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Forming, operating, and improving micro-systems of health care.

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Call No.	R729.5.G6 M64 2000
Author	Mohr, Julie J.
Title	Forming, operating, and improving micro-systems of health care.
Date	2000
Abstract	Health care micro-systems are small, organized groups of clinicians and staff working together with a shared clinical purpose to provide care for a defined set of patients. The size of individual micro-systems vary--a micro-system must be large enough to accomplish its clinical purpose, but small enough to allow knowledge of the individual parts and the interrelationships between the parts. Use of information is key to the micro-system''s ability to function; information technology facilitates collecting, assessing, and sharing information. Micro-systems may be part of a larger organization and are embedded in a legal, financial, social, and regulatory environment. This research used qualitative methods to explore, describe, and characterize the micro-systems that coexist to form our current health care delivery system. Telephone interviews were conducted with representatives from 43 micro-systems. The interview was designed to determine each micro-system's level of performance, patient experience, use of information and information technology, investment in improvement, and leadership and management. A cross-case analysis of these micro-systems revealed eight factors for thinking about characteristics of health care micro-systems--integration of information, measurement, interdependence of the care team, supportiveness of the larger system, constancy of purpose, connection to community, investment in improvement, and alignment of role and training. These eight factors became a framework that can be used for evaluating health care micro-systems. Five micro-systems were asked an additional set of questions to determine the process and outcomes of care provided to patients with diabetes. Two approaches were used to analyze the data. First a micro-system analysis linked the micro-system model to the process and outcomes of care in the five diabetes sites. This analysis did not reveal a "best" strategy for providing diabetes care. However it was clear that not all the patients were receiving the recommended care and the micro-systems were not consistently measuring the care that was provided. The second approach used to analyze the data applied the eight factors of the micro-system framework to the five diabetes sites. This provided additional insight into identifying areas that individual micro-systems could improve to eliminate some of the barriers to providing effective diabetes care.
Description	1 online resource (xiii, 231 leaves) : illustrations
Format	application/pdf
Advisor	Batalden, Paul B.
Subject	Clinical medicine -- Practice. ; Medicine -- Practice. ; Group medical practice.
College	Dartmouth Medical School -- Center for the Evaluative Clinical Sciences.
Issuing Body	Dartmouth Dissertations are made available through the Dartmouth Digital Library.
Degree	Thesis (Ph.D)--Dartmouth College.
Copyright	In Copyright. This material is protected by copyright and/or related rights. You are free to use this material in any way that is permitted by copyright law that applies to your use. For other uses, you need to obtain permission from the rights-holder(s). http://rightsstatements.org/page/InC/1.0/
DOI	https://doi.org/10.1349/ddlp.2830

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