A Cluster Randomized Trial of Primary Care Practice Redesign to Integrate Behavioral Health for Those Who Need It Most: Patients With Multiple Chronic Conditions.

Purpose: Patient outcomes can improve when primary care and behavioral health providers use a collaborative system of care, but integrating these services is difficult. We tested the effectiveness of a practice intervention for improving patient outcomes by enhancing integrated behavioral health (IBH) activities.

Methods: We conducted a pragmatic, cluster randomized controlled trial.

Integrating behavioral health & primary care for multiple chronic diseases: Clinical trial of a practice redesign toolkit.

Context: Most patients in need of behavioral health (BH) care are seen in primary care, which often has difficulty responding. Some practices integrate behavioral health care (IBH), with medical and BH providers at the same location, working as a team. However, it is difficult to achieve high levels of integration.

Virtual Care Adoption-Challenges and Opportunities From the Lens of Academic Primary Care Practitioners.

Telehealth and virtual care quickly became important tools in caring for patients while the COVID-19 pandemic evolved. Telehealth implementation can increase affordability for patients, eliminate access barriers, and improve patient satisfaction. Multiple challenges to successful telehealth implementation have been documented in the literature and are generally categorized as structural barriers of the health system, clinical barriers of the provider, and patient-centered barriers.

ACR Appropriateness Criteria® Dyspnea-Suspected Cardiac Origin (Ischemia Already Excluded): 2021 Update.

Dyspnea is the symptom of perceived breathing discomfort and is commonly encountered in a variety of clinical settings. Cardiac etiologies of dyspnea are an important consideration; among these, valvular heart disease (Variant 1), arrhythmia (Variant 2), and pericardial disease (Variant 3) are reviewed in this document. Imaging plays an important role in the clinical assessment of these suspected abnormalities, with usually appropriate procedures including resting transthoracic echocardiography in all three variants, radiography for Variants 1 and 3, MRI heart function and morphology in Variants 2 and 3, and CT heart function and morphology with intravenous contrast for Variant 3.

Differences in Occupational Burnout Among Primary Care Professionals.

Background: Occupational burnout is a major concern for personal well-being and patient care. We examined burnout among primary care providers (PCPs), medical residents, behavioral health providers (BHPs), nurses, and other clinical and nonclinical primary care team members.

Methods: This was a cross-sectional study, nested within a larger randomized trial.

Time to integrate oral health screening into medicine? A survey of primary care providers of older adults and an evidence-based rationale for integration.

Objective: Primary care providers were assessed regarding their training and interest to screen oral conditions in patients ≥55 years old.

Background: Oral health (OH) is an essential component of overall health and can affect systemic health. Medical/dental integration in older adults is underdeveloped.

Integrating Behavioral Health and Primary Care (IBH-PC) to improve patient-centered outcomes in adults with multiple chronic medical and behavioral health conditions: study protocol for a pragmatic cluster-randomized control trial.

Background: Chronic diseases that drive morbidity, mortality, and health care costs are largely influenced by human behavior. Behavioral health conditions such as anxiety, depression, and substance use disorders can often be effectively managed. The majority of patients in need of behavioral health care are seen in primary care, which often has difficulty responding.

Primary Care Physician Factors Associated with Inbox Message Volume.

Introduction: The objective of this study was to better understand the relationship between panel size, full-time status, and estimated socioeconomic status of a patient panel with types and number of primary care clinician inbox messages.

Methods: The study used data from the Epic Signal database to examine inbox volume and types of messages for 86 primary care clinicians at 19 primary care sites. We measured correlations and performed multiple regression analysis to understand the relationship between inbox volume and types of messages and 3 factors: panel size, full-time status, and estimated socioeconomic status of patient panels.

Why Compensation Tied to Group Quality Metrics Makes Sense.

Incorporation of group quality metrics into an adult primary care compensation track facilitates team-based care and accountability for shared groups of patients. This article describes the reasoning behind group quality metrics and shares lessons learned and improvements in health outcomes as a result. Take-away points are as follows: 1) group quality metrics in a compensation plan help foster team-based care toward quality goals and shared accountability for the health outcomes of attributed patients; 2) definition of the work team is important and should include members who share responsibility for the same groups of patients; 3) information technology infrastructure and dashboards for performance and feedback are critical to the success of a quality incentive program; 4) inclusion of key stakeholders early in the process of designing team-based incentives is important for acceptance; and 5) ongoing education is needed to ensure continued focus on quality goals.

Panel Size, Clinician Time in Clinic, and Access to Appointments.

