JAMA internal medicine
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JAMA internal medicine · Oct 2013
Randomized Controlled Trial Multicenter Study Comparative StudyDecision making in prostate cancer screening using decision aids vs usual care: a randomized clinical trial.
The conflicting recommendations for prostate cancer (PCa) screening and the mixed messages communicated to the public about screening effectiveness make it critical to assist men in making informed decisions. ⋯ Both decision aids improved participants’ informed decision making about PCa screening up to 13 months later but did not affect actual screening rates. Dissemination of these decision aids may be a valuable public health tool.
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JAMA internal medicine · Oct 2013
Randomized Controlled Trial Multicenter StudyCholecalciferol treatment to reduce blood pressure in older patients with isolated systolic hypertension: the VitDISH randomized controlled trial.
Observational data link low 25-hydroxyvitamin D levels to both prevalent blood pressure and incident hypertension. No clinical trial has yet examined the effect of vitamin D supplementation in isolated systolic hypertension, the most common pattern of hypertension in older people. ⋯ Vitamin D supplementation did not improve blood pressure or markers of vascular health in older patients with isolated systolic hypertension.
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JAMA internal medicine · Oct 2013
Multicenter Study Comparative StudyPatient-centered medical home intervention at an internal medicine resident safety-net clinic.
The patient-centered medical home (PCMH) model holds promise for improving primary care delivery, but it has not been adequately tested in teaching settings. ⋯ Our PCMH-guided intervention, which represented a modest but substantive step toward the PCMH vision, had favorable effects on patient and resident satisfaction at a safety-net teaching clinic but did not reduce emergency department or hospital utilization in the first year. Our experience may provide lessons for other teaching clinics in safety-net settings hoping to implement PCMH-guided reforms.
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JAMA internal medicine · Sep 2013
Randomized Controlled Trial Multicenter Study Comparative StudyEfficacy of an evidence-based clinical decision support in primary care practices: a randomized clinical trial.
There is consensus that incorporating clinical decision support into electronic health records will improve quality of care, contain costs, and reduce overtreatment, but this potential has yet to be demonstrated in clinical trials. ⋯ The integrated clinical prediction rule process for integrating complex evidence-based clinical decision report tools is of relevant importance for national initiatives, such as Meaningful Use. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01386047.
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JAMA internal medicine · Sep 2013
Multicenter Study Comparative StudyWorsening trends in the management and treatment of back pain.
Back pain treatment is costly and frequently includes overuse of treatments that are unsupported by clinical guidelines. Few studies have evaluated recent national trends in guideline adherence of spine-related care. ⋯ Despite numerous published clinical guidelines, management of back pain has relied increasingly on guideline discordant care. Improvements in the management of spine-related disease represent an area of potential cost savings for the health care system with the potential for improving the quality of care.