Annals of Family Medicine最新文献

The General Public Vastly Overestimates Primary Care Spending in the United States.

IF 4.4 2区医学

Annals of Family Medicine Pub Date : 2025-02-24 DOI: 10.1370/afm.240413

Melissa Ma, Rebecca Etz, Andrew Bazemore, Kevin Grumbach

引用次数: 0

Performance-Based Reimbursement, Illegitimate Tasks, Moral Distress, and Quality Care in Primary Care: A Mediation Model of Longitudinal Data.

IF 4.4 2区医学

Annals of Family Medicine Pub Date : 2025-02-24 DOI: 10.1370/afm.240179

Emma Brulin, Kevin Teoh

{"title":"Performance-Based Reimbursement, Illegitimate Tasks, Moral Distress, and Quality Care in Primary Care: A Mediation Model of Longitudinal Data.","authors":"Emma Brulin, Kevin Teoh","doi":"10.1370/afm.240179","DOIUrl":"https://doi.org/10.1370/afm.240179","url":null,"abstract":"Purpose: We tested for direct and indirect effects that performance-based reimbursement (PBR) in primary care has on perceived individual and organizational quality of care, and the role of illegitimate tasks and moral distress as potential mediators.Method: We used results from the Longitudinal Occupational Health survey in Healthcare Sweden with data collected in 2021, 2022, and 2023. The sample of primary care physicians who answered at all 3 years and were aged 68 or more was 433. Performance-based reimbursement was measured using a single item. The Bern Illegitimate Tasks Scale measured illegitimate tasks, and moral distress was measured with a 10-item scale. Six items from the English National Health Staff Survey were used to measure the quality of individual and organizational care.Result: Of the 433 participants, 70% reported that PBR negatively impacted their work. Performance-based reimbursement was negatively associated with illegitimate tasks (b = -0.160; 95% CI, -0.240 to -0.080) and moral distress (b = -0.134; 95% CI, -0.210 to -0.058). These work factors were in turn associated with both individual and organizational quality of care. Using mediation models, we found an indirect effect (b = 0.011; 95% CI, 0.004 to 0.021) but no direct effect (b = 0.062; 95% CI, -0.019 to 0.143) between PBR on the quality of individual care.Conclusion: Performance-based reimbursement systems should account for the experience of individual primary care physicians to ensure effective, safe, and quality care, as this study shows how the level of illegitimate tasks and moral distress due to a PBR system can undermine care delivery. Consequently, it is imperative for stakeholders to consider how health care systems relate to the health care staff's experience, well-being, and the care being provided.","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

All Quality Metrics are Wrong; Some Quality Metrics Could Become Useful.

IF 4.4 2区医学

Annals of Family Medicine Pub Date : 2025-02-24 DOI: 10.1370/afm.250087

Michael E Johansen, Andrew S Detty, Jonathan Doo Young Yun

引用次数: 0

Breaking ICD Codes: Identifying Ambiguous Respiratory Infection Codes via Regional Diagnosis Heterogeneity.

IF 4.4 2区医学

Annals of Family Medicine Pub Date : 2025-01-27 DOI: 10.1370/afm.3192

Marcin Piotr Walkowiak, Dariusz Walkowiak, Jarosław Walkowiak

{"title":"Breaking ICD Codes: Identifying Ambiguous Respiratory Infection Codes via Regional Diagnosis Heterogeneity.","authors":"Marcin Piotr Walkowiak, Dariusz Walkowiak, Jarosław Walkowiak","doi":"10.1370/afm.3192","DOIUrl":"10.1370/afm.3192","url":null,"abstract":"Purpose: We aimed to analyze regional variations in the assignment of International Classification of Diseases, 10th Revision (ICD-10) codes to acute respiratory infections, seeking to identify notable anomalies that suggest diverse diagnoses of the same condition.Methods: We analyzed national weekly diagnosis data for acute respiratory infections (ICD-10 codes J00-J22) in Poland from 2010 to 2019, covering all 380 county-equivalent administrative regions and encompassing 292 million consultations. Data were aggregated into age brackets. We calculated the Kendall tau correlations between shares of particular diagnoses.Results: We found staggering differences across regions in applied diagnoses that persisted even after disaggregating the data into age groups. The differences did not seem to stem from different levels of health care use, as there was no consistent pattern suggesting variability in milder diagnoses. Instead, there were numerous pairs of strongly negatively correlated codes implying classification ambiguity, with the most problematic diagnosis being J06 (acute upper respiratory infections of multiple and unspecified sites), which was used almost interchangeably with a diverse range of others, especially J00 (common cold) and J20 (bronchitis).Conclusions: To the best of our knowledge, this is the first study using observable anomalies to analyze regional coding variability for the same respiratory infection. Although some of these discrepancies may raise concerns about misdiagnosis, the majority of cases involving interchangeably used codes did not seem to substantially impact treatment or prognosis. This suggests that ICD codes may have clinical ambiguities and could face challenges not only in fulfilling their intended purpose of generating internationally comparable health data but also in their use for comprehensive government health planning.","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 1","pages":"9-15"},"PeriodicalIF":4.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Affirmative Action-A Crack in the Door to Higher Education.

