Journal of general internal medicine
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We previously found that autistic adults who received care through a primary care embedded specialized clinic, called the Center for Autism Services and Transition (CAST), had higher satisfaction, continuity of care, and preventive care use than national samples of autistic adults. ⋯ Although CAST patients had greater primary care utilization and expenditures, our findings suggest embedding specialized clinics within broader primary care settings could be an alternative to current standards of care and may reduce expenditures and healthcare utilization in other areas, particularly relative to standard care for privately insured autistic adults.
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Adverse childhood experiences (ACEs) are linked to higher risk of common conditions driving mortality in adulthood, but little evidence exists on whether ACEs are associated with risk of dementia, a leading cause of death in the USA. ⋯ Greater exposure to ACEs is independently associated with higher probability of a positive dementia screen in older adulthood.
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Observational Study
Road to Better Work-Life Balance? Lean Redesigns and Daily Work Time among Primary Care Physicians.
To assess the impact of Lean primary care redesigns on the amount of time that physicians spent working each day. ⋯ These findings suggest that Lean redesign may be associated with time savings for primary care physicians. However, since this was an observational analysis, further study is warranted (e.g., randomized trial) -to determine the impact of Lean interventions on physician work experiences.
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The emotional stress of caring for someone with Alzheimer's disease and related dementias is high and results in adverse effects on caregivers and the persons living with disease. In preliminary work, caregiver reports of regularly feeling "completely overwhelmed" were associated with lack of measurable clinical benefit from a comprehensive dementia care program. ⋯ A single question about whether a caregiver is overwhelmed might indicate caregivers who have considerable current and future symptom burden and who may benefit from increased support and resources.
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Academic health centers (AHCs) face unique challenges in providing continuity to a medically and socially complex patient population. Little is known about what drives patient loss in these settings. ⋯ Younger patient age, markers of social vulnerability, and physician transiency are associated with patient loss at AHCs, providing targets to improve continuity of care within these settings.