J Am Board Fam Med
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Multicenter Study
Evaluation of a Family Medicine Transitional Care Service Line.
As of 2013, the all-cause readmission rate among Medicare fee-for-service beneficiaries was 17.5%. In addition to poor outcomes, 30-day hospital readmissions account for over $17 billion in Medicare expenditures. The presence and involvement of a primary care provider can be essential during the transition period from hospital discharge to the outpatient setting. ⋯ Although there was no evidence of an impact of the new service line on a decline in 30-day readmission rates it was decided that this service was a benefit to the patients and the physicians involved.
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In 2013, Oregon initiated an Alternative Payment Methodology (APM) Experiment for select health centers, initiating capitated payments for patients with Medicaid. ⋯ APM clinics experienced a greater increase in same-day visits over the course of this experiment, but did not significantly differ from comparators in other visit metrics. Further research into other impacts of this experiment are necessary and ongoing.
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Opioid misuse in the United States has made it challenging for physicians to treat chronic noncancer pain (CNCP). We implemented an educational program aimed at promoting safe opioid prescribing practices in hopes of increasing the level of appropriateness associated with prescribing opioids for CNCP. ⋯ Clinician education on best practices while treating CNCP is associated with an increase in the level of opioid use appropriateness.
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Multicenter Study
Physician and Family Discussions about Driving Safety: Findings from the LongROAD Study.
Older adult drivers may experience decreases in driving safety with age or health status change. Discussing driving safety may help them plan for driving restriction and eventual cessation. Here, we sought to examine conversations between older adults and their family members and physicians. ⋯ Few older adults had driving safety conversations with their family or physicians. Practical and effective interventions are needed to engage family and physicians in assisting older adults with risk assessment and driving cessation planning to maintain mobility and well-being.
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Randomized Controlled Trial
Predicting Knee Pain and Knee Osteoarthritis Among Overweight Women.
There is a need for prediction of knee osteoarthritis (KOA) in general practice to motivate subjects for preventive therapies and optimize preventive trials. ⋯ In this study, easy-obtainable variables modestly improved the prediction of FKP and symptomatic KOA above age and BMI. To improve the identification of high-risk individuals, development of valid tests for other known risk factors, like meniscal damage, that are applicable in primary care, are urgently needed.