Journal of the American Board of Family Medicine最新文献

{"title":"Comprehensive Primary Care Team Model: Early Insights on Implementation from Care Teams in Family Medicine.","authors":"Katherine Sanchez, Jason Ramm, Stephen Sewell, Christian Vazquez, Sharon Reece","doi":"10.3122/jabfm.2025.250471R0","DOIUrl":"https://doi.org/10.3122/jabfm.2025.250471R0","url":null,"abstract":"<p><p>Family medicine faces critical challenges including workforce shortages, limited patient access, and the need for sustainable care models. We implemented a Comprehensive Primary Care Team (CPCT) model pairing physicians with three to four advanced practice clinicians (APCs) in four community-based clinics serving rural Central Texas. This special communication provides insights into early implementation of this model (about 12 months post-implementation). We conducted informal qualitative interviews to understand clinician perspectives on early implementation. This included site visits with the four clinics piloting the CPCT model (n = 19). Interviewees included physicians and APCs. Interviews focused on daily workflows, scheduling, interprofessional communication, patient access, panel-size management, collaborative practices, and perceived barriers. We also conducted an analysis of third next available appointment using administrative data to get a snapshot of our goal to increase access. This analysis compares one CPCT model clinic with a solo-practice clinic. Insights from these informal interviews centered on 4 themes: (1) Teamwork and Collaboration, (2) Access and Scheduling, (3) Panel-Size Management, (4) Clinician Satisfaction. The third next available appointment analysis revealed substantially more appointment availability in the CPCT model clinic across multiple visit types. The CPCT model has potential to be a scalable innovation enabling family medicine practices to safely expand panel sizes, improve access to care, and operationalize physician-led population health management. Ongoing challenges include right-sizing teams, space limitations, and workflow optimization, but early insights support replication in primary care settings seeking to address access gaps and workforce constraints while maintaining quality of care.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Race on Advanced Care Planning: Results of a Quality Improvement Project.","authors":"Aaron Lear, Michael Arnold, Rachida Bouhenni, Caroline Mangira, Megan Adelman, Kevin Baldie, Estee George","doi":"10.3122/jabfm.2025.250310R1","DOIUrl":"https://doi.org/10.3122/jabfm.2025.250310R1","url":null,"abstract":"<p><strong>Introduction: </strong>Research suggests racial disparities affect the likelihood that patients engage in advanced care planning (ACP). With this quality assurance initiative, we sought to determine whether racial disparities exist in ACP at our institution.</p><p><strong>Methods: </strong>We performed a retrospective chart review of patients 65 years of age and older who were seen at our institution from January 1, 2021 through December 31, 2022. The primary objective was to determine whether racial disparities exist in ACP among these patients. ACP was identified if the electronic health record (EHR) indicated presence of an advance directive, healthcare power of attorney, and/or ACP discussion or visit with a clinician.</p><p><strong>Results: </strong>In total, 22,372 patients were included. The median age was 74.1 (interquartile range [IQR] 69.4-80.5). White patients accounted for 87.4% of the total, 11.2% were Black, and 1.4% were another race. Females were 51.5%, 55.1% were married, and 88 % were insured by Medicare. Black patients and patients of other races were less likely than White patients to have an ACP (adjusted odds ratio [aOR] = 0.64; 95% confidence interval [CI], 0.58-0.71; P < .0001 and aOR = 0.63; 95% CI, 0.48-0.82; P = .0007, respectively). Older patients and those with more chronic disease (elevated Charlson comorbidity index) were more likely to complete ACP (aOR = 1.48; 95% CI, 1.42-1.54; P < .0001 and aOR = 1.32; 95% CI, 1.30-1.35; P < .0001, respectively).</p><p><strong>Conclusions: </strong>Our findings show differences in rates of ACP completion by race at our institution, which is consistent with previous research. The next step in our quality initiative is to develop interventions to promote equitable opportunities for such planning.