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Transitional Care Management care team impact on no-show rates to hospital discharge appointments [Patient education/adherence]

Annals of Family Medicine

Context: The Transitional Care Management (TCM) clinic visit is a uniquely billed visit type to review a recently discharged patient’s hospital course, reconcile medications, and continue ongoing workup. Objective: Our objective was to improve the TCM clinic no-show rate and thereby improve patient outcomes.

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Risks and Needs: Lessons Learned from Assessing Patients Willingness to Receive Help for Social Risks in Primary Care [Social determinants and vulnerable populations]

Annals of Family Medicine

Context: In May 2023, Mayo Clinic implemented a revised screening tool to assess social determinants of health (SDOH) for its patients. Setting or Dataset: Secondary data on social needs screening and referral generated through Epic. Study Design and Analysis: Descriptive analysis of secondary data.

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Visiting a Health Clinic for Women’s Health Screenings

Mesa Family Physician

Whether it’s your first pap smear or you’re wondering if you can have the test while on your period, this guide walks you through the essentials of women’s health checkups, how to prepare, and common questions many patients have. Many patients search online for variations like: Can you have a pap smear while menstruating?

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Pilot Testing of the Treatment Burden Screening in Diabetes Tool in Primary Care [Multimorbidity]

Annals of Family Medicine

Context: Nearly all patients with type 2 diabetes have comorbid chronic conditions, adding complexity to self-management. A tool to more efficiently relay points of patient-perceived treatment burden during a primary care visit may lead to more patient-centered care plans and improved outcomes.

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Flipping the Script: A Design thinking Approach to Enhancing Interprofessional Collaboration in Primary Care [Research capacity building]

Annals of Family Medicine

The challenges faced stem from the uncertainty and complexity of redefining professional roles and scopes of practice, as well as the skills needed to effectively work together and coordinate patient care as a cohesive team. This tabletop flip menu is available in each exam room and to all administrative staff at the clinic.

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Artificial Intelligence in Health Care

Integrated Care News by CFHA

That small win reminded me that artificial intelligence is already shaping the way our patients (and our families) search for health advice. Our Patients Are Already Using AI Many people now ask their first health question to a chatbot rather than to a clinician. Keep it simple because I’m not a great cook.”

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How to Improve Care for Patients With Multiple Chronic Conditions

Physician's Weekly

Caring for patients with multiple chronic conditions requires identifying those at risk, clear communication, and coordinated care to improve outcomes. Many of these patients are clinically complex and receive care from multiple professionals—which creates unique management hurdles.