Health Professions › General Health Professions

Primary Care and Health Outcomes

Works Count: 153630

Wikipedia

Description

This cluster of papers focuses on the contribution of primary care to health systems and health, emphasizing topics such as quality improvement, continuity of care, patient-centered medical home, pay for performance, health care quality, health system reform, clinical indicators, chronic disease management, and general practice.

Keywords

Primary Care; Quality Improvement; Continuity of Care; Patient-Centered Medical Home; Pay for Performance; Health Care Quality; Health System Reform; Clinical Indicators; Chronic Disease Management; General Practice

Best care at lower cost: the path to continuously learning health care in America

2014-01-21

Mark Smith , Robert J. Saunders , Leigh Stuckhardt +1 more

America's health care system has become too complex and costly to continue business as usual. Best Care at Lower Cost explains that inefficiencies, an overwhelming amount of data, and other … America's health care system has become too complex and costly to continue business as usual. Best Care at Lower Cost explains that inefficiencies, an overwhelming amount of data, and other economic and quality barriers hinder progress in improving health and threaten the nation's economic stability and global competitiveness. According to this report, the knowledge and tools exist to put the health system on the right course to achieve continuous improvement and better quality care at a lower cost.The costs of the system's current inefficiency underscore the urgent need for a systemwide transformation. About 30 percent of health spending in 2009--roughly $750 billion--was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering. By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state. This report states that the way health care providers currently train, practice, and learn new information cannot keep pace with the flood of research discoveries and technological advances.About 75 million Americans have more than one chronic condition, requiring coordination among multiple specialists and therapies, which can increase the potential for miscommunication, misdiagnosis, potentially conflicting interventions, and dangerous drug interactions. Best Care at Lower Cost emphasizes that a better use of data is a critical element of a continuously improving health system, such as mobile technologies and electronic health records that offer significant potential to capture and share health data better. In order for this to occur, the National Coordinator for Health Information Technology, IT developers, and standard-setting organizations should ensure that these systems are robust and interoperable. Clinicians and care organizations should fully adopt these technologies, and patients should be encouraged to use tools, such as personal health information portals, to actively engage in their care.This book is a call to action that will guide health care providers; administrators; caregivers; policy makers; health professionals; federal, state, and local government agencies; private and public health organizations; and educational institutions.

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Local opinion leaders: effects on professional practice and health care outcomes

2011-08-03

Gerd Flodgren , Elena Parmelli , Gaby Doumit +4 more

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What drives change? Barriers to and incentives for achieving evidence‐based practice

2004-03-01

Richard Grol , Michel Wensing

To bridge the gap between scientific evidence and patient care we need an in-depth understanding of the barriers and incentives to achieving change in practice. Various theories and models for … To bridge the gap between scientific evidence and patient care we need an in-depth understanding of the barriers and incentives to achieving change in practice. Various theories and models for change point to a multitude of factors that may affect the successful implementation of evidence. However, the evidence for their value in the field is still limited. When planning complex changes in practice, potential barriers at various levels need to be addressed. Planning needs to take into account the nature of the innovation; characteristics of the professionals and patients involved; and the social, organisational, economic and political context.

No magic bullets: a systematic review of 102 trials of interventions to improve professional practice.

1995-11-15

AD Oxman , M. Thomson , Dave A. Davis +1 more

To determine the effectiveness of different types of interventions in improving health professional performance and health outcomes. To determine the effectiveness of different types of interventions in improving health professional performance and health outcomes.

The Nottingham health profile: Subjective health status and medical consultations

1981-05-01

Sonja M. Hunt , S. P. McKenna , J McEwen +2 more

Continuity of care: a multidisciplinary review

2003-11-21

Jeannie Haggerty

The concept-and reality-of continuity of care crosses disciplinary and organisational boundaries.The common definitions provided here should help healthcare providers evaluate continuity more rigorously and improve communication Patients are increasingly seen … The concept-and reality-of continuity of care crosses disciplinary and organisational boundaries.The common definitions provided here should help healthcare providers evaluate continuity more rigorously and improve communication Patients are increasingly seen by an array of providers in a wide variety of organisations and places, raising concerns about fragmentation of care.Policy reports and charters worldwide urge a concerted effort to enhance continuity, 1-3 but efforts to describe the problem or formulate solutions are complicated by the lack of consensus on the definition of continuity.To add to the confusion, other terms such as continuum of care, coordination of care, discharge planning, case management, integration of services, and seamless care are often used synonymously.This synthesis was commissioned by three Canadian health services policy and research bodies.The aim was to develop a common understanding of the concept of continuity as a basis for valid and reliable measurement of practice in different settings.

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Selective Primary Health Care

1979-11-01

Julia Walsh , Kenneth S. Warren

Priorities among the infectious diseases affecting the three billion people in the less developed world have been based on prevalence, morbidity, mortality and feasibility of control. With these priorities in … Priorities among the infectious diseases affecting the three billion people in the less developed world have been based on prevalence, morbidity, mortality and feasibility of control. With these priorities in mind a program of selective primary health care is compared with other approaches and suggested as the most cost-effective form of medical intervention in the least developed countries. A flexible program delivered by either fixed or mobile units might include measles and diphtheria-pertussis-tetanus vaccination, treatment for febrile malaria and oral rehydration for diarrhea in children, and tetanus toxoid and encouragement of breast feeding in mothers. Other interventions might be added on the basis of regional needs and new developments. For major diseases for which control measures are inadequate, research is an inexpensive approach on the basis of cost per infected person per year.For major diseases for which control measures are inadequate, research is an inexpensive approach on the basis of cost per infected person per year. Priorities among the infectious diseases affecting the 3 billion people in the less developed world have been based on prevalence, morbidity, mortality and feasibility of control. With these priorities in mind, a program of selective primary health care is compared with other approaches and suggested as the most cost-effective form of medical intervention in the least developed countries. A flexible program delivered by either fixed or mobile units might include measles and diptheria-pertussis-tetanus vaccination, treatment for febrile malaria and oral rehydration for diarrhea in children, and tetanus toxoid and encouragement of breast feeding in mothers. Other interventions might be added on the basis of regional needs and new developments. Aiming services at the most important diseases is the only rational approach to absolute proverty and unsanitary conditions. The goal is to help the greatest number of people in the cost effective method possible.

Designing and evaluating complex interventions to improve health care

2007-03-01

Neil Campbell , Elizabeth Murray , Janet Darbyshire +7 more

Determining the effectiveness of complex interventions can be difficult and time consuming. Neil C Campbell and colleagues explain the importance of ground work in getting usable results Determining the effectiveness of complex interventions can be difficult and time consuming. Neil C Campbell and colleagues explain the importance of ground work in getting usable results

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The Institute of Medicine

1992-03-01

Ruth Ellen Bulger

The Institute of Medicine Ruth Ellen Bulger (bio) IN 1863 the National Academy of Sciences (NAS) was established by federal charter to advise the government on scientific matters. Almost 100 … The Institute of Medicine Ruth Ellen Bulger (bio) IN 1863 the National Academy of Sciences (NAS) was established by federal charter to advise the government on scientific matters. Almost 100 years later, in 1971, the Academy created the Institute of Medicine within the NAS to focus on health-related problems and issues. Today the IOM has a program budget of about $13 million, which includes both private and government funds, and is regarded as a leading center for health policy research. After briefly explaining the structure and general goals of IOM, this article describes several new or anticipated projects as well as some recently completed reports that have a strong ethical component. The IOM The IOM's distinguished membership is made up of health care professionals of all sorts, scientists working in health-related disciplines, and lawyers, economists, and others knowledgeable in and involved with policies and activities associated with health issues. It is organized around eight working groups or divisions: Health Sciences Policy; Health Care Services; Health Promotion and Disease Prevention, including AIDS activities; International Health; Biobehavioral Sciences and Mental Disorders; the Food and Nutrition Board; the Medical Follow-up Agency; and the Health Policy Fellowship Programs. Each of these divisions is assisted by an oversight board that provides advice on its activities. It is important to know at the outset that IOM has decided that each of the divisions will include consideration of human values and ethical issues in their activities. Therefore, no separate locus was established within the IOM to deal with these matters. I am director of the Division of Health Sciences Policy, which is the only division that has made ethics a priority in its work, and it is the focus of this article. We have addressed questions of ethics, human values, social values, decision making, and priority setting in many of the division's reports. In fact, most of our reports at least raise ethical questions. In addition, a portion of the interest from endowment funds given to IOM by the Howard Hughes Medical Institute has been devoted to work in this area. [End Page 73] The division's advisory board, headed by Claude Bennett, chairman of the Department of Medicine, University of Alabama at Birmingham School of Medicine, has decided on two major priorities for the division: (1) foster an environment conducive to productive research, and (2) anticipate the impact of scientific—especially biomedical—advances on society, monitoring and considering the social and ethical factors that accompany basic scientific and technological progress. These two priorities are interdependent because the fostering of a good environment for research presupposes that the results of this research will produce beneficial effects for the society that supports the research. Upcoming Studies Society has been unable to establish a mechanism for discussing in a meaningful way—and possibly resolving—a number of pressing national issues with social, ethical, legal, and scientific ramifications. The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research considered several such issues and produced important reports about them. However, the commission was funded only until 1983. The Congressional Biomedical Ethics Advisory Committee was authorized in 1985 to address these contentious issues, but it was caught in the crossfire of congressional abortion politics and subsequently died. A new model is needed to attempt to develop national consensus on these complex, contentious issues. The Board on Health Sciences Policy has wrestled with this idea. Recently, it approved a proposal to establish a study committee charged with developing effective alternative methodologies for anticipating and addressing the social, legal, and ethical issues that may accompany rapid advances in biomedical science and technology. This multidisciplinary committee will be given a series of tasks: (1) to explore past experiences with some of these varying methodologies (i.e., town meetings, consensus conferences, forums, commissions, etc.); (2) to develop an agenda of issues likely to arise in the future; (3) to define and test a variety of alternative methodological approaches to these questions; (4) to evaluate strengths, weaknesses, and impact of the various approaches; and (5) to make recommendations on the process and structure by which this fact-finding, analytical, and decision-making function could be...