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Spotlight: Implications of Using Artificial Intelligence as a Tool for Summarizing New Evidence.","authors":"Caroline Tietbohl, Nicholas LeFevre, Dean Seehusen, Christy Ledford","doi":"10.3122/jabfm.2026.260341R0","DOIUrl":"10.3122/jabfm.2026.260341R0","url":null,"abstract":"","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"US Trends in Lacking a Personal Doctor, by Educational Attainment, 2016-2023.","authors":"James R Burmeister, Ida J Rubino","doi":"10.3122/jabfm.2025.250314R1","DOIUrl":"https://doi.org/10.3122/jabfm.2025.250314R1","url":null,"abstract":"<p><strong>Background: </strong>Having a personal doctor is a cornerstone of primary care and is associated with improved preventive service use, chronic disease management, and patient satisfaction. Educational attainment is a key social determinant of health and access to care.</p><p><strong>Methods: </strong>We analyzed national trends in the percentage of US adults lacking a personal doctor from 2016 to 2023 using the State Health Compare tool (SHADAC) based on the Behavioral Risk Factor Surveillance System (BRFSS). Adults were classified by educational attainment: less than high school, high school graduate, some college/associate's degree, and bachelor's degree or higher. The SHADAC \"no personal doctor\" measure is based on self-report: respondents answering \"no\" to the BRFSS question \"Do you have one person you think of as your personal doctor or health care provider?\" were considered to lack a personal doctor. Only descriptive statistics were used; no inferential testing was performed.</p><p><strong>Results: </strong>Nationally, the share of adults without a personal doctor declined from 21.9% in 2016 to 17.1% in 2023 (absolute change -4.8 percentage points; relative change -21.8%). Reductions occurred across all education groups, but disparities persisted. In 2023, 30.8% of adults with less than a high school diploma reported lacking a personal doctor, compared with 9.7% among those with a bachelor's degree or higher-a gap of over 21 percentage points. Improvements were largest for college-educated adults (-36.0% relative change) and smallest for those without a high school diploma (-2.9%).</p><p><strong>Conclusions: </strong>Despite overall improvement, large and persistent education-related disparities remain. Interventions such as care-navigation support, insurance literacy programs, and payment models that fund outreach may help address these gaps. The persistent 21-point gap highlights the ongoing challenge for equity in primary care access in the United States.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Biases for Early-Career Women in Medicine: \"It's the Little Day-to-Day Microaggressions\".","authors":"Madeline Byrd, Melissa K Filippi, Anam Siddiqi, Sarah Fleischer, Andrew Bazemore, Annie Koempel","doi":"10.3122/jabfm.2025.250291R2","DOIUrl":"https://doi.org/10.3122/jabfm.2025.250291R2","url":null,"abstract":"<p><strong>Background: </strong>Women physicians face multiple systemic and social biases in the clinical setting that erode mental and physical well-being. Gender-based discrimination was reported by 76% of early-career women physicians, decreasing to 57% for mid-career, and 36% for late-career. While these trends suggest that these biases may diminish with career progression, they remain a persistent burden of women physician's careers. This article offers a unique contribution by centering early-career women family physicians, a group underrepresented in qualitative research on workplace bias. This article focuses on participants' microaggressive experiences in the clinical setting to better understand the biases they face.</p><p><strong>Methods: </strong>Via email we recruited 25 geographically and racially diverse early-career women physicians who responded to the 2021-2023 American Board of Family Medicine National Graduate Survey. A semi-structured interview guide was developed following a life-history approach to better understand the transitionary phase from residency to the practicing workforce. Interviews were transcribed verbatim, cleaned, and analyzed via Inductive Content Analysis in NVivo by qualitative researchers.</p><p><strong>Results: </strong>We identified three main themes that emerged from the data. First, biased communications within the clinical setting exposed a pattern of gender bias. Second, patients invalidate physicians' positions based on appearance and perception. Third, women physicians described navigating the emotional and psychological labor of clinical and societal expectations.