Electronics and Family - Primary Care Digest

Electronic Health Record Use and Patient-Centredness [Education and training]

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Large-scale electronic health record (EHR) programs have reported a number of issues to their implementation in primary care including physician patient-centredness and clinical performance. Setting: An academic primary care clinic based in a hospital. Population: Ten resident physicians and six staff physicians.

Electronics

Electronics Education Patients Primary Care

Implementation of a novel linkage of primary care electronic medical record data with hospital data in South Eastern Ontario [Big data]

Annals of Family Medicine

NOVEMBER 20, 2024

Objectives: To link primary care electronic medical record (EMR) data with community and hospital data and to test the utility of the merged dataset through a targeted quality improvement (QI) intervention among high-risk patients with chronic obstructive pulmonary disease (COPD).

Primary Care

Primary Care Electronics Hospital Medical

Utilization of Treatment for Chlamydia and Gonorrhea in the Primary Care Setting Using the American Family Cohort [Infectious diseases (not respiratory tract)]

Annals of Family Medicine

NOVEMBER 20, 2024

Setting or Dataset: Electronic health records from the PRIME Registry, years 2018-2022. The electronic health records are stored in the American Family Cohort, the largest national United States primary care database.

Primary Care

Primary Care Family Families Utilities

Describing Differences Across Place and Provider in Canadian Team-Based Care Settings Using Electronic Health Records [Health care informatics]

Annals of Family Medicine

NOVEMBER 20, 2024

Community Health Centres (CHCs) provide TBC for both urban and rural populations with barriers to care in Ontario, Canada, and they share a common electronic health record (EHR) system that records codes assigned by providers during an encounter.

Electronics

Electronics Provider Family Physician Mental Health

Pajama Time: The Association of EHR Documentation Time with Family Medicine Resident Outcomes [Education and training]

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Multiple studies have identified that working on the electronic health record (EHR) after clinic hours ("pajama time") is a source of burnout and decreasing professional satisfaction. Study Design and Analysis: Survey of US family medicine (FM) residents. Population Studied: PGY2 and above US FM residents.

DO

DO Family Medicine Family Families

Test-Retest Reliability of Electronic Handgrip Dynamometry and Accelerometry Measured Muscle Function in Older Adults [Musculoskeletal and rheumatology]

Annals of Family Medicine

NOVEMBER 20, 2024

Utilizing new electronic handgrip dynamometer and accelerometer technologies may allow for additional muscle function attributes to be feasibly measured, which in turn, may help elevate prognostic value and specificity for intervention referral. for maximal strength, 0.99 for asymmetry, 0.65 for submaximal control, 0.92

Electronics

Electronics Primary Care Utilities Referral

Machine learning models for atrial fibrillation detection in primary care using electronic health records: systematic review [Cardiovascular disease]

Annals of Family Medicine

NOVEMBER 20, 2024

Machine learning (ML) models offer potential for improved detection of AFib from electronic health records (EHR). Context: Atrial fibrillation (AFib) significantly impacts patient morbidity and mortality, despite existing screening practices.

Primary Care

Primary Care Electronics Screening Clinic

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

Annals of Family Medicine

NOVEMBER 20, 2024

Setting: Wellstar MCG Health is a 520-bed tertiary hospital with a Family Medicine inpatient service and an attached Family Medicine resident continuity clinic. Population Studied: Inpatients were referred if they were being discharged from the Family Medicine service to home.

Appointment

Appointment Hospital Management DO

Factors Associated with Documenting Social Determinants of Health in Electronic Health Records by Family Physicians [Social determinants and vulnerable populations]

Annals of Family Medicine

NOVEMBER 20, 2024

Understanding SDOH documentation in electronic health records (EHRs) is crucial for care management to improve patient outcomes and mitigate health inequities. Objective: To explore how family physicians document SDOH in EHRs and identify factors influencing this practice Study Design and Analysis: A cross-sectional observational analysis.

Family Physician

Family Physician Electronics Family Families

Exploring Trends in Postpartum Hemorrhage with SHRINE Network Aggregated Electronic Health Records (EHR) Data. [Health care disparities]

Annals of Family Medicine

NOVEMBER 20, 2024

Healthcare research involving patient medical data is often delayed by lengthy approval processes. The Shared Health Research Information Network (SHRINE) offers rapid, secure access to aggregate counts of patient data from participating hospitals.

