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When you redesign a practice around these principles, you can step off the productivity treadmill and focus on excellent patient care. [ABSTRACT FROM AUTHOR]

Many effective treatments are now available for benign prostatic hyperplasia. Use them when symptoms are troublesome -- or watch and wait when they're not. [ABSTRACT FROM AUTHOR]

Now more than ever an integral part of medical practice, the telephone can work for you -- or against you. Here's how to develop a sensible policy, triage calls, educate patients, and minimize medicolegal liability. [ABSTRACT FROM AUTHOR]

The relationship of trauma history to physical and emotional functioning in primary care pain patients was examined. Data were drawn from a mailed screening questionnaire for a larger study designed to evaluate an intervention for improving pain management in primary care. Results indicated that 50.4% of the pain patients reported experiencing at least one previous emotionally traumatic event. Further, 31% of patients with trauma history continued to be bothered by that experience. Finally, patients who continued to be significantly bothered by the trauma reported more pain, emotional distress, poorer social functioning, and more difficulty with engaging in their daily activities than did patients with either no trauma history or who had a trauma history but did not have bothersome thoughts of the trauma. These preliminary findings suggest that the experience of trauma alone was not related to additional impairments in physical and psychosocial functioning. However, the report that one continued to be bothered by thoughts of a trauma was associated with greater impairments in functioning. [ABSTRACT FROM AUTHOR]

A "What Matters Index" (WMI) represents the distillation of many self-reported measures about what matters. The WMI for adults contains only 5 items that efficiently identify important needs, reliably identify people at risk for future problems, and provide guidance for improving health care and well-being. This report uses data from 10 000 respondents to illustrate the value of a 3-item WMI for adolescents built on the model of the Adult WMI., (Copyright © 2023 The Author. Published by Wolters Kluwer Health, Inc.)

Purpose: To rectify the significant mismatch observed between what matters to patients and what clinicians know, our research group developed a standardized assessment, information, and networking technology (SAINT)., Methods: Controlled trials and field tests involving more than 230,000 adults identified characteristics of a successful SAINT- www.HowsYourHealth.org -for primary care and community settings., Results: Evidence supports SAINT effectiveness when the SAINT has a simple design that provides a service to patients and explicitly engages them in an information and communication network with their clinicians. This service orientation requires that an effective SAINT deliver easily interpretable patient reports that immediately guide provider actions. For example, our SAINT tracks patient-reported confidence that they can self-manage health problems, and providers can immediately act on patients' verbatim descriptions of what they want or need to become more health confident. This information also supports current and future resource planning, and thereby fulfills another characteristic of a successful SAINT: contributing to health care reliability. Lastly, SAINTs must manage or evade the "C-monsters," powerful obstacles to implementation that largely revolve around control and commercialism. Responses from more than 10,000 adult patients with diabetes illustrate how a successful SAINT offers a standard and expedient guide to managing each patient's concerns and adjusting health services to better meet the needs of any large patient population., Conclusion: Technologies that evolve to include the characteristics described here will deliver more effective tools for patients, providers, payers, and policymakers and give patients control over sharing their data with those who need it in real time., (© 2020. The Author(s).)

Patient-reported health confidence is a valuable indicator of effective patient-clinician communication, which improves outcomes and reduces costly care use. This national survey examines health confidence attainment in the United States before the COVID pandemic strained health care resources. Health confidence was low for both the percentage of respondents who were financially secure (36%) and financially insecure (18%). Persons enrolled in employer- and union-sponsored plans, who had the highest household income, did not report higher levels of health confidence. Health policy should support the measurement and monitoring of health confidence in clinical practice to improve population health and maximize resource efficiency.

During college and medical school, the author's summer employment acquainted him with members of organized crime families. After a full career as a primary care clinician and geriatrician with research on improving health care delivery, the author opines that several insights from organized crime should be of interest to health care professionals: (1) don't damage the host; (2) protect the brand; and (3) lead necessary adaption. From these insights, the author presents symptoms of failure evidenced by the US health care system, followed by several adaptations that would reduce the system's costs, improve its image, and address future challenges.

Using responses to HowsYourHealth.org from 9068 patients aged 65 years or older, I illustrate measurement compromises for quality-of-life assessment and management.

