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Research Studies is a compilation of published research articles funded by ´óÏóÊÓƵor authored by ´óÏóÊÓƵresearchers.

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1 to 25 of 794 Research Studies Displayed
Zhan C, Liu L, Simpson M
´óÏóÊÓƵAuthor: Zhan C, Liu L, Simpson M
Estimating primary care spending in the United States: toward a common method.
The study’s objective was to explore consistent approaches to estimating primary care spending. A recently developed framework for primary care services was applied to the datasets MEPS and MarketScan to estimate primary care spending per-person-per-year (PPPY) and as a percentage of total health care spending (PTHS) covering 2010-2021. In 2019 the average primary care spending was $504 PPPY, accounting for 8.07% PTHS, based on MEPS, and $378 PPPY, accounting for 6.30% PTHS, based on MarketScan. There were steady increases between 2010 and 2021 in PPPY primary care spending (from $309 to $639 based on MEPS and from $343 to $433 based on MarketScan), but only small fluctuations in PHTS primary care spending (between 6% and 9%). They identified misalignments between the definitions and the data, and standard errors for the estimates were calculated.
AHRQ-authored.
Citation: Zhan C, Liu L, Simpson M . Estimating primary care spending in the United States: toward a common method. Med Care 2025 Jul; 63(7):514-19. doi: 10.1097/mlr.0000000000002155..
Keywords: Medical Expenditure Panel Survey (MEPS), Primary Care, Healthcare Costs
Hamilton LK, Lapham GT, Day A
Improving alcohol-related care in small-medium primary care practices: an evaluation of an adaptation of the SPARC trial intervention for small-medium sized practices.
The Michigan Sustained Patient-centered Alcohol-Related Care (MI-SPARC) study tested an adaptation of the original SPARC trial to increase identification and treatment of unhealthy alcohol use. Results showed that, despite adaptions for smaller primary care practices and screening improvements, MI-SPARC did not increase brief intervention and AUD medication treatment. The researchers concluded that this reflected a mismatch between intervention complexity and implementation infrastructure in primary care practices.
AHRQ-funded; HS027076.
Citation: Hamilton LK, Lapham GT, Day A . Improving alcohol-related care in small-medium primary care practices: an evaluation of an adaptation of the SPARC trial intervention for small-medium sized practices. J Subst Use Addict Treat 2025 Jun; 173:209697. doi: 10.1016/j.josat.2025.209697..
Keywords: Alcohol Use, Primary Care, Patient-Centered Healthcare
Ghosh K, Beaulieu ND, Dalton M
Integrated health systems and medical care quality during the COVID-19 pandemic.
The objective of this study was to examine differences between patients treated in and outside of integrated systems of care during the COVID pandemic. Results indicated that health systems were associated with reduced deaths and adverse medical events, although this reduction appeared unrelated to use of primary care.
AHRQ-funded; HS024072.
Citation: Ghosh K, Beaulieu ND, Dalton M . Integrated health systems and medical care quality during the COVID-19 pandemic. Health Serv Res 2025 Jun; 60(3):e14433. doi: 10.1111/1475-6773.14433..
Keywords: COVID-19, Quality of Care, Healthcare Delivery, Primary Care, Health Systems
Eden AR, Simpson MJ, De La Mare J
´óÏóÊÓƵAuthor: Eden AR, Simpson MJ, De La Mare, J
AHRQ's National Center for Excellence in Primary Care Research (NCEPCR): a new home for primary care research.
This article introduces the ´óÏóÊÓƵ's newly established National Center for Excellence in Primary Care Research. For three decades, ´óÏóÊÓƵhas supported primary care research through various initiatives including funding the first ECHO grant, developing patient-centered medical home models, and supporting practice-based research networks. However, these efforts were previously distributed across different centers within the agency, making them difficult to recognize as a cohesive portfolio. Established in 2022, NCEPCR now serves as a dedicated home for primary care research at AHRQ. The center has developed a mission and vision while beginning to coordinate research efforts across the agency, disseminate information about primary care research, build a robust research workforce, and bring together key primary care partners. Looking ahead, NCEPCR plans to expand its activities in these areas and strengthen its position as a national hub for primary care research.
AHRQ-authored; AHRQ-funded; 75Q80122F80007.