Electronics

Electronics Patient-Centered Utilities Hospital

Predicting Likelihood of Missed Appointments in Primary Care [Health care informatics]

Annals of Family Medicine

NOVEMBER 20, 2024

Objective To evaluate the association between patient, health system, geosocial, and environmental factors on the likelihood of MA in Family Medicine clinics. Study Design and Analysis Retrospective, longitudinal study using electronic health records.

Appointment

Appointment Primary Care DO Family Medicine

Resident Voices: Key Findings from Journal Club Surveys [Education and training]

Annals of Family Medicine

NOVEMBER 20, 2024

Last year, our Family Medicine Residency Program restructured the Journal Club to incorporate a more resident-driven approach. Study Design and Analysis We conducted a retrospective survey distributed electronically and securely among the graduating class of residents.

Education

Education DO Family Medicine Electronics

A brief theory driven patient education video to reduce potentially harmful regular over-the-counter NSAID use [Patient education/adherence]

Annals of Family Medicine

NOVEMBER 20, 2024

Objective: To assess the effectiveness of a novel electronically delivered education video in reducing regular OTC NSAID use in high-risk patients (ie. Those who self-identified as regular NSAID users were randomized into either video or control and completed electronic assessments before, immediately after, and 4-weeks after education.

Education

Education Patients Electronics Hypertension

Development and Testing of an Interoperable e-care Plan for Person-Centered Care Planning for Multiple Chronic Conditions [Multimorbidity]

Annals of Family Medicine

NOVEMBER 20, 2024

Central tenets of primary care are essential to the delivery of effective MCC care: person & family-centered, comprehensive, equitable, team-based, collaborative, coordinated and integrated.

Chronic Condition

Chronic Condition Patient-Centered Primary Care Electronics

Advancing Primary Care through a Model Unit for Innovative Practice Enhancement [Practice management and organization]

Annals of Family Medicine

NOVEMBER 20, 2024

Setting or Dataset: Data includes secondary data gathered through Epic electronic medical records system as well as primary data collected from physicians, APPs, and staff working in the MU.

Management

Management Primary Care Telehealth Hypertension

Optimizing Medical Legal Partnerships for sustainable public funding through the tele-legal model [Mixed methods research]

Annals of Family Medicine

NOVEMBER 20, 2024

Descriptive analysis utilized primary legal record and secondary electronic health record sources. Setting or Dataset: Clinics: AF Williams Family Medicine, Lowry Internal Medicine; EPIC data; legal records. Nine focus groups were conducted and recorded, using semi-structured interviews.

Medical

Medical Referral Screening Internal Medicine

Quantifying Volume and Disparities in Electronic Workload [Health care informatics]

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Electronic health records (EHR) and patient portal systems have resulted in an unrestricted, undefined, and often uncompensated workload for Primary Care providers. Little information exists regarding the volume of work due to electronic portal messaging and if disparities exist among gender, race, age, and specialty of the provider.

Electronics

Electronics Primary Care Provider Relationship

A Multisite CFIR Study of Readiness to Implement Collaboration Oriented Approach to Controlling High Blood Pressure (COACH) [Dissemination and implementation research]

Annals of Family Medicine

NOVEMBER 20, 2024

Setting: Three academic health systems with EPIC and Oracle electronic health records. Intervention: COACH — a patient-facing decision support tool integrated into the electronic record. Study design: Deductive qualitative analysis. Population Studied: Primary care team members involved in high blood pressure management.

Electronics

Electronics Patient-Centered Hypertension Primary Care

Primary care severe asthma registry project-phase 1: e-Delphi results for registry entry and indices of clinician behaviour [Pulmonary and critical care]

Annals of Family Medicine

NOVEMBER 20, 2024

Population Studied: Family physicians, respirologists, allergists, respiratory therapists, and respiratory researchers from within and outside of UPLEARN were purposively sampled to participate on the e-Delphi panel.

