Reporting from war-torn Portland. Dropped my daughter off for theater class and now drinking a vegan sipping chocolate & reading a book while watching people exit the symphony. A guy in a care bear onesie just scootered past. It's rough out here.

You know you're looking at data from Norway when the rate of injury from "wind-thrown tree" matches the rate of gunshot injuries.

Using our diagrams and qualitative results, we mapped our findings onto Meadows’ framework. We found that Oregon’s coordinated care system utilizes a range of types of leverage points while also seeing many barriers and unintended consequences across these points of leverage. (10/12)

We also applied Donella Meadows’ leverage point framework, a well-known approach in #systemsthinking to identify and compare potential places to intervene to change system behavior. (9/12)

This results in reinforcing feedback loops--clinics that are bigger or have more capacity to engage in QI end up getting more support, which makes them easier to prioritize. (7.5/12)

CCOs reported supporting clinics with using their electronic health records, education & training, and understanding their performance with gap lists and dashboards. They also made an effort to build relationships with clinics. These distinct mechanisms are shown here. (6/12)

Quality improvement efforts can focus on improving care or improving how well clinics record and report that care, resulting in 2 feedback loops. (5/12)

This is a causal-loop diagram of the basic structure of Oregon’s CCO system: When performance falls short of state metrics, clinics engage in quality improvement (QI) projects and CCOs are motivated to support clinics. CCO performance depends on clinics, so these feedback loops are nested. (4/12)