Journal of general internal medicine
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Multicenter Study Pragmatic Clinical Trial
Proactive Population Health Strategy to Offer Tobacco Dependence Treatment to Smokers in a Primary Care Practice Network.
Population-based strategies can expand the reach of tobacco cessation treatment beyond clinical encounters. ⋯ Smokers responding to a population-based, proactive outreach strategy had better provision of tobacco cessation treatment when referred to either a health system-based or community-based program compared with usual care. The health system-based strategy outperformed the quitline-based one in several measures. Future work should aim to improve population reach and test the effect on smoking cessation rates.
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Clinical reasoning is a core component of clinical competency that is used in all patient encounters from simple to complex presentations. It involves synthesis of myriad clinical and investigative data, to generate and prioritize an appropriate differential diagnosis and inform safe and targeted management plans. The literature is rich with proposed methods to teach this critical skill to trainees of all levels. ⋯ In this perspective, we first introduce the concepts of illness scripts and dual-process theory that describe the roles of analytic system 1 and non-analytic system 2 reasoning in clinical decision making. Thereafter, we draw upon existing evidence and expert opinion to review a range of methods that allow for effective assessment of clinical reasoning, contextualized within Miller's pyramid of learner assessment. Key assessment strategies that allow teachers to evaluate their learners' clinical reasoning ability are described from the level of knowledge acquisition, through to real-world demonstration in the clinical workplace.
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Patient care ownership is essential to delivering high-quality medical care but appears to be eroding among trainees. The lack of an objective measure has limited the study of ownership in physicians. ⋯ We developed an instrument to quantify patient care ownership in residents. Our scale demonstrates good internal consistency and preliminary evidence of validity. With further validation, we expect this to be a valuable tool to evaluate interventions aimed at improving ownership.
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High patient out-of-pocket (OOP) spending for medical care is associated with medical debt, distress about household finances, and forgoing medical care because of cost in the USA. ⋯ Medical financial hardship is common in the USA, especially in adults aged 18-64 years and those without health insurance coverage. With trends towards higher patient cost-sharing and increasing health care costs, risks of hardship may increase in the future.
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Individuals with limited English proficiency (LEP) have worse healthcare access and report lower quality of care compared to individuals who are proficient in English. Policy efforts to improve patient-provider communication for LEP individuals have been going on for decades but linguistic disparities persist. ⋯ Our study sheds light on trends in patient-provider communication before and after 2010, a year that marked substantial efforts to reform the US healthcare system. Though patient-provider communication among LEP individuals has improved since 2010, linguistic disparities persist and constitute a formidable challenge to achieving healthcare equity, a long-standing US policy goal.