J Am Board Fam Med
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Randomized Controlled Trial
Characteristics of Veterans With Non-VA Encounters Enrolled in a Trial of Standards-Based, Interoperable Event Notification and Care Coordination.
Understanding how veterans use Veterans Affairs (VA) for primary care and non-VA for acute care can help policy makers predict future health care resource use. We aimed to describe characteristics of veterans enrolled in a multisite clinical trial of non-VA acute event notifications and care coordination and to identify patient factors associated with non-VA acute care. ⋯ We identified several patient-level factors associated with non-VA acute care that can inform the design of VA services and policies for veterans with non-VA acute care encounters and reintegration back into the VA system.
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Older veterans in urban settings rely less on the Veterans Health Administration (VHA) health care, suggesting deficits of access and services for aging veterans. We aimed to identify reasons for VHA and non-VHA use across the health status of older, urban-dwelling veterans. ⋯ Even in an urban environment, proximity was a leading issue with worse health. Addressing urban accessibility and coordination for older, sicker veterans may enhance care for a growing vulnerable VHA population.
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Evidence supports the clinical effectiveness of intimate partner violence (IPV) screening programs, but less is known about implementing and sustaining them. This qualitative study identified implementation strategies used to integrate IPV screening programs within Veterans Health Administration (VHA) women's health primary care. ⋯ Implementation strategies used collectively can enable integration of IPV screening programs in primary care.
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The history of cancer screening has demonstrated that the case for cancer screening is not straightforward. In contemporary practice, sharing decision-making with patients has become expected of family physicians. ⋯ Improving cancer outcomes should be a priority for family medicine, but the importance of this goal should not undermine doctors' commitment to helping patients make informed decisions that are consistent with their values and priorities. If we are serious about empowering patients, we need to be more open about the limitations of cancer screening, to help patients make up their minds.
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The COVID-19 pandemic has added further urgency to the need for primary care payment reform. Fee-for-service payments limit the flexibility of practices to respond to crises and leave practices without sufficient revenues when visit volumes decrease. ⋯ Evidence suggests setting primary care investment at 10% to 12% of the total cost of care, approximately translating to an average $85 per member per month, with significant variation based on age and adjustment for medical and social measures of risk. Enhanced investment in primary care should be aligned across payers and support practice transformation to advanced models of care.