Evidence map›Paper›PMID 31704752›Full record

ArticleJournal of the American Board of Family Medicine : JABFM

Features of U.S. Primary Care Physicians and Their Practices Associated with Advance Care Planning Conversations.

David Nowels, Molly A Nowels, Julia L Sheffler, Susan Kunihiro, Hillary D Lum

Open access · diamondAbstract read
In one paragraph

Article in Journal of the American Board of Family Medicine : JABFM. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.9field-weighted citation impact, top 22% of its field
1 · What the graph read from 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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 13 citations in OpenAlex.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 1 country.

David NowelsFrom University of Colorado School of Medicine, Aurora, CO (DN, MAN, HDL); Rutgers University Institute For Health, Health Care Policy, and Aging Research, New Brunswick, NJ (MAN); Florida State University College of Medicine, Tallahassee, FL (JLS); Emory University School of Medicine, Atlanta, GA (SK); Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado (HDL). david.nowels@CUAnschutz.edu.
Molly A NowelsFrom University of Colorado School of Medicine, Aurora, CO (DN, MAN, HDL); Rutgers University Institute For Health, Health Care Policy, and Aging Research, New Brunswick, NJ (MAN); Florida State University College of Medicine, Tallahassee, FL (JLS); Emory University School of Medicine, Atlanta, GA (SK); Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado (HDL).
Julia L ShefflerFrom University of Colorado School of Medicine, Aurora, CO (DN, MAN, HDL); Rutgers University Institute For Health, Health Care Policy, and Aging Research, New Brunswick, NJ (MAN); Florida State University College of Medicine, Tallahassee, FL (JLS); Emory University School of Medicine, Atlanta, GA (SK); Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado (HDL).
Susan KunihiroFrom University of Colorado School of Medicine, Aurora, CO (DN, MAN, HDL); Rutgers University Institute For Health, Health Care Policy, and Aging Research, New Brunswick, NJ (MAN); Florida State University College of Medicine, Tallahassee, FL (JLS); Emory University School of Medicine, Atlanta, GA (SK); Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado (HDL).
Hillary D LumFrom University of Colorado School of Medicine, Aurora, CO (DN, MAN, HDL); Rutgers University Institute For Health, Health Care Policy, and Aging Research, New Brunswick, NJ (MAN); Florida State University College of Medicine, Tallahassee, FL (JLS); Emory University School of Medicine, Atlanta, GA (SK); Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado (HDL).
Emory University · USUniversity of Colorado Denver · USFlorida State University · US

Funding

Refining an Advance Care Planning Group Visit intervention – a novel intervention to engage older adults in advance care planningK76AG054782 · NIA · UNIVERSITY OF COLORADO DENVER · PI LUM, HILLARY · 2016 to 2019
$864k
NIA NIH HHS K76 AG054782
6 · The paper itself

Abstract

introductionPrimary care practices are essential settings for Advance Care Planning (ACP) conversations with patients. We hypothesized that such conversations occur more routinely in Advanced Primary Care/Patient Centered Medical Home (APCP/PCMH) Practices using practice transformation strategies.

methodsWe analyzed characteristics of physician respondents and their practices associated with ACP discussions in older and sicker patients using US data from the 2015 Commonwealth Fund International Survey of Primary Care Physicians in 10 Nations. The primary outcome was how routinely these ACP conversations are reported. We developed an index of APCP/PCMH features as a practice covariable.

resultsRespondents (N = 1001) were predominantly male (60%) and ≥45 years old (74%). Multivariable analyses showed that suburban practice location was associated with fewer ACP conversations; working in a practice commonly seeing patients with multiple chronic conditions or who have palliative care needs, and working in a practice from which home visits are made, were associated with more ACP conversations. Physicians compensated in part by capitation were more likely to report ACP conversations. No association was found between a single item asking if the practice was an APCP/PCMH and having ACP conversations. However, higher scores on an index of APCP/PCMH features were associated with more ACP conversations.

conclusionsIn this sample of US primary care physicians, the types of patients seen, practice location, and physician compensation influenced whether physicians routinely discuss ACP with patients who are older and sicker. Practices demonstrating more features of APCP/PCMH models of primary care are also associated with ACP discussions.

Indexed as

Advance Care PlanningAgedCommunicationFemaleHumansMaleMiddle AgedPatient-Centered CarePhysician-Patient RelationsPhysicians, Primary CarePractice Patterns, Physicians'Primary Health CareReimbursement MechanismsSurveys and QuestionnairesAdvance Care PlanningHealth Care SurveysHouse CallsMultimorbidityMultiple Chronic ConditionsPalliative CarePatient-Centered CarePhysician-Patient RelationsPrimary Care PhysiciansTerminal Care

Identifiers

PMID31704752
PMCPMC7406384
OpenAlexW2985303014

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

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.