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February 2017

Trust but Verify (Ideally With a Randomized Clinical Trial)

Author Affiliations
  • 1Los Angeles County Department of Health Services, Los Angeles, California
  • 2Deputy Editor, JAMA Internal Medicine
JAMA Intern Med. 2017;177(2):162-163. doi:10.1001/jamainternmed.2016.8433

The publication of Atul Gawande’s groundbreaking New Yorker article, “The Hot Spotters,”1 intensified interest in identifying “high-users,” those patients who use the most health care services and are extremely expensive for their health care systems, and developing better and less expensive ways to care for them. These programs attempt to replace costly ambulance trips, emergency department visits, and hospitalizations with patient-centered primary care, case management, and access to key services such as social work, transportation, and substance abuse treatment.

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