Large panel sizes are often held responsible for worse access to appointments in primary care. We evaluated the relationship between appointment backlog, panel size, and primary care clinician time in clinic, using Spearman correlation and multiple regression in a retrospective analysis. We found no independent association between panel size and days until third next available appointment, but larger panel size adjusted for clinician time in clinic was associated with worse access.

One Leader's Journey Toward Empanelment.

Empanelment is an important step toward managing population health. Achieving empanelment in a fee-for-service world necessitates organizational support for panel size measurement and creativity regarding use of panel size to inform access decisions. Empanelment efforts and access must be balanced to create sustainable, high-quality care models and to improve practitioner and patient experiences.

Medication adherence, medical record accuracy, and medication exposure in real-world patients using comprehensive medication monitoring.

Background: Poor adherence to medication regimens and medical record inconsistencies result in incomplete knowledge of medication therapy in polypharmacy patients. By quantitatively identifying medications in the blood of patients and reconciling detected medications with the medical record, we have defined the severity of this knowledge gap and created a path toward optimizing medication therapy.

Methods And Findings: We validated a liquid chromatography-tandem mass spectrometry assay to detect and/or quantify 38 medications across a broad range of chronic diseases to obtain a comprehensive survey of patient adherence, medical record accuracy, and exposure variability in two patient populations.

Are Providers Prepared to Engage Younger Women in Shared Decision-Making for Mammography?

Background: The U.S. Preventive Services Task Force recommends providers engage women aged 40-49 years in shared decision-making (SDM) for mammography.

Factors Associated with Routine Recommendation of Mammography for Women Aged 40-49: Provider Characteristics and Screening Influences.

Objectives: Despite the US Preventive Services Task Force recommendation against screening mammography in women younger than 50 years, rates remain high, suggesting that screening recommendations may be motivated by other factors. The objective of this study was to understand provider-reported influences on screening recommendations for women 40 to 49 years old at average risk for breast cancer.

Methods: An online survey of primary care providers was conducted at four health centers in Cleveland, Ohio in 2015.

Implementation of Clinical Pharmacogenomics within a Large Health System: From Electronic Health Record Decision Support to Consultation Services.

The number of clinically relevant gene-based guidelines and recommendations pertaining to drug prescribing continues to grow. Incorporating gene-drug interaction information into the drug-prescribing process can help optimize pharmacotherapy outcomes and improve patient safety. However, pharmacogenomic implementation barriers exist such as integration of pharmacogenomic results into electronic health records (EHRs), development and deployment of pharmacogenomic decision support tools to EHRs, and feasible models for establishing ambulatory pharmacogenomic clinics.

A shift toward personalized healthcare: does the Affordable Care Act provide enough incentive for change?

Personalized healthcare, which uses individual characteristics to better predict and prevent disease and customize therapies, is a potential solution to our current healthcare crisis. Personalized care aims to improve quality of care and reduce overall healthcare costs. Despite its potential, adoption of personalized healthcare has been slow for several reasons, one of which is related to financial incentives toward change.

Formative evaluation of clinician experience with integrating family history-based clinical decision support into clinical practice.

Family health history is a leading predictor of disease risk. Nonetheless, it is underutilized to guide care and, therefore, is ripe for health information technology intervention. To fill the family health history practice gap, Cleveland Clinic has developed a family health history collection and clinical decision support tool, MyFamily.

Screening for abdominal aortic aneurysms in outpatient primary care clinics.

Background: The US Preventive Services Task Force (USPSTF) guidelines recommend one-time abdominal aortic aneurysm ultrasound screening for men aged 65 to 75 years who ever smoked. Reported screening rates have been 13% to 26% but did not include computed tomography, magnetic resonance imaging, and nonaortic abdominal ultrasound, which provide adequate visualization of the aorta. The objective of this study was to evaluate rates of screening performed intentionally with ultrasound and incidentally with other abdominal imaging, determine rates of redundant screening, and evaluate patient and physician characteristics associated with screening.

Physicians caring for physicians: the perspective of the primary care physician.

Objectives: How physicians provide longitudinal primary care to physician-patients (ie, physicians as patients) has not been well studied. The potential challenges of providing care to physician-patients include maintaining professional boundaries and adhering to practice guidelines. The objective was to explore the differences in identifying how physicians perceive caring for physicians-patients in the longitudinal setting versus caring for other patients in the general population.

Genomics in primary care practice.

This article discusses the clinical utility of genomic information for personalized preventive care of a healthy adult. Family health history is currently the most applicable genomic predictor for common, multifactorial diseases, and can also show patterns that suggest an inherited high susceptibility to a particular form of cancer or other disease. Both bloodline ancestry and shared environmental factors are important predictors for many disease states.