National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (1)
- Alcohol Use (1)
- Ambulatory Care and Surgery (3)
- Antibiotics (4)
- Antimicrobial Stewardship (2)
- Back Health and Pain (1)
- Behavioral Health (1)
- Cancer: Colorectal Cancer (1)
- Cancer: Prostate Cancer (3)
- Cardiovascular Conditions (1)
- Care Management (3)
- Children/Adolescents (5)
- Chronic Conditions (3)
- Clinical Decision Support (CDS) (1)
- Clinician-Patient Communication (1)
- Comparative Effectiveness (1)
- Complementary and Alternative Medicine (1)
- Diabetes (4)
- Diagnostic Safety and Quality (1)
- Elderly (4)
- Electronic Health Records (EHRs) (5)
- Evidence-Based Practice (1)
- Guidelines (1)
- Health Information Technology (HIT) (4)
- Health Services Research (HSR) (1)
- Health Status (1)
- Imaging (1)
- Medicare (1)
- Medication (9)
- Medication: Safety (1)
- Obesity (1)
- Obesity: Weight Management (1)
- Opioids (3)
- Pain (1)
- Patient-Centered Healthcare (4)
- Patient Safety (1)
- (-) Practice Patterns (30)
- (-) Primary Care (30)
- Primary Care: Models of Care (1)
- Provider (2)
- Provider: Clinician (1)
- Provider: Nurse (2)
- Provider: Physician (4)
- Provider: Physician Assistant (1)
- Quality Improvement (2)
- Quality of Care (1)
- Respiratory Conditions (4)
- Screening (4)
- Shared Decision Making (3)
- Skin Conditions (1)
- Substance Abuse (1)
- Teams (2)
- Tools & Toolkits (1)
- U.S. Preventive Services Task Force (USPSTF) (2)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 30 Research Studies DisplayedYu J, Wang AA, Zimmerman LP
A cohort analysis of statin treatment patterns among small-sized primary care practices.
The purpose of this retrospective cohort analysis study was to describe statin treatment patterns in small-sized primary care practices and explore the patient and practice factors that are related to lack of statin treatment. The researchers included all statin-eligible adults (13,330) who received care at one of 53 Healthy Hearts in the Heartland (H3) practices, a cardiovascular care quality improvement initiative, between 2013 and 2016. The study found that among 43% of patients (5,780), there was no record of moderate- to high-intensity statin therapy. A lack of appropriate intensity statin therapy was independently associated with the female sex, a younger age, and lower low-density lipoprotein cholesterol (LDL-C). Also associated with lower appropriate intensity statin use was a higher proportion of patients insured by Medicaid and having only family medicine trained physicians (vs. having at least one internal medicine trained physician) at the practice. A lack of appropriate intensity statin therapy was greater in independent practices than in Federally Qualified Health Centers (FQHCs). The study concluded that factors influencing lack of statin treatment vary by practice setting, emphasizing the role of approaches that are customized to individual settings.
AHRQ-funded; HS023921.
Citation: Yu J, Wang AA, Zimmerman LP .
A cohort analysis of statin treatment patterns among small-sized primary care practices.
J Gen Intern Med 2022 Jun;37(8):1845-52. doi: 10.1007/s11606-021-07191-9..
Keywords: Cardiovascular Conditions, Medication, Practice Patterns, Primary Care
Patel E, Kandrack R
Differences in the number of services provided by nurse practitioners and physicians during primary care visits.
Due to differential training, nurse practitioners (NPs) and physicians may provide different quantities of services to patients. The purpose of this study was to assess differences in the number of laboratory, imagining, and procedural services provided by primary care NPs and physicians. The investigators found that NPs provided fewer laboratory and imaging services than physicians during primary care visits.
AHRQ-funded; HS000032.
Citation: Patel E, Kandrack R .
Differences in the number of services provided by nurse practitioners and physicians during primary care visits.
Nurs Outlook 2021 Sep-Oct;69(5):886-91. doi: 10.1016/j.outlook.2021.04.003..
Keywords: Primary Care, Practice Patterns, Provider: Physician, Provider: Nurse
Truitt KN, Brown T, Lee JY
Appropriateness of antibiotic prescribing for acute sinusitis in primary care: a cross-sectional study.
The proportion of sinusitis visits that meet antibiotic prescribing criteria is unknown. In this cross-sectional study the authors investigated the appropriateness of antibiotic prescribing for acute sinusitis in primary care. The investigators found that of 425 randomly selected sinusitis visits, 50% met antibiotic prescribing criteria.
AHRQ-funded; HS024930; 233201500020I; HS026506.
Citation: Truitt KN, Brown T, Lee JY .
Appropriateness of antibiotic prescribing for acute sinusitis in primary care: a cross-sectional study.
Clin Infect Dis 2021 Jan 15;72(2):311-14. doi: 10.1093/cid/ciaa736..
Keywords: Antibiotics, Medication, Antimicrobial Stewardship, Primary Care, Respiratory Conditions, Practice Patterns
Lozada MJ, Raji MA, Goodwin JS
Opioid prescribing by primary care providers: a cross-sectional analysis of nurse practitioner, physician assistant, and physician prescribing patterns.