Citation: Eden AR, Simpson MJ, De La Mare J . AHRQ's National Center for Excellence in Primary Care Research (NCEPCR): a new home for primary care research. Ann Fam Med 2025 May/June; 23(3):262-66. doi: 10.1370/afm.240501..
Keywords: Primary Care, Health Services Research (HSR)
Biro JM, Handley JL, Malcolm McCurry J
Opportunities and risks of artificial intelligence in patient portal messaging in primary care.
The purpose of this study was to evaluate the opportunities and risks of using artificial intelligence to draft responses to patient portal messages in primary care. Through a cross-sectional simulation study, twenty practicing primary care physicians reviewed patient portal messages with AI-generated draft responses, some containing deliberate errors. Results showed that 13-15 participants insufficiently addressed each error, with 35-45% of erroneous drafts submitted entirely unedited. Despite these findings, 80% of participants reported that AI drafts reduced cognitive workload and 75% considered them safe.
AHRQ-funded; HS030307.
Citation: Biro JM, Handley JL, Malcolm McCurry J . Opportunities and risks of artificial intelligence in patient portal messaging in primary care. NPJ Digit Med 2025 Apr 24; 8(1):222. doi: 10.1038/s41746-025-01586-2.
Keywords: Primary Care, Electronic Health Records (EHRs), Health Information Technology (HIT), Clinician-Patient Communication, Communication
O'Connor EA, Webber EM, Martin AM
Preventive services for food insecurity: evidence report and systematic review for the US Preventive Services Task Force.
This systematic review examined the benefits and harms of screening and interventions for food insecurity in health care settings as part of a final recommendation of the U.S. Preventive Services Task Force. The results indicated that brief screening tools have sufficient sensitivity to identify people with food insecurity, but most studies of interventions had high risk of bias, limiting the ability to draw firm conclusions.
AHRQ-funded; 75Q80120D00004.
Citation: O'Connor EA, Webber EM, Martin AM . Preventive services for food insecurity: evidence report and systematic review for the US Preventive Services Task Force. JAMA 2025 Apr 15; 333(15):1340-51. doi: 10.1001/jama.2024.22805.
Keywords: U.S. Preventive Services Task Force (USPSTF), Screening, Nutrition, Evidence-Based Practice, Guidelines, Primary Care
Bond AM, Schpero WL, Civelek Y
Changes in primary care practice setting and practice type for Medicare beneficiaries.
The purpose of this study was to examine changes in primary care practice settings and practice types for traditional Medicare beneficiaries between 2012 and 2022. Using a 20% sample of Medicare claims, researchers analyzed visits billed by primary care physicians or delivered in federally qualified health centers and rural health clinics. Results showed significant shifts in care delivery patterns over the decade, with primary care visits moving from physician offices (79.2% to 68.8%) to rural health clinics, federally qualified health centers, and hospital outpatient departments. Similarly, visits to solo practitioners decreased (33.4% to 24.7%) while visits to practices with 20-40% primary care physicians increased substantially. These findings suggest primary care is increasingly delivered in safety-net facilities and multi-specialty settings.
AHRQ-funded; HS029012.
Citation: Bond AM, Schpero WL, Civelek Y . Changes in primary care practice setting and practice type for Medicare beneficiaries. JAMA Health Forum 2025 Apr 4; 6(4):e250445. doi: 10.1001/jamahealthforum.2025.0445.
Keywords: Primary Care, Medicare
Nankervis H, Huntley AL, Whiting P
Communicating blood test results in primary care: a mixed-methods systematic review.
The goal of this mixed-methods systematic review was to summarize existing evidence for blood test result communication between primary care providers and their patients and carers. The authors included 71 studies, including 10 experimental studies and no randomized controlled trials. Study quality was mostly poor with a high risk of bias, partly owing to lack of reported information. The authors found that patients want more information about their blood test results, particularly in terms of 'what next', and prefer results to be provided quickly. Most patients accepted electronic methods such as online access or text messages, but not by everyone and not for all results. There were mixed opinions by the clinicians as to whether online direct release of test results to patients was beneficial or could cause problems, such as increased patient anxiety and increased workload.
AHRQ-funded; HS028595; HS029318; HS029347.
