Journal of general internal medicine
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The growing interest in pay-for-performance and other quality improvement programs has generated concerns about potential performance measurement penalties for providers who care for more complex patients, such as patients with more chronic conditions. Few data are available on how multimorbidity affects common performance metrics. ⋯ In our nationally representative sample, patients with more chronic conditions gave their doctors modestly lower patient-doctor communication scores than their healthier counterparts. Accounting for concordance among conditions does not widen the difference in communication scores. Concerns about performance measurement penalty related to patient complexity cannot be entirely addressed by adjusting for multimorbidity. Future studies should focus on other aspects of clinical complexity (e.g., severity, specific combinations of conditions).
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The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is a brief validated screen for risky drinking and alcohol abuse and dependence (alcohol misuse). However, the AUDIT-C was validated in predominantly White populations, and its performance in different racial/ethnic groups is unclear. ⋯ The overall performance of the AUDIT-C was excellent in all 3 racial/ethnic groups as reflected by high AuROCs. At recommended cut points, there were significant differences in the AUDIT-C's sensitivity but not in specificity across the 3 racial/ethnic groups.
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Challenges in implementing electronic health records (EHRs) have received some attention, but less is known about the process of transitioning from legacy EHRs to newer systems. ⋯ Leadership at paper- and EHR-based practices in 1 academic network has different priorities for implementing a new EHR. Ambulatory practices upgrading their legacy EHR have unique challenges.
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Obesity is rapidly approaching tobacco as the leading cause of preventable morbidity and mortality. Health care providers have the opportunity to address this through primary prevention strategies. ⋯ Only a very small proportion of healthy-weight adults received primary prevention, which suggests that physicians are missing opportunities to help address the epidemic of adult obesity in the US.
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Population-based rates for the delivery of adult vaccinations or screenings are typically tracked as individual services. The current approach is useful in monitoring progress toward national health goals but does not yield information regarding how many U.S. adults receive a combination of preventive services routinely recommended based on a person's age and gender. A composite measure is important for policymaking, for developing public health interventions, and for monitoring the quality of clinical care. During the period under study, influenza vaccination was newly recommended (2000) to be routinely delivered to adults in this age range. The objective of the study was to compare the delivery of routine clinical preventive services to U.S. adults aged 50-64 years between 1997 and 2004 using a composite measure that includes cancer screenings and vaccinations. ⋯ In 2004, the percentage of adults aged 50-64 years receiving routinely recommended cancer screenings and influenza vaccination was low with fewer than 1 in 4 being up to date.