Primary Care

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

Expanding Scope of Practice After COVID-19

Feb. 15, 2021

To expand access to health care during the COVID-19 pandemic, many states relaxed or waived regulations that define the scope of health professional practice. This experience highlights the need to ensure that all health care professionals practice to the full extent of their capabilities—an issue that predates and will outlast the pandemic. In a virtual conference on November 20, 2020, Penn LDI and Penn Nursing brought together experts in law, economics, nursing, medicine, and dentistry to discuss current gaps in health professional scope of practice, what we have learned from COVID-19, and how to rethink scope of practice to better meet community and public health needs.

Preconception and Interconception Pediatric Primary Care Utilization of Pregnant and Parenting Teens

Jan. 19, 2021

Emily F. Gregory, Drisana Henry, Aletha Y. Akers

Abstract [from journal]

Purpose: Gaps in preventive care may contribute to adverse outcomes among pregnant teens. This study quantified teen preventive care utilization before and after pregnancy.

Methods: A continuous retrospective cohort identified 150 teens with a positive pregnancy test (July 2015 to May 2017) at two pediatric primary care sites. Chart review assessed office visits for 18 months before and after the pregnancy test. We also assessed contraceptive counseling, pregnancy outcomes (live birth,


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