Citation: Nankervis H, Huntley AL, Whiting P . Communicating blood test results in primary care: a mixed-methods systematic review. Br J Gen Pract 2025 Apr; 75(753):e222-e31. doi: 10.3399/bjgp.2024.0338..
Keywords: Primary Care, Communication, Diagnostic Safety and Quality
Quigley DD, Qureshi N, Predmore Z
Is primary care patient experience associated with provider-patient language concordance and use of interpreters for Spanish-preferring patients: a systematic literature review.
The goal of this systematic literature review was to review associations of patient experience with provider-patient language concordance (LC) and use of interpreters for Spanish-preferring patients. The authors reviewed 217 (of 2193) articles, yielding 17 for inclusion. All articles were cross-sectional, collected data by self-administered surveys or interviews. Results were mixed, with null findings (n = 4) and associations with better patient experience (n = 3) (e.g., receiving diet/exercise counseling and better provider communication). Evidence on interpreter use was also mixed, indicating better (n = 2), worse (n = 2), and no association (n = 2) with patient experience. Associations between Spanish-language preference and patient experience were not significant (n = 5) or indicated worse experience (n = 4). The use of high-quality interpreters was associated with better patient experience.
AHRQ-funded; HS025920; HS02932.
Citation: Quigley DD, Qureshi N, Predmore Z . Is primary care patient experience associated with provider-patient language concordance and use of interpreters for Spanish-preferring patients: a systematic literature review. J Racial Ethn Health Disparities 2025 Apr; 12(2):1170-83. doi: 10.1007/s40615-024-01951-z..
Keywords: Primary Care, Cultural Competence, Clinician-Patient Communication, Communication
Dixon J, Turi E, Pollifrone M
Methodology of a social network survey in primary care practices with medical home attributes.
The purpose of this study was to provide an overview of varying methods of a cross-sectional sociometric social network survey utilized to gather data on team structures, compositions, and social networks in primary care practices. The study found that the researcher’s social network survey methods achieved high participation rates among primary care practices, effectively capturing team structures and interactions despite generally declining survey responses in healthcare settings.
AHRQ-funded; HS025937.
Citation: Dixon J, Turi E, Pollifrone M . Methodology of a social network survey in primary care practices with medical home attributes. J Ambul Care Manage 2025 Apr-Jun; 48(2):84-94. doi: 10.1097/jac.0000000000000520..
Keywords: Primary Care, Patient-Centered Healthcare
Huang J, Lieu TA, Gopalan A
Patient photo attachments and telemedicine visit effectiveness: is a picture worth a thousand words?
Researchers studied patients with skin-related concerns in a large integrated health care delivery system to assess whether clinical needs can be effectively addressed by telephone visits. Findings indicated that telephone visits may pose more difficulty in diagnosis, due to a lack of visual information; less than a third included a photo attached. The study also found that photo attachments were associated with lower follow-up visit rates.
AHRQ-funded; HS025189.
Citation: Huang J, Lieu TA, Gopalan A . Patient photo attachments and telemedicine visit effectiveness: is a picture worth a thousand words? J Gen Intern Med 2025 Apr; 40(5):1208-10. doi: 10.1007/s11606-024-09110-0..
Keywords: Telehealth, Health Information Technology (HIT), Primary Care
Simon CB, Britz JB, Keiser B
Supporting Unhealthy Substance use care Through a whole person Approach and user centered INtegration into primary care (SUSTAIN): study protocol for a type 2 hybrid effectiveness-implementation trial.
This paper describes a research protocol called Supporting Unhealthy Substance use care Through a whole person Approach and user centered INtegration into primary care (SUSTAIN) which will test whether the implementation of a co-designed change package for unhealthy substance use (USU) improves patient function. This randomized controlled two-phase implementation trial will take place at 24 primary care clinics in two practice-based research networks (PBRNs). Phase one will have primary care practice champions and patients with lived USU experience co-design a change package to identify and treat USU. In phase two, the researchers will test the effectiveness of the change package versus usual care and evaluate the implementation of the change package. Primary outcomes will include mental and physical health patient function scales. Secondary outcomes will be prevalence of USU, recovery, health care utilization, USU screening rates, provision/referral to behavioral health services and prescription of appropriate medications. They will also evaluate implementation outcomes.