Introduction: Current health care delivery relies on complex, computer-generated risk models constructed from insurance claims and medical record data. However, these models produce inaccurate predictions of risk levels for individual patients, do not explicitly guide care, and undermine health management investments in many patients at lesser risk. Therefore, this study prospectively validates a concise patient-reported risk assessment that addresses these inadequacies of computer-generated risk models., Methods: Five measures with well-documented impacts on the use of health services are summed to create a "What Matters Index." These measures are: 1) insufficient confidence to self-manage health problems, 2) pain, 3) bothersome emotions, 4) polypharmacy, and 5) adverse medication effects. We compare the sensitivity and predictive values of this index with two representative risk models in a population of 8619 Medicaid recipients., Results: The patient-reported "What Matters Index" and the conventional risk models are found to exhibit similar sensitivities and predictive values for subsequent hospital or emergency room use. The "What Matters Index" is also reliable: akin to its performance during development, for patients with index scores of 1, 2, and ≥3, the odds ratios (with 95% confidence intervals) for subsequent hospitalization within 1 year, relative to patients with a score of 0, are 1.3 (1.1-1.6), 2.0 (1.6-2.4), and 3.4 (2.9-4.0), respectively; for emergency room use, the corresponding odds ratios are 1.3 (1.1-1.4), 1.9 (1.6-2.1), and 2.9 (2.6-3.3). Similar findings were replicated among smaller populations of 1061 mostly older patients from nine private practices and 4428 Medicaid patients without chronic conditions., Summary: In contrast to complex computer-generated risk models, the brief patient-reported "What Matters Index" immediately and unambiguously identifies fundamental, remediable needs for each patient and more sensibly directs the delivery of services to patient categories based on their risk for subsequent costly care.

Introduction: Targeting resources for a designated higher-risk subgroup is a strategy for chronic care management. However, risk-designation has several limitations: it is inaccurate, seldom helpful for care guidance, and potentially misallocates care away from many patients., Methods: To address limitations of risk designation, we tested a "what matters index" (WMI) in 19,593 adult patients with chronic conditions. The WMI contains five binary measures: insufficient confidence to manage health problems, level of pain, emotional problems, polypharmacy, and adverse medication effects. We examined its sum for association with patient-reported quality of life and prior emergency or hospital use. We compared its accuracy to a prototypic risk-designation model., Results: The WMI was a good indicator for quality of life and in three diverse test populations it was strongly associated with the use of hospital and emergency services. For example, a sum of WMI ≥2 was associated with twice as many average uses as none; for ≥3, uses were three times higher. However, since relatively few patients use costly care, both the WMI and a prototypic risk-designation model had comparably low-positive predictive values. The WMI uses the patient voice to identify needs strongly associated with quality of life. Akin to risk designation models, the WMI can be used to place patients into groups associated with levels of costly services, but neither is likely to forecast costly service use for individuals. However, unlike risk-designation models, the WMI is based on measures that will immediately guide care for every patient.

Regular exercise is a healthy behavior associated with desirable benefits. Regular exercise also makes manifest 2 fundamental behaviors-a choice and the discipline to continuously act on that choice. This cross-sectional analysis of more than 10 000 adults examines the association of regular exercise with unhealthy behaviors. Compared with people who are more regularly exercising, nonexercisers are less likely to choose to change an unhealthy habit. Nonexercisers are also much less likely to be confident of their success when they do choose a habit to change. Regular exercise seems to be a gateway behavior for reducing other unhealthy habits.

We use an Internet-based health assessment and feedback system to examine the range of needs and diverse experiences of 520 hospitalized adults in transition and the factors most strongly associated with their self-reported health confidence. Our results strongly suggest that patient engagement prior to admission and the quality of care coordination and communication during hospitalization can greatly enhance successful transition from the hospital back to the community. Hospitals are complex institutions. This report illustrates how the Internet or a straightforward graphic can make the complexity less overwhelming to patients and efficiently increase their health confidence for transitions.

Patient health confidence is an easy-to-obtain proxy measure for patient engagement and patient activation. In evidence-based literature syntheses, longitudinal studies, and empiric analyses, this measure is related to desirable consequence of medical care. Adult patients from 15 primary care practices and a national sample report on changes in health confidence over time. Exemplary practices describe how this information is used as a foundation for behaviorally sophisticated actions so necessary for improving health confidence.

