Patient and Clinician Decision Support to Increase Genetic Counseling for Hereditary Breast and Ovarian Cancer Syndrome in Primary Care: A Cluster Randomized Clinical Trial.

Importance: To promote the identification of women carrying BRCA1/2 variants, the US Preventive Services Task Force recommends that primary care clinicians screen asymptomatic women for an increased risk of carrying a BRCA1/2 variant risk.

Objective: To examine the effects of patient and clinician decision support about BRCA1/2 genetic testing compared with standard education alone.

Design, Setting, And Participants: This clustered randomized clinical trial was conducted at an academic medical center including 67 clinicians (unit of randomization) and 187 patients.

Opioid Medications Prescribing and the Pain-Depression Dyad in Primary Care: Analysis of 2014-2015 National Ambulatory Medical Care Survey (NAMCS) Data.

Background: Increased drug overdose deaths have become a serious public health problem. Primary care providers prescribe about 50% all opioid medications. This study examined opioids prescribing during primary visits to patients with a pain-depression dyad and patient demographic characteristics associated with opioids prescribing.

"Treated me … like I was family": Qualitative Evaluation of a Culturally-Adapted Health Care Manager Intervention for Latinos with Serious Mental Illness and at Risk for Cardiovascular Disease.

Latinos with serious mental illness (SMI) experience health and health care disparities and may benefit from interventions that improve access to, coordination of, and receipt of primary care services. The aim of this qualitative study was to examine the experiences of Latinos with SMI and at risk for cardiovascular disease participating in Bridges to Better Health and Wellness (B2BHW), a culturally-adapted health care manager intervention delivered in a public outpatient mental health clinic. A total of 29 Latino participants completed a post-intervention survey that included an open-ended question about the three things they liked most about B2BHW; a subset of 16 participants participated in one of three post-intervention focus groups.

Bridges to Better Health and Wellness: An Adapted Health Care Manager Intervention for Hispanics with Serious Mental Illness.

This study examined the feasibility, acceptability, and initial impact of bridges to better health and wellness (B2BHW), a culturally-adapted health care manager intervention for Hispanics with serious mental illness (SMI). Thirty-four Hispanics with SMI and at risk for cardiovascular disease were enrolled. Mixed-linear models were used to examine changes over 12-months on patient activation, self-efficacy, patient-rated quality of care, receipt of preventive primary care services, and quality of life.

Does receiving care in a medical home reduce racial/ethnic disparities in ED visits among children with asthma in the United States?

Evidence has shown the implementation of medical home model improves care quality and outcomes. However, it is not clear whether receiving care from a medical home has any impact on racial/ethnic disparities in emergency department (ED) use by children with asthma. This study using the US National Survey of Children with Special Health Care Needs, 2009-2010, estimated racial/ethnic disparities in ED use.

Peer-led healthy lifestyle program in supportive housing: study protocol for a randomized controlled trial.

Background: The risk for obesity is twice as high in people with serious mental illness (SMI) compared to the general population. Racial and ethnic minority status contribute additional health risks. The aim of this study is to describe the protocol of a Hybrid Trial Type 1 design that will test the effectiveness and examine the implementation of a peer-led healthy lifestyle intervention in supportive housing agencies serving diverse clients with serious mental illness who are overweight or obese.

Using the collaborative intervention planning framework to adapt a health-care manager intervention to a new population and provider group to improve the health of people with serious mental illness.

Background: Health-care manager interventions improve the physical health of people with serious mental illness (SMI) and could be widely implemented in public mental health clinics. Local adaptations and customization may be needed to increase the reach of these interventions in the public mental health system and across different racial and ethnic communities. In this study, we describe how we used the collaborative intervention planning framework to customize an existing health-care manager intervention to a new patient population (Hispanics with SMI) and provider group (social workers) to increase its fit with our local community.

Primary health care experiences of hispanics with serious mental illness: a mixed-methods study.