Book: Crossing the Quality Chasm: A New Health System for the 21st Century

2001-11-17

Alexi Baker

Institute of Medicine National Academy Press, $44.95, pp 364 ISBN 0 309 07280 8 See http://www.nap.edu/catalog/10027.html for ordering details Rating: ![Graphic][1]</img> ![Graphic][2]</img> ![Graphic][3]</img> ![Graphic][4]</img> Even with catchy titles, committee reports … Institute of Medicine National Academy Press, $44.95, pp 364 ISBN 0 309 07280 8 See http://www.nap.edu/catalog/10027.html for ordering details Rating: ![Graphic][1]</img> ![Graphic][2]</img> ![Graphic][3]</img> ![Graphic][4]</img> Even with catchy titles, committee reports are unlikely bestsellers. This one has the background and intention to be different. The committee members, who were appointed by the US National Academy of Science for their creative thinking and knowledge of medicine, healthcare, and commerce, provide excellently researched evidence for the failure of the US healthcare system. They justify radical change and establish six aims and 10 simple rules for a completely different … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif [3]: /embed/inline-graphic-3.gif [4]: /embed/inline-graphic-4.gif

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Mental health: A report of the surgeon general

2000-06-01

Tina M. Marrelli

Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians

2000-01-05

Mary OʼNeil Mundinger , Robert L Kane , Elizabeth R. Lenz +6 more

<h3>Context</h3> Studies have suggested that the quality of primary care delivered by nurse practitioners is equal to that of physicians. However, these studies did not measure nurse practitioner practices that … <h3>Context</h3> Studies have suggested that the quality of primary care delivered by nurse practitioners is equal to that of physicians. However, these studies did not measure nurse practitioner practices that had the same degree of independence as the comparison physician practices, nor did previous studies provide direct comparison of outcomes for patients with nurse practitioner or physician providers. <h3>Objective</h3> To compare outcomes for patients randomly assigned to nurse practitioners or physicians for primary care follow-up and ongoing care after an emergency department or urgent care visit. <h3>Design</h3> Randomized trial conducted between August 1995 and October 1997, with patient interviews at 6 months after initial appointment and health services utilization data recorded at 6 months and 1 year after initial appointment. <h3>Setting</h3> Four community-based primary care clinics (17 physicians) and 1 primary care clinic (7 nurse practitioners) at an urban academic medical center. <h3>Patients</h3> Of 3397 adults originally screened, 1316 patients (mean age, 45.9 years; 76.8% female; 90.3% Hispanic) who had no regular source of care and kept their initial primary care appointment were enrolled and randomized with either a nurse practitioner (n = 806) or physician (n = 510). <h3>Main Outcome Measures</h3> Patient satisfaction after initial appointment (based on 15-item questionnaire); health status (Medical Outcomes Study Short-Form 36), satisfaction, and physiologic test results 6 months later; and service utilization (obtained from computer records) for 1 year after initial appointment, compared by type of provider. <h3>Results</h3> No significant differences were found in patients' health status (nurse practitioners vs physicians) at 6 months (<i>P</i>= .92). Physiologic test results for patients with diabetes (<i>P</i>= .82) or asthma (<i>P</i>= .77) were not different. For patients with hypertension, the diastolic value was statistically significantly lower for nurse practitioner patients (82 vs 85 mm Hg;<i>P</i>= .04). No significant differences were found in health services utilization after either 6 months or 1 year. There were no differences in satisfaction ratings following the initial appointment (<i>P</i>= .88 for overall satisfaction). Satisfaction ratings at 6 months differed for 1 of 4 dimensions measured (provider attributes), with physicians rated higher (4.2 vs 4.1 on a scale where 5 = excellent;<i>P</i>= .05). <h3>Conclusions</h3> In an ambulatory care situation in which patients were randomly assigned to either nurse practitioners or physicians, and where nurse practitioners had the same authority, responsibilities, productivity and administrative requirements, and patient population as primary care physicians, patients' outcomes were comparable.

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Contribution of Primary Care to Health Systems and Health

2005-09-01

Bárbara Starfield , Leiyu Shi , James Macinko

Evidence of the health‐promoting influence of primary care has been accumulating ever since researchers have been able to distinguish primary care from other aspects of the health services delivery system. … Evidence of the health‐promoting influence of primary care has been accumulating ever since researchers have been able to distinguish primary care from other aspects of the health services delivery system. This evidence shows that primary care helps prevent illness and death, regardless of whether the care is characterized by supply of primary care physicians, a relationship with a source of primary care, or the receipt of important features of primary care. The evidence also shows that primary care (in contrast to specialty care) is associated with a more equitable distribution of health in populations, a finding that holds in both cross‐national and within‐national studies. The means by which primary care improves health have been identified, thus suggesting ways to improve overall health and reduce differences in health across major population subgroups.

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Qualitative Research: Qualitative interviews in medical research

1995-07-22

Nicky Britten

<h3>Objective</h3> To examine the association between maternal age at first birth and infant mortality, stunting, underweight, wasting, diarrhoea and anaemia in children in low- and middle-income countries. <h3>Design</h3> Cross-sectional analysis … <h3>Objective</h3> To examine the association between maternal age at first birth and infant mortality, stunting, underweight, wasting, diarrhoea and anaemia in children in low- and middle-income countries. <h3>Design</h3> Cross-sectional analysis of nationally representative household samples. A modified Poisson regression model is used to estimate unadjusted and adjusted RR ratios. <h3>Setting</h3> Low- and middle-income countries. <h3>Population</h3> First births to women aged 12–35 where this birth occurred 12–60 months prior to interview. The sample for analysing infant mortality is comprised of 176 583 children in 55 low- and middle-income countries across 118 Demographic and Health Surveys conducted between 1990 and 2008. <h3>Main outcome measures</h3> Infant mortality in children under 12 months and stunting, underweight, wasting, diarrhoea and anaemia in children under 5 years. <h3>Results</h3> The investigation reveals two salient findings. First, in the sample of women who had their first birth between the ages of 12 and 35, the risk of poor child health outcome is lowest for women who have their first birth between the ages of 27 and 29. Second, the results indicate that both biological and social mechanisms play a role in explaining why children of young mothers have poorer outcomes. <h3>Conclusions</h3> The first-born children of adolescent mothers are the most vulnerable to infant mortality and poor child health outcomes. Additionally, first time mothers up to the age of 27 have a higher risk of having a child who has stunting, diarrhoea and moderate or severe anaemia. Maternal and child health programs should take account of this increased risk even for mothers in their early 20s. Increasing the age at first birth in developing countries may have large benefits in terms of child health.

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Diffusion of Innovations in Service Organizations: Systematic Review and Recommendations

2004-12-01

Trisha Greenhalgh , Glenn Robert , Fraser Macfarlane +2 more

This article summarizes an extensive literature review addressing the question, How can we spread and sustain innovations in health service delivery and organization? It considers both content (defining and measuring … This article summarizes an extensive literature review addressing the question, How can we spread and sustain innovations in health service delivery and organization? It considers both content (defining and measuring the diffusion of innovation in organizations) and process (reviewing the literature in a systematic and reproducible way). This article discusses (1) a parsimonious and evidence-based model for considering the diffusion of innovations in health service organizations, (2) clear knowledge gaps where further research should be focused, and (3) a robust and transferable methodology for systematically reviewing health service policy and management. Both the model and the method should be tested more widely in a range of contexts.

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Scoping studies: advancing the methodology

2010-09-20

Danielle Levac , Heather Colquhoun , Kelly K. O’Brien

Scoping studies are an increasingly popular approach to reviewing health research evidence. In 2005, Arksey and O'Malley published the first methodological framework for conducting scoping studies. While this framework provides … Scoping studies are an increasingly popular approach to reviewing health research evidence. In 2005, Arksey and O'Malley published the first methodological framework for conducting scoping studies. While this framework provides an excellent foundation for scoping study methodology, further clarifying and enhancing this framework will help support the consistency with which authors undertake and report scoping studies and may encourage researchers and clinicians to engage in this process.We build upon our experiences conducting three scoping studies using the Arksey and O'Malley methodology to propose recommendations that clarify and enhance each stage of the framework. Recommendations include: clarifying and linking the purpose and research question (stage one); balancing feasibility with breadth and comprehensiveness of the scoping process (stage two); using an iterative team approach to selecting studies (stage three) and extracting data (stage four); incorporating a numerical summary and qualitative thematic analysis, reporting results, and considering the implications of study findings to policy, practice, or research (stage five); and incorporating consultation with stakeholders as a required knowledge translation component of scoping study methodology (stage six). Lastly, we propose additional considerations for scoping study methodology in order to support the advancement, application and relevance of scoping studies in health research.Specific recommendations to clarify and enhance this methodology are outlined for each stage of the Arksey and O'Malley framework. Continued debate and development about scoping study methodology will help to maximize the usefulness and rigor of scoping study findings within healthcare research and practice.

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Profession of Medicine: A Study of the Sociology of Applied Knowledge.

1971-12-01

Geraldine Tate Clausen , Eliot Freidson

Must be judged as a landmark in medical sociology.-Norman Denzin, Journal of Health and Social Behavior of Medicine is a challenging monograph; the ideas presented are stimulating and thought provoking. … Must be judged as a landmark in medical sociology.-Norman Denzin, Journal of Health and Social Behavior of Medicine is a challenging monograph; the ideas presented are stimulating and thought provoking. . . . Given the expanding domain of what illness is and the contentions of physicians about their rights as professionals, Freidson wonders aloud whether expertise is becoming a mask for privilege and power. . . . Profession of Medicine is a landmark in the sociological analysis of the professions in modern society.-Ron Miller, Sociological Quarterly This is the first book that I know of to go to the root of the matter by laying open to view the fundamental nature of the professional claim, and the structure of professional institutions.-Everett C. Hughes, Science

Coordinating Care — A Perilous Journey through the Health Care System

2008-03-05

Thomas Bodenheimer

Patients with chronic illness often receive care from multiple providers in multiple settings and require coordination of their complex care. This report assesses the quality of the coordination of care, … Patients with chronic illness often receive care from multiple providers in multiple settings and require coordination of their complex care. This report assesses the quality of the coordination of care, describes barriers to coordinated care, and discusses some solutions to improve care coordination in the United States.

Medical Education in the United States and Canada.

1911-01-01

Abraham Flexner

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew … Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal

Is primary care essential?

1994-10-01

Bárbara Starfield

Qualitative Research: Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research

1995-07-01

Catherine Pope , N Mays

Qualitative research methods have a long history in the social sciences and deserve to be an essential component in health and health services research. Qualitative and quantitative approaches to research … Qualitative research methods have a long history in the social sciences and deserve to be an essential component in health and health services research. Qualitative and quantitative approaches to research tend to be portrayed as antithetical; the aim of this series of papers is to show the value of a range of qualitative techniques and how they can complement quantitative research.

