Annals of family medicine
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Annals of family medicine · Jan 2017
Regional Variation in Primary Care Involvement at the End of Life.
Variation in end-of-life care in the United States is frequently driven by the health care system. We assessed the association of primary care physician involvement at the end of life with end-of-life care patterns. ⋯ Regions with greater primary care physician involvement in end-of-life care have overall less intensive end-of-life care.
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Annals of family medicine · Jan 2017
Health Benefits and Cost-Effectiveness of Brief Clinician Tobacco Counseling for Youth and Adults.
To help clinicians and care systems determine the priority for tobacco counseling in busy clinic schedules, we assessed the lifetime health and economic value of annually counseling youth to discourage smoking initiation and of annually counseling adults to encourage cessation. ⋯ Brief tobacco counseling provides substantial health benefits while producing cost savings. Both youth and adult intervention are high-priority uses of limited clinician time.
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Annals of family medicine · Jan 2017
Health Benefits and Cost-Effectiveness of Asymptomatic Screening for Hypertension and High Cholesterol and Aspirin Counseling for Primary Prevention.
Our aim was to update estimates of the health and economic impact of clinical services recommended for the primary prevention of cardiovascular disease (CVD) for the comparative rankings of the National Commission on Prevention Priorities, and to explore differences in outcomes by sex and race/ethnicity. ⋯ All 3 CVD preventive services continue to rank highly among other recommended preventive services for US adults, but individual priorities can be tailored in practice by taking a patient's demographic characteristics and clinical objectives into account.
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Annals of family medicine · Jan 2017
Measuring Outcomes: Lessons From the World of Public Education.
The quality and efficiency of American health care are increasingly measured using clinical and financial data with a goal of improving clinical practice. Proponents believe such efforts can improve outcomes, motivate clinicians, and inform the public about quality. ⋯ Drawing on lessons from similar performance management policies in public education, we provide guidance about this trend for primary care physicians and health care policy makers. We argue that public school teacher evaluations that use value-added modeling foretell specific pitfalls for the use of similar models to evaluate physician effectiveness, and that unintended consequences of performance management in both education and health care can include the narrowing of purpose, deprofessionalization, and a loss of local/community control.