J Am Board Fam Med
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To increase the utilization of Community Health Service (CHS) centers for primary care, the Central Government of China has promoted the use of contracts-known as "service agreements" (SAs)-between patients and primary care physicians. This study sought to identify factors that predict who signed SAs and the association between SAs and frequency of primary care visits in a CHS center in Beijing. ⋯ The evidence provides an important consideration for reducing gaps in the use of primary care services during the nationwide transition from the fee-for-service specialty care system to the patient-centered primary care-driven medical home model.
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The rise of health system and hospital ownership of primary care practices raises policy questions about the survival of independent physician-owned practices. Our data indicate that a substantial proportion of FPs in 2017-2019 remained in independently owned practice: 81% of solo practitioners and 35% of FPs in practices with 2-5 clinicians. These findings suggest that independent practice is surviving, and that it's incumbent on researchers, payers, and policymakers to better understand their unique contributions and challenges in the effort to improve primary care access, quality, and cost.
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Healthcare is in need of improvement. It harms too often, costs too much, learns and improves too slowly, and burns out its workforce. Large healthcare systems (HCS) have an important role in influencing the quality and value of care. ⋯ Clinical teams often rely on local QI efforts to improve care at the delivery site. At the same time, managers and executives focus on a centralized, system-wide approach, generally focused on externally reported metrics. We propose that a hybrid of the 2 most popular healthcare QI approaches, local QI and centralized QI, might be the best method for achieving and sustaining quality care across a wide variety of conditions.
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This study evaluated how often patients who reported social risk factors requested assistance with these risks in an integrated health system. ⋯ Patients do not request assistance for all reported social needs. Our findings could help shape future work examining patients' reasons for not accepting assistance and developing interventions to help patients with high social risk more effectively.
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The Coronavirus disease 2019 (COVID-19) pandemic forced not only rapid changes in how clinical care and educational programs are delivered but also challenged academic medical centers (AMCs) like never before. The pandemic made clear the need to have coordinated action based on shared data and shared resources to meet the needs of patients, learners, and communities. ⋯ The pandemic also surfaced the biological and social interactions that reveal underlying socioeconomic inequalities, for which family medicine has advocated since its inception. Key to success was the department's ability to integrate "horizontally" with the broader community, thereby accelerating the institution's response to the pandemic.