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Rationale and Standards for the Systematic Review of Qualitative Literature in Health Services Research

1998-05-01

Jennie Popay , Anne Rogers , Gareth Williams

Despite growing recognition of the need for qualitative methods in health services research, there have been few attempts to define quality standards for assessing the results. This article acknowledges the … Despite growing recognition of the need for qualitative methods in health services research, there have been few attempts to define quality standards for assessing the results. This article acknowledges the desirability of a plurality of standards. However, it is argued that three interrelated criteria can be identified as the foundation of good qualitative health research: interpretation of subjective meaning, description of social context, and attention to lay knowledge. These criteria can be examined in relation to different dimensions of any research report, including theoretical basis, sampling strategy, scope of data collection, description of data collected, and concern with generalizability or typicality. But if the concern is with the appropriateness of care and with understanding the factors that shape lay and clinical behavior, then these criteria must form the basis of a hierarchy of qualitative research evidence.

Continuing education meetings and workshops: effects on professional practice and health care outcomes

2009-04-15

Louise Forsetlund , Arild Bjørndal , Arash Rashidian +6 more

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Validity, reliability, and generalizability in qualitative research

2015-01-01

Lawrence Leung

In general practice, qualitative research contributes as significantly as quantitative research, in particular regarding psycho-social aspects of patient-care, health services provision, policy setting, and health administrations. In contrast to quantitative … In general practice, qualitative research contributes as significantly as quantitative research, in particular regarding psycho-social aspects of patient-care, health services provision, policy setting, and health administrations. In contrast to quantitative research, qualitative research as a whole has been constantly critiqued, if not disparaged, by the lack of consensus for assessing its quality and robustness. This article illustrates with five published studies how qualitative research can impact and reshape the discipline of primary care, spiraling out from clinic-based health screening to community-based disease monitoring, evaluation of out-of-hours triage services to provincial psychiatric care pathways model and finally, national legislation of core measures for children's healthcare insurance. Fundamental concepts of validity, reliability, and generalizability as applicable to qualitative research are then addressed with an update on the current views and controversies.

Welcome to Implementation Science

2006-02-22

Martin Eccles , Brian S. Mittman

Implementation research is the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and, hence, to improve the quality and … Implementation research is the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and, hence, to improve the quality and effectiveness of health services and care. This relatively new field includes the study of influences on healthcare professional and organisational behaviour. Implementation Science will encompass all aspects of research in this field, in clinical, community and policy contexts. This online journal will provide a unique platform for this type of research and will publish a broad range of articles – study protocols, debate, theoretical and conceptual articles, rigorous evaluations of the process of change, and articles on methodology and rigorously developed tools – that will enhance the development and refinement of implementation research. No one discipline, research design, or paradigm will be favoured. Implementation Science looks forward to receiving manuscripts that facilitate the continued development of the field, and contribute to healthcare policy and practice.

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Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups

2006-07-26

Mary Dixon‐Woods , Debbie Cavers , Shona Agarwal +7 more

Conventional systematic review techniques have limitations when the aim of a review is to construct a critical analysis of a complex body of literature. This article offers a reflexive account … Conventional systematic review techniques have limitations when the aim of a review is to construct a critical analysis of a complex body of literature. This article offers a reflexive account of an attempt to conduct an interpretive review of the literature on access to healthcare by vulnerable groups in the UK This project involved the development and use of the method of Critical Interpretive Synthesis (CIS). This approach is sensitised to the processes of conventional systematic review methodology and draws on recent advances in methods for interpretive synthesis. Many analyses of equity of access have rested on measures of utilisation of health services, but these are problematic both methodologically and conceptually. A more useful means of understanding access is offered by the synthetic construct of candidacy. Candidacy describes how people's eligibility for healthcare is determined between themselves and health services. It is a continually negotiated property of individuals, subject to multiple influences arising both from people and their social contexts and from macro-level influences on allocation of resources and configuration of services. Health services are continually constituting and seeking to define the appropriate objects of medical attention and intervention, while at the same time people are engaged in constituting and defining what they understand to be the appropriate objects of medical attention and intervention. Access represents a dynamic interplay between these simultaneous, iterative and mutually reinforcing processes. By attending to how vulnerabilities arise in relation to candidacy, the phenomenon of access can be better understood, and more appropriate recommendations made for policy, practice and future research. By innovating with existing methods for interpretive synthesis, it was possible to produce not only new methods for conducting what we have termed critical interpretive synthesis, but also a new theoretical conceptualisation of access to healthcare. This theoretical account of access is distinct from models already extant in the literature, and is the result of combining diverse constructs and evidence into a coherent whole. Both the method and the model should be evaluated in other contexts.

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The Quality of Health Care Delivered to Adults in the United States

2003-06-25

Elizabeth A. McGlynn , Steven M. Asch , John Adams +4 more

We have little systematic information about the extent to which standard processes involved in health care--a key element of quality--are delivered in the United States.We telephoned a random sample of … We have little systematic information about the extent to which standard processes involved in health care--a key element of quality--are delivered in the United States.We telephoned a random sample of adults living in 12 metropolitan areas in the United States and asked them about selected health care experiences. We also received written consent to copy their medical records for the most recent two-year period and used this information to evaluate performance on 439 indicators of quality of care for 30 acute and chronic conditions as well as preventive care. We then constructed aggregate scores.Participants received 54.9 percent (95 percent confidence interval, 54.3 to 55.5) of recommended care. We found little difference among the proportion of recommended preventive care provided (54.9 percent), the proportion of recommended acute care provided (53.5 percent), and the proportion of recommended care provided for chronic conditions (56.1 percent). Among different medical functions, adherence to the processes involved in care ranged from 52.2 percent for screening to 58.5 percent for follow-up care. Quality varied substantially according to the particular medical condition, ranging from 78.7 percent of recommended care (95 percent confidence interval, 73.3 to 84.2) for senile cataract to 10.5 percent of recommended care (95 percent confidence interval, 6.8 to 14.6) for alcohol dependence.The deficits we have identified in adherence to recommended processes for basic care pose serious threats to the health of the American public. Strategies to reduce these deficits in care are warranted.

Structural Violence and Clinical Medicine

2006-10-18

Paul E. Farmer , Bruce Nizeye , Sara Stulac +1 more

Structural violence refers to the social structures that put people in harm's way. Farmer and colleagues describe the impact of social violence upon people living with HIV in the US … Structural violence refers to the social structures that put people in harm's way. Farmer and colleagues describe the impact of social violence upon people living with HIV in the US and Rwanda.

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What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs

2013-02-01

Judith H. Hibbard , Jessica Greene

Patient engagement is an increasingly important component of strategies to reform health care. In this article we review the available evidence of the contribution that patient activation—the skills and confidence … Patient engagement is an increasingly important component of strategies to reform health care. In this article we review the available evidence of the contribution that patient activation—the skills and confidence that equip patients to become actively engaged in their health care—makes to health outcomes, costs, and patient experience. There is a growing body of evidence showing that patients who are more activated have better health outcomes and care experiences, but there is limited evidence to date about the impact on costs. Emerging evidence indicates that interventions that tailor support to the individual’s level of activation, and that build skills and confidence, are effective in increasing patient activation. Furthermore, patients who start at the lowest activation levels tend to increase the most. We conclude that policies and interventions aimed at strengthening patients’ role in managing their health care can contribute to improved outcomes and that patient activation can—and should—be measured as an intermediate outcome of care that is linked to improved outcomes.

Evidence based medicine: a movement in crisis?

2014-06-13

Trisha Greenhalgh , Jeremy Howick , Neal Maskrey

<b>Trisha Greenhalgh and colleagues</b> argue that, although evidence based medicine has had many benefits, it has also had some negative unintended consequences. They offer a preliminary agenda for the movement’s … <b>Trisha Greenhalgh and colleagues</b> argue that, although evidence based medicine has had many benefits, it has also had some negative unintended consequences. They offer a preliminary agenda for the movement’s renaissance, refocusing on providing useable evidence that can be combined with context and professional expertise so that individual patients get optimal treatment

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The Quality of Mixed Methods Studies in Health Services Research

2008-04-01

Alicia O’Cathain , Elizabeth Murphy , Jon Nicholl

Objectives To assess the quality of mixed methods studies in health services research (HSR). Methods We identified 118 mixed methods studies funded by the Department of Health in England between … Objectives To assess the quality of mixed methods studies in health services research (HSR). Methods We identified 118 mixed methods studies funded by the Department of Health in England between 1994 and 2004, and obtained proposals and/or final reports for 75. We applied a set of quality questions to both the proposal and report of each study, addressing the success of the study, the mixed methods design, the individual qualitative and quantitative components, the integration between methods and the inferences drawn from completed studies. Results Most studies were completed successfully. Researchers mainly ignored the mixed methods design and described only the separate components of a study. There was a lack of justification for, and transparency of, the mixed methods design in both proposals and reports, and this had implications for making judgements about the quality of individual components in the context of the design used. There was also a lack of transparency of the individual methods in terms of clear exposition of data collection and analysis, and this was more a problem for the qualitative than the quantitative component: 42% (19/45) versus 18% (8/45) of proposals (p 5 0.011). Judgements about integration could rarely be made due to the absence of an attempt at integration of data and findings from different components within a study. Conclusions The HSR community could improve mixed methods studies by giving more consideration to describing and justifying the design, being transparent about the qualitative component, and attempting to integrate data and findings from the individual components.

State of Disparities in Cardiovascular Health in the United States

2005-03-15

George A. Mensah , Ali H. Mokdad , Earl S. Ford +2 more

Reducing health disparities remains a major public health challenge in the United States. Having timely access to current data on disparities is important for policy and program development. Accordingly, we … Reducing health disparities remains a major public health challenge in the United States. Having timely access to current data on disparities is important for policy and program development. Accordingly, we assessed the current magnitude of disparities in cardiovascular disease (CVD) and its risk factors in the United States.Using national surveys, we determined CVD and risk factor prevalence and indexes of morbidity, mortality, and overall quality of life in adults > or =18 years of age by race/ethnicity, sex, education level, socioeconomic status, and geographic location. Disparities were common in all risk factors examined. In men, the highest prevalence of obesity (29.2%) was found in Mexican Americans who had completed a high school education. Black women with or without a high school education had a high prevalence of obesity (47.3%). Hypertension prevalence was high among blacks (39.8%) regardless of sex or educational status. Hypercholesterolemia was high among white and Mexican American men and white women in both groups of educational status. Ischemic heart disease and stroke were inversely related to education, income, and poverty status. Hospitalization was greater in men for total heart disease and acute myocardial infarction but greater in women for congestive heart failure and stroke. Among Medicare enrollees, congestive heart failure hospitalization was higher in blacks, Hispanics, and American Indians/Alaska Natives than among whites, and stroke hospitalization was highest in blacks. Hospitalizations for congestive heart failure and stroke were highest in the southeastern United States. Life expectancy remains higher in women than men and higher in whites than blacks by approximately 5 years. CVD mortality at all ages tended to be highest in blacks.Disparities in CVD and related risk factors remain pervasive. The data presented here can be invaluable for policy development and in the planning, implementation, and evaluation of interventions designed to eliminate health disparities.

