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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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.
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Identifying and addressing unmet social needs without attention to other contributors to health inequities-such as medical mistrust-is unlikely to yield desired outcomes.
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Evaluation of a collaborative model between managed care and affordable housing on acute care costs.
This study evaluated a collaborative service model between the largest Medicaid managed care organization (MCO) in Texas, Superior HealthPlan, and the affordable housing provider Prospera Housing Community Services. ⋯ These findings provide needed evidence of the clinical and economic value of forming multisector collaborative models between MCOs and other community providers.
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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.