AHRQ-funded; HS029773.
Citation: Simon CB, Britz JB, Keiser B . Supporting Unhealthy Substance use care Through a whole person Approach and user centered INtegration into primary care (SUSTAIN): study protocol for a type 2 hybrid effectiveness-implementation trial. J Subst Use Addict Treat 2025 Apr; 171:209626. doi: 10.1016/j.josat.2025.209626..
Keywords: Substance Abuse, Behavioral Health, Patient-Centered Healthcare, Primary Care
Ianni K, Chen A, Rodrigues D
Transporting difference-in-differences estimates to assess health equity impacts of payment and delivery models.
This simulation study’s objective was to transport the effects of the Comprehensive Primary Care Plus (CPC+) model to a target population of Black fee-for-service (FFS) Medicare beneficiaries living outside the original 18 CPC+ regions. Main outcome variable was total Medicare spending per beneficiary per year (pbpy). The authors simulated practice-level spending in 18 CPC+ regions and 32 non-CPC+ regions (1200 practices per region). They calibrated the parameters from the literature and then varied four key parameters to create 16 realistic simulation scenarios. Across the 16 simulation scenarios, transporting the treatment effect regions yielded median treatment effects that ranged from $15.5 pbpy smaller to $10 pbpy larger than in the sample. These differences turned out to be roughly the same magnitude as the estimated overall effect of $13 pbpy.
AHRQ-funded; HS028985.
Citation: Ianni K, Chen A, Rodrigues D . Transporting difference-in-differences estimates to assess health equity impacts of payment and delivery models. Health Serv Res 2025 Apr; 60(suppl 2):e14419. doi: 10.1111/1475-6773.14419.
Keywords: Primary Care, Payment, Medicare, Healthcare Costs, Simulation
Childs E, Swan H, Evans L
´óÏóÊÓƵAuthor: Perfetto D, Hogan E
A toolkit to implement opioid quality improvement efforts in primary care: findings from a mixed-methods study.
This study evaluated the How-to-Implement Toolkit for the Six Building Blocks program, which aims to improve opioid management for chronic pain in primary care settings. Eight healthcare organizations with 62 clinics participated in the evaluation. Through interviews and surveys with clinical staff, researchers found that while organizations valued the Toolkit's resources, they preferred having practice facilitator support during implementation. Participants reported using specific tools rather than the entire Toolkit. The findings emphasize the importance of implementation support for opioid quality improvement initiatives in primary care settings. The Toolkit and related resources are available through the ´óÏóÊÓƵ.
AHRQ-authored.
Citation: Childs E, Swan H, Evans L . A toolkit to implement opioid quality improvement efforts in primary care: findings from a mixed-methods study. J Opioid Manag 2025 Jan-Feb; 21(1):29-40. doi: 10.5055/jom.0894..
Keywords: Quality Improvement, Primary Care, Opioids, Medication, Quality of Care, Implementation
Dauber-Decker KL, Serafini MA, Monane R
User-centered design of a preference-driven patient activation tool for optimizing depression treatment in integrated primary care settings (The Transform DepCare Study).
The purpose of this study was to characterize a user-centered design (UCD) process for implementing a tool for preference-driven patient activation. The study found that the tool, which included UCD and the principles of behavior change/implementation science, improved patient engagement and decision-making comfort in primary care depression treatment. The results emphasized usability and accessibility of a real-world, patient experience-driven and workflow-aligned patient activation tool in a variety of populations.
AHRQ-funded; HS025198.
Citation: Dauber-Decker KL, Serafini MA, Monane R . User-centered design of a preference-driven patient activation tool for optimizing depression treatment in integrated primary care settings (The Transform DepCare Study). J Gen Intern Med 2025 Feb; 40(2):556-68. doi: 10.1007/s11606-024-08833-4..
Keywords: Patient-Centered Healthcare, Depression, Behavioral Health, Primary Care, Patient and Family Engagement
Bishop D, Parsons D, Villalobos G
Reducing stigma through conversations in primary care about unhealthy alcohol use.
