This Viewpoint reviews evidence of poor health outcomes experienced by American Indian/Alaska Native persons owing to structural disadvantage and proposes an aggressive agenda to improve their health and well-being by addressing social determinants of health, improving access to and quality of care, and improving data availability and transparency.
This cohort study uses US Medicare claims data to estimate the prevalence of routine electrocardiogram, urinalyses, and thyrotropin tests performed during annual wellness visits and assesses the prevalence and cost of laboratory tests, imaging tests, procedures, visits, hospitalizations, and new diagnoses that may follow.
This cross-sectional study examines the patient and visit characteristics associated with online portal-based scheduling of medical visits.
This Viewpoint discusses the importance of investing in the health of American Indians and Alaskan Natives.
This cohort study examines factors associated with increased collection of patient reported outcomes by clinics in a large health care system.
This survey study estimates the national frequency and consequences of cascades of care after incidental findings using results from a national survey of US physicians.
This cohort study reviews data from fee-for-service Medicare beneficiaries without known heart disease who underwent cataract surgery to compare care cascades (tests, treatments, visits, hospitalizations, a and new diagnoses) between those who received preoperative electrocardiograms and those who did not.
This study describes the scarcity of dermatological services and practitioners as well as community infrastructures or resources for American Indian people who live in isolated areas in the United States.
This cluster randomized clinical trial evaluates the effect of a remotely delivered multicomponent behaviorally tailored intervention vs usual care on adherence to medications for hyperlipidemia, hypertension, and diabetes in patients who are nonadherent to prescribed medications.
This study evaluates changes in insurance and Indian Health Service coverage among Native Americans following the Affordable Care Act’s implementation.
This randomized trial investigated the effects of financial incentives paid to physicians, patients, and both on low-density lipoprotein cholesterol levels among patients with high cardiovascular risk.
Colorectal cancer is a leading cause of cancer mortality, yet effective screening tests are often underused. Electronic patient messages and personalized risk assessments delivered via an electronic personal health record could increase screening rates.
We conducted a randomized controlled trial in 14 ambulatory health centers involving 1103 patients ranging in age from 50 to 75 years with an active electronic personal health record who were overdue for colorectal cancer screening. Patients were randomly assigned to receive a single electronic message highlighting overdue screening status with a link to a Web-based tool to assess their personal risk of colorectal cancer. The outcomes included colorectal cancer screening rates at 1 and 4 months.
Screening rates were higher at 1 month for patients who received electronic messages than for those who did not (8.3% vs 0.2%, P < .001), but this difference was no longer significant at 4 months (15.8% vs 13.1%, P = .18). Of 552 patients randomized to receive the intervention, 296 (54%) viewed the message, and 47 (9%) used the Web-based risk assessment tool. Among 296 intervention patients who viewed the electronic message, risk tool users were more likely than nonusers to request screening examinations (17% vs 4%, P = .04) and to be screened (30% vs 15%, P = .06). One-fifth of patients (19%) using the risk assessment tool were estimated to have an above-average risk for colorectal cancer.
Electronic messages to patients produce an initial increase in colorectal cancer screening rates, but this effect is not sustained over time.
clinicaltrials.gov Identifier: NCT01032746
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