</p><p><strong>Conclusion: </strong>In the context of primary care, microaggressions demand direct and intentional intervention. Failing to address these experiences jeopardizes both equity and workforce sustainability. Leadership must be equipped to recognize, interrupt, and respond to microaggressions-not only to support individual clinicians but to strengthen organizational culture and the broader primary care mission. Interference reflects the broader societal imperative and commitment to equity in healthcare.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventive Care: Cornerstone or Constraint for Family Medicine? How Much Should We Prioritize Clinical Preventive Services?","authors":"Carl G Morris, Dean A Seehusen, Sarah Cole","doi":"10.3122/jabfm.2026.260034R0","DOIUrl":"https://doi.org/10.3122/jabfm.2026.260034R0","url":null,"abstract":"<p><p>In August 2025, family physicians gathered for the Family Medicine Leaders Consortium to share perspectives on whether family physicians should continue to prioritize clinical preventive services amid rising patient complexity, documentation burdens, policy constraints, and post-pandemic challenges. This paper synthesizes competing perspectives and overarching commentary from the consortium meeting. One viewpoint argues that preventive care remains essential to family medicine's core values, patient expectations, and economic viability. The opposing viewpoint contends that preventive services are increasingly algorithmic, delegable, poorly reimbursed, and, while important, are no longer core to family medicine. Together, these perspectives illustrate the need for ongoing, future-focused discussions about family medicine's identity as a specialty.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a Primary Care Value-Based Compensation Model.","authors":"Lindsey Ulin, Lisa Rotenstein, Richard Gitomer, Lipika Samal, Salina Bakshi, Lance Rachelefsky, John Lewis, Erin E Sullivan","doi":"10.3122/jabfm.2025.250220R2","DOIUrl":"https://doi.org/10.3122/jabfm.2025.250220R2","url":null,"abstract":"<p><strong>Background: </strong>Primary care is essential for achieving high quality population health; however, its future remains uncertain with pervasive provider burnout, compensation structures based on service volume, and systemic undervaluation relative to specialty care. Value-based payment models aim to improve health outcomes and reduce costs, yet their implementation in academic medical centers remains complex. This study examined primary care physicians' perceived impacts of changing to a value-based compensation model in a large academic medical center.</p><p><strong>Methods: </strong>A mixed methods study was conducted using semi-structured interviews with 17 primary care physicians across 12 practices affiliated with Brigham and Women's Hospital (BWH), an academic medical center in Boston, Massachusetts. Interview transcripts were analyzed using a hybrid deductive-inductive thematic approach. Quantitative data included changes in panel size, panel growth, the proportion of physicians meeting panel targets, and quality metrics for patients with chronic disease.</p><p><strong>Results: </strong>Three years after implementing a value-based compensation model, the total number of covered lives in BWH's primary care department increased by 31,000, representing a growth rate of 6.8%-9% annually. Physicians identified three primary domains differentiating fee-for-service (FFS) and value-based compensation models: provider experience, access to care, and system-level factors. Reported advantages of the new model included recognition of inter-visit work and reduced productivity pressures. However, concerns emerged about limitations in patient access and persistent systemic challenges, including understaffing.</p><p><strong>Conclusion: </strong>A value-based compensation model in academic primary care may enhance panel management and physician experience. However, long-term success depends on addressing systemic barriers and aligning clinical productivity expectations with value-based goals.