Evaluating equity in a national virtual care management intervention: Delivery and outcomes by race/ethnicity among Veterans with hypertension and diabetes.

Objective: To evaluate whether the Preventive Health Inventory (PHI)-a virtual care management intervention addressing hypertension and diabetes management implemented nationally in the Veterans Health Administration (VHA)-was delivered equitably among racial/ethnic groups and if existing inequities in hypertension and diabetes outcomes changed following PHI receipt.

Data Sources And Study Setting: We used data from the VHA Corporate Data Warehouse among Veterans enrolled in primary care nationally from February 28, 2021 to March 31, 2022.

Study Design: We used logistic regression to evaluate PHI receipt and hypertension and diabetes outcomes after PHI implementation among Veterans with hypertension and/or diabetes.

Factors associated with primary care physician turnover in the VA.

Objectives: To quantify the association between primary care team workload satisfaction and primary care physician (PCP) turnover and examine potential mediation of workplace climate factors using survey and administrative data.

Study Design: Longitudinal observational study using data from 2008 to 2016.

Methods: The outcome variable was PCP turnover.

Leveraging human-centered design and causal pathway diagramming toward enhanced specification and development of innovative implementation strategies: a case example of an outreach tool to address racial inequities in breast cancer screening.

Background: Implementation strategies are strategies to improve uptake of evidence-based practices or interventions and are essential to implementation science. Developing or tailoring implementation strategies may benefit from integrating approaches from other disciplines; yet current guidance on how to effectively incorporate methods from other disciplines to develop and refine innovative implementation strategies is limited. We describe an approach that combines community-engaged methods, human-centered design (HCD) methods, and causal pathway diagramming (CPD)-an implementation science tool to map an implementation strategy as it is intended to work-to develop innovative implementation strategies.

Automated Opt-Out vs Opt-In Patient Outreach Strategies for Breast Cancer Screening: A Randomized Clinical Trial.

Importance: Optimal strategies for population-based outreach for breast cancer screening remain unknown.

Objective: To evaluate the effect on breast cancer screening of an opt-out automatic mammography referral strategy compared with an opt-in automated telephone message strategy.

Design, Setting, And Participants: This pragmatic randomized clinical trial was conducted from April 2022 to January 2023 at a single Veterans Affairs (VA) medical center.

Factors associated with lung cancer risk factor documentation.

Objectives: To identify factors associated with the minimum necessary information to determine an individual’s eligibility for lung cancer screening (ie, sufficient risk factor documentation) and to characterize clinic-level variability in documentation.

Study Design: Cross-sectional observational study using electronic health record data from an academic health system in 2019.

Methods: We calculated the relative risk of sufficient lung cancer risk factor documentation by patient-, provider-, and system-level variables using Poisson regression models, clustering by clinic.

A call to integrate health equity into learning health system research training.

In 2016, the Agency for Healthcare Research and Quality (AHRQ) recommended seven domains for training and mentoring researchers in learning health systems (LHS) science. Health equity was not included as a competency domain. This commentary from scholars in the Consortium for Applied Training to Advance the Learning health system with Scholars/Trainees (CATALyST) K12 program recommends that competency domains be extended to reflect growing demands for evidence on health inequities and interventions to alleviate them.

Improving smoking history documentation in the electronic health record for lung cancer risk assessment and screening in primary care: A case study.

Improving risk factor documentation in the electronic health record (EHR) is important in order to determine patient eligibility for lung cancer screening. System-level prioritization combined with a clinic-level initiative can improve risk factor documentation rates. Multi-faceted interventions that include training, process improvement, data management, and continuous performance feedback are effective and can be integrated into existing workflows.

How to Keep Diffusion of Responsibility From Undermining Value-Based Care.

Diffusion of responsibility describes how individuals can underperform in circumstances of shared accountability. While not well studied in health care settings, this phenomenon is an unintended consequence of the health care sector's complexity and fragmentation. This article considers 3 ways in which monetary and nonmonetary incentives can mitigate negative consequences of diffusion of responsibility.

Key Features Underlying Low-Value Care Recommendations.

One potential reason that low-value care remains persistent is variation in recommendations created to deter it. A better understanding of key features, and how they differ across a range of recommendations, can offer insight about improvement opportunities. To address this knowledge gap, the authors described 3 features using a broad set of consensus Choosing Wisely recommendations: underlying rationales (ie, avoidance of waste and/or harm), types of services targeted, and types of supportive evidence used.

What we talk about when we talk about care management.

To support effective care management programs in the context of value-based care, we propose a framework categorizing care management as disease management, utilization management, and care navigation interventions.

Trends in Utilization of Transitional Care Management in the United States.

This economic evaluation uses Medicare claims data to evaluate changes in utilization of and Medicare payments for transitional care management services from 2013 to 2018.

Prevention as a Population Health Strategy.

Many health care systems are shifting to value-based care and beginning to integrate population-based strategies into care delivery. Preventive care is an important domain of this work. Properly applied, these services improve population health and reduce health care costs.

Addressing Avoidable Healthcare Costs: Time to Cool Off on Hotspotting in Primary Care?

One increasingly popular strategy for addressing avoidable healthcare costs is to couple "hotspotting" with interventions that deliver expanded, more intense primary care services to high-cost patient populations. While there is rationale for such intensive primary care programs, early results have been lackluster. Geoffrey Rose's preventive medicine strategy provides insight about a potential explanation: that the narrow scope of these initiatives on small groups of high-cost patients may inherently prevent them from achieving overall cost reductions across entire patient populations.

Professionalism as the Bedrock of High-Value Care.

"High-value care" has become a popular mantra and a call to action among health system leaders, policymakers, and educators who are advocating widespread practice changes to reduce costs, minimize overuse, and optimize outcomes in the United States. Regrettably, current research does not demonstrate significant progress in improving high-value care. Many investigators have looked to payment models, benefit design, and policy changes as the main levers to reduce low-value care delivery; thus, the prevailing approach to ensuring high-value care has been to identify and limit low-value services.

Handoff communication between hospital and outpatient dialysis units at patient discharge: a qualitative study.

Background: Hemodialysis patients are vulnerable to adverse events, including those surrounding hospital discharge. Little is known about how dialysis-specific information is shared with outpatient dialysis clinics for discharged patients, and the applicability of existing models of handoff transitions is unknown.

Methods: Semistructured interviews were performed with 36 dialysis care physicians, nurses, and social workers in hospital and outpatient settings.