ArticleJournal of general internal medicine2017
Disruptive Models in Primary Care: Caring for High-Needs, High-Cost Populations.
Article in Journal of general internal medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03689049 (SPIDER), which is not on this map. Cited by 44 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
SPIDER: A Structured Process Informed by Data, Evidence and Research - A Research and Quality Improvement Collaboration Supporting Practices in Improving Care for Complex Elderly Patients
Who cites it
44 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Pooled it
- Pooled it
- Quality Indicators for High-Need Patients: a Systematic Review.Journal of general internal medicine · 2022Pooled it
- Effectiveness of Intensive Primary Care Interventions: A Systematic Review.Journal of general internal medicine · 2017Pooled it
- Hospital Readmissions by Variation in Engagement in the Health Care Hotspotting Trial: A Secondary Analysis of a Randomized Clinical Trial.JAMA network open · 2023Trial
- Study of a Quasi-Experimental Trial to Compare Two Models of Home Care for the Elderly in an Urban Primary Care Setting in Spain: Results of Intermediate Analysis.International journal of environmental research and public health · 2022Trial
- [Validity of Starfield́s model in the chronic care strategies of the Canary Islands (2015-2024)].Atencion primaria · 2026Article
- Time to care: the lived experience of receiving care from a primary care service for people with frequent hospital admissions.Family medicine and community health · 2026Article
- Baseline Housing Stability Positively Impacts the Effect of an Ambulatory Intensive Care Unit on Decreasing Hospitalization Rates.Journal of general internal medicine · 2025Article
- Implementation, intervention, and downstream costs for implementation of a multidisciplinary complex pain clinic in the Veterans Health Administration.Health services research · 2024Article
- Caring for high-need patients.BMC health services research · 2023Article
- Organisation of care for people receiving drug-resistant tuberculosis treatment in South Africa: a mixed methods study.BMJ open · 2023Article
- High-performing primary care clinics across high-need, high-cost Medicare populations.BMJ open quality · 2023Article
- Differential Impact of a Plan-Led Standardized Complex Care Management Intervention on Subgroups of High-Cost High-Need Medicaid Patients.Population health management · 2023Article
- Article
- Association between service scope of primary care facilities and prevalence of high-cost population: a retrospective study in rural Guizhou, China.BMC primary care · 2022Article
- The Case for Mobile "Street Medicine" for Patients Experiencing Homelessness.Journal of general internal medicine · 2022Article
- Comparative Effectiveness of a Complex Care Program for High-Cost/High-Need Patients: a Retrospective Cohort Study.Journal of general internal medicine · 2021Article
- Characteristics of Departments That Provided Primary Support for Households with Complex Care Needs in the Community: A Preliminary Cross-Sectional Study.Healthcare (Basel, Switzerland) · 2021Article
- Family Physician's and Primary Care Team's Perspectives on Supporting Family Caregivers in Primary Care Networks.International journal of environmental research and public health · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Starfield and colleagues have suggested four overarching attributes of good primary care: "first-contact access for each need; long-term person- (not disease) focused care; comprehensive care for most health needs; and coordinated care when it must be sought elsewhere." As this series on reinventing primary care highlights, there is a compelling need for new care delivery models that would advance these objectives. This need is particularly urgent for high-needs, high-cost (HNHC) populations. By definition, HNHC patients require extensive attention and consume a disproportionate share of resources, and as a result they strain traditional office-based primary care practices. In this essay, we offer a clinical vignette highlighting the challenges of caring for HNHC populations. We then describe two categories of primary care-based approaches for managing HNHC populations: complex case management, and specialized clinics focused on HNHC patients. Although complex case management programs can be incorporated into or superimposed on the traditional primary care system, such efforts often fail to engage primary care clinicians and HNHC patients, and proven benefits have been modest to date. In contrast, specialized clinics for HNHC populations are more disruptive, as care for HNHC patients must be transferred to a multidisciplinary team that can offer enhanced care coordination and other support. Such specialized clinics may produce more substantial benefits, though rigorous evaluation of these programs is needed. We conclude by suggesting policy reforms to improve care for HNHC populations.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.