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Compass Rose for Generating Community-based Referrals via Epic: Best Practices and Lessons Learned [Social determinants and vulnerable populations]

Annals of Family Medicine

Setting or Dataset: We used data from Epic on social needs screening and Compass Rose utilization. A Compass Rose episode was automatically generated in the patient’s medical record in Epic if patients indicated that they had at least one of the four social risk factors on the screening tool.

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Assessment of Project ECHO(R) Opioid Use Disorder Sessions for Primary Care Teams [Education and training]

Annals of Family Medicine

Study Design and Analysis: PC teams (clinical and non-clinical roles) attended 12 online monthly OUD sessions. Population studied: PC teams (clinical and non-clinical roles). Intervention: 12 monthly online OUD sessions held from April 2023 to March 2024.

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Top studies of 2024 relevant to primary care: From the PEER team

Canadian Family Physician

Objective To identify and summarize the most impactful medical articles published in 2024 relevant to primary care. Main message Articles addressed various clinical areas in primary care. Four studies that evaluated the impact of screening and guideline-adherence strategies on patient outcomes were honourable mentions.

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Association of Tobacco Assessment and Cessation Assistance with Social Determinants of Health Risk in Primary Care [Smoking cessation]

Annals of Family Medicine

Setting or Dataset: Electronic health record data from 11 community-based clinics within a safety-net system in the Midwest from 07/01/2021-3/31/2024. Results: Among 119,926 patients, 40% did not have SDOH assessed; 31% had 3 or more social needs identified during screening, 11% had 2, 7% had 1, and 11% had no social needs.

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Substance Use Disorder Screening in Adolescent Patients in Primary Care: Findings, Challenges, Lessons Learned [Behavioral, psychosocial, and mental illness]

Annals of Family Medicine

SUD screening is not universally done in primary care (PC). In our institution, screenings are completed for patients ≥15 years during well visits; those not presenting for well visits and under 15 may represent missed opportunities. A score ≥2 constitutes a positive screen for possible substance misuse.

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AMPLIFY™ Technology Enhances Prenatal Screening for 22q11.2 Microdeletion

Myriad Genetics

Less invasive options like prenatal cell-free DNA (cfDNA) screens can also be used to help identify the microdeletion. According to a study in Genes (Basel) , cfDNA screens have “a 70–83% detection rate and a 40–50% positive predictive value (PPV) for most associated 22q microdeletions.” Mayo Clinic. Accessed February 22, 2024.

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Position Statement on Measurement Based Care

Integrated Care News by CFHA

MBC is presented not simply as data collection, but as a dynamic, evidence-based clinical process that enhances outcomes, promotes equity, and strengthens team-based care. MBC supports optimal clinical practice, demonstrates the value of integrated care teams, and improves outcomes. What is MBC? 3, 4) Why is MBC important? 3, 5, 6) b.