To improve how primary care teams talk with patients about alcohol use, this study implemented an ´óÏóÊÓƵEvidenceNOW strategy that used practice facilitators to support respectful, nonjudgmental communication. Clinics adopted standard language and workflows to normalize screening and reduce stigma. Materials emphasized that alcohol screening is routine and not targeted, helping patients feel less judged. Findings suggest that even small changes in language and approach can significantly enhance trust and uptake of alcohol-related health interventions.
AHRQ-funded.
Citation: Bishop D, Parsons D, Villalobos G . Reducing stigma through conversations in primary care about unhealthy alcohol use. Ann Fam Med 2025 Jan 27; 23(1):83. doi: 10.1370/afm.240384..
Keywords: Alcohol Use, Substance Abuse, Social Stigma, Primary Care, Communication, Clinician-Patient Communication, Behavioral Health
Kenzie ES, Weekley T, Barnes C
Co-created improvement goals and strategies for implementing SBIRT and MAUD in primary care settings in a facilitator-supported, tailored implementation study.
This study’s goal was to create improvement goals and and strategies for implementing screening, brief intervention, and referral to treatment (SBIRT) and medication-assisted treatment for alcohol use disorder (MAUD) in primary care settings in a facilitator-supported, tailored implementation study. The authors used practice facilitation to support the implementation of SBIRT and MAUD in 48 clinical practices across Oregon, Washington, and Idaho. They used clinic contact logs, individual interviews, group periodic reflections with practice facilitators, and exit interviews with clinic staff to inform qualitative analysis. Clinics identified goals spanning SBIRT, MAUD, reporting, targeted patient outreach, and quality improvement capacity. Goals addressed both the technical (e.g., data tracking) and social (e.g. staff training) aspects of SBIRT and MAUD. A decision tree was also created that summarized emergent findings into a tool to support future implementation of SBIRT in primary care settings.
AHRQ-funded; HS027080.
Citation: Kenzie ES, Weekley T, Barnes C . Co-created improvement goals and strategies for implementing SBIRT and MAUD in primary care settings in a facilitator-supported, tailored implementation study. Transl Behav Med 2025 Jan 16; 15(1). doi: 10.1093/tbm/ibae059..
Keywords: Primary Care, Implementation, Evidence-Based Practice, Alcohol Use, Substance Abuse, Behavioral Health, Screening
Kukhareva P, Balbin C, Stevens E
The MyLungHealth study protocol: a pragmatic patient-randomised controlled trial to evaluate a patient-centred, electronic health record-integrated intervention to enhance lung cancer screening in primary care.
This paper describes an upcoming study that will investigate a patient-centered intervention, MyLungHealth, delivered through the patient portal. This intervention is designed to improve early lung cancer screening (LCS) rates through increased identification of eligible patients and informed decision-making. MyLungHealth will take place at the University of Utah Health and New York University Langone Health primary care clinics. The intervention's effectiveness will be evaluated through a patient-randomized trial, comparing the combined use of MyLungHealth and DecisionPrecision+ against DecisionPrecision+ alone. The first study hypothesis is that among patients aged 50-79 with uncertain LCS eligibility, MyLungHealth eligibility questionnaires will result in increased identification of LCS-eligible patients. The second study hypothesis is that among patients aged 50-79 with documented LCS eligibility (20+ pack-years, quit within the last 15 years if individuals who used to smoke, and no recent screening or screening discussion), MyLungHealth education will result in increased LDCT ordering. Primary outcomes will be increased identification of LCS-eligible patients among individuals with uncertain LCS eligibility and LDCT ordering rates among individuals with documented LCS eligibility.
AHRQ-funded; HS028791.
Citation: Kukhareva P, Balbin C, Stevens E . The MyLungHealth study protocol: a pragmatic patient-randomised controlled trial to evaluate a patient-centred, electronic health record-integrated intervention to enhance lung cancer screening in primary care. BMJ Open 2024 Dec 22; 14(12):e087056. doi: 10.1136/bmjopen-2024-087056..
Keywords: Cancer: Lung Cancer, Cancer, Patient-Centered Healthcare, Electronic Health Records (EHRs), Health Information Technology (HIT), Screening, Primary Care
Bradley K, McCormack J, Addis M
Do electronic health records used by primary care practices support recommended alcohol-related care?
