Industrialized countries face a daunting challenge in providing high-quality care for aging
patients with increasingly complex health care needs who will need ongoing chronic care …

Objectives. To test the effect of CommunityRx, a scalable, low-intensity intervention that
matches patients to community resources, on mental health-related quality of life …

Background: We evaluated a large-scale transition of primary care physicians to blended
capitation models and team-based care in Ontario, Canada, to understand the effect of each …

The article discusses the role of registered nurses (RN) in ambulatory care, particularly in
the US Also cited are the changes in healthcare since the issuance by the American …

Background: Telemedicine-based diabetes management improves outcomes versus clinic
care but is seldom implemented by healthcare systems. In order to advance telemedicine …

Objective Individuals with schizophrenia are more likely to develop diabetes than individuals
without schizophrenia. The objective of this study was to determine the quality of diabetes …

Background Support for ongoing care management and coordination between office visits
for patients with multiple chronic conditions has been inadequate. In January 2015 …

Background: Efforts to better support primary care include the addition of primary care–
focused billing codes to the Medicare Physician Fee Schedule (MPFS). Objective: To …

Methods| We analyzed Medicare claims data from 2012 through 2016 for a random 20%
sample of fee-for-service beneficiaries. Beginning with the first year of each of their …

Personalized care planning, a formal process in which clinicians and patients collaborate in
the creation of longitudinal treatment plans, is a frequently mentioned tool to improve the …