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Staff Burn‐Out

1974-01-01

Herbert J. Freudenberger

The concept of staff burn‐out is explored in terms of the physical signs and the behavioral indicators. There is a discussion of how the cognitive, the judgmental as well as … The concept of staff burn‐out is explored in terms of the physical signs and the behavioral indicators. There is a discussion of how the cognitive, the judgmental as well as the emotional factors are intruded upon once the process is in motion. Further material deals with who is prone to staff burn‐out and what dedication and commitment can imply from both a positive and negative point of view. A practical section deals with what preventive measures a clinic staff can take to avoid burn‐out among themselves, and if unluckily it has taken place then what measures may be taken to insure caring for that person, and the possibility of his return to the clinic at some future time.

From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider

2014-11-01

T. Bodenheimer , Christine A. Sinsky

The Triple Aim-enhancing patient experience, improving population health, and reducing costs-is widely accepted as a compass to optimize health system performance. Yet physicians and other members of the health care … The Triple Aim-enhancing patient experience, improving population health, and reducing costs-is widely accepted as a compass to optimize health system performance. Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs. Burnout thus imperils the Triple Aim. This article recommends that the Triple Aim be expanded to a Quadruple Aim, adding the goal of improving the work life of health care providers, including clinicians and staff.

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Educational outreach visits: effects on professional practice and health care outcomes

2007-10-10

Mary Ann O’Brien , Stephen Rogers , Gro Jamtvedt +7 more

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Primary Care: Is There Enough Time for Prevention?

2003-04-01

Kimberly S. H. Yarnall , Kathryn I. Pollak , Truls Østbye +2 more

Objectives. We sought to determine the amount of time required for a primary care physician to provide recommended preventive services to an average patient panel. Methods. We used published and … Objectives. We sought to determine the amount of time required for a primary care physician to provide recommended preventive services to an average patient panel. Methods. We used published and estimated times per service to determine the physician time required to provide all services recommended by the US Preventive Services Task Force (USPSTF), at the recommended frequency, to a patient panel of 2500 with an age and sex distribution similar to that of the US population. Results. To fully satisfy the USPSTF recommendations, 1773 hours of a physician’s annual time, or 7.4 hours per working day, is needed for the provision of preventive services. Conclusions. Time constraints limit the ability of physicians to comply with preventive services recommendations.

Evidence On The Chronic Care Model In The New Millennium

2009-01-01

Katie Coleman , Brian T. Austin , Cindy Brach +1 more

Developed more than a decade ago, the Chronic Care Model (CCM) is a widely adopted approach to improving ambulatory care that has guided clinical quality initiatives in the United States … Developed more than a decade ago, the Chronic Care Model (CCM) is a widely adopted approach to improving ambulatory care that has guided clinical quality initiatives in the United States and around the world. We examine the evidence of the CCM’s effectiveness by reviewing articles published since 2000 that used one of five key CCM papers as a reference. Accumulated evidence appears to support the CCM as an integrated framework to guide practice redesign. Although work remains to be done in areas such as cost-effectiveness, these studies suggest that redesigning care using the CCM leads to improved patient care and better health outcomes.

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Do Practice Guidelines Guide Practice?

1989-11-09

Jonathan Lomas , Geoffrey M. Anderson , Karin Domnick-Pierre +3 more

Abstract Guidelines for medical practice can contribute to improved care only if they succeed in moving actual practice closer to the behaviors the guidelines recommend. To assess the effect of … Abstract Guidelines for medical practice can contribute to improved care only if they succeed in moving actual practice closer to the behaviors the guidelines recommend. To assess the effect of such guidelines, we surveyed hospitals and obstetricians in Ontario before and after the release of a widely distributed and nationally endorsed consensus statement recommending decreases in the use of cesarean sections. These surveys, along with discharge data from hospitals reflecting actual practice, revealed that most obstetricians (87 to 94 percent) were aware of the guidelines and that most (82.5 to 85 percent) agreed with them. Attitudes toward the use of cesarean section were congruent with the recommendations even before their release. One third of the hospitals and obstetricians reported changing their practice as a consequence of the guidelines, and obstetricians reported rates of cesarean section in women with a previous cesarean section that were significantly reduced, in keeping with the recommendations (from 72.2 percent to 61.1 percent; P<0.01). The surveys also showed, however, that knowledge of the content of the recommendations was poor (67 percent correct responses). Furthermore, data on actual practice after the publication of the guidelines showed that the rates of cesarean section were 15 to 49 percent higher than the rates reported by obstetricians, and they showed only a slight change from the previous upward trend. We conclude that guidelines for practice may predispose physicians to consider changing their behavior, but that unless there are other incentives or the removal of disincentives, guidelines may be unlikely to effect rapid change in actual practice. We believe that incentives should operate at the local level, although they may include system-wide economic changes. (N Engl J Med 1989;321:1306–11.)

Continuous Improvement as an Ideal in Health Care

1989-01-05

Donald M. Berwick

Imagine two assembly lines, monitored by two foremen.Foreman 1 walks the line, watching carefully. "I can see you all," he warns. "I have the means to measure your work, and … Imagine two assembly lines, monitored by two foremen.Foreman 1 walks the line, watching carefully. "I can see you all," he warns. "I have the means to measure your work, and I will do so. I will find those among you who are unprepared or unwilling to do your jobs, and when I do there will be consequences. There are many workers available for these jobs, and you can be replaced."Foreman 2 walks a different line, and he too watches. "I am here to help you if I can," he says. "We are in this together for the long . . .

Health and social care in the community

1989-02-01

Mary Elliott

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Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework

2017-01-26

Mandeep Sekhon , Martin Cartwright , Jill Francis

It is increasingly acknowledged that 'acceptability' should be considered when designing, evaluating and implementing healthcare interventions. However, the published literature offers little guidance on how to define or assess acceptability. … It is increasingly acknowledged that 'acceptability' should be considered when designing, evaluating and implementing healthcare interventions. However, the published literature offers little guidance on how to define or assess acceptability. The purpose of this study was to develop a multi-construct theoretical framework of acceptability of healthcare interventions that can be applied to assess prospective (i.e. anticipated) and retrospective (i.e. experienced) acceptability from the perspective of intervention delivers and recipients. Two methods were used to select the component constructs of acceptability. 1) An overview of reviews was conducted to identify systematic reviews that claim to define, theorise or measure acceptability of healthcare interventions. 2) Principles of inductive and deductive reasoning were applied to theorise the concept of acceptability and develop a theoretical framework. Steps included (1) defining acceptability; (2) describing its properties and scope and (3) identifying component constructs and empirical indicators. From the 43 reviews included in the overview, none explicitly theorised or defined acceptability. Measures used to assess acceptability focused on behaviour (e.g. dropout rates) (23 reviews), affect (i.e. feelings) (5 reviews), cognition (i.e. perceptions) (7 reviews) or a combination of these (8 reviews). From the methods described above we propose a definition: Acceptability is a multi-faceted construct that reflects the extent to which people delivering or receiving a healthcare intervention consider it to be appropriate, based on anticipated or experienced cognitive and emotional responses to the intervention. The theoretical framework of acceptability (TFA) consists of seven component constructs: affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy. Despite frequent claims that healthcare interventions have assessed acceptability, it is evident that acceptability research could be more robust. The proposed definition of acceptability and the TFA can inform assessment tools and evaluations of the acceptability of new or existing interventions.

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Health Professions Education: A Bridge to Quality

2004-01-01

Ann C. Greiner , Elisa Knebel

The Institute of Medicine study Crossing the Quality Chasm (2001) recommended that an interdisciplinary summit be held to further reform of health professions education in order to enhance quality and … The Institute of Medicine study Crossing the Quality Chasm (2001) recommended that an interdisciplinary summit be held to further reform of health professions education in order to enhance quality and patient safety. Health Professions Education: A Bridge to Quality is the follow up to that summit, held in June 2002, where 150 participants across disciplines and occupations developed ideas about how to integrate a core set of competencies into health professions education. These core competencies include patient-centered care, interdisciplinary teams, evidence-based practice, quality improvement, and informatics. This book recommends a mix of approaches to health education improvement, including those related to oversight processes, the training environment, research, public reporting, and leadership. Educators, administrators, and health professionals can use this book to help achieve an approach to education that better prepares clinicians to meet both the needs of patients and the requirements of a changing health care system.

A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance

2021-09-30

Kathryn Skivington , Lynsay Matthews , Sharon Simpson +7 more

The UK Medical Research Council's widely used guidance for developing and evaluating complex interventions has been replaced by a new framework, commissioned jointly by the Medical Research Council and the … The UK Medical Research Council's widely used guidance for developing and evaluating complex interventions has been replaced by a new framework, commissioned jointly by the Medical Research Council and the National Institute for Health Research, which takes account of recent developments in theory and methods and the need to maximise the efficiency, use, and impact of research.

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Physical Activity and Health: A Report of the Surgeon General

1996-01-01

David Satcher , James S. Marks , Virginia S. Bales +3 more

Developing and evaluating complex interventions: The new Medical Research Council guidance

2012-11-15

Peter Craig , Paul Dieppe , Sally MacIntyre +3 more

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Crossing the Quality Chasm: A New Health System for the 21st Century

2002-09-01

Journal For Healthcare Quality: September 2002 - Volume 24 - Issue 5 - p 52 doi: 10.1111/j.1945-1474.2002.tb00463.x Journal For Healthcare Quality: September 2002 - Volume 24 - Issue 5 - p 52 doi: 10.1111/j.1945-1474.2002.tb00463.x

Australian Family Physician.

1984-01-01

Impact of pay for performance in primary care

2025-06-25

Azeem Majeed , Mariam Molokhia | BMJ

President’s Message: Summer Rest and Celebrating the 7th Biennial National Summit for Building Healthy Academic Communities

2025-06-25

Megan Amaya | Building Healthy Academic Communities Journal

No abstract available. No abstract available.

