who implemented it and where it was carried out -- information readers need to make decisions about how to transport or reinvent the innovation in their own setting," Annals editor Kurt Stange, M.D., Ph.D., wrote in an editorial introducing the feature.

Story Highlights
  • The current issue of Annals of Family Medicine introduces a new feature that focuses on novel innovations in primary care.
  • Authors describe a vexing problem that a practice sought to solve, such as better serving complex patients at a single care site.
  • Readers are encouraged to submit their own innovations and participate in an online discussion.  

Innovations authors describe a practice's approach to a vexing problem such as how to better serve complex patients at a single care site. Readers are encouraged to submit their own innovations, and they can participate in an online discussion about each article.

"We're excited to share with our readers stories that are making a difference in primary care," said Annals managing editor Beth Anderson. "These brief articles hope to bring practical applications, lessons or inspiration from family medicine innovators."

One of the first innovations articles described an integrated primary care program in North Carolina that focuses on low-income, uninsured patients who made at least six visits to the county hospital in the previous year. The target patient group represented just 0.2 percent of the population but received 50 percent of the uncompensated care at the local hospital. Most of these patients suffered from serious trauma, chronic medical conditions and/or untreated mood disorders.  

Co-author Bryan Hodge, D.O., told AAFP News that creating an integrated care model was essential for the program's success. Forming an integrated team allowed patients to have multiple conditions, including mental health needs, addressed in one visit. The team includes a primary care physician, a behavioral health specialist, a substance abuse counselor, an occupational therapist, a pharmacist and a nurse care manager who manages patient flow.

Annals Introduces Twitter Journal Club

In addition to the Innovations in Primary Care feature, the May/June issue of Annals of Family Medicine introduces the Twitter Journal Club.( This is a moderated chat on Twitter using the hashtag #AJC that features questions posed at regular intervals about a preselected article.

The first chat will be held May 31 from noon-1 p.m. EDT and will focus on the article "Internet-Based Vestibular Rehabilitation for Older Adults With Chronic Dizziness: A Randomized Controlled Trial in Primary Care."(

"We asked ourselves, 'What if we scrapped everything in the system and streamlined the process so there was no barrier to get these patients in?'" Hodge said.

Besides meeting with the medical team, patients are encouraged to participate in drop-in group medical appointments that are held each Thursday. The sessions last one hour and usually attract four to nine participants. To facilitate attendance, patients can receive vouchers for transportation or meals. Same-day appointments are available for patients whose conditions cannot wait for the weekly sessions.

The program started in 2010 with grant funding from North Carolina Health Net and support from the Kate B. Reynolds Charitable Trust. Five hundred patients have received care through the program since its inception, and hospital visits have been reduced by 50 percent.

During the first drop-in visit, participants tell their story and receive feedback from patients with similar needs. Patients later update the group on their conditions, which builds engagement and motivates everyone to take responsibility for their own health. As a patient's condition improves, they find they do not need to attend the drop-in sessions as often.

"At the end of the visit, patients are asked, 'What is the one thing you will do before your next visit to improve your health?'" Hodge said. "That's when it crystallizes for them."

Hodge said the program changed his perspective about patient care, reminding him why he entered medicine.

"It seemed like a daunting challenge to take on the most vulnerable patients at first, but it turned out to be the opposite," he said. "Now it's what I look forward to, and it's the most rewarding part of medicine because we're helping people that need help the most."