Patient-reported experience of care predicts health care outcomes. Fourteen US and Canadian practices intercalated a standard ambulatory care Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey within their usual Internet-based survey to compare results from the Internet survey, Internet CAHPS survey, and a mailed CAHPS survey. They found that practice performance rankings obtained via the multi-item CAHPS survey were equivalent to a single measure captured by the Internet survey.

As part of a health "checkup," a large national sample of adults used an Internet technology that also asks about adverse experiences. About half of all respondents do not feel very confident they can manage and control most of their health problems, almost 30% consider that their hospital or emergency department use was unnecessary, 20% believe that their medications may be causing illness, and 1.5% report a medical-related harm. Routine measures across a spectrum of adverse experiences are easy to obtain as part of everyday practice. Attention to these measures by health professionals should make care safer and less wasteful.

With the phrase "the medium is the message", Marshall McLuhan argued that technologies are the messages themselves and not just the medium. Almost 50 years later, we understand that modern information and communication technologies expand our ability to perceive our world to an extent that would be impossible without the medium. In this article, we contend that information and communication technologies are becoming the dominant medium for patient engagement. Information and communication technologies will efficiently change patient-reported measurement into much more behaviorally sophisticated information that will create a very different interaction between patients and a new kind of health care workforce.

There is a large gap between the promise of patient-centered medical home (PCMH) and our current capacity to define and measure it. The purpose of this article is to describe the findings of "real-time" patient-reported data about constructs of the PCMH and to demonstrate how an Internet-based method can be useful for obtaining patient report about the PCMH. We find that patients' Internet ratings seem stable and demonstrate relationships that fit constructs and models for the PCMH. We also find that current PCMH performance across this sample of 69 clinical settings is highly variable and still leaves a great deal of room for improvement.

Medical practice redesign refers to the intentional efforts to improve practice processes and outcomes. Efforts to redesign office-based medical care go back some forty years. We divide the history of practice redesign into three overlapping phases: basic investigation, model development, and dissemination. The "medical home" movement in primary care has accelerated this dissemination phase. The acceleration and scaling up of efforts in practice redesign that have resulted from interest in the medical home present substantial opportunities and challenges for the medical profession and the U.S. health care system. We review the history and extract lessons to inform today's medical practice redesign efforts.

CARE Vital Signs refers to a standard form created by practices to Check what matters to patients, Act on that assessment, Reinforce the actions, and systematically Engineer or incorporate actions into staff roles and clinical processes. On its face, CARE Vital Signs is a deceptively simple tool that, when properly used, can help a practice attain levels of efficiency and quality. This article describes the rationale for CARE Vital Signs and the ways it can be used for the greatest benefit.

The Institute for Healthcare Improvement has long supported the use of balanced measures to assess improvement among patients at both the individual and the population levels. Although biomedical outcomes and process measures have been widely accepted, patient-reported measures are still not in widespread use. The most common use of such measures is at the population level to gauge satisfaction with care long after it has been provided. This article examines barriers and solutions to including patient-reported measures at the point of care.

The Institute for Healthcare Improvement and others have spent a decade transforming the concept of patient-centered care from the realm of idea to the reality of practice. In this introduction, we provide a summary of this transformation, and the practical steps practices and health systems can take to make their transition to providing more patient-centered care.

Background: Usual medical care in the United States is frequently not a satisfying experience for either patients or primary care physicians. Whether primary care can be saved and its quality improved is a subject of national concern. An increasing number of physicians are using microsystem principles to radically redesign their practices. Small, independent practices-micro practices-are often able to incorporate into a few people the frontline attributes of successful microsystems such as clear leadership, patient focus, process improvement, performance patterns, and information technology., Patient Focus, Process Improvement, and Performance Patterns: An exemplary microsystem will (1) have as its primary purpose a focus on the patient-a commitment to meet all patient needs; (2) make fundamental to its work the study, measurement, and improvement ofcare-a commitment to process improvement; and (3) routinely measure its patterns of performance, "feed back" the data, and make changes based on the data., Lessons From Micro Practices: The literature and experience with micro practices suggest that they (1) constitute an important group in which to demonstrate the value of microsystem thinking; (2) can become very effective clinical microsystems; (3) can reduce their overhead costs to half that of larger freestanding practices, enabling them to spend more time working with their patients; (4) can develop new tools and approaches without going through layers of clearance; and (5) need not reinvent the wheel., Conclusions: Patient-reported data demonstrate how micro practices are using patient focus, process improvement, performance patterns, and information technology to improve performance. Pati ents should be able to report that they receive "exactly the care they want and need exactly when and how they want and need it."

