The Department of Veterans Affairs (VA) now offers eligible Veterans an urgent care benefit covering visits and 14-day prescriptions outside of VA. Prescriptions written and dispensed outside VA lack the clinical decision support of VA-issued prescriptions, raising concerns about safety and polypharmacy. To date, there has been limited analyses of prescribing patterns through the urgent care benefit.

The United States is facing a shortage of pregnancy care providers, especially in tribal, rural, and underserved (TRU) communities. In Oklahoma, more than half of the state's counties are considered maternity care deserts that lack obstetric (OB) providers or services. Limited access to pregnancy care in Oklahoma's TRU areas contributes to the state's high rates of maternal morbidity and mortality. Family medicine (FM) physicians receive basic OB training during residency and are often the only providers delivering pregnancy care for geographically isolated and socially vulnerable populations in these counties. In 2021, the University of Oklahoma School of Community Medicine launched an enhanced OB training curriculum for FM residents to help address workforce shortages in Oklahoma's TRU communities. This article describes the design and implementation of the enhanced training curriculum, summarizes results from the first 2 years of implementation, and shares lessons learned for the field.

A foundational principle of health care is patient autonomy - respecting an individual's right to control what happens to their body, including what care they do and do not receive. That right is not lost when an individual loses the ability to speak for themselves or make reasoned decisions. One way to ensure health care decision-making aligns with a patient's wishes is for an individual to appoint a health care agent (HCA) to make decisions on their behalf if they are unable to. However, some people are 'unrepresented', meaning they do not have anyone to appoint. Lack of an HCA can result in delays in care, care that does not reflect a patient's wishes, and avoidable costs to the health care system. Strategies to address this have largely focused on courts appointing a guardian after an individual has lost decision-making capacity-a lengthy process that often exacerbates delays and, most importantly, does not result in a decision-maker who knows the individual's priorities and preferences. To address this challenge, four Massachusetts organizations developed a volunteer HCA program matching employees of each organization as HCAs for 'unrepresented' individuals receiving care at the other organizations. This model shows promise as an approach to ensure individuals can choose their HCA and personally communicate their priorities and preferences to them. Additionally, training volunteers as HCAs for strangers and learning from their experiences may offer insights into how everyone can be better at these conversations and representing the choices of others - especially with people close to them.

Despite the progress towards Universal Health Coverage (UHC) in Canada, individuals experiencing socioeconomic disadvantages continue to face barriers to accessing necessary health services. This study explored the observational insights of social care providers (SCPs), who regularly engage with vulnerable populations and healthcare systems, to better understand these barriers in Edmonton, Canada.

Electronic health record (EHR) transitions can cause major disruptions in the provision of primary care services. Veteran Health Administration (VHA), one of the largest integrated healthcare systems, underwent a major EHR transition at two sites. To date, there is limited data on the experience of primary care service lines at EHR transition sites.

With mounting accountability pressure on their publicly funded health system and the demand for a medically ready military force, the military health system (MHS) employs a strategy to optimize care delivery. Research suggests that analysis of episodes of care is a valuable tool for identifying the relative resource use for a given procedure and can direct enhancements in care delivery.

Healthcare has experienced significant transformation in recent years with many changes being imposed on practices from outside sources. When tailoring outside interventions to specific settings, it is important to engage practice members in participatory processes. Yet, tailoring remains a difficult and poorly understood element of implementation. Codesign is one method to achieve context-sensitive, bottom-up change by engaging stakeholders in the design process. With a complex adaptive system (CAS) perspective, codesign reframes interventions as tools to empower practices to drive change based on local challenges and experiences rather than change being imposed upon them. Observing adaptations and facilitating innovations of practice members offers insight into dynamics of the CAS, implementation context, and its limitations. Here, the codesign process is illustrated through a pediatric primary care practice adopting integrated health. Contextual inquiry was performed using ethnographic observations to identify barriers and facilitators to integrated health. Observation findings informed codesign workshops with clinicians. Workshop transcripts and drawings were analyzed using an immersion/crystallization approach guided by the Practice Change Model (PCM), an established framework based on complexity science concepts. In these workshops, clinicians described tension between their motivations to care for complex patients and limitations imposed by the health system. Participants' knowledge of their real-world context allowed them to identify resources and opportunities for changes they could make within their current environment. The reconciliation of the ideal and the real is a core benefit of codesign methods. This innovative approach can be applied more generally to support the development, implementation, and evaluation of interventions that reflect real world interactions and complexities.

Social Determinants of Health impact health outcomes. Area Deprivation Index (ADI) is used to risk-adjust for neighborhood affluence/deprivation but guidance on choosing deprivation cutoffs is lacking. We hypothesize that different ADI cutoffs are required for different insurance types.

Non-evidence based factors influence post-surgical opioid prescribing practices. Delivering automated near real-time opioid prescribing feedback may encourage providers to prescribe opioid quantities which are more aligned with patient consumption and institutional guidelines. COVID-19 presented unprecedented challenges to healthcare delivery. We observed a substantial deviation in guideline-concordant opioids prescribing during the initial outbreak. However, our institution's pre-existing opioid prescribing feedback system and decision aid may have helped limit the duration and magnitude of the observed deviations by informing prescribers of atypically large opioid prescriptions and encouraging use of institutional data. Combined with provider education, a non-directive decision aid, in the form of near, real-time email feedback, may be an effective mechanism to advance evidence-based opioid prescribing, as it retains flexibility and provider autonomy while encouraging data-driven decision making.

Remdesivir is FDA-approved for the treatment of hospitalized patients with severe COVID-19. Many patients improve clinically to allow for hospital dismissal before completing the 5-day course. In a prior work, patients who continued remdesivir in an outpatient setting experienced better 28-day clinical outcomes. Here, we assessed patients' perspectives and the economic impact of this outpatient practice.

To measure rates of patient-reported financial burden, compare them across cancer types, and determine whether they are predictive of catastrophic health expenditures (CHE).

NAMCS, sponsored by the Centers for Disease Control and Prevention, is an annual nationally representative sample survey of visits to non-federal office-based physicians, excluding anesthesiologists, radiologists, and pathologists. NAMCS has collected physician-reported ambulatory care encounter-specific content over five decades. We assessed trends in the use of the data by the health services research community, response rates, and questionnaire changes.

This case report describes the development of information and communication technology (ICT) for a large scale, federally funded demonstration healthcare Program designed to treat low-income children and adolescents with chronic medical conditions. The ICT developers faced the challenge of supporting a Program with many components to treat pediatric patients with one or more chronic health conditions. The Program's ICT provided means and materials to train and monitor Community Health Workers (CHWs) and the Care Coordination Team (CCT) and to provide disease-specific information to patients and caregivers. The Program ICT was organized into five components: (1) Data Storage Systems, (2) Care Coordination Software, (3) On-line Patient Education, (4) a Social Services Referral component, and (5) Patient Engagement software. The average cost of providing care services to the engaged population utilizing the ICT was $7.39 per member per month (PMPM) and $20.33 PMPM for the subset of children who received direct outreach and services. A description of the Program's ICT development, functioning, strengths, and weaknesses is presented.