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IN THIS ISSUE
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The patient-centered medical home (PCMH) model is being implemented widely, but its effects on quality of care are unclear. This longitudinal study of primary care physicians in a multipayer community sought to determine whether practice within a PCMH was associated with improved quality of care. The authors found that the PCMH model was associated with modestly greater improvement in 4 of 10 Healthcare Data and Information Set measures. Quality improvement was distinct from but may have been enabled by electronic health record technology.
Some guidelines caution against routine screening for colorectal cancer in persons older than 75 years with an adequate screening history but have not addressed screening in those without a screening history. This modeling study estimates that screening elderly persons without previous screening has good value up to age 86 years for persons with no comorbid conditions, age 83 years for those with moderate comorbid conditions, and age 80 years for those with severe comorbid conditions.
Atrial fibrillation (AF) is a major public health problem, but uncertainties around its management remain. This review evaluated the comparative effectiveness of rate- and rhythm-control therapies for AF. It found that pharmacologic strategies have similar efficacy across outcomes in primarily older patients with mild AF symptoms and that pulmonary vein isolation is better than antiarrhythmic medications at reducing recurrences of AF in younger patients with paroxysmal AF and mild structural heart disease.
Almost 25% of patients hospitalized with heart failure (HF) are readmitted within 30 days. This systematic review of 47 trials examined the efficacy of transitional care interventions to reduce readmission and mortality rates for such patients. It found that few trials reported 30-day readmission rates. Over 3 to 6 months, home-visiting programs and multidisciplinary HF clinics reduced all-cause readmission and mortality, and structured telephone support reduced only HF-specific readmission and mortality.
This Update summarizes studies published in 2013 that the authors consider highly relevant to the practice of endocrinology. Topics include thyroid disease, diabetes, and bone disease.
The U.S. Preventive Services Task Force found that evidence is insufficient to assess the balance of benefits and harms of screening for cognitive impairment in community-dwelling adults who are older than 65 years and have no signs or symptoms of cognitive impairment.
The U.S. Food and Drug Administration assesses the safety and effectiveness of new high-risk medical devices through a process known as “premarket approval” (PMA), whereas modifications of existing devices may be approved by a less rigorous procedure known as “PMA supplement.” This commentary discusses safety concerns for this alternate pathway and its implications for clinicians and policymakers.
The Accreditation Council on Graduate Medical Education's Next Accreditation System aims to move residency evaluations from an episodic to a more continuous process that requires evaluation of a resident's achievement of “milestones” indicative of competencies necessary for the practice of medicine. This commentary raises concern that the requirements are untested and that the balance of milestones to be evaluated deemphasizes medical knowledge and diagnostic skills.
In this issue, Kern and colleagues studied the effect of the PCMH model on quality of care. The editorialists discuss the findings and recommend that providers consider the interplay of clinicians, staff, patients, and information systems and how each area depends on the presence of others for care outcomes to improve.
In this issue, van Hees and colleagues examined the efficacy of colorectal cancer screening in persons older than 75 years who had no previous screening. The editorialists discuss the findings and agree that screening this population is effective and cost-effective and that strategies to safely, effectively, and inexpensively implement screening are needed.
We all recognize that we are not the same doctor from day to day. Although we like to think that the quality of care we deliver stays constant, the focus with which I attend to my patients varies enormously.