Primary Care

The entry point into the health system for most individuals, through a provider that delivers non-specialized, continuous, and coordinated care.

Surviving COVID-19 After Hospital Discharge: Symptom, Functional, And Adverse Outcomes Of Home Health Recipients

Nov. 24, 2020

Kathryn H. Bowles, Margaret McDonald, Yolanda Barrón, Erin Kennedy, Melissa O'Connor, Mark Mikkelsen

Abstract [from journal]

Background: Little is known about recovery from coronavirus disease 2019 (COVID-19) after hospital discharge.

Objective: To describe the home health recovery of patients with COVID-19 and risk factors associated with rehospitalization or death.

Design: Retrospective observational cohort.

Setting: New York City.

Participants: 1409 patients with COVID-19 admitted to home health care (HHC) between 1 April and 15 June 2020


Spontaneous Vaginal Birth Varies Significantly Across U.S. Hospitals

Nov. 10, 2020

Rebecca R. S. Clark and Eileen Lake

Abstract [from journal]

Background: Birth is the most common reason for hospitalization in the United States. Hospital variation in maternal outcomes is an important indicator of health care quality. Spontaneous vaginal birth (SVB) is the most optimal birth outcome for the majority of mothers and newborns. The purpose of this study was to examine hospital‐level variation in SVB overall and among low‐risk women in a four‐state sample representing 25% of births in the United States in 2016.


Evaluation of COVID-19 Testing Strategies for Repopulating College and University Campuses: A Decision Tree Analysis

Nov. 2, 2020

Amelia Van PeltHenry A. Glick, Wei Yang, David Rubin, Michael Feldman, Stephen E. Kimmel

Abstract [from journal]

Purpose: The optimal approach to identify SARS-CoV-2 infection among college students returning to campus is unknown. Recommendations vary from no testing to two tests per student. This research determined the strategy that optimizes the number of true positives and negatives detected and reverse transcription polymerase chain reaction (RT-PCR) tests needed.

Methods: A decision tree analysis evaluated five strategies: (1) classifying students with symptoms as having COVID-19, (2) RT-PCR


Promotion Of Clinical Educators: A Critical Need In Academic Family Medicine

Peter Cronholm, MD, MSCE
Oct. 1, 2020

Christine K. Jacobs, Kelly M. Everard, Peter F. Cronholm

Abstract [from journal]

Background and objectives: Academic family medicine departments have traditionally promoted faculty using research and scholarship criteria augmented by teaching, clinical care, and service. Clinic-focused faculty who spend significant time in direct patient care may not have enough time to meet promotion criteria, although they are critical for training future family physicians and for rebalancing the system of academic promotion.

Methods: We surveyed family medicine department chairs on the


Persistent Hypertension In Children And Adolescents: A 6-Year Cohort Study

Alexander G. Fiks, MD, MSCE
Sep. 18, 2020

David C. Kaelber, A. Russell Localio, Michelle Ross, Janeen B. Leon, Wilson D. Pace, Richard C. Wasserman, Robert W. Grundmeier, Jennifer Steffes, Alexander G. Fiks

Abstract [from journal]

Objectives: To determine the natural history of pediatric hypertension.

Methods: We conducted a 72-month retrospective cohort study among 165 primary care sites. Blood pressure measurements from two consecutive 36 month periods were compared.

Results: Among 398 079 primary care pediatric patients ages 3 to 18, 89 347 had ≥3 blood pressure levels recorded during a 36-month period, and 43 825 children had ≥3 blood pressure levels for 2 consecutive 36-month periods. Among


Informal and Formal Home Care For Older Adults With Disabilities Increased, 2004-16

Aug. 1, 2020

Courtney H. Van Houtven, R. Tamara Konetzka, Elizabeth Taggert, Norma B. Coe

Abstract [from journal]

Rates of informal home care use among older adults with disabilities increased from 2004 to 2016, such that in 2016 almost three-quarters of these adults received informal home care. Informal care remains the most common source of home care, even though formal home care use grew at almost twice the rate, with a 6-percentage-point increase to 36.9 percent in 2016.

Visual Impairment Is More Common In Parkinson's Disease And Is A Risk Factor For Poor Health Outcomes

Maureen Maguire, PhD, ScM
Jul. 28, 2020

Ali G. Hamedani, Danielle S. Abraham, Maureen G. MaguireAllison W. Willis

Abstract [from journal]

Background: Visual impairment is associated with hip fracture, depression, anxiety, and dementia in the general population, and many causes of visual impairment are preventable or treatable with early detection. However, the prevalence, outcomes, and healthcare utilization patterns associated with visual impairment have not been examined in Parkinson's disease (PD).

