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4.  Reassessing the HPI: The Chronology of Present Illness (CPI) 
doi:10.1007/s11606-013-2573-3
PMCID: PMC3889925  PMID: 23949574
6.  Visiting 
doi:10.1007/s11606-013-2580-4
PMCID: PMC3889927  PMID: 23959746
8.  Warfarin-Induced Skin Necrosis 
doi:10.1007/s11606-013-2560-8
PMCID: PMC3889929  PMID: 23943419
skin necrosis; warfarin; adverse drug reactions
9.  Back Attack 
doi:10.1007/s11606-013-2487-0
PMCID: PMC3889930  PMID: 23733373
decision making; clinical problem solving; back pain
11.  Theory of Relativity 
doi:10.1007/s11606-013-2509-y
PMCID: PMC3889932
12.  A Randomized Clinical Trial of Alcohol Care Management Delivered in Department of Veterans Affairs Primary Care Clinics Versus Specialty Addiction Treatment 
ABSTRACT
BACKGROUND
Alcohol use disorder is one of the leading causes of disability worldwide. Despite the availability of efficacious treatments, few individuals with an alcohol use disorder are actively engaged in treatment. Available evidence suggests that primary care may play a crucial role in the identification of patients with an alcohol use disorder, delivery of interventions, and the success of treatment.
OBJECTIVE
The principal aims of this study were to test the effectiveness of a primary care-based Alcohol Care Management (ACM) program for alcohol use disorder and treatment engagement in veterans.
DESIGN
The design of the study was a 26-week single-blind randomized clinical trial. The study was conducted in the primary care practices at three VA medical centers. Participants were randomly assigned to treatment in ACM or standard treatment in a specialty outpatient addiction treatment program.
PARTICIPANTS
One hundred and sixty-three alcohol-dependent veterans were randomized.
INTERVENTION
ACM focused on the use of pharmacotherapy and psychosocial support. ACM was delivered in-person or by telephone within the primary care clinic.
MAIN MEASUREMENTS
Engagement in treatment and heavy alcohol consumption.
KEY RESULTS
The ACM condition had a significantly higher proportion of participants engaged in treatment over the 26 weeks [OR = 5.36, 95 % CI = (2.99, 9.59)]. The percentage of heavy drinking days were significantly lower in the ACM condition [OR = 2.16, 95 % CI = (1.27, 3.66)], while overall abstinence did not differ between groups.
CONCLUSIONS
Results demonstrate that treatment for an alcohol use disorder can be delivered effectively within primary care, leading to greater rates of engagement in treatment and greater reductions in heavy drinking.
doi:10.1007/s11606-013-2625-8
PMCID: PMC3889933  PMID: 24052453
addiction; primary care; treatment; randomized clinical trial
13.  Is Mortality Risk Reduced in Overweight or Obese Diabetics? 
doi:10.1007/s11606-013-2608-9
PMCID: PMC3889934  PMID: 24002636
14.  The Innovator’s DNA and Health Care Improvement 
doi:10.1007/s11606-013-2694-8
PMCID: PMC3889935  PMID: 24309951
15.  Highway Tollbooth Worker 
doi:10.1007/s11606-013-2558-2
PMCID: PMC3889936
16.  Physicians as Part of the Solution? Community-Based Participatory Research as a Way to Get Shared Decision Making into Practice 
ABSTRACT
Although support among policy makers and academics for the wide scale adoption of shared decision making (SDM) is growing, actual implementation is slow, and faces many challenges. Extensive systemic barriers exist that prevent physicians from being able to champion SDM and lead practice change. In other areas of public health where implementation has been a challenge, community-based participatory research (CBPR) has effectively engaged resistant stakeholders to improve practice and the delivery of care. Might CBPR, defined broadly as research that engages participants in the conception, design, and implementation of relevant health programs, be a more effective way to engage physicians, patients, and managers in the implementation process? Consequently, we argue that adopting a participatory approach may help to overcome recognized barriers to progress in this area.
doi:10.1007/s11606-013-2602-2
PMCID: PMC3889937  PMID: 24002635
shared decision making; community-based participatory research; implementation; patient engagement; clinical practice
17.  The Impact of Managed Care Contracting on Physicians 
ABSTRACT
BACKGROUND
Prior literature suggests that the fragmented U.S. health care system places a large administrative burden on physicians. Less is known about how this burden varies with physician contracting practices.
OBJECTIVE
To assess the extent to which physician practice outcomes vary with the number of managed care contracts held or the availability of such contracts.
DESIGN, PARTICIPANTS, AND MAIN MEASURES
We perform secondary data analyses of the first four rounds of the nationally representative Community Tracking Study Physician Survey (1996–2005), which includes 36,340 physicians (21,567 PCPs [primary care physicians] and 14,773 specialists) across the four survey periods. Our measures include reported hours in patient care, share of hours outside patient care, adequacy of time with patients, career satisfaction, and income.
RESULTS
Doctors who contract with more plans report spending more time in patient care (per 11 additional contracts, about 30 min per week for PCPs and 20 min per week for specialists), report spending a modestly larger share of their time outside patient care (per 11 additional contracts, about 10 min per week for PCPs and specialists), are slightly more likely to report inadequate time with patients (odds ratio 1.005 per additional contract for PCPs), and earn higher incomes (per 11 additional contracts, about 3 % more per year for specialists).
CONCLUSIONS
Contracting opportunities confer significant benefits on physicians, although they do add modest costs in terms of time spent outside patient care and lower adequacy of time with patients. Simplifications that reduce the administrative burden of contracting may improve care by optimizing allocation of physician effort.
doi:10.1007/s11606-013-2589-8
PMCID: PMC3889938  PMID: 24002628
managed care contracts; administrative costs; time with patients; physician income
18.  10 Bold Steps to Prevent Burnout in General Internal Medicine 
doi:10.1007/s11606-013-2597-8
PMCID: PMC3889939  PMID: 24002633
burnout; prevention; general internal medicine
22.  Evaluating the Brief Health Literacy Screen 
doi:10.1007/s11606-013-2654-3
PMCID: PMC3889943  PMID: 24129859
25.  Calcinosis in Adult-Onset Dermatomyositis: Metastatic or Dystrophic? 
doi:10.1007/s11606-013-2564-4
PMCID: PMC3889946  PMID: 23943420
calcinosis; dermatomyositis; leukocytoclastic vasculitis; hypercalcemia; lymphoma

Results 1-25 (4468)