RESUMEN
We studied a primary care clinic transitioning to Meaningful Use stage 1 and a comparison clinic within the same health system. In the 6 months following implementation, after adjusting for confounders, mean systolic blood pressure worsened (+3.3 mm Hg; P = .004) in the intervention clinic compared with the comparison clinic. We did not see a change in the mean or proportion of patients meeting target goals for diabetes (hemoglobin A1c) or obesity (body mass index). Our findings suggest that the worsening of systolic blood pressure associated with Meaningful Use implementation is likely due to distractions of system changes negatively impacting health outcomes.
Asunto(s)
Instituciones de Atención Ambulatoria , Difusión de Innovaciones , Uso Significativo , Evaluación de Resultado en la Atención de Salud , Atención Primaria de Salud , Humanos , Evaluación de Resultado en la Atención de Salud/métodos , Estudios Retrospectivos , Estados UnidosRESUMEN
The American College of Preventive Medicine Prevention Practice Committee contributes to policy guidelines and recommendations on preventive health topics for clinicians and public health decision makers. As an update to a previously published statement on weight management counseling of overweight adults, the College is providing a consensus-based recommendation designed to more effectively integrate weight management strategies into clinical practice and to incorporate referrals to effective evidence-based community and commercial weight management programs. The goal is to empower providers to include lifestyle interventions as part of the foundation of clinical practice.
Asunto(s)
Programas de Reducción de Peso , Humanos , Tamizaje Masivo , Obesidad/diagnósticoRESUMEN
OBJECTIVE: To review the impact of the Joint Principle of the Patient Centered Medical Home (PCMH) on hemoglobin A1C (HbA1C) in primary care patients with diabetes. METHODS: Systematic review of English articles using approximate terms for (1) the 7 principles of the PCMH, (2) primary care, and (3) HbA1C. We included experimental and observational studies. Three authors independently extracted data and obtained summary estimates for concepts with more than 2 high-quality studies. RESULTS: Forty-three studies published between 1998 and 2012 met inclusion criteria, 33 randomized and 10 controlled before-after studies. A physician-directed medical practice (principle 2) lowered HbA1C values when utilizing nursing (mean difference [MD] -0.36, 95% confidence interval [CI] -0.43 to -0.28) or pharmacy care management (MD -0.76; 95% CI -0.93 to -0.59). Whole-person orientation (principle 3) also lowered HbA1C (MD -0.72, 95% CI -0.98 to -0.45). Studies of coordinated and integrated care (principle 4) and quality and safety interventions (principle 5) did not consistently lower HbA1C when reviewed in aggregate. We did not identify high-quality studies to make conclusions for personal physician (principle 1), enhanced access (principle 6), and payment (principle 7). CONCLUSION: Our review found individual interventions that reduced the HbA1C by up to 2.0% when they met the definitions set by of the Joint Principles of the PCMH. Two of the principles-physician-led team and whole-person orientation-consistently lowered the HbA1C. Other principles had limited data or made little to no impact. Based on current evidence, PCMH principles differentially influence the HbA1C, and there are opportunities for additional research.