Methods: We performed a cross-sectional analysis of all Medicare beneficiaries with complete data in 2014 and longitudinal


Adoption Of Immune Checkpoint Inhibitors And Patterns Of Care At The End Of Life

Jul. 17, 2020

Fauzia Riaz, Geliang Gan, Fangyong Li, Amy J. Davidoff, Kerin B. Adelson, Carolyn J. Presley, Blythe J. Adamson, Pooja Shaw, Ravi B. Parikh, Ronac Mamtani, Cary P. Gross

Abstract [from journal]

Purpose: As immune checkpoint inhibitors (ICIs) have transformed the care of patients with cancer, it is unclear whether treatment at the end of life (EOL) has changed. Because aggressive therapy at the EOL is associated with increased costs and patient distress, we explored the association between the Food and Drug Administration (FDA) approvals of ICIs and treatment patterns at the EOL.

Methods: We conducted a retrospective, observational study using patient-level data from a nationwide


Pediatric Provider Perspectives And Practices Regarding Health Policy Discussions With Families: A Mixed Methods Study

Jul. 13, 2020

Aditi Vasan, Polina Krass, Leah Seifu, Talia A. Hitt, Nadir Ijaz, Leonela Villegas, Kathryn Pallegedara, Sindhu Pandurangi, Morgan Congdon, Beth Rezen, Chén C. Kenyon 

Abstract [from journal]

Background: Advocacy regarding child health policy is a core tenet of pediatrics. Previous research has demonstrated that most pediatric providers believe collective advocacy and political involvement are essential aspects of their profession, but less is known about how pediatric providers engage with families about policy issues that impact child health. The objectives of this study were to examine providers' perceptions and practices with regards to discussing health policy issues with families and to identify


Multiple Complications In Emergency Surgery: Identifying Risk Factors For Failure-to-Rescue

Jul. 10, 2020

Justin S. Hatchimonji, Robert A. Swendiman, Elinore J. Kaufman, Dane Scantling, Jesse E. Passman, Wei Yang, M. Kit Delgado, Daniel N. Holena

Abstract [from journal]

Background: While the use of the failure-to-rescue (FTR) metric, or death after complication, has expanded beyond elective surgery to emergency general surgery (EGS), little is known about the trajectories patients take from index complication to death.

Methods: We conducted a retrospective cohort study of EGS operations using the National Surgical Quality Improvement Project (NSQIP) dataset, 2011-2017. 16 major complications were categorized as infectious, respiratory, thrombotic, cardiac,


Utilization And Cost Effects Of The VHA Caring For Older Adults And Caregivers At Home (COACH) Program

Bruce Kinosian, MD
Jul. 9, 2020

Wei Song, Orna Intrator, Jack Twersky, Judith Davagnino, Bruce Kinosian, Darryl Wieland

Abstract [from journal]

Since 2010, the Veterans Health Administration has initiated a home-based Caring for Older Adults and Caregivers at Home (COACH) program to provide clinical support to dementia patients and family caregivers. But its impact on health care utilization and costs is unknown. We compared 354 COACH care recipients with a propensity score weighted comparison group of 9,857 community-dwelling Veterans during fiscal years 2010-2015. In 1-year follow-up, COACH program was associated with a lower rate of long-term nursing home placement (


How Primary Care Provider Communication With Team Relates To Patients’ Disease Management

Ingrid Nembhard, PhD, MS, Associate Professor at the University of Pennsylvania's Wharton School
Jul. 1, 2020

 Yuna S.H. Lee, Marissa D. King, Daren Anderson, Paul D. Cleary, Ingrid M. Nembhard

Abstract [from journal]

Background: Investigating primary care provider (PCP)-team communication can provide insight into how colleagues work together to become high-functioning teams more able to address an increasingly complex set of tasks associated with chronic disease management.

Objective: To assess how PCP communication with their care team relates to patients’ health.

Research Design: Longitudinal study of how 3


Parent Preferences For Pediatric Clinician Messaging To Promote Smoking Cessation Treatment

Jun. 22, 2020

Brian P. Jenssen, Mary Kate Kelly, Jennifer Faerber, Chloe Hannan, David A. Asch, Justine Shults, Robert A. Schnoll, Alexander G. Fiks

Abstract [from journal]

Background and objectives: Insights from behavioral economics suggests that the effectiveness of health messages depends on how a message is framed. Parent preferences for smoking cessation messaging has not been studied in pediatrics, warranting further exploration to maximize benefit. We sought to assess parents' perceptions regarding the relative importance of distinct message framings to promote their smoking cessation.

Methods: We conducted a cross-sectional discrete choice experiment in