In a multi-state sample of 167 primary care practices, electronic health records (EHRs) demonstrated limited functionality for alcohol-related prevention and treatment. Fewer than two-thirds of EHRs provided a validated screening questionnaire or automatically scored screening results, and only a small portion could document or report brief interventions. For alcohol use disorders, slightly under half tracked diagnostic information and a minority supported referrals or monitored medication use. Experts from regional improvement initiatives had identified these features as crucial for promoting evidence-based care.
AHRQ-funded; HS027078; HS027088; HS027077; HS027076; HS027080.
Citation: Bradley K, McCormack J, Addis M . Do electronic health records used by primary care practices support recommended alcohol-related care? JAMIA Open 2024 Dec 4; 7(4):ooae125. doi: 10.1093/jamiaopen/ooae125..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Alcohol Use
Zaidi AH, Sood E, De Ferranti S
Parent and primary care clinician perceptions about pediatric hypertension.
This study examined the knowledge and perceptions of parents and health care teams regarding pediatric hypertension to identify common themes contributing to low hypertension detection. The researchers interviewed parents of children diagnosed with hypertension who did not follow up within 1 year after diagnosis and health care clinicians across 10 clinics in Delaware and Pennsylvania. A total of 38 stakeholders including 13 parents and 25 health care clinicians were interviewed. While parents thought blood pressure checks were important, clinicians often had competing priorities during annual visits. Both groups expressed skepticism about high blood pressure readings, attributing them to white coat syndrome or situational factors. Both groups shared concerns about medication use and preferred lifestyle changes.
AHRQ-funded; HS026393.
Citation: Zaidi AH, Sood E, De Ferranti S . Parent and primary care clinician perceptions about pediatric hypertension. JAMA Netw Open 2024 Dec 2; 7(12):e2451103. doi: 10.1001/jamanetworkopen.2024.51103.
Keywords: Children/Adolescents, Blood Pressure, Primary Care
Marcotte LM, Wheat CL, Rao M
Evaluating equity in a national virtual care management intervention: delivery and outcomes by race/ethnicity among veterans with hypertension and diabetes.
The objective of this study was to evaluate whether the Preventive Health Inventory (PHI), a virtual care management intervention implemented in the Veterans Health Administration (VHA), was delivered equitably among racial/ethnic groups. Researchers used data from the VHA Corporate Data Warehouse among veterans enrolled in primary care nationally. Their findings suggested that the PHI intervention was deployed equitably across race/ethnicity groups without significantly impacting most existing inequities in hypertension and diabetes.
AHRQ-funded; HS026369.
Citation: Marcotte LM, Wheat CL, Rao M . Evaluating equity in a national virtual care management intervention: delivery and outcomes by race/ethnicity among veterans with hypertension and diabetes. Health Serv Res 2024 Dec; 59(6):e14352. doi: 10.1111/1475-6773.14352.
Keywords: Diabetes, Blood Pressure, Racial and Ethnic Minorities, Disparities, Primary Care, Telehealth, Health Information Technology (HIT)
Davis MM, Coury J, Sanchez V
Improving screening, brief intervention and referral to treatment for unhealthy alcohol use in diverse, low-resourced primary care clinics.
This paper discusses the results of the ANTECEDENT (Partnerships to Enhance Alcohol Screening, Treatment, and Intervention) practice-facilitator implementation study, whose goal was to increase screening brief intervention and referral to treatment (SBIRT) and medication-assisted treatment for alcohol use disorder (MAUD) use in diverse primary care clinics. From November 2019 to April 2023, the authors conducted a convergent parallel mixed methods evaluation using participants from small- to medium-sized primary care clinics in Northwestern U.S. Clinics received foundational support (i.e., baseline/exit assessment, access to SBIRT Oregon website) and the option for supplemental implementation support (e.g., practice facilitation, expert consultation) over the 15-month intervention period. They recruited 75 unique clinics; 66 participated and 48 (73%) completed the study. Eight participating clinics chose to receive foundational support only while 58 chose to engage in supplemental support activities. The forty-two clinics that received supplemental support and completed the intervention engaged in practice facilitation, data review (38%), HIT support (31%), expert consultation (19%), and peer-to-peer learning (5%). There was significant improvement shown in self-reported SBIRT process outcomes. Positive experiences were described by clinics with ANTECEDENT support and highlighted remaining barriers to SBIRT and MAUD implementation.
