Annals of family medicine
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Annals of family medicine · Nov 2017
ReviewThe Foundations Framework for Developing and Reporting New Models of Care for Multimorbidity.
Multimorbidity challenges health systems globally. New models of care are urgently needed to better manage patients with multimorbidity; however, there is no agreed framework for designing and reporting models of care for multimorbidity and their evaluation. ⋯ By encouragin greater clarity about the underpinning theory and target population, and by categorizing the wide range of potentially important elements of an intervention to improve care for patients with multimorbidity, the framework may be useful in designing and reporting models of care and help advance the currently limited evidence base.
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Medicare's merit-based incentive payment system and narrowing of physician networks by health insurers will stoke clinicians' and policy makers' interest in care delivery attributes associated with value as defined by payers. ⋯ Awareness of care delivery attributes that distinguish their high-value peers may help physicians respond successfully to incentives from Medicare and private payers to lower annual health care spending and improve quality of care.
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Annals of family medicine · Nov 2017
Trends in Patient-Perceived Shared Decision Making Among Adults in the United States, 2002-2014.
To ascertain changes in shared decision making (SDM), we analyzed data from the nationally representative Medical Expenditure Panel Survey. We aggregated responses to questions into a 7-point SDM composite score. ⋯ Scores were lower for patients with poor-perceived health (-0.41 points), Asian vs white race/ethnicity (-0.28 points), and no insurance (-0.17 points; all P <.05). Improvement efforts should target Americans without a same-race/ethnicity usual source of care and with poor-perceived health.