The Re-engineered Visit (REV) for Primary Care

Geographic Scope: Nationwide

Client(s): Agency for Healthcare Research and Quality (AHRQ)

Services: Applied Research & Evaluation, Health Systems Transformation, Policy Development & Implementation

Technical Expertise: Health Care Reform, Integrated Care Models, Patient Safety, Primary Care

High rates of readmissions are a major patient safety problem associated with medical errors such as prescribing errors and misdiagnoses of conditions in the hospital and ambulatory care settings. Since the passage of the Affordable Care Act, payer and provider efforts to reduce readmissions have proliferated. Many of these national programs have been informed or guided by evidence-based toolkits and guides, including Project RED (Re-Engineered Discharge), STAAR (STate Action on Avoidable Readmission), Project BOOST (Better Outcomes by Optimizing Safe Transitions), the Hospital Guide to Reducing Medicaid Readmissions, and Coleman’s Care Transitions Intervention. These resources have largely focused on enhancing practices occurring within the hospital setting, including the discharge process and hand offs to receiving providers or settings of care. While many of these guides have recognized the critical role of primary care in managing care transitions, they have not had an explicit focus on enhancing primary care with the aim of reducing avoidable readmissions.

Evidence-based guidance for the primary care setting to reduce readmissions and improve patient safety is comparatively lacking, and this gap in the literature is becoming more pronounced as primary care is increasingly being called to serve as the key integrator role across the health system as part of payment and delivery system reforms. Primary care providers’ training and general orientation towards wellness and illness care across a spectrum of both acute and chronic conditions make them ideally suited to play this integrator role and assume leadership roles in delivery system transformation.

JSI was awarded a contract under the Agency for Healthcare Research and Quality’s (AHRQ) ACTION III Network to conduct formative research to identify the key principles that should be incorporated into a re-engineered visit (REV) in primary care. The overall technical approach will combine formative qualitative research with quality improvement techniques, including an environmental scan, key informant interviews, root cause analysis, work flow mapping, and failure mode effects analysis.