J Am Board Fam Med
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Previous work has shown that $210 billion may be spent annually on unnecessary medical services and has identified patient and hospital characteristics associated with low value care (LVC). However, little is known about the association between primary care physician (PCP) characteristics and LVC spending. The objective of this study was to assess this association. ⋯ Our analysis suggests that LVC services are associated with specific PCP characteristics. Further research should assess the strength of these associations, and future policy efforts should focus on systemic interventions to reduce LVC spending.
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The purpose of this project was to evaluate the real-world usability and usefulness of a revised version of the published Agency for Healthcare Research and Quality "Improving Your Office Testing Process" toolkit, designed to help primary care practices standardize and systematize laboratory testing processes. ⋯ The usability and usefulness of the toolkit were related to the characteristics of the toolkit itself (adaptability, simplicity, and design quality and packaging, and guidance in planning) and practice processes (presence of practice champions and implementation teams). In a set of 2 practices in which laboratory testing process improvement was a high priority and where well-established QI infrastructure exists, the toolkit was easy to use with little technical assistance.
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This issue of the Journal evidences the wide variety of research methods that can effectively answer questions important to the practice of family medicine. For example, this issue includes 4 highly informative reports from qualitative or mix-methods research, plus surveys, a meta-analysis, a case report, and more. Mixed-methods were used to look at practice changes and to compare advance directive tools. ⋯ Retrospective chart analysis of patients with frequent hospital admissions identified important characteristics of the patients and their problems. Meta-analysis methodology was used to stratify risks for pneumonia. And, a randomized trial was used to compare ways to train patients to use medical record patient portals.
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Meta Analysis
Signs and Symptoms That Rule out Community-Acquired Pneumonia in Outpatient Adults: A Systematic Review and Meta-Analysis.
A systematic review of clinical decision rules to identify patients at low risk for community-acquired pneumonia (CAP) has not been previously presented in the literature. ⋯ Adults with an acute respiratory infection who have normal vital signs and a normal pulmonary examination are very unlikely to have CAP. Given a baseline CAP risk of 4%, these patients have only a 0.4% likelihood of CAP.
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Multicenter Study
The Burden of Childhood Atopic Dermatitis in the Primary Care Setting: A Report from the Meta-LARC Consortium.
Little is known about the burden of atopic dermatitis (AD) encountered in US primary care practices and the frequency and type of skin care practices routinely used in children. ⋯ Our study found a large burden of AD in the primary care practice setting in the US. The majority of households reported skin care practices that may be detrimental to the skin barrier, such as frequent bathing and the routine use of moisturizers with high water: oil ratios. Clinical trials are needed to identify which skin care practices are optimal for reducing the significant burden of AD in the community.