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10.1001/jamainternmed.2017.0410 http://scihub22266oqcxt.onion/10.1001/jamainternmed.2017.0410 C5540052!5540052 !28395013     free     free     free Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 245.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 245.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 245.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Warning: imagejpeg(C:\Inetpub\vhosts\kidney.de\httpdocs\phplern\28395013 .jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117       JAMA+Intern+Med 2017 ; 177 (6 ): 838-845 Nephropedia Template TP {{tp|p=28395013 |t=2017. Association of Primary Care Practice Location and Ownership With the Provision of Low-Value Care in the United States |pdf=|usr=}}{{28395013 }} gab.com Text Association of Primary Care Practice Location and Ownership With the Provision of Low-Value Care in the United States JO: JAMA Intern Med http://www.kidney.de/pget.php?&tw=1&pmid=28395013 #FOAvip IMPORTANCE: Hospital-employed physicians provide primary care within the hospital or within community-based office practices. Yet, little is understood regarding the influence of hospital location and ownership on the delivery of low-value care. OBJECTIVE: To assess the association of hospital location and hospital ownership with the provision of low-value health services. DESIGN, SETTING, AND PARTICIPANTS: This study compared low-value service use after primary care visits at hospital-based outpatient practices from January 1, 1997, to December 31, 2011, vs community-based office practices and at hospital-owned vs physician-owned community-based office practices from January 1, 1997, to December 31, 2013. Logistic regression models adjusted for patient and health care professional characteristics and year, and weighted results were used to reflect population estimates. Results were also stratified by symptom acuity and whether a generalist physician (eg, general internist or family practitioner) was the patient's primary care provider. This study used nationally representative data from the National Ambulatory Medical Care Survey (January 1, 1997, to December 31, 2013) and the National Hospital Ambulatory Medical Care Survey (January 1, 1997, to December 31, 2011) on outpatient visits to generalist physicians. Participants were patients seen with 3 common primary care conditions, namely, upper respiratory tract infection, back pain, and headache. MAIN OUTCOMES AND MEASURES: The use of antibiotics (for upper respiratory tract infection), computed tomography or magnetic resonance imaging (for back pain and headache), radiographs (for upper respiratory tract infection and back pain), and specialty referrals (for all 3 conditions). RESULTS: This study identified 31?162 visits for upper respiratory tract infection, back pain, and headache, representing an estimated 739 million US primary care visits from 1997 to 2013. Compared with visits with community-based physicians, patients in visits to hospital-based physicians were younger (mean age, 44.5 vs 49.1 years; P?<?.001) and less frequently saw their primary care provider (52.7% vs 81.9%, P?<?.001). Although antibiotic use was similar in both settings, hospital-based visits had more orders for computed tomography and magnetic resonance imaging (8.3% vs 6.3%, P?=?.01), radiographs (12.8% vs 9.9%, P?<?.001), and specialty referrals (19.0% vs 7.6%, P?<?.001) than community-based visits. Multivariable adjustment and symptom acuity stratification revealed similar findings. Visits with a generalist other than the patient's primary care provider were associated with greater provision of low-value care but mainly within hospital-based settings. Practice patterns were similar among hospital-owned vs physician-owned community-based practices with the exception of specialty referrals, which were more frequent in hospital-owned community-based practices. CONCLUSIONS AND RELEVANCE: Visits to US hospital-based practices are associated with greater use of low-value computed tomography and magnetic resonance imaging, radiographs, and specialty referrals than visits to community-based practices, and visits to hospital-owned community-based practices had more specialty referrals than visits to physician-owned community-based practices. These findings raise concerns about the provision of low-value care at hospital-associated primary care practices. Twit Text FOAVip Association of Primary Care Practice Location and Ownership With the Provision of Low-Value Care in the United States ????JAMA Intern Med http://www.kidney.de/pget.php?&tw=1&pmid=28395013 #FOAvip Twit Text # Free Paper on # # # # # LINK http://www.kidney.de/pget.php?&tw=1&pmid=28395013 #FOAvip English Wikipedia <ref>{{Cite pmid|28395013 }}</ref> Association of Primary Care Practice Location and Ownership With the Provision of Low-Value Care in the United States #MMPMID28395013 Mafi JN ; Wee CC ; Davis RB ; Landon BE JAMA Intern Med 2017[Jun]; 177 (6 ): 838-845 PMID28395013 show ga IMPORTANCE: Hospital-employed physicians provide primary care within the hospital or within community-based office practices. Yet, little is understood regarding the influence of hospital location and ownership on the delivery of low-value care. OBJECTIVE: To assess the association of hospital location and hospital ownership with the provision of low-value health services. DESIGN, SETTING, AND PARTICIPANTS: This study compared low-value service use after primary care visits at hospital-based outpatient practices from January 1, 1997, to December 31, 2011, vs community-based office practices and at hospital-owned vs physician-owned community-based office practices from January 1, 1997, to December 31, 2013. Logistic regression models adjusted for patient and health care professional characteristics and year, and weighted results were used to reflect population estimates. Results were also stratified by symptom acuity and whether a generalist physician (eg, general internist or family practitioner) was the patient's primary care provider. This study used nationally representative data from the National Ambulatory Medical Care Survey (January 1, 1997, to December 31, 2013) and the National Hospital Ambulatory Medical Care Survey (January 1, 1997, to December 31, 2011) on outpatient visits to generalist physicians. Participants were patients seen with 3 common primary care conditions, namely, upper respiratory tract infection, back pain, and headache. MAIN OUTCOMES AND MEASURES: The use of antibiotics (for upper respiratory tract infection), computed tomography or magnetic resonance imaging (for back pain and headache), radiographs (for upper respiratory tract infection and back pain), and specialty referrals (for all 3 conditions). RESULTS: This study identified 31?162 visits for upper respiratory tract infection, back pain, and headache, representing an estimated 739 million US primary care visits from 1997 to 2013. Compared with visits with community-based physicians, patients in visits to hospital-based physicians were younger (mean age, 44.5 vs 49.1 years; P? |Ambulatory Care/statistics & numerical data [MESH] |Back Pain/therapy [MESH] |Community Health Centers/economics/*statistics & numerical data [MESH] |Female [MESH] |Headache/therapy [MESH] |Health Services Accessibility/economics/*statistics & numerical data [MESH] |Humans [MESH] |Male [MESH] |Outcome Assessment, Health Care [MESH] |Physicians' Offices/statistics & numerical data [MESH] |Primary Health Care/economics/*statistics & numerical data [MESH] |Professional Practice Location/economics/*statistics & numerical data [MESH] |Respiratory Tract Infections/therapy [MESH]Association of Primary Care Practice Location and Ownership With the P(epmc).pdf DeepDyve Pubget Overpricing