Asthma

Asthma Primary Care Primary Care Physician Family Physician

Exploring Primary Care Provider eConsult Utilization Trends [Health care services, delivery, and financing]

Annals of Family Medicine

NOVEMBER 20, 2024

It includes templated eConsult exchange data extracted from the electronic health record. Intervention/Instrument: eConsult platform and electronic health record. Study Design and Analysis: This retrospective analysis of program data spans from 2018 through 2023. Setting or Dataset: CUSOM and University Hospital.

Utilities

Utilities Primary Care Provider PCP

Economic analysis of virtual Medical Legal Partnership model [Economic or policy analysis]

Annals of Family Medicine

NOVEMBER 20, 2024

Setting or Dataset: Medicaid Claims, Epic electronic health record. Clinics: AF Williams Family Medicine, Lowry Internal Medicine. Control groups were matched on socioeconomic status, racial and ethnic group, age. Cost measures were adjusted to 2022 dollars using seasonally adjusted Personal Consumption Expenditures.

Primary Care

Primary Care Medical Behavioral Health Services Utilities

Artificial Intelligence in Health Care

Integrated Care News by CFHA

MAY 1, 2025

That small win reminded me that artificial intelligence is already shaping the way our patients (and our families) search for health advice. Within minutes he integrated the latest findings into practical recommendations for the family. Annals of Family Medicine , 23(1), 5–6. Below, I share three reasons why.

Patient-Centered

Patient-Centered Integrated Care Primary Care Healthcare Professional

Electronic consultation questions asked to addiction medicine specialists by primary care providers: Retrospective content analysis

Canadian Family Physician

MAY 14, 2025

Objective To determine the major themes among clinical questions asked to addiction medicine specialists sent by primary care providers (PCPs) via the Champlain Building Access to Specialists through the eConsultation (BASE™) electronic consultation (eConsult) service and the PCP-perceived benefits of this service.

Primary Care

Primary Care Consulting Electronics Provider

Infant Mortality Needs Assessment for Fairborn, Ohio [Social determinants and vulnerable populations]

Annals of Family Medicine

NOVEMBER 20, 2024

This project is based on a grant given to provide infant mortality health education and promotion interventions to low-income families at Hawthorne Landing, an apartment complex in Fairborn. Context Fairborn is a city in Greene County, Ohio.

Health Assessment

Health Assessment Healthcare Electronics Utilities

Health Trends Across Communities: Engaging Healthcare Systems, Public Health and Community in a Statewide Public Health Tool [Social determinants and vulnerable populations]

Annals of Family Medicine

NOVEMBER 20, 2024

Health Trends Across Communities (HTAC) is an innovative health data surveillance project that provides public health professionals, healthcare systems, researchers, community organizations, and policy makers with robust and timely summary electronic health record (EHR) information to support health equity and improve health across Minnesota.

Community

Community Healthcare Electronics Patient-Centered

Maryland's Primary Care Program: incremental progress or breakthrough?

The Health Policy Exchange

SEPTEMBER 2, 2020

Our residency, formerly a collaboration with Providence Hospital, is now known as the Medstar Health/Georgetown-Washington Hospital Center Family Medicine Residency Program. What hasn't changed is that our family medicine residents remain excited about health policy and advocacy. I stepped down as director of the Robert L.

Primary Care

Primary Care Primary Care Physician Patient-Centered Behavioral Health Services

Early Prevention of Critical Illness in Older Adults: Adaptation and Pilot Testing of an Electronic Risk Score and Checklist [Geriatrics]

Annals of Family Medicine

NOVEMBER 20, 2024

Objective: Evaluate implementation of an electronic scoring system (Elders Risk Assessment—ERA) to detect and an adapted risk-factor checklist (Checklist for Early Recognition and Treatment of Acute IllNess in Family Medicine – CERTAIN-FM) to assess older patients at high risk of critical illness in a primary care setting.

Illness

Illness Electronics Primary Care Nurse Practitioner

Exploring Iron Deficiency in Alberta: Following up on Clinical Observations [Population health and epidemiology]

Annals of Family Medicine

NOVEMBER 20, 2024

Study Design: Retrospective analysis of electronic medical data obtained from the Canadian Primary Care Research Network, Southern Alberta Primary Care Research Network (SAPCReN-CPCSSN). Instrument: Secondary data were extracted from de-identified SAPCReN-CPCSSN electronic medical records. serum ferritin below 15 μg/mL).