Coordination, Comprehensiveness and Continuity as the Quality Measures of Remote Primary Healthcare in Poland

2025-06-24

Liliana Hawrysz , Renata Walczak , Agnieszka Bitkowska +3 more | Krakow Review of Economics and Management/Zeszyty Naukowe Uniwersytetu Ekonomicznego w Krakowie

Objective: The purpose of this article is to examine the quality of remote primary healthcare in Poland measured through three dimensions: coordination, comprehensiveness, and continuity (3Cs) and examine the relationship … Objective: The purpose of this article is to examine the quality of remote primary healthcare in Poland measured through three dimensions: coordination, comprehensiveness, and continuity (3Cs) and examine the relationship between them. Research Design & Methods: The 3Cs were measured using a proprietary questionnaire to measure the quality of primary healthcare in a teleconsultation setting. The survey was conducted among 98 patients in primary healthcare facilities nationwide in 2021. Structural equation modelling was used in the data analysis. Findings: The survey results showed that coordination and continuity are one common dimension of quality of primary healthcare. In Poland, patients distinguish only between continuity of care and comprehensiveness. Coordination can be considered part of continuity because it requires a long-term relationship between the patient and the general practitioners. We found that continuity positively affects the comprehensiveness of primary healthcare. Implications / Recommendations: This study is the first of its kind in primary healthcare in Poland, and its results may be of particular value to general practitioners and healthcare managers wishing to improve the quality of teleconsultation services. Contribution: The evidence can help develop appropriate strategies for improving the quality of 3Cs-based care. Validated research tools provide basic metrics that can be used for future research to see to what extent the development of the telehealth system improves the continuity, coordination and comprehensiveness of remote primary healthcare.

Scarlett McNally: My experience as a patient and doctor gives insight into rebuilding the NHS

2025-06-24

Scarlett McNally | BMJ

Educating for optimal health outcomes: training physicians to be system-level advocates

2025-06-23

Brett Schrewe , Charlotte Moore Hepburn | Canadian Medical Education Journal

Mental health consultations during the perimenopausal age range – Are GPs and patients on the same page?: A qualitative study

2025-06-23

Jo Burgin , Yvette Pyne , Anna Davies +1 more | British Journal of General Practice

Background There is an increased risk of mood changes in perimenopause. There is evidence that patients and General Practitioners (GPs) may overlook this association and that there is a lack … Background There is an increased risk of mood changes in perimenopause. There is evidence that patients and General Practitioners (GPs) may overlook this association and that there is a lack of confidence in managing such perimenopausal symptoms. Aim This study aimed to explore the experiences of clinical consultations in 1) patients in the perimenopausal age range presenting with mental health symptoms, and 2) GPs providing care to patients with mental health symptoms in the perimenopausal age range. Design & Setting A qualitative study was conducted with 18 women aged 45-55 who had consulted with their GP about a mental health symptom in the last 6 months and 11 GPs in the same area. Participants were recruited between February and August 2023. Method Data were collected through semi-structured interviews and thematic analysis was used to identify recurring patterns and key insights regarding consultation practices, patient-GP communication, and education gaps. Results Women either did not recognise, or were uncertain, as to whether perimenopause was a factor in their mental health symptoms and felt inhibited or embarrassed about raising the issue. GPs reported variable approaches to asking about perimenopausal symptoms and acknowledged gaps in their training. Time constraints and the stigma surrounding menopause further hindered consultations. Conclusion Addressing mental health symptoms during perimenopause requires a proactive and informed approach in primary care. Improved GP training on menopause, coupled with patient education to increase awareness and confidence, could improve consultations and management of mental health symptoms in perimenopause.

Correction: Can We Help Our Physicians and Our Profession?

2025-06-23

William E. Greenberg , Anthony P. S. Guerrero , Mary K. Morreale +7 more | Academic Psychiatry

Primary care quality of primary healthcare institutions in china: current status and influencing factors

2025-06-23

Kun Zhan , Chuchuan Wan , Ennan Wang +1 more | Archives of Public Health

Corrigendum to “Continuity of Primary Care and the Timing of Preventive Care: Investigating the Relationship Among Medicare Beneficiaries with Fee-for-Service Coverage”

2025-06-23

| Journal of Prevention and Health Promotion

Student’s Perspective: Navigating the Health Care System as a Patient

2025-06-23

Alex J. Portillo | Circulation Cardiovascular Quality and Outcomes

Exploring patients’ intentions to switch from hospitals to primary care institutions for primary care: a push-pull-mooring framework

2025-06-22

Jingrong Zhu , Maoxing Liu , Ming‐guang Zhang +1 more | Australian Journal of Primary Health

Background China's tiered healthcare delivery system encourages patients to choose primary care institutions (PCIs) as their first point of contact, but no mandatory gatekeeping role has been imposed. Despite this … Background China's tiered healthcare delivery system encourages patients to choose primary care institutions (PCIs) as their first point of contact, but no mandatory gatekeeping role has been imposed. Despite this policy encouragement, patients often prefer higher-level institutions. Existing research has largely focused on factors influencing patient preferences for higher-level care, but there is a gap in understanding the factors that drive patients to switch to primary care provided by general practitioners (GPs). Methods This study applied the push-pull-mooring (PPM) framework to analyze patients' switching intentions from higher-level healthcare institutions to a GP in PCIs for primary care, focusing on dissatisfaction with hospital services (push factors), attractiveness of the GP system (pull factors), and entrenched hospital habits and distrust in GPs (mooring factors). Data from 612 respondents in China were collected to test the proposed hypotheses using partial least squares-structural equation modeling. Results Our results suggest that both push factors, such as dissatisfaction with hospital services, and pull factors, such as the attractiveness of the GP system, positively influence switching intentions. Conversely, mooring factors, including entrenched hospital care habits and distrust in GPs, exert a negative influence on switching behavior. Furthermore, mooring factors moderate the relationship between push-pull factors and switching intentions. Conclusions The findings highlight the importance of addressing push and pull factors while mitigating the impact of mooring factors to promote efficient healthcare utilization. Policy interventions should focus on improving GP system attractiveness and reducing patient distrust in primary care.

Implementing a free continuing education webinar series: a case study of the Partners in Contraceptive Choice and Knowledge (PICCK) program

2025-06-21

Lillian W. Acton , Natasha M. Lerner , Elisabeth Woodhams +1 more | Public Health

Confidence is ClinicalKey

2025-06-20

| Elsevier eBooks

Value-Based Payment in Medicare: Progress, Challenges, and Future Directions

2025-06-20

José F. Figueroa , Ciara Duggan , Karen E. Joynt Maddox | Journal of Health Politics Policy and Law

Abstract Despite having the highest healthcare spending globally, the United States lags in key health outcomes compared to peer nations. Over recent decades, this concerning disconnect between spending and outcomes … Abstract Despite having the highest healthcare spending globally, the United States lags in key health outcomes compared to peer nations. Over recent decades, this concerning disconnect between spending and outcomes has spurred substantial national reforms focused on promoting “value” over “volume” of care, prompting the development of numerous value-based payment models. In this analysis, we provide an overview of the experience with value-based payment efforts in the United States, particularly within the Medicare program. We outline and evaluate four main value-based care paradigms: public reporting programs, pay-for-performance models, episode-based payment models, and population-based payment models. Across these models, we argue that there has been mixed success in achieving cost reduction and quality improvements. While some episode-based and population-based models have shown modest savings, the overall efficacy of value-based care reforms remains suboptimal, and many models have yielded unintended consequences that have exacerbated existing health disparities. Considering this evidence alongside the current and emerging threats to value-based payment efforts, we identify several key areas for improvement across these models and discuss a path forward for strengthening value-based payment and delivery system reforms, highlighting key strategies to ensure that future value-based payment models achieve the goals of fostering high-quality, cost-effective, and equitable care.

Crisis Intervention for Women with Chronic Health Issues

2025-06-19

Sarah J. Lewis | Oxford University Press eBooks

Abstract This chapter aims to shed light on the specific struggles faced by women with chronic diseases and explore the impact of these conditions on their overall well-being. By examining … Abstract This chapter aims to shed light on the specific struggles faced by women with chronic diseases and explore the impact of these conditions on their overall well-being. By examining the prevalence, disparities, and contextual factors surrounding women’s experiences with chronic illness, we can gain a deeper understanding of the crisis they face and how to address it effectively. This chapter examines contextual factors that play a significant role in shaping women’s experiences with chronic health issues. Socioeconomic factors, cultural and gender influences, and dynamics within the healthcare system contribute to disparities and challenges faced by women. It is essential to examine these contextual factors comprehensively to understand the social determinants that affect women’s health outcomes.

Training in the speciality of General and Family Medicine in Angola: A cross-sectional study

2025-06-19

Claudia Almeida Fernandes , Isabel Ferreira , Manuel dos Santos +1 more | African Journal of Primary Health Care & Family Medicine

Background: Primary healthcare plays a crucial role in health system, acting as the first line of assistance in preventing, treating and caring for diseases. In Angola, primary healthcare is a … Background: Primary healthcare plays a crucial role in health system, acting as the first line of assistance in preventing, treating and caring for diseases. In Angola, primary healthcare is a recent and developing reality. Aim: To evaluate the strengths and weaknesses of the Angolan General and Family Medicine speciality training programme, identifying areas for improvement and promotion of medical education quality. Setting: Primary healthcare doctors in Angola, including General and Family Medicine specialists and residents in training. Methods: A cross-sectional study was conducted from April 2024 to June 2024 using an online structured questionnaire. The survey was distributed via email and messaging platforms to all primary care doctors practising in Angola. Participants were asked about their opinions regarding the education process and training conditions. Two open-ended questions complemented the data collection. Results: A total of 584 doctors responded (61.1% females), with a mean age of 40.6 years. The most positively evaluated dimensions were faculty and mentoring, supervision, resident guidance, and programme evaluation. Conversely, the quality of infrastructure and access to educational resources were identified as major weaknesses in the training process. Conclusion: Despite limitations in teaching materials and infrastructure, the overall perception of General and Family Medicine training in Angola is positive. There is a recognised opportunity to expand and strengthen the programme nationally. Contribution: These findings reflect the perspectives of primary care doctors in Angola and provide valuable insights for policymakers and medical institutions to reinforce a speciality essential to national health system development and population health outcomes.

Does Social Work Operate in an Unequal and Unfair World? How Do the Social Work Educators and Students Respond to These Issues?

2025-06-19

Adi Fahrudin , Husmiati Yusuf | Oxford University Press eBooks

Abstract This chapter investigates the position of social work in an unequal and unfair world, as well as how social work educators and students respond to these issues. Individuals, groups, … Abstract This chapter investigates the position of social work in an unequal and unfair world, as well as how social work educators and students respond to these issues. Individuals, groups, and communities face a variety of forms of injustice and inequality in the complex and frequently uneven society in which social work operates. Social work educators play a critical role in teaching future social workers to navigate and successfully handle these difficulties. Social work educators should ensure that students have a thorough grasp of societal structural injustices such as racism, sexism, classism, and ableism. Approaches taken by educators and students encompass awareness raising, training, and advocacy for social change. Despite these challenges, educators and students continuously strive to address injustice and inequality in social work practice. Social work education should emphasize antioppressive practice, which includes identifying and criticizing oppressive structures as well as advocating for change.