IF 4.4 2区医学

Annals of Family Medicine Pub Date : 2025-01-27 DOI: 10.1370/afm.230646

Billy Thomas

{"title":"Affirmative Action-A Crack in the Door to Higher Education.","authors":"Billy Thomas","doi":"10.1370/afm.230646","DOIUrl":"10.1370/afm.230646","url":null,"abstract":"The impact of the Supreme Court of the United States ruling against race-conscious admissions extends beyond college admissions to professional schools. Based partially on the idea that enough time had elapsed for achievement of the stated goals of affirmative action, the court ruled race-conscious admissions are unconstitutional under the 14th Amendment's Equal Protection Clause. The ruling left a crack in the door to higher education, however, allowing students to write an essay showing how race or ethnicity affected their lives. But without guidelines or a standardized approach, admissions committee members' background, personal experiences, and biases could influence evaluations.Historically, Black Indigenous People of Color (BIPOC) have experienced residential segregation. Thus, they are products of poorly funded and understaffed K-12 schools. Grade point average and standardized tests scores are heavily weighted during the admissions process in higher education; however, these metrics largely reflect the attributes of K-12 schools and access to advanced placement and science, technology, engineering, math, and medicine (STEMM) courses. These courses are often lacking in schools with predominantly BIPOC students. We must continue to develop and support K-16 STEMM programs.Higher education institutions must respond to the Supreme Court ruling. Recruitment and retention strategies should encourage, guide, and support students who pursue health care careers. Enhanced admissions processes must include a standardized, unbiased approach in assessing personal essays and the lived experience. Admissions committees should complete implicit bias and cultural humility training. Support and allocation of funds must be provided to maintain training. Safeguards must ensure applicant and institutional legal compliance.","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"23 1","pages":"73-78"},"PeriodicalIF":4.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluation of an AI-Based Voice Biomarker Tool to Detect Signals Consistent With Moderate to Severe Depression. 评估一种基于人工智能的语音生物标记工具，以检测与中度至重度抑郁症一致的信号。

IF 4.4 2区医学

Annals of Family Medicine Pub Date : 2025-01-27 DOI: 10.1370/afm.240091

Alexa Mazur, Harrison Costantino, Prentice Tom, Michael P Wilson, Ronald G Thompson

{"title":"Evaluation of an AI-Based Voice Biomarker Tool to Detect Signals Consistent With Moderate to Severe Depression.","authors":"Alexa Mazur, Harrison Costantino, Prentice Tom, Michael P Wilson, Ronald G Thompson","doi":"10.1370/afm.240091","DOIUrl":"10.1370/afm.240091","url":null,"abstract":"Purpose: Mental health screening is recommended by the US Preventive Services Task Force for all patients in areas where treatment options are available. Still, it is estimated that only 4% of primary care patients are screened for depression. The goal of this study was to evaluate the efficacy of machine learning technology (Kintsugi Voice, v1, Kintsugi Mindful Wellness, Inc) to detect and analyze voice biomarkers consistent with moderate to severe depression, potentially allowing for greater compliance with this critical primary care public health need.Methods: We performed a cross-sectional study from February 1, 2021 to July 31, 2022 to examine ≥25 seconds of free-form speech content from English-speaking samples captured from 14,898 unique adults in the United States and Canada. Participants were recruited via social media, provided informed consent, and their voice biomarker results were compared with a self-reported Patient Health Questionnaire-9 (PHQ-9) at a cut-off score of 10 (moderate to severe depression).Results: From as few as 25 seconds of free-form speech, machine learning technology was able to detect vocal characteristics consistent with an increased PHQ-9 ≥10, with a sensitivity of 71.3 (95% CI, 69.0-73.5) and a specificity of 73.5 (95% CI, 71.5-75.5).Conclusions: Machine learning has potential utility in helping clinicians screen patients for moderate to severe depression. Further research is needed to measure the effectiveness of machine learning vocal detection and analysis technology in clinical deployment.","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":" ","pages":"60-65"},"PeriodicalIF":4.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Reducing Stigma Through Conversations in Primary Care About Unhealthy Alcohol Use.

