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What AHRQ Learned While Working to Transform Primary Care. AHRQ 在改革初级保健时学到了什么。
IF 4.4 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-03-01 DOI: 10.1370/afm.3090
David Meyers, Therese Miller, Jan De La Mare, Jessie S Gerteis, Gail Makulowich, Gabrielle H Weber, Chunliu Zhan, Janice Genevro

Building on previous efforts to transform primary care, the Agency for Healthcare Research and Quality (AHRQ) launched EvidenceNOW: Advancing Heart Health in 2015. This 3-year initiative provided external quality improvement support to small and medium-size primary care practices to implement evidence-based cardiovascular care. Despite challenges, results from an independent national evaluation demonstrated that the EvidenceNOW model successfully boosted the capacity of primary care practices to improve quality of care, while helping to advance heart health. Reflecting on AHRQ's own learnings as the funder of this work, 3 key lessons emerged: (1) there will always be surprises that will require flexibility and real-time adaptation; (2) primary care transformation is about more than technology; and (3) it takes time and experience to improve care delivery and health outcomes. EvidenceNOW taught us that lasting practice transformation efforts need to be responsive to anticipated and unanticipated changes, relationship-oriented, and not tied to a specific disease or initiative. We believe these lessons argue for a national primary care extension service that provides ongoing support for practice transformation.

在以往转变初级保健工作的基础上,医疗保健研究与质量局(AHRQ)于 2015 年推出了 EvidenceNOW:推进心脏健康。这项为期 3 年的计划为中小型初级保健实践提供外部质量改进支持,以实施循证心血管保健。尽管面临挑战,但一项独立的国家评估结果表明,EvidenceNOW 模式成功地提高了初级医疗实践的能力,改善了医疗质量,同时有助于促进心脏健康。作为这项工作的资助者,美国健康与人类服务部在反思自己的经验教训时,总结出了三条关键经验:(1)总会有意外,需要灵活和实时的调整;(2)初级医疗转型不仅仅是技术问题;(3)改善医疗服务和健康结果需要时间和经验。EvidenceNOW 告诉我们,持久的实践转型工作需要对预期和未预期的变化做出反应,以关系为导向,不与特定疾病或倡议挂钩。我们认为,这些经验教训证明,全国初级保健推广服务应为实践转型提供持续支持。
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引用次数: 0
"It Can't Hurt!": Why Many Patients With Limited Life Expectancy Decide to Accept Lung Cancer Screening. "不会疼的!":为什么许多预期寿命有限的患者决定接受肺癌筛查?
IF 4.4 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-03-01 DOI: 10.1370/afm.3081
Eduardo R Núñez, Rendelle E Bolton, Jacqueline H Boudreau, Samantha K Sliwinski, Abigail N Herbst, Lauren E Kearney, Tanner J Caverly, Renda Soylemez Wiener

Purpose: Lung cancer screening (LCS) has less benefit and greater potential for iatrogenic harm among people with multiple comorbidities and limited life expectancy. Yet, such individuals are more likely to undergo screening than healthier LCS-eligible people. We sought to understand how patients with marginal LCS benefit conceptualize their health and make decisions regarding LCS.

Methods: We interviewed 40 people with multimorbidity and limited life expectancy, as determined by high Care Assessment Need scores, which predict 1-year risk of hospitalization or death. Patients were recruited from 6 Veterans Health Administration facilities after discussing LCS with their clinician. We conducted a thematic analysis using constant comparison to explore factors that influence LCS decision making.

Results: Patients commonly held positive beliefs about screening and perceived LCS to be noninvasive. When posed with hypothetical scenarios of limited benefit, patients emphasized the nonlongevity benefits of LCS (eg, peace of mind, planning for the future) and generally did not consider their health status or life expectancy when making decisions regarding LCS. Most patients were unaware of possible additional evaluations or treatment of screen-detected findings, but when probed further, many expressed concerns about the potential need for multiple evaluations, referrals, or invasive procedures.