Clinic

Clinic Primary Care Electronics Individual

AAA screening rates in Internal Medicine and Family Medicine at UNMC [Clinical research (other)]

Annals of Family Medicine

NOVEMBER 20, 2024

Study Design and Analysis: Retrospective chart search of the electronic medical records of a specific sub-group of patients at UNMC. Number of patients who meet inclusion criteria at Family Medicine Clinics: 6,551 Patients. Setting: Criteria Time Frame: 2013-01-01 to 2023-12-31.

Internal Medicine

Internal Medicine DO Family Medicine Screening

Feasibility,reliability,validity of an electronic Frailty Index based on Comprehensive Geriatric Assessment in Primary Care [Community based participatory research]

Annals of Family Medicine

NOVEMBER 20, 2024

To promote early management of frailty, we developed an electronic Frailty Index based on deficit accumulation in a Comprehensive Geriatric Assessment (eFI-CGA) from electronic health records. Here, we examined the feasibility, reliability, and validity of the eFI-CGA by primary care providers (PCP).

Primary Care

Primary Care Electronics PCP PCP

Validation of Mood and Anxiety Disorder Case Definitions using Primary Care Electronics Medical Records [Big data]

Annals of Family Medicine

NOVEMBER 20, 2024

Objective: To validate and apply electronic medical record (EMR)-based definitions for mood and anxiety disorders (inc. Context: Mental health conditions have increasing prevalence, co-occurrence, and high management burden within primary care settings. depression, anxiety, bipolar disorder), and schizophrenia.

Primary Care

Primary Care Electronics Medical Mental Health

Seven Opportunities for Artificial Intelligence in Primary Care Electronic Visits: Qualitative Study of Staff and Patient Views [Original Research]

Annals of Family Medicine

MAY 27, 2025

PURPOSE Increased workload associated with electronic visits (eVisits) in primary care could potentially be decreased by the use of artificial intelligence (AI); however, it is unknown whether this use of AI would be acceptable to staff and patients.

Primary Care

Primary Care Electronics Patients Appointment

Developing actionable strategies to implement evidence-based breast cancer follow-up in primary care using codesign [Dissemination and implementation research]

Annals of Family Medicine

NOVEMBER 20, 2024

Intervention: Ongoing codesign process to optimize electronic health record (EHR) customizations and support materials for breast cancer survivorship care. We integrated codesign principles into facilitation and learning collaboratives to implement and refine intervention materials and processes. Setting: Large integrated health system.

Primary Care

Primary Care Referral Electronics Utilities

Health Trends Across Communities: a healthcare system-public health collaboration to advance health equity across Minnesota [Population health and epidemiology]

Annals of Family Medicine

NOVEMBER 20, 2024

Health Trends Across Communities (HTAC) is a collaboration of Minnesota healthcare systems and state and local public health that helps fill the gap in community health information by providing timely, detailed, and accessible summary electronic health record (EHR) information and reports.

Community

Community Healthcare Electronics Illness

An umbrella review of mHealth tool implementation strategies: a 6-step guide to optimize patient, caregiver and clinician use [Dissemination and implementation research]

Annals of Family Medicine

NOVEMBER 20, 2024

They addressed mHealth tools in general (n=17), patient portals (n=6), electronic Patient Reported Outcome Measures (n=5), or chatbots (n=1), from the perspectives of patient/caregiver users (n=14), clinician users (n=5), or both (n=10). Results: From the 8244 records identified, 201 were selected for full text reading.

Patients

Patients Clinical Practice Electronics Clinic

Profiling patterns of patient experiences of access to care and continuity at team-based primary healthcare clinics [Health care services, delivery, and financing]

Annals of Family Medicine

NOVEMBER 20, 2024

Setting/Dataset: 121,570 registered patients over 18 years of age with an email address available in their electronic medical record. Setting: 104 PHC clinics across Quebec, Canada. Measures: The optimal number of profiles (four) was determined using LCA measures (best model determined by AIC, BIC, and entropy).

Healthcare

Healthcare Clinic Chronic Condition Finance

A Multi-Sector Pilot Design in the Northeast Ohio QI Hub: Engaging Community Based Organizations to Advance Diabetes Equity [Health care disparities]

Annals of Family Medicine

NOVEMBER 20, 2024

Results: Key priorities across all sectors included access to behavioral health, economic mobility, social cohesion, and transportation.

