Annals of family medicine
-
Annals of family medicine · May 2005
Multicenter StudyEvaluation of a quality improvement collaborative in asthma care: does it improve processes and outcomes of care?
We wanted to examine whether a collaborative to improve asthma care influences process and outcomes of care in asthmatic adults. ⋯ The intervention was associated with improved process-of-care measures that have been linked with better outcomes. Patients benefited through increased satisfaction with communication. Follow-up of patients who participated in the intervention may have been too brief to be able to detect significant improvement in health-related outcomes.
-
Annals of family medicine · May 2005
Comorbidity and the use of primary care and specialist care in the elderly.
The impact of comorbidity on use of primary care and specialty services is poorly understood. The purpose of this study was to determine the relationship between morbidity burden, comorbid conditions, and use of primary care and specialist services ⋯ In the elderly, a high morbidity burden leads to higher use of specialist physicians, but not primary care physicians, even for patients with common diagnoses not generally considered to require specialist care. This finding calls for a better understanding of the relative roles of generalists and specialists in the US health services system.
-
Annals of family medicine · May 2005
Breast and cervical cancer screening: impact of health insurance status, ethnicity, and nativity of Latinas.
Although rates of cancer screening for Latinas are lower than for non-Latina whites, little is known about how insurance status, ethnicity, and nativity interact to influence these disparities. Using a large statewide database, our study examined the relationship between breast and cervical cancer screening rates and socioeconomic and health insurance status among foreign-born Latinas, US-born Latinas, and non-Latina whites in California. ⋯ Breast and cervical cancer screening rates vary by ethnicity and nativity, with foreign-born Latinas experiencing the highest rates of never being screened. After accounting for socioeconomic factors, differences by ethnicity and nativity are reversed or eliminated. Lack of health insurance coverage remains the strongest predictor of cancer screening underutilization.
-
The health care system in the United States is inherently hierarchical. Patients are "nested" within physicians who in turn are "nested" within practices. Much of the research data gathered in practice-based research networks (PBRNs) also have similar patterns of nesting (clustering). When research data are nested, statistical approaches to the data must account for the multilevel nature of the data or risk errors in interpretation. We illustrate the concept of multilevel structure and provide examples with implications for practice-based research. ⋯ Recognizing and accounting for multilevel structure when analyzing data from PBRN studies can lead to more accurate conclusions, as well as offer opportunities to explore contextual effects and differences across sites. Accommodating multilevel structure in planning research studies can result in more appropriate estimation of required sample size.
-
Annals of family medicine · May 2005
COGME's 16th Report to Congress: too many physicians could be worse than wasted.
Departing from past reports, the latest Council on Graduate Medical Education (COGME) report warns of a physician deficit of 85,000 by 2020 and recommends increases in medical school and residency output. COGME notes that contributions of other clinicians and changes in how medical care is delivered in the future would likely offset physician deficits but chose not to modify their recommendations. ⋯ Producing a physician surplus could be far worse than wasted, because the investment required and resulting rise in health care cost may harm, not help, the health of people in the United States. Instead, these resources could be applied in ways that improve health.