Background: Wherever, however, and whenever health care is delivered-no matter the setting or population of patients-the body of knowledge on clinical microsystems can guide and support innovation and peak performance. Many health care leaders and staff at all levels of their organizations in many countries have adapted microsystem knowledge to their local settings., Clinical Microsystems: A PANORAMIC VIEW: HOW DO CLINICAL MICROSYSTEMS FIT TOGETHER? As the patient's journey of care seeking and care delivery takes place over time, he or she will move into and out of an assortment of clinical microsystems, such as a family practitioner's office, an emergency department, and an intensive care unit. This assortment of clinical microsystems-combined with the patient's own actions to improve or maintain health--can be viewed as the patient's unique health system. This patient-centric view of a health system is the foundation of second-generation development for clinical microsystems., Lessons From the Field: These lessons, which are not comprehensive, can be organized under the familiar commands that are used to start a race: On Your Mark, Get Set, Go! ... with a fourth category added-Reflect: Reviewing the Race. These insights are intended as guidance to organizations ready to strategically transform themselves., Conclusion: Beginning to master and make use of microsystem principles and methods to attain macrosystem peak performance can help us knit together care in a fragmented health system, eschew archipelago building in favor of nation-building strategies, achieve safe and efficient care with reliable handoffs, and provide the best possible care and attain the best possible health outcomes.

The problem faced by primary care physicians is that they can only maintain or increase their (inflation adjusted) incomes by increasing the volume of visits and associated services. The fundamental flaw in a fee-for-service system is that only paying for individual services creates incentives for more services. This article offers a very different approach to paying primary care physicians that will result in both significantly higher incomes for these underpaid professionals together with incentives for creating a medical home.

Background: As patients directly experience harm from adverse events, investigators have proposed patient-report to complement professional reporting of adverse events., Objective: To investigate how an automated health assessment system can be used to identify adverse events., Design and Setting: Internet survey responses from April 2003 to April 2005 involving communities and clinical practices across the USA., Patients: 44,860 adults aged 19-69 years., Outcome: Patient perceptions of adverse events experienced during the previous year. Independent legal review was also used to estimate how many patient-reports were serious enough to be potentially compensable., Results: Although patient reports of possible adverse events was low (1.4%), the percentage of adverse events was eight times higher for patients with the greatest burden of illness than for those with the least (3.4% vs 0.4%). Two expert malpractice attorneys agreed that 9% of the adverse events seemed to be serious., Conclusions: PATIENTS will use internet technology to report their perceptions of health-related adverse events. Some of the patient-reported events reported will be serious.

Collaborative Care refers to a partnership between healthcare professionals and patients who feel confident to manage their health conditions. Using an Internet-based assessment of health needs and healthcare quality, we surveyed 24,609 adult Americans aged 19 to 69 who had common chronic diseases or significant dysfunction. In these patients, we examined the association of Collaborative Care with specific measures for treatment effect, disease control, prevention, and economic impacts. These measures were adjusted for respondents' demographic characteristics, burden of illness, health behaviors, and overall quality of healthcare. Only 21% of respondents participated in good Collaborative Care, 36% attained fair Collaborative Care, and 43% experienced poor Collaborative Care. Regardless of overall care quality or the respondents' personal characteristics, burden of illness, or health behaviors, good Collaborative Care was associated with better control of blood pressure, blood glucose level, serum cholesterol level, and treatment effectiveness for pain and emotional problems. Some preventive actions were better, and some adverse economic impacts of illness were mitigated.

In this report, we compare healthcare processes for patients with low (n = 7467) and adequate financial status (n = 43,701) after adjustment for age, gender, burden of illness, and health behaviors. Patients with low financial status were 10% to 30% less likely to report good service and collaborative care; they report that markers of disease management and prevention were 7% to 18% below the levels of patients with adequate income. From the patient perspective, these results confirm that inadequate financial status has a broad and adverse influence on health and healthcare. Technology for patient-centered, collaborative care alone will not remedy the problem of health disparity.