Community

Community Diabetes Referral Screening

Clinical outcomes of administering an ePROM of barriers to adherence to ART to people with HIV through a patient portal [Clinical research (other)]

Annals of Family Medicine

NOVEMBER 20, 2024

We used the patient portal (Opal) to administer the I-Score, a 7-item electronic patient-reported outcome measure (ePROM) of barriers to ART adherence. Context: Adherence to antiretrovirals (ART) by people with HIV (PWH) is crucial, however, many face obstacles that go undiscussed with health professionals.

Clinic

Clinic Patients Electronics Management

Pain-Related Medication in Adults with Intellectual Disability: a systematic review [Pain management]

Annals of Family Medicine

NOVEMBER 20, 2024

Measures: Varied by study design; self/carer-report or electronic health records (EHR). Outcome: Analgesic medication or medication for painful conditions, pain and pain-related MCCs, views/experience of pain medication. Results: 21,603 articles identified.

Management

Management Medical Healthcare Professional Chronic Condition

Effects of the COVID-19 pandemic on primary care for diabetes in Canada: Results from a mixed-methods study [Health care services, delivery, and financing]

Annals of Family Medicine

NOVEMBER 20, 2024

Setting & Dataset: The CPCSSN database contains de-identified patient-level electronic medical record data from 13 primary care research networks across Canada. 2) Qualitative interviews were conducted to understand patient experiences with navigating diabetes care during the pandemic and analyzed using qualitative description.

Primary Care

Primary Care Diabetes Finance Electronics

Adoption, implementation, and impact of a Diabetes Navigator program based in primary care [Diabetes and endocrine disease]

Annals of Family Medicine

NOVEMBER 20, 2024

Population Studied: Patients with recent hemoglobin A1c levels of ≥8% were invited to join the Diabetes Navigator program, identified through the electronic health record at two academic primary care clinics.

Primary Care

Primary Care Diabetes Referral Integrated Care

Pap-HPV co-testing adoption trends for cervical cancer screening in a multi-state Practice Research Network (PBRN) 2012-2017 [Health care disparities]

Annals of Family Medicine

NOVEMBER 20, 2024

Setting or dataset: Electronic health record data from 25 primary care clinics in 3 FQHCs in Washington and Idaho PBRN from 2012-2017. Population Studied: Average-risk females ages 21-64 with ≥1 medical encounter and ≥1 routine CCS during 2012-2017.

Screening

Screening Insurance Patient-Centered Primary Care

Validation of an Administrative Knee Osteoarthritis Severity Index in a Veterans Health Affairs Cohort [Big data]

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Administrative electronic health record (EHR) datasets offer a low-cost opportunity to investigate influences on knee osteoarthritis (OA) prevalence and outcomes such as total knee arthroplasty (TKA).

Diagnosis

Diagnosis Electronics Physicals Clinic

Nested order panels for primary care medication and laboratory orders: adoption and impact on ordering efficiency [Health care services, delivery, and financing]

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Electronic health record (EHR) order preference lists and order sets potentially improve efficiency but have limited utility in complex primary care settings. Objective: We assessed adoption, impact on time spent in orders, and clinician perceptions of a comprehensive set of nested order panels (xOrders) for adult primary care.

Primary Care

Primary Care Nurse Practitioner Utilities Finance

Electronic Health Record Use and Patient-Centredness [Education and training]

Implementation of a novel linkage of primary care electronic medical record data with hospital data in South Eastern Ontario [Big data]

Trending Sources

Utilization of Treatment for Chlamydia and Gonorrhea in the Primary Care Setting Using the American Family Cohort [Infectious diseases (not respiratory tract)]

Describing Differences Across Place and Provider in Canadian Team-Based Care Settings Using Electronic Health Records [Health care informatics]

Pajama Time: The Association of EHR Documentation Time with Family Medicine Resident Outcomes [Education and training]

Test-Retest Reliability of Electronic Handgrip Dynamometry and Accelerometry Measured Muscle Function in Older Adults [Musculoskeletal and rheumatology]

