J Am Board Fam Med
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To determine whether the construct of family medicine clinical decision making ability was invariant across modes of administration, the 1-day examination and the longitudinal assessment. We attempted to identify item characteristics associated with differences in difficulty across modes of administration. ⋯ This study suggests that changes in item difficulty do occur when extra time and the use of external resources are permitted. Usually the questions get easier, but in some cases the question becomes more difficult. Possible reasons for this are presented, and a method to adjust the item difficulty in a way to maintain a single construct is presented.
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To understand how primary care clinics coordinate services for complex patients and whether clinics with an integrated social worker do it differently. ⋯ Clinics with an integrated social worker seem to differ in the frequency and approach to care coordination as well as in how social needs are addressed from those that use a nursing model while providing most medical/nursing services at similar or higher rates.
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The minority tax has been defined as a set of disparities that those who are underrepresented in medicine face in addition to clinical care, education, and research responsibilities. These taxes include systemic racism, diversity efforts, clinical and promotion disparities, lack of faculty development, and isolation. ⋯ The authors, who are all academic family medicine physicians from minoritized communities, use their lived experiences to share how the diversity efforts disparity impacts patient care. Themes noted include health system wide challenges for patients whose preferred language is not English and the importance of racial and ethnic concordance between patients and the physician workforce.
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Integrated behavioral health (IBH) is a promising approach which embeds behavioral health services into primary care. Yet, IBH has had limited implementation. Our objective was to identify strategies to successfully implement the "Cherokee" IBH model by examining a 2013 to 2019 IBH demonstration project in New Jersey that included Federally Qualified Health Centers (FQHCs) and Community Health Centers (CHCs). ⋯ Future implementations should apply multi-faceted approaches that address persistent and seemingly intractable barriers that have inhibited IBH integration.
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Income is an important social determinant of health, yet it is rarely discussed among patients and clinicians. Discussing income could open the door to addressing issues like high deductibles, prescription costs, copays, housing expenses, and medical debt. We identify ways to overcome obstacles to talking about this taboo subject.