Clinical and translational science award hub portfolio analysis and interorganizational collaborations with Los Angeles County to improve population health and health care delivery (ID 1565096)

2025-06-19

Pamela L. Davidson , Terry T. Nakazono , Albert D. Min +2 more | Frontiers in Public Health

Demonstrating impact in the Clinical and Translational Science Award (CTSA) Program is crucial to continue governmental, taxpayer, institutional, and donor support and investment. We present an innovative portfolio analysis to … Demonstrating impact in the Clinical and Translational Science Award (CTSA) Program is crucial to continue governmental, taxpayer, institutional, and donor support and investment. We present an innovative portfolio analysis to summarize the Scientific Achievement Translational Science Impact at the hub level. Additionally, a unique feature of the UCLA CTSA hub includes the many interorganizational collaborations with Los Angeles County (LAC). This is the first study to examine the Translational Science Benefits Model (TSBM) impact on projects with CTSA hub-county interorganizational collaborations. A Framework for Evaluating Scientific Achievement Translational Science Impact (SATSI) was used to guide the analyses, with impact indicators derived from the TSBM: (i) clinical and medical, (ii) community and public health, (iii) economic, and (iv) policy and legislation. Two major data sources were used for the evaluation: (i) The CTSI’s Longitudinal Scientific Achievement and Impact survey (LSAS-I), and (ii) longitudinal interviews with principal investigators who reported high-impact projects in hub-county collaborations. We reported baseline data from 2 years of LSAS-I data showing n = 507 new CTSA-assisted grants and the associated demonstrated and potential impact using the hub portfolio analysis. Eighteen ( n = 18) of these grants involved a hub-county interorganizational collaboration. Among these, we identified the highest impact projects and developed impact stories and vignettes describing improvements in health care delivery and population health. Our research offers a model for other CTSA hubs to summarize impact using the hub portfolio analysis, and to partner with local public health departments and governmental agencies to address health concerns in low-income and at-risk populations. This research directly addresses the mission of the UCLA hub, “to produce and implement innovations that impact the greatest health needs of Los Angeles and the nation.”

“One mistake could cost you everything”: five lessons from teaching clinicians in trouble

2025-06-18

D. Daniel Sokol | BMJ

Developing and assessing the usability of a prescribing quality and safety dashboard in Irish general practice: protocol for a qualitative study

2025-06-18

Caroline McCarthy , Tom Fahey , Frank Moriarty +3 more | HRB Open Research

<ns3:p>Background The third WHO Global patient safety challenge, “Medication Without Harm” aims to reduce severe avoidable medication related ham by 50% globally. One approach to reducing medication related harm is … <ns3:p>Background The third WHO Global patient safety challenge, “Medication Without Harm” aims to reduce severe avoidable medication related ham by 50% globally. One approach to reducing medication related harm is to develop interventions that improve prescribing. Audit and feedback is one such intervention that has been shown to have an effect on professional behaviour. With advancements in the data infrastructure of primary care it is now possible to harness routine prescribing data for ongoing and up-to-date comparative benchmarking. The aim of this study was to assess the usability and usefulness of a prescribing safety dashboard developed in Irish general practice. Methods Practices utilising the data analytics platform, MedVault opted in to share anonymous prescription data to enable the development of the prescribing safety dashboard. Participants from these practices who had previously expressed an interest in taking part in this qualitative study will be formally invited to take part. Recruited prescribers will take part in an online interview with a think aloud process where they will share their screen as they navigate the dashboard and verbalise their thoughts. This will be followed by a semi-structured interview where their views on prescribing safety and receiving feedback on prescribing will be explored. For the think aloud process, screen recordings will be reviewed alongside the transcripts, and analysed using Nielsen’s five quality components of usability: learnability, efficiency, memorability, error recovery and satisfaction as a framework. An inductive thematic approach will be used to analyse GPs’ perspectives on prescribing safety and feedback. Discussion This study will explore the usability and acceptability of a prescribing quality and safety dashboard. To design future interventions, policies, and quality improvement initiatives that make use of routine data, it is essential to understand how GPs engage with and use these tools. This understanding can help ensure such initiatives are developed in ways that maximise relevance, usability, and engagement.</ns3:p>

Counting GPs: A comparative repeat cross-sectional analysis of NHS general practitioners

2025-06-18

Luisa M Pettigrew , Soraya Akl , Aamena Bharmal +5 more | British Journal of General Practice

Aim To compare how National Health Service (NHS) general practice GP numbers and trends differ depending on how GPs are defined and data are analysed. Design and Setting Comparative repeat … Aim To compare how National Health Service (NHS) general practice GP numbers and trends differ depending on how GPs are defined and data are analysed. Design and Setting Comparative repeat cross-sectional study, English NHS general practice. Method We compare NHS England’s General Practice Workforce GP data quarterly between September 2015 and September 2024 by headcount and full-time-equivalent (FTE); with and without trainees; and relative to population size. Results Between September 2015 and September 2024, counting fully qualified GPs and GP trainees showed an 18% rise (41,193 to 48,758); whereas counting fully qualified FTE GPs alone showed a 5% reduction (29,364 to 27,966). Considering the growth of the registered population with an NHS general practice, the trend in GPs per capita varied between a 6% rise and a 15% reduction. The number of patients per GP between practices increased, with the 5th to 95th percentile range rising from 1,204-4,139 patients per fully qualified FTE GP in 2015 to 1,357-5,559 in 2024. Conclusion How GPs are defined, whether working hours are considered, and what measure of population size is used affects the interpretation of workforce trends. Using fully qualified FTE GPs per capita most closely reflects GP capacity, although there are limitations to current NHS data. Reporting the spread of patients per GP at practice level is necessary to capture the widening variation in GP provision in England.

Knowledge and perception of market women about the roles of physiotherapists in health promotion in Ghana: A qualitative phenomenological study

2025-06-17

Opoku Kwadwo Konadu , Joseph Kwasi Brenyah , Isaac Mensah Bonsu | Heliyon

Comparison of Domestic and Foreign Family Medicine Residency Education and Training Systems

2025-06-17

Seung Guk Park | Korean Journal of Family Practice

Family Medicine Residency Education and Training Systems

2025-06-17

Youn Huh | Korean Journal of Family Practice

Current Status and Future Directions of Primary Care in the World: Insights from United States (2) —Innovative Models for the Transformation of Primary Care—

2025-06-17

Kyae Hyung Kim , Belong Cho | Korean Journal of Family Practice

Healthier SG: a gateway for evolving public-private-population partnerships in population health

2025-06-17

Chuan De Foo , Ting Hui Woon , Hui Xiang Chia +6 more | The Lancet Regional Health - Western Pacific

Hospital Decision-Making and Adoption of Health-Related Social Needs Programs in US Hospitals

2025-06-17

Dina Zein , Cory E. Cronin , Neeraj Puro +3 more | JAMA Network Open

This cross-sectional study examines associations among hospital management involvement in health equity goals and the hospital’s adoption of social needs initiatives. This cross-sectional study examines associations among hospital management involvement in health equity goals and the hospital’s adoption of social needs initiatives.

The tip of the iceberg and beyond: Here's to all those who enable health professional education

2025-06-17

Kevin W. Eva | Medical Education

Helping people access benefits: Millions of unclaimed federal dollars are available

2025-06-17

Noralou P. Roos , Sharon Macdonald , Eileen Boriskewich +3 more | Can J Public Health

Rural Medical Centers Struggle to Produce Well-Calibrated Clinical Prediction Models: Data Augmentation Can Help

2025-06-17

Katherine Brown , Bradley Malin , Sharon E. Davis | medRxiv (Cold Spring Harbor Laboratory)

Abstract Machine learning models support many clinical tasks; however, challenges arise with the transportability of these models across a network of healthcare sites. While there are guidelines for updating models … Abstract Machine learning models support many clinical tasks; however, challenges arise with the transportability of these models across a network of healthcare sites. While there are guidelines for updating models to account for local context, we hypothesize that not all healthcare organizations, especially those in smaller and rural communities, have the necessary patient volumes to facilitate local fine tuning to ensure models are reliable for their populations. To investigate these challenges, we conducted an experiment using data from a real network of hospitals to predict 30-day unplanned hospital readmission and a simulation study using data from a multi-site ICU dataset to evaluate the utility of synthetic data generation (SDG) to augment local data volumes. Several factors associated with rurality were correlated with model miscalibration and rural sites failed to meet sample size requirements for local recalibration. Our results indicate that deep learning approaches to SDG produced the best local classifiers.

Patient Task Facilitator: Redefining the Shadower Role

2025-06-16

Adam Janicki | Western Journal of Emergency Medicine

Dissatisfaction and Barriers in Electronic Health Record Use for Inflammatory Bowel Disease Patients: A Nationwide Survey of Major IBD Centers

2025-06-16

Hasan Saleh , Sara N. Horst , Jami Kinnucan | The American Journal of Gastroenterology

Background: Electronic health records (EHR) are a growing source of burden for clinicians treating inflammatory bowel disease (IBD). Methods: We conducted an EHR survey study targeting IBD clinicians at leading … Background: Electronic health records (EHR) are a growing source of burden for clinicians treating inflammatory bowel disease (IBD). Methods: We conducted an EHR survey study targeting IBD clinicians at leading IBD programs throughout the United States. Results: Surveys were sent to 65 IBD participants, with 46 (70.8%) responses collected, 41 (89%) were physicians. All clinicians (100%) believe there are opportunities for EHR improvement. Nineteen (41.3%) clinicians felt that their EHR does not enhance IBD patient care. Conclusion: This is the first IBD program survey in the United States showing significant dissatisfaction and opportunity for EHR enhancements to improve patient care.

