Primary Care

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

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


The Influence Of Medicare for All On Reimbursement For Emergency Care Treat-and-Release Visits

May. 24, 2020

Alexander Pomerantz, Ryan Burke, Ari Friedman, Laura Burke, Richard Wolfe, Peter Smulowitz

Abstract [from journal]

Study objective: Single-payer health care is supported by most Americans, but the effect of single payer on any particular sector of the health care market has not been well explored. We examine the effect of 2 potential single-payer designs, Medicare for All and an alternative including Medicare and Medicaid, on total payments and out-of-pocket spending for treat-and-release emergency care (patients discharged after an emergency department [ED] visit).

Methods: We used the 2013 to 2016 Medical


Telephone Triage In Pediatric Head Injury: Follow-up Patterns And Subsequent Diagnosis Of Concussion

May. 22, 2020

Catherine C. McDonald, Melissa R. Pfeiffer, Roni L. Robinson, Kristy B. Arbogast, Christina L. Master

Abstract [from journal]

Head injuries in childhood can result in concussion. Families of a child with a head injury often seek medical advice through telephone triage call systems. It is important to understand if patients follow telephone triage recommendations and what proportion of triage calls result in subsequent concussion diagnosis. We used a one-year retrospective cohort of triage calls screened with the Barton Schmitt Pediatric Head Injury Telephone Triage Protocol. The objectives were to estimate the proportion who followed up with urgent recommendations...

Phenotyping Physician Practice Patterns And Associations With Response To A Nudge In The Electronic Health Record For Influenza Vaccination: A Quasi-Experimental Study

May. 20, 2020

Sujatha Changolkar, Jeffrey Rewley, Mohan Balachandran, Charles A L Rareshide, Christopher K Snider, Susan C Day, Mitesh S Patel

Abstract [from journal]

Background: Health systems routinely implement changes to the design of electronic health records (EHRs). Physician behavior may vary in response and methods to identify this variation could help to inform future interventions. The objective of this study was to phenotype primary care physician practice patterns and evaluate associations with response to an EHR nudge for influenza vaccination.

Methods and findings: During the 2016-2017 influenza season, 3 primary care practices at Penn Medicine...

Do Incentive Payments Improve Home-Based Primary Care?

Feb. 4, 2020

After five years, a small experiment to improve care for frail elderly patients receiving primary care at home has delivered some savings to Medicare—although it might be too small to know for sure. Authorized by the Affordable Care Act, the Independence at Home (IAH) Demonstration is part of a broader strategy of testing innovative ways to pay for value in health care—tying additional payment to higher quality care and cutting wasteful spending.