Annals of family medicine
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Annals of family medicine · May 2013
Spreading a medical home redesign: effects on emergency department use and hospital admissions.
The patient-centered medical home (PCMH) is being rapidly deployed in many settings to strengthen US primary care, improve quality, and control costs; however, evidence supporting this transformation is still lacking. We describe the Group Health experience in attempting to replicate the effects on health care use seen in a PCMH prototype clinic via a systemwide spread using Lean as the change strategy. ⋯ The Group Health experience shows it is possible to reduce emergency department use with PCMH transformation across a diverse set of clinics using a clear change strategy (Lean) and sufficient resources and supports.
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Annals of family medicine · May 2013
Prognosis of abdominal pain in children in primary care--a prospective cohort study.
Abdominal pain is a common complaint in children. Because few data exist on its natural history, we wanted to investigate the prognosis of abdominal pain in children in general practice. ⋯ The presence and development of chronic abdominal pain is common and of long duration among children consulting in primary care for abdominal pain. These poor outcome data warrant follow-up.
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Annals of family medicine · May 2013
Contrasting trajectories of change in primary care clinics: lessons from New Orleans safety net.
We sought to compare and contrast patterns of change toward patient-centered medical homes (PCMHs) in 5 New Orleans primary care safety net clinics in the aftermath of Hurricane Katrina. We assessed the general direction of change in practice to discover possible reasons for differences in patterns of change, and to identify impediments to change. ⋯ The PCMH model can successfully address the needs of safety net populations. Stable leadership committed to serving safety net patients via the PCMH model is important for successful practice transformation. Beyond clinic walls, cultivating deep ties to the communities that clinics serve also supports the PCMH model.
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Annals of family medicine · May 2013
Comparative StudyParticipants' explanatory model of being overweight and their experiences of 2 weight loss interventions.
We explored participants' accounts of weight loss interventions to illuminate the reasons behind the greater weight loss observed among those attending a commercial program compared with those receiving standard care in a recent large-scale trial. We further wanted to examine how participants' general explanatory model of being overweight related to the 2 different interventions. ⋯ Primary care referral to a commercial weight loss program for people who do not require specific clinical care appears to be in accord with their general explanatory model about being overweight, offering motivation and support to lose weight outside a strictly medical context. This approach may not be effective or acceptable for everyone, however, and there are likely to be considerable variations in the explanatory models held. Findings support the argument that a range of evidence-based options for weight management should be available in primary care.
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Annals of family medicine · May 2013
Publication of research presented at STFM and NAPCRG conferences.
Presentations of research are important in the dissemination of new knowledge, but they do not reach the same audience as research published in journals. The purpose of this study was to evaluate the proportion of presentations at recent major primary care research conferences that have become published. ⋯ More than one-third of all presentations at STFM and NAPCRG conferences were published in journals indexed in PubMed. Time to publication was comparable to that of other specialties. Fewer than 2 of every 5 reports were published are in a family medicine journal, suggesting vast breadth in family medicine research. Family medicine academicians need to refocus efforts on transforming presentations into published articles in peer-reviewed journals for broader dissemination of research findings.