From Data to Development: Formative Feedback via Electronic Health Record Derived Metrics

2025-06-15

Ashley Rider , J. Carl Hughes , Loretta Matheson +2 more | Western Journal of Emergency Medicine

Advanced Access in Primary Healthcare and Its Effects on Emergency Department Utilization: A Rapid Review

2025-06-15

Rafael Alves Pinheiro Tannure , Salma Sarkis Simão , Amanda Barbosa Peres +7 more | Healthcare

Background: The advanced access (AA) scheduling model in primary healthcare (PHC) may reduce unnecessary visits to the emergency department (ED). However, evidence of this effect remains uncertain and limited. Objective: … Background: The advanced access (AA) scheduling model in primary healthcare (PHC) may reduce unnecessary visits to the emergency department (ED). However, evidence of this effect remains uncertain and limited. Objective: To evaluate whether the adoption of AA models in PHC may reduce ED visits, when compared to the traditional model. Methods: A rapid review of the literature according to the World Health Organization's guidelines was performed, using two databases (PubMed and Lilacs) with articles from 1980 to 2023. Results: A total of 1286 articles were found according to our search. Of them, 1245 were excluded based on their titles, most of them due to not evaluating advanced accesses as an intervention. Of the remaining 41 articles, many did not evaluate ED visits as an outcome, nor did they have the criteria of inclusion. Eight articles evaluated ED visits as an outcome and had inclusion criteria. Five articles were included and three found an association between the adoption of advanced access in PHC and a reduction in ED visits. Conclusion: This review shows that the adoption of AA in PHC may reduce ED visits. However, it is essential to carry out new studies to understand the relationship between the adoption of AA in PHC and its outcomes in universal healthcare systems.

Building diabetes prevention and remission programs across Canada: learning from England

2025-06-15

Samantha Jacobson , Nisha Gupta , Kimberley Hanson +6 more | Canadian Medical Association Journal

The Urology Foundation research and training grants

2025-06-14

Rakesh Heer , Louise de Winter , Rosie Cockroft | Journal of Clinical Urology

For 30 years, The Urology Foundation has been transforming the urology space. We’ve been funding vital research and education and driving positive change for the 1 in 2 of us … For 30 years, The Urology Foundation has been transforming the urology space. We’ve been funding vital research and education and driving positive change for the 1 in 2 of us who will experience a urology disease in their lifetime. We hope this article provides an overview of how we support the urology community including the grants available to urology professionals. Level of evidence: not applicable

Effectiveness of data-driven quality improvement on hospitalizations and health outcomes for people with coronary heart disease in primary care (QUEL): a cluster randomised controlled trial with 24-month follow-up

2025-06-14

Julie Redfern , Nashid Hafiz , Qiang Tu +7 more | medRxiv (Cold Spring Harbor Laboratory)

Background: Using data to drive improved health outcomes offers an healthcare approach that has potential to benefit secondary prevention of coronary heart disease (CHD). The aim of this trial was … Background: Using data to drive improved health outcomes offers an healthcare approach that has potential to benefit secondary prevention of coronary heart disease (CHD). The aim of this trial was to test the effectiveness of a data-driven quality improvement program in primary care on cardiovascular hospitalizations, major adverse cardiovascular events (MACE), risk factor profiles and medication prescriptions at 24 months in people with CHD. Methods: Single-blind, cluster randomised controlled trial conducted in 51 Australian primary care practices. Practices having ≥200 adult patients annually with CHD were the units of randomization and people with CHD the units of analysis. Practices were randomised (1:1) to intervention (12-month data-driven quality improvement including benchmarking, monthly reporting, improvement planning) or control (standard care). Primary outcome was proportion of people with CHD who had unplanned CVD hospitalizations at 24-months. Secondary outcomes were MACE, guideline-recommended medication prescription, risk factor targets, and management planning. Data were extracted from electronic records linked to administrative data and analysed using intention-to-treat log-binomial regression within the framework of generalized estimating equations accounting for clustering of patients within practices. Trial was registered with ANZCTR (ACTRN12619001790134). Results: Between November 2019 and November 2021, 51 primary care practices participated, resulting in a patient cohort of 7864 (4524 from control practices, 3340 from intervention practices). The practices in control and intervention groups were well balanced for practice characteristics, socioeconomic status according to postcode, and median number of patients per practice. Mean age of the patient cohort was 71.9 (±11.8) years, 68% were male and 24% had a prior myocardial infarction. At 24-months, there was no significant in between the control (11.5%) and intervention (10.6%) groups for unplanned CVD hospitalizations (relative risk: 0.91, 95% CI 0.75 to 1.10). Similarly, there was no evidence that secondary outcomes of MACE, clinical measures, or medication prescriptions were different between the groups at 24 months. Conclusions: A primary care, 12-month data-driven quality improvement program did not improve unplanned hospitalizations, MACE or medication prescriptions for people with CHD at 24-month follow-up. Robust evidence for use of a data-driven, collaborative approach to improving care for people with coronary heart disease in primary care remains elusive.

Clinically Relevant Thresholds in Patient-Reported Outcomes: Do Patients’ Expectations Evolve Over Long-term Follow-up?

2025-06-14

Elizabeth G. Walsh , Tyler McCarroll , Benjamin D. Kuhns +3 more | The American Journal of Sports Medicine

Background: Clinically relevant thresholds have been utilized to provide insight into postoperative functional status and patient satisfaction. Purpose: To define and evaluate the minimal clinically important difference (MCID), Patient Acceptable … Background: Clinically relevant thresholds have been utilized to provide insight into postoperative functional status and patient satisfaction. Purpose: To define and evaluate the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) thresholds over the 2-, 5-, and 10-year timepoints for the modified Harris Hip Score (mHHS), Hip Outcome Score–Sports-Specific Subscale (HOS-SSS), and International Hip Outcome Tool (iHOT12). Study Design: Case series; Level of evidence, 4. Methods: Data were retrospectively reviewed for patients who underwent primary hip arthroscopy from 2008 to 2021. The inclusion criteria comprised complete patient-reported outcome scores with anchor questions at the 2-, 5-, or 10-year timepoints. Groups were propensity score–matched 1 to 1 to 1 for these 3 timepoints to limit confounding variables. The PASS, SCB, and MCID thresholds were defined using the anchor-based method for the mHHS, HOS-SSS, and iHOT12. Results: A total of 414 hips were included in the study. Area under the curve for all defined thresholds indicated acceptable to excellent discrimination. The thresholds for achieving the PASS, defined at the 2-, 5-, and 10-year respectively, were as follows: mHHS: 77.5, 85.5, and 78.5; HOS-SSS: 82.7, 76.4, and 67.7; and iHOT12: 67.4, 76.9, and 62.9. The percentage of patients achieving the PASS increased from 2 to 10 years, with the highest percentage at 10 years. The threshold for achieving the SCB was defined as follows: mHHS: 95, 99, and 88; HOS-SSS: 97, 80.9, and 90.5; and iHOT12: 89.4, 94.1, and 82.5. The percentage of patients achieving the SCB increased from 2 to 10 years. The mean changes required to achieve the MCID were defined as follows: mHHS: 7, 7.1, and 7.4; HOS-SSS: 10.6, 10.7, and 11.2; and iHOT12: (9.6, 9.7, -). The MCID and the percentage of patients achieving the MCID remained constant over 2 to 10 years. Conclusion: Patients met the MCID, PASS, and SCB thresholds at high rates over 10 years. Based on the PASS and SCB thresholds, patient expectations for function evolved. Lower expectations at long-term follow-ups may result in a higher percentage of patients meeting certain thresholds, as evidenced in the mHHS, HOS-SSS, and iHOT12 in this cohort. Understanding the evolution of patient expectations may help interpret clinically relevant thresholds in future studies.

ACA health insurance expansions, health professional shortage areas, and the geographic distribution of healthcare providers

2025-06-13

Cuiping Schiman | Empirical Economics

‘I don't know’—reclaiming not‐knowing in medical transitions

2025-06-13

Yvonne Carlsson , Matilda Liljedahl | Medical Education

WOMANOCA calls for better ANOCA care for all

2025-06-13

Christiaan Vrints | European Heart Journal - Quality of Care and Clinical Outcomes

1406-P: Impact of County-Level Social Vulnerability on Preventable Diabetes-Related Hospitalization in California

2025-06-13

BERNICE BINEY , A. G. B. Amoah , Chinenye Nneoma Amanze +4 more | Diabetes

Introduction and Objective: Diabetes-related preventable hospitalizations (DRPH) are associated with low socioeconomic status and the Social Vulnerability Index (SVI) is a framework for studying the impact of social vulnerability on … Introduction and Objective: Diabetes-related preventable hospitalizations (DRPH) are associated with low socioeconomic status and the Social Vulnerability Index (SVI) is a framework for studying the impact of social vulnerability on health outcomes at the county level. However, there is paucity of data on the impact of social vulnerability on DRPH. We examined the association between county-level SVI and DRPH focusing on short- and long-term complications, lower extremity amputations, and uncontrolled diabetes in California. Methods: In this retrospective cross-sectional study, we linked risk-adjusted DRPH (RA-DRPH) for patients aged ≥20 years with SVI data for all counties in California in 2022. SVI values range from 0 to 1, with higher values indicating greater social vulnerability. SVI percentile rankings were divided into four quartiles (1st quartile [SVI-Q1], least vulnerable; SVI-Q4, most vulnerable). RA-DRPH rate per 100,000 with 95% confidence intervals (CI) were stratified by the SVI quartiles. A negative impact by SVI was characterized by a higher RA-DRPH rate in SVI-Q4 than in the SVI-Q1 with non-overlapping CI. Results: For short-term complications and uncontrolled diabetes, there was no significant difference between SVI-Q4 and SVI-Q1. SVI-Q4 had higher RA-DRPH rate for long-term complications (114.7; CI: 98.1-131.3) than SVI-Q1 (71.5; CI: 54.9-88.1), with an excess RA-DRPH rat of 43.2. For lower extremity amputation, SVI-Q4 had higher RA-DRPH rate (40.7; CI: 33.9-47.5) than SVI-Q1 (26.7: CI: 19.8-33.3) with an excess of 14 RA-DRPH rate in SVI-Q4. For RA-DPRH for any of the four complications, SVI-Q4 (240; CI: 207.6-273) had higher rate than SVI-Q1 (170.1; CI: 137.4-202.8) with an excess of 70 RA-DRPH. Conclusion: Higher county-level social vulnerability is associated with increased DRPH in California. The allocation of more resources to counties with higher SVIs can potentially reduce DRPH in these counties. Disclosure B. Biney: None. A.O. Amoah: None. C. Amanze: None. N.A. Addo-Quaye: None. E. Nkrumah: None. A. Rashid: None. H.E. Brown: None.

