Becker's Clinical Quality & Infection Control

49 QUALITY IMPROVEMENT & MEASUREMENT High-quality primary care for all Americans: National Academies release plan to achieve it By Gabrielle Masson T he National Academies of Sciences, Engineering and Med- icine released an implementation plan May 4 for the U.S. government, recommending it provide high-quality primary care to all Americans. e academies are private, nonprofit institutions that provide indepen- dent analysis and advice and inform certain U.S. public policy decisions. "Implementing High-Quality Primary Care: Rebuilding the Founda- tion of Health Care" states that ensuring access to primary care will require reforming payment models, expanding telehealth services and supporting integrated, team-based care. Since no federal agency currently oversees primary care, the report recommends HHS es- tablish a Secretary's Council on Primary Care as well as an Office of Primary Care Research at the National Institutes of Health. Primary care is the only part of healthcare where increased supply is tied to better population health and more equitable outcomes, according to the report. Declining primary care workforce capacity is associated with a loss of 85 lives each day, the report finds. To achieve its vision, the committee recommends: Reforming payment models: Public and private payers should shi from a fee-for-service payment model to hybrid models. CMS should aim to boost physician payment rates for primary care services by 50 percent and reduce the rates of overpriced healthcare services. As the largest payer in the U.S., Medicare should be priori- tized for payment reform. Increasing access points: HHS should invest in the creation of new health centers, particularly in areas that are underserved or have a physician shortage. Designing interprofessional care teams: Primary care teams should fit the needs of communities and coordinate care across multiple settings. Supporting community-based training programs: Training primary care clinicians individually in inpatient settings won't ade- quately prepare them. HHS should support training opportunities in community, rural and underserved settings and provide economic incentives such as loan forgiveness and salary supplements. Making health IT user-friendly: In the next phase of EHR certifi- cation standards, the Office of the National Coordinator for Health Information Technology and CMS should account for the user experience of clinicians and patients. n Will mobile clinics offering HIV, substance use care improve outcomes? 5 US cities aim to find out By Erica Carbajal F ive U.S. cities are participating in a clinical trial, fund- ed by the National Institutes of Health, to test wheth- er mobile clinics offering integrated health services will improve HIV and substance use outcomes among people with opioid use disorder who inject drugs. As part of the trial, one-stop mobile clinics in Los Ange- les, New York City, Houston, Philadelphia and Washington, D.C., will offer the following: buprenorphine, an opioid use disorder medication; naloxone, an overdose reversal; sy- ringe services where available; HIV testing; antiretroviral therapy for HIV treatment; pre-exposure prophylaxis for HIV prevention; testing for hepatitis and STIs; and primary care services. Since many community-based agencies are located in hard-to-reach downtown areas, the mobile clinics will be stationed across residential areas determined to be acces- sible by the underserved participant population, the NIH said in a June 9 news release. "Too often, lifesaving addiction treatment and HIV care are administered by a patchwork of health professionals un- der several different roofs, presenting major access chal- lenges for people who use opioids and other drugs," said Nora Volwok, MD, director of the National Institute on Drug Abuse. "By providing these services through a welcoming one-stop shop and meeting people where they are, we hope to find a way to more effectively treat people for HIV and substance use disorders." The trial aims to enroll 860 participants with opioid use dis- order who inject drugs. Participants will be equally divided among two groups: one will receive care through a single mobile clinic and the other will receive care through multi- ple community based-agencies. Researchers will evaluate and compare a number of health measures in both groups, including use of opioid use disorder medications and rates of viral suppression among participants with HIV, among other measures. Results from the study are expected in 2025. n

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