Journal of general internal medicine
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Randomized controlled trials to improve care for complex, high-need, high-cost patients have not consistently demonstrated a relative decrease in acute care utilization or cost savings. However, the Veterans Health Administration (VHA) has been able to glean lessons from these trials and generate realistic expectations for success. Lessons include the following: (1) combining population management tools (e.g., risk scores) and clinician judgment is more effective than either alone to identify the patients best suited for intensive management; (2) treatment adherence and engagement may contribute more to preventable emergency department visits and hospitalizations than care coordination; and (3) efforts should focus on assessing for and treating those risk factors that are most amenable to intervention. Because it is unlikely that cost savings can fund add-on intensive management programs, the VHA Office of Primary Care plans to incorporate those intensive management practices that are feasible into existing patient-centered medical homes as a high reliability organization.
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There is a paucity of evidence regarding the association between family physicians' panel size and health outcomes of patients with hypertension in China. ⋯ The panel size of family physicians was curvilinearly associated with health outcomes of patients with hypertension in urban China.
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Given efforts to reduce opioid use, and because marijuana potentially offers a lower-risk alternative for treating chronic pain, there is interest in understanding the public health impact of marijuana legalization on opioid-related outcomes. ⋯ Our analysis does not support the supposition that access to marijuana lowers use of chronic opioids for pain.
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Quantitative evaluations of the effectiveness of intensive primary care (IPC) programs for high-needs patients have yielded mixed results for improving healthcare utilization, cost, and mortality. However, IPC programs may provide other value. ⋯ Patients and primary care facility leaders report benefits for high-needs patients from IPC interventions that translated into perceived improvements in healthcare, health behaviors, and physical and mental health status. Most program evaluations focus on cost and utilization, which may be less amenable to change given this cohort's numerous comorbid health conditions and complex social circumstances. Future IPC program evaluations should additionally examine IPC's effects on quality of care, patient satisfaction, quality of life, and patient health behaviors other than utilization (e.g., engagement, self-efficacy).
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This study examines the use of career ladders for medical assistants (MAs) in primary care practices as a mechanism for increasing wages and career opportunity for MAs. A growing body of research on primary care suggests that successful expansion of support staff roles such as MAs may have positive organizational and quality of care outcomes, but little is known about worker outcomes. ⋯ Investing in career ladders in primary care clinics can improve MA job quality while also potentially addressing issues of equity, efficiency, and quality in the health care sector.