Editorial AWMH June 2025

2025-06-13

Anita Riecher‐Rössler | Archives of Women s Mental Health

1965-LB: Assessing the CDC’s Program Engagement Criteria in Evaluating Diabetes Prevention Program Effectiveness

2025-06-13

JOON SOO KIM , Benjamin Lalani , DEVIN M. DISHONG +4 more | Diabetes

Introduction and Objective: The Centers for Disease Control and Prevention (CDC) evaluates Diabetes Prevention Program (DPP) effectiveness based on outcomes only in participants who meet program completion criteria. However, little … Introduction and Objective: The Centers for Disease Control and Prevention (CDC) evaluates Diabetes Prevention Program (DPP) effectiveness based on outcomes only in participants who meet program completion criteria. However, little is known about outcomes among those who are referred, but do not complete the program. This study aims to evaluate DPP outcomes among all referred participants and compare success rates between CDC-defined completers and non-completers. Methods: This prospective study utilized data from a single arm of a randomized controlled trial (NCT05056376). Following CDC criteria, “completers” were defined as having attended at least eight DPP core sessions with at least 270 days between their first and last sessions. Weight and A1C were measured at baseline and 12-months, and weekly physical activity was measured objectively via Actigraphy. Outcomes at 12-months were analyzed as continuous variables and binary outcomes using CDC-defined thresholds for diabetes risk reduction: ≥5% weight loss, ≥4% weight loss with ≥150 minutes of average weekly physical activity, and ≥0.2-point reduction in A1C. Chi-square tests evaluated outcome attainment and completer status, and logistic regressions examined outcomes across attendance quartiles. Results: Among 156 total participants, 92 met CDC-defined completer criteria. Completer status did not significantly predict any of the individual DPP outcomes or composite outcome attainment, but it weakly predicted average weekly physical activity at 12 months. Higher attendance quartiles were associated with successful weight loss and physical activity outcomes, but not with A1C reduction or composite success. Conclusion: Attainment of DPP success outcomes was significantly associated with higher session attendance, but not with CDC-defined completer status. Further analysis may be required to refine the threshold of engagement that qualifies as program completion, particularly if engagement is to be used when assessing DPP effectiveness. Disclosure J. Kim: None. B. Lalani: None. D.M. Dishong: None. D. Zade: None. A. Shehadeh: None. M.S. Abusamaan: None. N.N. Mathioudakis: None. Funding The National Institute of Diabetes and Digestive and Kidney Diseases (R01DK125780)

1900-LB: Inpatient Education and Discharge Support in the T1D Exchange Quality Improvement Collaborative (T1DX-QI)

2025-06-13

Grenye O’Malley , DHRUVI VORA , LEAH KAPLAN +7 more | Diabetes

Introduction and Objective: Readmission rates are higher for people with diabetes, but data and guidance for optimization of discharge management is lacking. Methods: The annual T1DX-QI survey was conducted Sept-Nov … Introduction and Objective: Readmission rates are higher for people with diabetes, but data and guidance for optimization of discharge management is lacking. Methods: The annual T1DX-QI survey was conducted Sept-Nov 2024 with a response rate of 90% of 62 centers: 38 pediatric, 18 adult. Respondents answered questions about inpatient resources and practices. Response data was cleaned and summarized. Results: Automatic consultation to an endocrine service was common in pediatrics (elevated HbA1c: 42%, diabetic ketoacidosis: 66%, elevated readmission risk score: 16%, other: 45%) but only used in 50% of adult centers. Knowledge of readmission rates for people with diabetes was low in adult centers, and use of risk calculators to predict readmission risk was low (pediatric 16%, adult 6%). Inpatient diabetes education is performed by a range of professionals: most commonly CDCES (82%) at pediatric centers and floor registered nurse (72%) or midlevel provider (72%) at adult centers. Inpatient initiation of CGM is more common at pediatric centers (66%) than adult centers (44%). Discharge order sets are common (peds 76%, adult 71%), but discharge checklists (peds 71%, adult 39%) and discharge coordinators (peds 37%, adult 11%) are rarer. Discharge medications are given in hand at 71% of pediatric centers and coverage confirmed in 28%. Lower prescription support was reported by adult centers: 24% give medications in hand, 18% use a central pharmacy, and 18% confirm insurance coverage before discharge. Average wait time to follow up appointments is within 2 weeks in 48% of pediatric centers. Adult centers reported 11% of visits within 2 weeks and 50% in 2-4 weeks. Conclusion: While hospitalization is an opportunity for education and medication optimization, inpatient and post-discharge management of diabetes remains underemphasized—especially at adult centers. Quality improvement initiatives are needed to evaluate discharge tools and support services in reducing readmission rates and optimizing post-discharge diabetes care. Disclosure G. O'Malley: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc, Novo Nordisk, MannKind Corporation. D. Vora: None. L. Kaplan: None. C. Levister: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc. J. Dawson: None. A. Neyman: None. T.S. Hannon: Research Support; Eli Lilly and Company, Novo Nordisk. Y. Tsushima: None. D. Plante: None. J. Lonier: None. K.M. Williams: None. C.J. Levy: Research Support; Tandem Diabetes Care, Inc. Advisory Panel; Tandem Diabetes Care, Inc. Research Support; MannKind Corporation, Dexcom, Inc., Novo Nordisk, Eli Lilly and Company. Funding The Leona M. and Harry B. Helmsley Charitable Trust

2048-LB: Early Findings from the Population Health Management Initiative—A Multisite Primary Care Model to Improve Diabetes and Hypertension Outcomes in Health Centers

2025-06-13

Jacob P. Tanumihardjo , Maggie Jones , Mengqi Zhu +5 more | Diabetes

Introduction and Objective: Population health management (PHM) is an established strategy to manage chronic conditions like type 2 diabetes across large populations. California’s federally qualified health centers (FQHCs) serve predominantly … Introduction and Objective: Population health management (PHM) is an established strategy to manage chronic conditions like type 2 diabetes across large populations. California’s federally qualified health centers (FQHCs) serve predominantly Medicaid beneficiaries who face more complications related to uncontrolled chronic conditions and socioeconomic disparities (e.g., poverty, poor neighborhood conditions). The Population Health Management Initiative (PHMI) was designed to improve PHM capabilities across 32 FQHCs and align with ongoing state healthcare payment and policy reform. We evaluated changes in process measures (e.g., PHM capabilities) and clinical outcomes during the first year of implementation. Methods: A 50-question survey was developed to assess PHM capabilities across eight different domains on a 10-point scale. Clinical outcomes at each FQHC were measured by the percent of patients with controlled diabetes (HbA1c&lt;9%) or blood pressure (&lt;140/90 mm Hg). Weighted linear mixed model (LMM) was used to evaluate change over time of the PHM capabilities and LMM for clinical outcomes. Surveys were collected among staff at 32 FQHCs in April 2023 (n=212) & Nov. 2024 (n=285) and clinical outcomes were collected among 32 FQHCs in Feb. 2024 (n=29) & July 2024 (n=28). Results: Significant improvements (p&lt;0.05) were observed in mean (SD) scores for the following PHM capabilities: Leadership & Culture (+0.28 [0.84]), Business Case for PHM (+0.44 [1.12]), Technology & Data Infrastructure (+0.54 [0.82]), Empanelment & Access (+0.69 [0.96]), Care Team & Workforce (+0.68 [0.94]), Patient-centered, Population-based Care (+0.17 [0.95]), and Social Health (+0.29 [1.08]). Non-significant changes were observed in clinical outcomes: HbA1c control (+0.03 [0.04]) and blood pressure control (-0.03 [0.02]). Conclusion: Early findings of PHMI have shown promising process measure improvements among foundational PHM capabilities and the capacity to improve clinical care. Disclosure J. Tanumihardjo: None. M. Jones: None. M. Zhu: None. C.E. Levitz: None. Y. O'Neal: None. C. Dinh: None. M.E. Peek: Research Support; Kaiser Permanente, National Institutes of Health, PCORI. Other Relationship; CMEO. Research Support; Merck Foundation. M. Chin: Advisory Panel; Bristol-Myers Squibb Company, Blue Cross Blue Shield. Research Support; Kaiser Foundation Health Plan, Inc. Other Relationship; Sutter Health, Genentech, Inc. Advisory Panel; America's Health Insurance Plans. Funding Kaiser Permanente Foundation (148785)

627-P: Learnings from Equitably Developing and Administering a Survey for the National Center for Engagement in Diabetes Equity Research (CEDER)

2025-06-13

C. Cooper , Tabia Henry Akintobi , Ş. Albert +7 more | Diabetes

Introduction and Objective: The National Center for Engagement in Diabetes Equity Research (CEDER) fosters nationwide collaborations to increase engagement and equity in type 2 diabetes research. Co-led by community and … Introduction and Objective: The National Center for Engagement in Diabetes Equity Research (CEDER) fosters nationwide collaborations to increase engagement and equity in type 2 diabetes research. Co-led by community and academic partners, CEDER utilizes a partnership hub (PH) and steering committee (SC), comprising diverse members, to provide input on CEDER’s model. We describe lessons learned on how to advance equity in co-developing and co-administering CEDER’s national needs & asset assessment. Methods: CEDER staff and faculty trained in community-based participatory methods developed a survey and outreach plan from March-June 2024. Materials were shared in advance of and during 5 PH and SC meetings; two 1.5 hour listening sessions with 12 community-based and academic partners from varied geographical locations and experience with diverse populations; and were disseminated through partner networks to broaden reach/input. To increase accessibility, partners could share written or oral feedback. Feedback was iteratively synthesized and applied to improve relevance and acceptability of the materials and strategies. Results: Lessons learned were: 1) Include community members earlier in the development phase; 2) Include more iterations to incorporate feedback adequately; 3) Leverage non-traditional engagement methods, including informational videos and use of existing networks to boost participation from community-based organizations; and 4) Ensure materials language, tone, and content resonate with different audiences, which may require cultural and linguistic tailoring. Conclusion: Coordinating national efforts to assess diabetes equity research across diverse partners and underrepresented communities highlights challenges in community-partnered research. When developing materials, centers may benefit from implementing processes to better integrate and balance community participation and perspectives. Disclosure C. Cooper: None. T. Akintobi: None. S.L. Albert: None. S. Albrecht: None. M. AuYoung: None. D. Buchwald: Advisory Panel; Novo Nordisk. C.K. Townsend: None. G. Kim: None. D.W. Lounsbury: None. A. Luitel: None. K.D. Ramirez: None. E. Rodgers: None. S.A. Stotz: None. R.C. Quarells: Consultant; UCB Pharmaceutical Company. C. Trinh-Shevrin: None. J.A. Wong: None. L. Wyatt: None. J. Zanowiak: None. A. Brown: None. E. Chambers: None. N. Islam: None. Funding U2CDK137135

Clinical Considerations When Working with Veterans Who are First Responders

2025-05-01

Thalia P. Nicholson , Meredith K. Ginley | Journal of Health Service Psychology