title: What can family medicine practices do to facilitate knowledge management?
abstract: BACKGROUND
  Family medicine practices face increasing demands to enhance efficiency and quality of care. Current solutions propose major practice redesign and investment in sophisticated technology. Knowledge management (KM) is a process that increases the capacity of a practice to deliver effective care by finding and sharing information and knowledge among practice members or by developing new knowledge for use by the practice. Our preliminary research in family medicine practices has suggested improved patient outcomes with greater and more effective KM. Research in other organizational settings has suggested that KM can be facilitated by certain organizational characteristics.
  
  
  OBJECTIVE
  To identify those organizational characteristics within a family medicine practice that management can effect to enhance KM.
  
  
  METHODS
  We performed a cross-sectional secondary analysis of second-year data from 13 community family medicine practices participating in a practice improvement project. Practice KM, leaderships' promotion of participatory decision making, existence of activities supportive of human resource processes, and effective communication were derived from clinician's, nurses', and staff's responses to a survey eliciting responses on practice organizational characteristics. Hierarchical linear modeling examined relationships between individual practice members' perception of KM and organizational characteristics of the practice, controlling for practice covariates (solo-group, electronic medical record use, and perception of a chaotic practice environment) and staff-level covariates (gender, age, and role).
  
  
  RESULTS
  Practices with greater participatory decision making and human resources' processes and effective communication significantly (p < .019, p < .0001, and p < .004) increased odds of reporting satisfactory KM (odds ratio = 2.48, 95% confidence interval = 1.32-4.65; odds ratio = 10.84, 95% confidence interval = 4.04-29.12; and odds ratio = 4.95, 95% confidence interval = 2.02-12.16). The sizes of these effects were not substantially changed even when practice members perceived their practice environment as more chaotic.
  
  
  CONCLUSIONS
  Steps to facilitate KM should be considered when evaluating more intensive and costly organizational solutions for enhancing family medicine practice performance.
authors.affiliation: Research Division, Department of Family Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Somerset, USA. orzanoaj@umdnj.edu
authors.forename: A John
authors.initials: AJ
authors.lastname: Orzano
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Ohman-Strickland
authors.forename: Meghal
authors.initials: M
authors.lastname: Patel
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D006801:Humans; D033181:Information Dissemination; D019359:Knowledge; D008297:Male; D008875:Middle Aged; D011361:Professional Competence; D011787:Quality of Health Care