Journal of general internal medicine
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Beginning in 2017, policy changes impacting the U. S. Refugee Admissions Program (USRAP) led to dramatic cuts in U. ⋯ Such rebuilding is a necessary step in addressing the global refugee crisis and a potential life-saving intervention for many refugees, who suffer a range of threats and maladies. Many have chronic untreated medical issues and untold psychological trauma-physical and emotional wounds from years of persecution. They need-and deserve-our help.
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A culture of improvement is an important feature of high-quality health care systems. However, health care teams often need support to translate quality improvement (QI) activities into practice. One method of support is consultation from a QI coach. The literature suggests that coaching interventions have a positive impact on clinical outcomes. However, the impact of coaching on specific process outcomes, like adoption of clinical care activities, is unknown. Identifying the process outcomes for which QI coaching is most effective could provide specific guidance on when to employ this strategy. ⋯ This study was registered and followed a published protocol (PROSPERO: CRD42020165069).
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Frailty is often cited as a factor influencing oral anticoagulation (OAC) prescription in patients with non-valvular atrial fibrillation (NVAF). We sought to determine the prevalence of frailty and its association with OAC prescription in older veterans with NVAF. ⋯ There are high rates of frailty among older veterans with NVAF. Frailty using an EHR-derived index is associated with decreased OAC prescription.
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Prior work has shown that provider network structures correlate with outcomes such as patient costs, utilization, and care. However, it remains unknown whether certain provider networks are associated with reduced disparity gaps. ⋯ Network structures where PCPs are more central relative to medical and surgical specialists are associated with reduced non-Hispanic black-to-white disparity gaps, suggesting that how we organize and structure our health systems has implications for disparity gaps between non-Hispanic black and white Medicare beneficiaries with diabetes.