The American journal of managed care
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Objectives: To quantify the association between primary care team workload satisfaction and primary care physician (PCP) turnover and examine potential mediation of workplace climate factors using survey and administrative data. Study Design: Longitudinal observational study using data from 2008 to 2016. Methods: The outcome variable was PCP turnover. ⋯ In the mediation analysis, we found that workload satisfaction impacted turnover through only 1 of the 7 workplace climate measures: satisfaction with direction by senior managers. Conclusions: Our study findings highlight the key role that achieving primary care workload satisfaction can play in reducing PCP turnover. Identification of direction by senior managers as an underlying mechanism is an important finding for strategic planning to mitigate PCP turnover.
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Bone mineral density (BMD) and fracture risk calculators (eg, the Fracture Risk Assessment Tool [FRAX]) guide primary prevention care in postmenopausal women. BMD scores use non-Hispanic White (NHW) reference data for T-score classification, whereas FRAX incorporates BMD, clinical risk factors, and population differences when calculating risk. This study compares findings among Asian, Black, and NHW women who underwent osteoporosis screening in a US health care system. ⋯ A large subset of Asian women have discordant BMD and FRAX scores, presenting challenges in osteoporosis management. Furthermore, FN-BMD and especially FRAX scores identified few Black women at high fracture risk warranting treatment. Studies should examine whether fracture risk assessment can be optimized in understudied racial minority populations, particularly when findings are discordant.
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To assess the national prevalence and cost of inappropriate MRI in patients with wrist pain prior to and following American College of Radiology (ACR) guideline publication. ⋯ MRI as a diagnostic tool for wrist pain is often inappropriate and expensive. Our findings support interventions to increase guideline adherence, such as integrated clinical decision support tools.
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Low-value care (LVC) health services are unsupported by current evidence, are associated with harmful patient outcomes, and equate to more than $100 billion in wasteful spending annually. Nurse practitioner (NP) LVC ordering practices among adult patients in outpatient settings are described and compared with those of other health care clinicians. Factors impacting NP ordering practices are also explored. ⋯ The full extent to which NPs order LVC services, as well as a comprehensive understanding of the factors influencing their decisions, remains unknown. It is unclear whether NPs order fewer or equal LVC services compared with other health care clinicians. More research on NPs and LVC is indicated.
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Randomized Controlled Trial
At-home hemoglobin A1c testing during COVID-19 improved glycemic control.
COVID-19 has exacerbated barriers to routine testing for chronic disease management. This study investigates whether a home hemoglobin A1c (HbA1c) test kit intervention increases frequency of HbA1c testing and leads to changes in HbA1c 6 months post testing and whether self-reinforcement education improves maintenance of HbA1c testing. ⋯ This novel, at-home approach to test HbA1c is an effective intervention to increase testing rates and facilitate HbA1c reduction over time in patients with T2D.