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Will direct primary care bring joy back to medicine

by Bich-May Nguyen, MD, MPH in Affordability & Delivery System

More than half of physicians report at least one symptom of burnout. This is much higher than in the general population. Source: Jeff Kubina (Flickr/CC) The major factors of [...]


Quality of Care

Continuity of Care

Health care costs

Access to Care

  • Source: Eric Schmuttenmaer (Flickr/CC)

    Disparities due to Pre-existing Conditions

    Despite attempts to improve access to care via the implementation of the Affordable Care Act, disparities in health outcomes continue to persist. This study examines some of the causes of racial disparities between blacks and whites; it further attempts to understand and isolate the individual effects of pre-operative risk factors. Selected subjects were black Medicare patients who underwent general surgery procedures and were matched with white controls within 6 states and within 838 [...]
  • Source: Ben Roffer (Flickr/CC)

    An Ounce of Prevention

    The projected benefits of the Affordable Care Act (ACA) are based on several central tenants inherent to the law, such as the expected improvement in utilization of cost-saving preventative medicine when access to insurance is increased and cost to patients is decreased. The effectiveness of the ACA will be an important talking point as we near the 2016 presidential election, yet little data exists on how the ACA has affected access to preventative health care since major components of the law [...]
  • Source: Kris Krüg (Flickr/CC)

    Primary Care is Still the Answer

    Though the patient-centered medical home has been praised as the ultimate strategy in keeping patients out of emergency departments and hospitals, so far the actual results have been mixed. A new study out of California, however, provides more positive evidence for the benefits of a continuous, longitudinal relationship with a primary care physician. Source: Kris Krüg (Flickr/CC) The Health Care Coverage Initiative in California created a provider network and defined benefits for a previously [...]
  • Source: CDC Global (Flickr/CC)

    Are We There Yet?

    In 2004, President George W. Bush launched an initiative to provide all Americans with electronic health records (EHR) by 2014. In 2009, Congress passed the HITECH Act, providing $30 billion to help get there. But as 2015 concludes, we have yet to achieve the goal. What were initially incentive payments to help providers adopt EHRs have become financial penalties for those failing to meet Meaningful Use requirements. A recent study in Health Affairs shows that the number of US hospitals with at [...]
  • Source: A Tale of a Halo (Public Domain)

    Hospital Quality: The Devil is in the Details

    In the debate over health care reform, one of the few issues everyone agrees on is the need for quality improvement (QI). Many believe we should reward the best performers and penalize those that fail to meet quality standards. It seems like a no-brainer, but of course the devil is in the details: What metrics should be used to accurately measure quality? Source: A Tale of a Halo (Public Domain) QI is one of the core pillars of the Affordable Care Act (ACA) and is being implemented through a [...]
  • Source: COM SALUD Agencia de comunicación (Flickr/CC)

    Saving Primary Care, One NP at a Time

    This meta-analysis by Martinez-Gonzalez and colleagues examined the effects of task-shifting from physicians to nurse practitioners in primary care. Twenty studies included in the meta-analysis all compared nurse-led care with physician-led care in general practices, including frequency and length of consultations, amount of referrals, prescriptions, tests, investigations ordered, and costs. Source: COM SALUD Agencia de comunicación (Flickr/CC) Nurses were about 20% more likely to have return [...]
  • Source: Russell Lee (Public Domain)

    The Country Nurse

    A recent study published in Medical Care examined the relationship of geographic accessibility to primary care providers. Data derived from the 2013 Area Health Resource File, which provides a comprehensive data on a broad range of health resources and socioeconomic indicators, and the U.S. Census Bureau county travel data. Accessibility was defined as low if the population-to-provider ratio was in the top third of counties, medium if this index fell in the middle third, and high if it fell in [...]
  • Source: Joaquim Alves Gaspar (CC)

    Minorities more likely to be Readmitted

    Prevention of hospital readmissions serves as one of the primary metrics for quality improvement under the Affordable Care Act. In 2012, the Centers for Medicare and Medicaid Services (CMS) began levying penalties for hospitals that had 30-day readmissions for acute myocardial infarction, heart failure, and pneumonia. In 2015, CMS expanded this metric to include total hip arthroplasties (replacements) or THAs. Source: Joaquim Alves Gaspar (CC) Elective THA is the sixth most common procedure and [...]
  • Source: (Flickr/CC)

    ACA Contraception Mandate is a Success

    One of the most impactful aspects of the Affordable Care Act (ACA) on public health is the mandate that insurers cover all contraceptive methods. The mandate predictably caused push-back from faith-based corporations, but there has been little discussion in public and legal debates on its benefits to individuals and society. Source: (Flickr/CC) In this study, authors calculated contraceptive out-of-pocket spending of a large sample of women from January 2012 to June 2013 for [...]
  • Source: Got Credit (Flickr/CC)

    Delivery System Reforms: Delivering Value?

    Restructuring health care delivery to reduce costs and improve quality is a fundamental part of the Affordable Care Act (ACA) and a response to the long history of high domestic healthcare spending with suboptimal outcomes. In fact, the ACA mandated programs such as patient-centered medical homes (PCMH) and pay-for-performance (P4P) before there was clear evidence demonstrating their effectiveness. Source: Got Credit (Flickr/CC) In this study, authors performed a systematic review of studies of [...]

Health IT

Public Health

Lessons from Abroad

A Policy Prescription for 2016

Affordable Care Act

  • Source: Alan Cleaver (Flickr / Creative Commons)

    Does Health Insurance Help?

    June 30, 2014 // 1 Comment

    Source: Alan Cleaver (Flickr / Creative Commons) While it has been estimated that 45,000 Americans perish unnecessarily each year due to lack of health insurance, there has [...]
  • Source: Quasifly (Flickr/CC)

    No Good Deed Goes Unpunished

    January 26, 2015 // 0 Comments

    The cost-reductions built into the Patient Protection and Affordable Care Act (ACA) are based upon the assumption that as the number of uninsured decreases, the need for [...]
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    The Math of Medicaid Expansion

    July 31, 2013 // 0 Comments

    The following 2 minute video is excerpted from the RAND Corporation. It explains the effects on states that opt-out of the Medicaid expansion scheduled for [...]
  • Source: Kevin Dooley (Flickr/CC)

    Quality over Quantity: Reforming Payment

    October 17, 2011 // 2 Comments

    A new research report from the RAND Corporation and sponsored by the National Quality Forum offers insight into new concepts of payment methods for medical services. A [...]
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    Medicaid expansion benefits emergency departments

    November 11, 2013 // 0 Comments

    Twenty-five states have still refused to expand Medicaid under the Affordable Care Act; that’s bad news for ERs everywhere. A recent article in the Annals of Emergency [...]
  • Source: University of Southern California Online (

    The Evolution of Health Care

    July 17, 2014 // 0 Comments

      Source: University of Southern California [...]