Reassurance for Patients-Essential Not Optional.

Appropriate patient reassurance is an essential feature of clinical practice. My recent experience as a patient, interpreted via my expertise as a health services researcher, led me to insights on ideal and suboptimal reassurance styles in the context of worrisome symptoms. Reassurance is complex: often poorly defined in the scientific literature, rarely rigorously studied, imperfectly understood, and requiring some adaptation to each patient situation.

A Narrative Review of Slow Medicine Outcomes.

Background: Primary care practice in the United States suffers from short consultation duration and distracting electronic health record tasks. This leads to patient and physician dissatisfaction and physician burnout, as well as potentially unnecessary referrals and interventions. Slow medicine - providing longer and higher-quality consultations - has been proposed to improve medical care quality and patient outcomes.

Multivariate Risk Adjustment of Primary Care Patient Panels in a Public Health Setting: A Comparison of Statistical Models.

We compared prospective risk adjustment models for adjusting patient panels at the San Francisco Department of Public Health. We used 4 statistical models (linear regression, two-part model, zero-inflated Poisson, and zero-inflated negative binomial) and 4 subsets of predictor variables (age/gender categories, chronic diagnoses, homelessness, and a loss to follow-up indicator) to predict primary care visit frequency. Predicted visit frequency was then used to calculate patient weights and adjusted panel sizes.

Increasing Colorectal Cancer Screening at Community-Based Primary Care Clinics in San Francisco.

Context: Adult colorectal cancer screening (CRCS) can lower disease incidence and mortality. However, widespread implementation is inconsistent, especially in the public sector. While specific interventions to increase CRCS have been identified, firsthand accounts of CRCS improvement efforts using multiple techniques in public sector settings are lacking.

Assessing and increasing patient panel size in the public sector.

Context: Panel management is a central component of the primary care medical home, but faces numerous challenges in the safety net setting. In the San Francisco Department of Public Health, many of our community-based primary care clinics have difficulty accommodating all patients seeking care.

Objective: We evaluated patient panel size in our 7 clinics providing cradle-to-grave primary care services to more than 25,000 active patients.

Creating a medical home in the San Francisco department of public health: establishing patient panels.

Patients with a medical home tend to fare better. One of the first steps toward establishing a medical home is to create panels by designating a clinic responsible for each patient. In 2006, we defined active clinic panels (all patients assigned to a clinic and seen there for one or more outpatient medical visits during the past 2 years) for the San Francisco Department of Public Health's 13 community- and four public hospital-based primary care clinics and began automatically assigning previously unassigned patients to clinics based on utilization.

Highly active antiretroviral therapy use and HIV transmission risk behaviors among individuals who are HIV infected and were recently released from jail.

We evaluated highly active anti-retroviral therapy (HAART) use and risk behaviors among 177 inmates who were HIV infected and were released and reincarcerated in San Francisco, Calif, jails over a 12-month period. During the month preceding reincarceration, HIV transmission risk behaviors were common among respondents, and 59% of those with a history of antiretroviral use were not taking HAART. HAART discontinuation was independently associated with homelessness, marijuana use, injection drug use, and not receiving community medical care.