Machine learning models for atrial fibrillation detection in primary care using electronic health records: systematic review [Cardiovascular disease]

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

Factors Associated with Documenting Social Determinants of Health in Electronic Health Records by Family Physicians [Social determinants and vulnerable populations]

Exploring Trends in Postpartum Hemorrhage with SHRINE Network Aggregated Electronic Health Records (EHR) Data. [Health care disparities]

Predicting Likelihood of Missed Appointments in Primary Care [Health care informatics]

Resident Voices: Key Findings from Journal Club Surveys [Education and training]

A brief theory driven patient education video to reduce potentially harmful regular over-the-counter NSAID use [Patient education/adherence]

Development and Testing of an Interoperable e-care Plan for Person-Centered Care Planning for Multiple Chronic Conditions [Multimorbidity]

Advancing Primary Care through a Model Unit for Innovative Practice Enhancement [Practice management and organization]

Optimizing Medical Legal Partnerships for sustainable public funding through the tele-legal model [Mixed methods research]

Quantifying Volume and Disparities in Electronic Workload [Health care informatics]

A Multisite CFIR Study of Readiness to Implement Collaboration Oriented Approach to Controlling High Blood Pressure (COACH) [Dissemination and implementation research]

Primary care severe asthma registry project-phase 1: e-Delphi results for registry entry and indices of clinician behaviour [Pulmonary and critical care]

Exploring Primary Care Provider eConsult Utilization Trends [Health care services, delivery, and financing]

Economic analysis of virtual Medical Legal Partnership model [Economic or policy analysis]

Artificial Intelligence in Health Care

Electronic consultation questions asked to addiction medicine specialists by primary care providers: Retrospective content analysis

Infant Mortality Needs Assessment for Fairborn, Ohio [Social determinants and vulnerable populations]

Health Trends Across Communities: Engaging Healthcare Systems, Public Health and Community in a Statewide Public Health Tool [Social determinants and vulnerable populations]

Maryland's Primary Care Program: incremental progress or breakthrough?

Early Prevention of Critical Illness in Older Adults: Adaptation and Pilot Testing of an Electronic Risk Score and Checklist [Geriatrics]

Exploring Iron Deficiency in Alberta: Following up on Clinical Observations [Population health and epidemiology]

AAA screening rates in Internal Medicine and Family Medicine at UNMC [Clinical research (other)]

Feasibility,reliability,validity of an electronic Frailty Index based on Comprehensive Geriatric Assessment in Primary Care [Community based participatory research]

Validation of Mood and Anxiety Disorder Case Definitions using Primary Care Electronics Medical Records [Big data]

Seven Opportunities for Artificial Intelligence in Primary Care Electronic Visits: Qualitative Study of Staff and Patient Views [Original Research]

Developing actionable strategies to implement evidence-based breast cancer follow-up in primary care using codesign [Dissemination and implementation research]

Health Trends Across Communities: a healthcare system-public health collaboration to advance health equity across Minnesota [Population health and epidemiology]

An umbrella review of mHealth tool implementation strategies: a 6-step guide to optimize patient, caregiver and clinician use [Dissemination and implementation research]

Profiling patterns of patient experiences of access to care and continuity at team-based primary healthcare clinics [Health care services, delivery, and financing]

A Multi-Sector Pilot Design in the Northeast Ohio QI Hub: Engaging Community Based Organizations to Advance Diabetes Equity [Health care disparities]

Clinical outcomes of administering an ePROM of barriers to adherence to ART to people with HIV through a patient portal [Clinical research (other)]

Pain-Related Medication in Adults with Intellectual Disability: a systematic review [Pain management]

Effects of the COVID-19 pandemic on primary care for diabetes in Canada: Results from a mixed-methods study [Health care services, delivery, and financing]

Adoption, implementation, and impact of a Diabetes Navigator program based in primary care [Diabetes and endocrine disease]

Pap-HPV co-testing adoption trends for cervical cancer screening in a multi-state Practice Research Network (PBRN) 2012-2017 [Health care disparities]

Validation of an Administrative Knee Osteoarthritis Severity Index in a Veterans Health Affairs Cohort [Big data]

Nested order panels for primary care medication and laboratory orders: adoption and impact on ordering efficiency [Health care services, delivery, and financing]

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