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital Utilization Among Users of Electronic Nicotine Delivery Systems (ENDS) Compared to Other Tobacco Users.","authors":"Niharika Khanna, Carissa S Kwan, Elena N Klyushnenkova, Colleen Kernan, Michael Dark, Julia Melamed, Janaki Deepak","doi":"10.3122/jabfm.2025.250265R1","DOIUrl":"https://doi.org/10.3122/jabfm.2025.250265R1","url":null,"abstract":"<p><strong>Introduction: </strong>Use of electronic nicotine delivery systems (ENDS) poses a significant and avoidable risk to respiratory health, yet its effect is not fully understood. This study examines the levels of hospital utilization among those who use ENDS and/or other tobacco and develop respiratory conditions.</p><p><strong>Methods: </strong>260,149 adult patients were screened for ENDS use between August 2020 and June 2022 at the University of Maryland Medical System. Multivariable nominal logistic regression modeling was used to assess associations between tobacco/nicotine use and emergency department (ED) or inpatient utilization due to respiratory conditions defined by admission or discharge ICD-10 J codes. Covariates included age, sex, race, Elixhauser comorbidity score, and history of COVID-19.</p><p><strong>Results: </strong>Among ENDS-only users, non-Hispanic White and Other-race patients had statistically significant increased healthcare utilization compared to never users (those who never use ENDS or tobacco). 18-44 year-old patients in these two race groups had 1.9-2.3 times higher odds of utilizing the ED compared to those who never used tobacco; and 65+ year-old non-Hispanic White patients had 2.4 times higher odds of inpatient admission compared to patients who never used tobacco. The odds of increased healthcare utilization among those who used both ENDS and other tobacco ranged from 1.4-2.4 and also varied by age and race.</p><p><strong>Conclusions: </strong>ENDS and tobacco use were associated with increased hospital utilization, including ED and inpatient, due to respiratory illnesses in an age- and race-dependent manner.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large Language Model versus Clinician Written Summaries of Research Papers.","authors":"Richard Guthmann, Robert Martin, Erin Lee, Christopher Boisselle","doi":"10.3122/jabfm.2025.250401R1","DOIUrl":"https://doi.org/10.3122/jabfm.2025.250401R1","url":null,"abstract":"<p><strong>Introduction: </strong>Clinicians require concise, accurate summaries of new research to inform practice. Patient-Oriented Evidence that Matters (POEMs), published in American Family Physician, are a benchmark for summarizing primary literature in family medicine, while large language models (LLMs) offer scalable summarization but require rigorous evaluation. The objective of this study was to evaluate the accuracy and quality of summaries generated by large language models compared with expert-authored POEMs.</p><p><strong>Methods: </strong>In this study, we compared LLM-generated summaries (Microsoft Copilot, GPT-4o class) with 24 recent matched POEMs using a standardized prompt. Two trained raters independently scored each summary with a 13-item tool (score range 0-13), cataloged errors, recorded word counts, and indicated preferences on a 5-point scale.</p><p><strong>Results: </strong>LLM summaries outperformed POEMs in total score (mean 12.1 vs 10.6; mean difference 1.5, 95% CI 1.1-2.0; P < 0.001), with similar lengths (328 vs 353 words; P = 0.23). Errors occurred in fewer LLM-DOCSs (2/24) than POEMs (9/24), with a mean error score difference of 20% (95% CI 7% -33%; P < 0.001). POEMs most often missed in the categories Contextual Background and Limitations; both approaches frequently missed in Clinical Applicability. Reviewer preference favored LLM-DOCS (mean 2.44 on a 1-5 scale; 95% CI 2.1-2.8).</p><p><strong>Conclusions: </strong>An enterprise LLM, prompted in POEM style, produced accurate, low-error clinical summaries that matched or exceeded expert-edited POEMs and were generally preferred by reviewers, though further research is needed to assess broader applicability and impact. Findings support pragmatic LLM-assisted summarization and highlight the need for standardized evaluation tools and explicit prompts for clinical applicability.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Power of Primary Care to Improve Health.","authors":"Sumi M Sexton, Sarina Schrager, Dean A Seehusen, Christopher P Morley, Caroline Richardson, Jon Neher, James DomDera","doi":"10.3122/jabfm.2026.260266R0","DOIUrl":"https://doi.org/10.3122/jabfm.2026.260266R0","url":null,"abstract":"","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}