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Primary Care and Public Health: Exploring Integration to Improve Population Health
No full textEnsuring that members of society are healthy and reaching their full potential requires the prevention of disease and injury; the promotion of health and well-being; the assurance of conditions in which people can be healthy; and the provision of timely, effective, and coordinated health care. Achieving substantial and lasting improvements in population health will require a concerted effort from all these entities, aligned with a common goal. The Health Resources and Services Administration (HRSA) and the Centers for Disease Control and Prevention (CDC) requested that the Institute of Medicine (IOM) examine the integration of primary care and public health.
Primary Care and Public Health identifies the best examples of effective public health and primary care integration and the factors that promote and sustain these efforts, examines ways by which HRSA and CDC can use provisions of the Patient Protection and Affordable Care Act to promote the integration of primary care and public health, and discusses how HRSA-supported primary care systems and state and local public health departments can effectively integrate and coordinate to improve efforts directed at disease prevention.
This report is essential for all health care centers and providers, state and local policy makers, educators, government agencies, and the public for learning how to integrate and improve population health
Lifestyle Change and Mobility in Obese Adults with Type 2 Diabetes
No full textBackground
Adults with type 2 diabetes mellitus often have limitations in mobility that increase with age. An intensive lifestyle intervention that produces weight loss and improves fitness could slow the loss of mobility in such patients.
Methods
We randomly assigned 5145 overweight or obese adults between the ages of 45 and 74 years with type 2 diabetes to either an intensive lifestyle intervention or a diabetes support-and-education program; 5016 participants contributed data. We used hidden Markov models to characterize disability states and mixed-effects ordinal logistic regression to estimate the probability of functional decline. The primary outcome was self-reported limitation in mobility, with annual assessments for 4 years.
Results
At year 4, among 2514 adults in the lifestyle-intervention group, 517 (20.6%) had severe disability and 969 (38.5%) had good mobility; the numbers among 2502 participants in the support group were 656 (26.2%) and 798 (31.9%), respectively. The lifestyle-intervention group had a relative reduction of 48% in the risk of loss of mobility, as compared with the support group (odds ratio, 0.52; 95% confidence interval, 0.44 to 0.63; P<0.001). Both weight loss and improved fitness (as assessed on treadmill testing) were significant mediators of this effect (P<0.001 for both variables). Adverse events that were related to the lifestyle intervention included a slightly higher frequency of musculoskeletal symptoms at year 1.
Conclusions
Weight loss and improved fitness slowed the decline in mobility in overweight adults with type 2 diabetes. (Funded by the Department of Health and Human Services and others; ClinicalTrials.gov number, NCT00017953.
Racial-Ethnic Differences in Pregnancy-Related Weight
No full textAbstract available at publisher's website
Impact of Electronic Health Records on Racial and Ethnic Disparities in Blood Pressure Control at US Primary Care Visits
No full textPrior literature suggests that practice level characteristics mediate racial/ethnic disparities in clinical outcomes.1 One such practice level characteristic, use of electronic health records (EHRs) with clinical decision support (CDS), has been associated with improved blood pressure (BP) control in a national study.2 However, we do not know whether these effects differ across racial/ethnic groups.3 We sought to determine whether physician use of EHRs with and without CDS is associated with a reduction in racial/ethnic disparities in BP control in a nationally representative sample.
Methods
We examined data from primary care visits in the 2007-2008 National Ambulatory Medical Care Survey (NAMCS), a nationally representative survey of nonhospital-based ambulatory visits administered by the National Center for Health Statistics (NCHS).4 In a recent article, we examined visits to NAMCS physicians who answered questions about EHRs and electronic guideline-based reminders.2 Primary care . .
The National Bioethics Research Infrastructure Initiative: Building Trust Between Minorities and Researchers.
No full textThis video short is one product of our Building Trust between Minorities and Researchers training curriculum. This work is made possible through a grant from the NIH National Institute on Minority Health and Health Disparities. For more information visit
www.healthequity.umd.ed
Transforming Health in Prince George's County, Maryland: A Public Health Impact Study
Full text linkExecutive Summary and
Technical Reports and Supporting Documents
Section II of the Public Health Impact Study of Prince George’s County report includes technical reports that document the methods, findings, limitations and a summary for each of the seven study components. We also include copies of the study instruments, where appropriate. While the findings of these study components formed the basis for the integrated answers to the study’s five framing questions, the technical reports include more detailed data than was possible to include in Section I, and also provide insights for the study as a whole