Conclusions: Patients in this study with multimorbidity and limited life expectancy were unaware of their greater risk of potential harm when accepting LCS. Given patient trust in clinician recommendations, it is important that clinicians engage patients with marginal LCS benefit in shared decision making, ensuring that their values of desiring more information about their health are weighed against potential harms from further evaluations.

目的:肺癌筛查(LCS)对有多种并发症且预期寿命有限的人群的益处较小,而造成先天性伤害的可能性较大。然而,与符合肺癌筛查条件的健康人群相比,这些人更有可能接受筛查。我们试图了解LCS微利患者是如何看待自己的健康并就LCS做出决定的:我们采访了 40 名患有多种疾病且预期寿命有限的患者,他们的护理评估需求分数较高,可预测 1 年的住院或死亡风险。患者是在与临床医生讨论过 LCS 后从退伍军人健康管理局的 6 家机构中招募的。我们使用恒定比较法进行了主题分析,以探讨影响 LCS 决策的因素:结果:患者普遍对筛查持积极态度,并认为 LCS 是非侵入性的。当被问及益处有限的假设情况时,患者强调 LCS 的非长寿益处(如安心、规划未来),在做出 LCS 决定时一般不考虑自己的健康状况或预期寿命。大多数患者不知道对筛查出的结果可能进行额外的评估或治疗,但当进一步询问时,许多患者对可能需要进行多次评估、转诊或侵入性治疗表示担忧:结论:在本研究中,患有多种疾病且预期寿命有限的患者在接受 LCS 时并未意识到他们面临的潜在伤害风险更大。考虑到患者对临床医生建议的信任度,临床医生必须让LCS仅有微弱获益的患者参与共同决策,确保他们希望获得更多健康信息的价值观与进一步评估的潜在危害进行权衡。
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引用次数: 0
Qualitative Study of Black Birthing People Experiencing Preterm Birth. 对早产黑人的定性研究。
IF 4.4 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-01-01 DOI: 10.1370/afm.3074
Michael E Johansen
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引用次数: 0
Communication and Birth Experiences Among Black Birthing People Who Experienced Preterm Birth. 经历过早产的黑人分娩者的沟通和分娩经历。
IF 4.4 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-01-01 DOI: 10.1370/afm.3048
Emily F Gregory, Geminesse T Johnson, Alejandra Barreto, Arthurine K Zakama, Adya I Maddox, Lisa D Levine, Scott A Lorch, Alexander G Fiks, Peter F Cronholm

Purpose: Physically or psychologically distressing birth experiences can influence postpartum health, parenting efficacy, and future pregnancy plans. Communication deficits contribute to negative birth experiences. This qualitative analysis explored themes related to communication and negative birth experiences among Black birthing people who experienced preterm birth.

Methods: We conducted qualitative interviews with non-Hispanic Black, English language-proficient birthing people with Medicaid-insured preterm infants. Interviews were designed to explore experiences with health care access and well-being after birth. Interviews were audio recorded, transcribed, and coded following an integrated approach where we applied a priori codes and captured emergent themes from the data.

Results: We interviewed 30 participants from October 2018 to July 2021. Median gestational age at birth was 30 weeks (range 22-36 weeks). Interviews occurred a median of 7 months postpartum (range 2-34 months). Themes emerged related to negative birth experiences and communication: (1) communication gaps during urgent or emergent intrapartum procedures contributed to negative birth experiences; (2) postpartum opportunities to share birth experiences, particularly with peers, sometimes mitigated the psychological consequences of negative birth experiences; (3) participants did not consistently discuss concerns about future pregnancy risk related to negative birth experiences with clinical teams.

Conclusions: Themes from this sample of Black birthing people who experienced preterm birth suggest 3 ways health systems might intervene to improve communication to mitigate the consequences of negative birth experiences. Improvement efforts in these areas may improve postpartum health, future pregnancy outcomes, and long-term health.