AHRQ-funded; HS027080.
Citation: Davis MM, Coury J, Sanchez V . Improving screening, brief intervention and referral to treatment for unhealthy alcohol use in diverse, low-resourced primary care clinics. BMC Health Serv Res 2024 Nov 12; 24(1):1384. doi: 10.1186/s12913-024-11870-8.
Keywords: Alcohol Use, Substance Abuse, Behavioral Health, Screening, Primary Care
Liu T, Zhu Z, Thompson MP
Primary care practice telehealth use and low-value care services.
The purpose of this study was to examine how telehealth adoption in primary care practices affected the delivery of unnecessary medical services. The study analyzed Medicare claims data from 2019 to 2022, involving nearly 578,000 beneficiaries across 2,552 Michigan practices. The investigation evaluated eight measures of low-value care, including office visits, laboratory tests, and imaging services. Findings showed that practices with high telehealth usage had lower rates of certain unnecessary services, such as cervical cancer screening in older women and thyroid testing, while most other low-value care measures remained unchanged.
AHRQ-funded; HS028397.
Citation: Liu T, Zhu Z, Thompson MP . Primary care practice telehealth use and low-value care services. JAMA Netw Open 2024 Nov 4; 7(11):e2445436. doi: 10.1001/jamanetworkopen.2024.45436.
Keywords: Primary Care, Telehealth, Health Information Technology (HIT)
Fenton JJ, Cipri C, Gosdin M
Standardized patient communication and low-value spinal imaging: a randomized clinical trial.
This randomized clinical trial’s objective was to evaluate the effect of a standardized patient-delivered intervention on rates of low-value spinal imaging among primary care patients with acute low back pain. Physicians or advanced practice clinicians were recruited from 10 adult primary care or urgent care clinics. The intervention clinician group received 3 simulated office visits, each with a standardized patient instructor (SPI) portraying a patient with acute uncomplicated back pain. Primary outcome was lumbar spinal imaging completion within 90 days of acute low back pain visits, with study clinicians assessed up to 18 months of follow-up. The secondary outcomes were cervical spine imaging completion after acute neck pain visits, any imaging completion after an adult visit, patient experience ratings of clinicians, and use of targeted communication skills during an audio-recorded standardized patient evaluation visit. A total of 53 clinicians were included, with 25 in the intervention group, and 28 in the control group. Patients with acute low back pain who saw intervention and control clinicians during follow-up had similar rates of lumbar imaging. Adjusted follow-up rates of imaging for acute neck pain and overall imaging were not significantly different among patients of intervention and control clinicians. Intervention and control clinicians had similar mean (SD) patient experience ratings during follow-up. During audio-recorded standardized patient visits, intervention clinicians had significantly better ratings than controls on eliciting the patient's perspective and conveying empathy.
AHRQ-funded; HS026415.
Citation: Fenton JJ, Cipri C, Gosdin M . Standardized patient communication and low-value spinal imaging: a randomized clinical trial. https://www.pubmed.ncbi.nlm.nih.gov/39504026.
Keywords: Communication, Imaging, Back Health and Pain, Primary Care, Pain
Kalwani NM, Kling SMR, Vilendrer S
Electronic health record alert to promote adoption of limited transthoracic echocardiograms in primary care and cardiology clinics: a mixed methods evaluation.
The purpose of this study was to evaluate the implementation of electronic health record alerts promoting limited transthoracic echocardiograms at an academic medical center. The research analyzed ordering patterns from cardiology and primary care clinics, involving over 14,000 echocardiogram orders for more than 10,000 patients. The investigation included interviews with 24 healthcare providers to understand implementation factors. Results showed significant increases in limited echocardiogram orders at clinics using the alert system, with different preferences between specialists and primary care providers regarding alert content.
AHRQ-funded; HS026128.
Citation: Kalwani NM, Kling SMR, Vilendrer S . Electronic health record alert to promote adoption of limited transthoracic echocardiograms in primary care and cardiology clinics: a mixed methods evaluation. Circ Cardiovasc Qual Outcomes 2024 Nov; 17(11):e010621. doi: 10.1161/circoutcomes.123.010621..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Cardiovascular Conditions

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