IF 4.4 2区医学

Annals of Family Medicine Pub Date : 2025-01-27 DOI: 10.1370/afm.240384

Dawn Bishop, Darla Parsons, Gabriela Villalobos, Jennifer Bannon, Michelle Rockwell, Alex Krist, Daniel E Jonas, Melinda M Davis, Sean Riley, Leslie Brouwer, Theresa Walunas, Abel Kho, Hildie Cohen, Tracy McPherson, Amy Rosenfeld, Elizabeth Flanagan

引用次数: 0

For AI in Primary Care, Start With the Problem. 初级保健中的人工智能，从问题开始。

IF 4.4 2区医学

Annals of Family Medicine Pub Date : 2025-01-27 DOI: 10.1370/afm.240504

John Thomas Menchaca

引用次数: 0

Evaluation of a Program Designed to Support Implementation of Prescribing Medication for Treatment of Opioid Use Disorder in Primary Care Practices. 旨在支持在初级保健实践中治疗阿片类药物使用障碍的处方药物实施方案的评估。

IF 4.4 2区医学

Annals of Family Medicine Pub Date : 2025-01-27 DOI: 10.1370/afm.3190

Tristen L Hall, David Mendez, Chelsea Sobczak, Susan Mathieu, Kimberly Wiggins, Kathy Cebuhar, Lauren Quintana, Jacob Weiss, Kyle Knierim

{"title":"Evaluation of a Program Designed to Support Implementation of Prescribing Medication for Treatment of Opioid Use Disorder in Primary Care Practices.","authors":"Tristen L Hall, David Mendez, Chelsea Sobczak, Susan Mathieu, Kimberly Wiggins, Kathy Cebuhar, Lauren Quintana, Jacob Weiss, Kyle Knierim","doi":"10.1370/afm.3190","DOIUrl":"10.1370/afm.3190","url":null,"abstract":"Purpose: Offering medication for opioid use disorder (MOUD) in primary care can increase access to effective opioid use disorder treatment and help address the US opioid crisis. We describe a primary care office-based opioid treatment program and addiction consultation service model designed to support small, rural clinics to increase their capacity for MOUD.Methods: This is an evaluation of an intervention to increase clinic capacity to offer MOUD. The intervention consists of a standardized curriculum, addiction medicine consultants, practice facilitation, and financial incentives. Fifteen Colorado primary care practices participated from January 2022 through January 2023. Primary outcomes included overall change in the number of active buprenorphine prescriptions and implementation of MOUD milestones before and after the intervention.Results: The mean number of active buprenorphine prescriptions in the 3 months preceding the intervention (baseline) increased from 2.1 (SD = 7.7) to 11.3 (SD = 11.2) at 13 months. Adjusted means from the Poisson model demonstrated significant improvement over time (P <.001). Mean implementation of MOUD milestones ranged from 23% to 40% at baseline and grew to 84% to 93% by the end of the program (P <.001).Conclusions: This model supported primary care practices that were initially doing little to no MOUD prescribing, to prescribe at significantly higher levels by the end of the program. This scalable model for addiction consultation in primary care settings illustrates how education and support to clinical teams can help practices makes changes, especially those with limited MOUD experience.","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":" ","pages":"44-51"},"PeriodicalIF":4.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Use of AI in Family Medicine Publications: A Joint Editorial From Journal Editors. 人工智能在家庭医学出版物中的应用：期刊编辑的联合社论。

IF 4.4 2区医学

Annals of Family Medicine Pub Date : 2025-01-27 DOI: 10.1370/afm.240575

Sarina Schrager, Dean A Seehusen, Sumi Sexton, Caroline R Richardson, Jon Neher, Nicholas Pimlott, Marjorie A Bowman, José Rodríguez, Christopher P Morley, Li Li, James Dom Dera

引用次数: 0