目的:生理或心理上痛苦的分娩经历会影响产后健康、育儿效率和未来的怀孕计划。沟通障碍会导致负面的分娩经历。本定性分析探讨了经历过早产的黑人分娩者中与沟通和负面分娩经历有关的主题:我们对有医疗补助保险的早产儿的非西班牙裔黑人、精通英语的分娩者进行了定性访谈。访谈的目的是探讨产后获得医疗保健服务和幸福感方面的经验。我们对访谈进行了录音、转录,并采用综合方法进行编码,在此过程中,我们应用了先验编码,并从数据中捕捉到了新出现的主题:从 2018 年 10 月到 2021 年 7 月,我们对 30 名参与者进行了访谈。出生时的中位胎龄为 30 周(范围为 22-36 周)。访谈发生在产后中位数 7 个月(范围为 2-34 个月)。出现了与负面分娩经历和沟通有关的主题:(1)紧急或紧急产前程序中的沟通缺失导致了负面分娩经历;(2)产后有机会分享分娩经历,特别是与同伴分享,有时会减轻负面分娩经历的心理后果;(3)参与者并未与临床团队持续讨论与负面分娩经历有关的未来妊娠风险问题:这个早产黑人分娩样本的主题表明,医疗系统可以通过三种方式进行干预,以改善沟通,减轻负面分娩经历的后果。这些方面的改进措施可能会改善产后健康、未来妊娠结果和长期健康。
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引用次数: 0
STFM Offers Support and Resources to New and Transitioning Residency Learning Networks. STFM 为新建和转型中的驻校学习网络提供支持和资源。
IF 4.4 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-01-01 DOI: 10.1370/afm.3089
Mary Theobald
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引用次数: 0
From Cradle to Grave: Health During Pregnancy and Over a Lifetime. 从摇篮到坟墓:孕期和一生的健康。
IF 4.4 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-01-01 DOI: 10.1370/afm.3084
Carolyn F Pearce, Mary Beth Sutter
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引用次数: 0
New AAFP President Calls on Family Physicians to be "Servant Leaders". 全美家庭医生协会新任主席呼吁家庭医生成为 "服务型领导者"。
IF 4.4 2区 医学 Q1 Medicine Pub Date : 2024-01-01 DOI: 10.1370/afm.3085
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引用次数: 0
Celebrating the Election of Dr Gerardo Moreno to the National Academy of Medicine. 庆祝杰拉尔多-莫雷诺博士当选美国国家医学科学院院士。
IF 4.4 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-01-01 DOI: 10.1370/afm.3082
José E Rodríguez
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引用次数: 0
Enhancing Patient-Centered Care Through Firsthand Experience With Continuous Glucose Monitoring in Rural Wyoming. 通过在怀俄明州农村地区使用连续血糖监测仪的亲身体验,加强以患者为中心的护理。
IF 4.4 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-01-01 DOI: 10.1370/afm.3055
Drew Mahoney, Lavinia Salama
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引用次数: 0
The Color of Medicine. 医学的色彩
IF 4.4 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-01-01 DOI: 10.1370/afm.3054
John E Ukadike

During my family medicine residency training, I was the junior doctor on the wards team when we encountered a young Black man who was hesitant to begin a new medication. I was also the only Black person on the team. After some initial trepidation about speaking up, I discussed my experiences with the patient and his mother and helped them see that the medication was not something to be feared. Later I faced criticism from a senior team member for bringing up the topic of race. Race is in fact an important consideration when treating patients. Understanding patients' lived experiences, especially when it comes to race, is essential in providing equitable health care.

在我接受家庭医学住院医师培训期间,我是病房小组的初级医生,当时我们遇到了一位年轻的黑人男子,他对开始服用一种新药犹豫不决。我也是团队中唯一的黑人。起初,我对开口说话感到有些惶恐,后来我与病人及其母亲讨论了我的经历,帮助他们认识到药物治疗并不可怕。后来,我因为提出种族问题而受到了一位资深团队成员的批评。事实上,在治疗病人时,种族是一个重要的考虑因素。了解病人的生活经历,尤其是种族经历,对于提供公平的医疗服务至关重要。
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Annals of Family Medicine
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