This mixed-methods study examines the primary health care experiences of Hispanic patients with serious mental illness. Forty patients were recruited from an outpatient mental health clinic. Participants reported a combination of perceived discrimination and stigmatization when receiving medical care.

Does elevated plasma triglyceride level independently predict impaired fasting glucose?: the Multi-Ethnic Study of Atherosclerosis (MESA).

Objective: Elevated plasma triglycerides (TGs) have been included in diabetes risk prediction models. This study examined whether elevated TGs predict risk for impaired fasting glucose (IFG).

Research Design And Methods: This study used the baseline and longitudinal follow-up data from the Multi-Ethnic Study of Atherosclerosis (MESA).

Incomplete follow-up of hemoglobinopathy carriers identified by newborn screening despite reporting in electronic medical records.

Objective: Has the recent availability of newborn hemoglobinopathy screening results within patient electronic medical records (EMR) of birth hospitals facilitated follow-up by primary care pediatric providers?

Methods: An online survey of all 137 primary care pediatric providers at a New York City academic medical center was conducted in 2008-2009 to assess practices for hemoglobin-apathy trait follow-up. Physicians were resurveyed 1 year later, following educational outreach and a letter of instruction underscoring the availability of screening results in the EMR. All 62 primary care pediatricians were surveyed at a nearby city hospital for comparison.

Does continuity of care have an effect on diabetes quality measures in a teaching practice in an urban underserved community?

Teaching clinics are an important source of care for urban, minority, underserved communities and face great challenges to improve quality of care for diabetics. This study examined the impact of continuity with the same primary care provider on health care process and outcome measures for patients with diabetes treated at an urban, family medicine resident teaching practice. The Modified Modified Continuity of Care Index was used to measure care continuity.

Medical student awareness of the Patient-centered Medical Home.

Background And Objectives: The Patient-centered Medical Home (PCMH) has come to the forefront of primary care practice redesign and can potentially improve health care outcomes and reduce costs. There are several initiatives in medical schools to teach concepts of the PCMH to students, but it is unknown what knowledge and attitudes medical students currently possess. We report students' awareness and opinions at two medical schools without comprehensive PCMH curricula.

Depressed parents' treatment needs and children's problems in an urban family medicine practice.

Objective: The study examined interest in treatment and treatment preferences and obstacles of low-income depressed parents.

Methods: A total of 273 primarily low-income, Hispanic parents of children aged seven to 17 attending an urban family medicine practice agreed to complete a survey by interview or self-report, including screening diagnoses and treatment history. Three groups were compared: major, subthreshold, and no depression.

The New York City eClinician Project: using Personal Digital Assistants and wireless internet access to support emergency preparedness and enhance clinical care in community health centers.

The New York City Department of Health and Mental Hygiene, The Community Health Care Association of New York State and Clinical Directors Network are collaborating on the "eClinician Project," which has distributed seven hundred public health-friendly, wireless (WiFi) enabled Personal Digital Assistants (PDAs) to primary care clinicians working in New York City, federally funded, Community Health Centers (CHC) which serve minority underserved communities that suffer a disproportionate burden of chronic disease and lack access to health promotion disease prevention services. Each participating health center also received a wireless router to create an onsite internet hot spot to enable clinicians to have internet access. The goals of the eClinician Project are to: 1) To encourage adoption of information technology among providers in Community Health Centers in New York City by providing PDAs as a first line strategy towards achieving this goal, 2) enhance access to information on emergency preparedness, 3) improve patient outcomes by providing PDA-based clinical decision-support tools that support evidence-based care, 4) encourage chronic care management and health promotion/disease prevention activities, and 5) increase productivity and efficiency.

Telephone care management to improve cancer screening among low-income women: a randomized, controlled trial.

Background: Minority and low-income women receive fewer cancer screenings than other women.

Objective: To evaluate the effect of a telephone support intervention to increase rates of breast, cervical, and colorectal cancer screening among minority and low-income women.

Design: Randomized, controlled trial conducted between November 2001 and April 2004.