The purpose of this study was to identify prescription opioid over-prescribers by comparing prescribing patterns of primary care physicians (MDs), nurse practitioners (NPs), and physician assistants (PAs). Participants were a national sample of 2015 Medicare Part D enrollees. Findings showed that most NPs/PAs prescribed opioids in a pattern similar to MDs, but NPs/PAs had more outliers who prescribed high-frequency, high-dose opioids than did MDs. Recommendations included efforts to reduce opioid overprescribing including targeted provider education, risk stratification, and state legislation.
AHRQ-funded; HS020642.
Citation: Lozada MJ, Raji MA, Goodwin JS .
Opioid prescribing by primary care providers: a cross-sectional analysis of nurse practitioner, physician assistant, and physician prescribing patterns.
J Gen Intern Med 2020 Sep;35(9):2584-92. doi: 10.1007/s11606-020-05823-0..
Keywords: Opioids, Medication, Primary Care, Practice Patterns, Medication: Safety, Provider: Nurse, Provider: Physician, Provider: Physician Assistant, Provider
Fishbein AB, Hamideh N, Lor J
Management of atopic dermatitis in children younger than two years of age by community pediatricians: a survey and chart review.
The authors characterized primary care providers' (PCPs) practice patterns for atopic dermatitis (AD) in children under 2 years of age and determined the need for AD guidelines for PCPs focused on this age group. They found that PCP management of AD in children under 2 years of age is different from that of older children, with possible underuse of medium/high-potency topical corticosteroids. They recommended clear guidelines for this age group.
AHRQ-funded; HS023011.
Citation: Fishbein AB, Hamideh N, Lor J .
Management of atopic dermatitis in children younger than two years of age by community pediatricians: a survey and chart review.
J Pediatr 2020 Jun;221:138-44.e3. doi: 10.1016/j.jpeds.2020.02.015..
Keywords: Children/Adolescents, Skin Conditions, Provider: Physician, Practice Patterns, Primary Care, Medication, Care Management
Kuhns LM, Carlino B, Greeley K
A chart review of substance use screening and related documentation among adolescents in outpatient pediatric clinics: implications for practice.
This study looked at rates of substance use screening and related documentation among adolescents aged 12-17 in outpatient pediatric clinics in a large academic medical center. The authors abstracted a random sample of 127 records and coded clinical notes to describe screening cases and related characteristics. They then analyzed descriptive patterns within the data to calculate screening rates, characteristics of screening, and identify related factors. Rates of screening by providers was 72% for each common substance and a total of 6% of patients reported substance use during screening.
AHRQ-funded; HS026385.
Citation: Kuhns LM, Carlino B, Greeley K .
A chart review of substance use screening and related documentation among adolescents in outpatient pediatric clinics: implications for practice.
Subst Abuse Treat Prev Policy 2020 May 25;15(1):36. doi: 10.1186/s13011-020-00276-4..
Keywords: Children/Adolescents, Substance Abuse, Screening, Ambulatory Care and Surgery, Alcohol Use, Practice Patterns, Primary Care
Peterson EL, Ndumele CD, Busch SH
National referral and treatment patterns among mental health pediatric primary care visits.
The current study explored factors that predict referral from pediatric primary care to mental health specialty care among a nationally representative sample of visits. Results indicated that patient visits that included rarer/serious diagnoses (e.g., bipolar disorder) were more likely to receive a referral in comparison to those with ADHD.
AHRQ-funded; HS017589.
Citation: Peterson EL, Ndumele CD, Busch SH .
National referral and treatment patterns among mental health pediatric primary care visits.
Adm Policy Ment Health 2020 Jan;47(1):86-93. doi: 10.1007/s10488-019-00972-9..
Keywords: Children/Adolescents, Behavioral Health, Primary Care, Practice Patterns
Parchman ML, Penfold RB, Ike B
Team-based clinic redesign of opioid medication management in primary care: effect on opioid prescribing.
This study examined the effect of using an opioid medication management program called Six Building Blocks in primary care practices to help reduce the rate of opioid prescriptions. Six rural-serving organizations with 20 clinic locations received support for 15 months to help them implement the Six Building Blocks. This case-control study compared monthly trends in patients undergoing long-term opioid therapy (LtOT) for patients enrolled in the intervention clinics with those enrolled in a regional health plan who did not receive care at the study sites but resided in the same areas. There was a significant rate of decrease of patients on LtOT at intervention clinics compared with the control group.
AHRQ-funded; HS023750.
Citation: Parchman ML, Penfold RB, Ike B .
Team-based clinic redesign of opioid medication management in primary care: effect on opioid prescribing.
Ann Fam Med 2019 Jul;17(4):319-25. doi: 10.1370/afm.2390..
Keywords: Opioids, Primary Care: Models of Care, Primary Care, Teams, Medication, Pain, Chronic Conditions, Practice Patterns, Patient-Centered Healthcare
Kistler CE, Vu M, Sutkowi-Hemstreet A
Exploring factors that might influence primary-care provider discussion of and recommendation for prostate and colon cancer screening.
This study sought to examine circumstances under which primary-care providers would discuss and recommend two types of cancer screening services across a spectrum of net benefit and other factors known to influence screening. While most providers' reported practice patterns aligned with net benefit, some providers would discuss and recommend low-value cancer screening, particularly when faced with a patient request.
AHRQ-funded; HS019468; HS021133.
Citation: Kistler CE, Vu M, Sutkowi-Hemstreet A .
Exploring factors that might influence primary-care provider discussion of and recommendation for prostate and colon cancer screening.
Int J Gen Med 2018 May 17;11:179-90. doi: 10.2147/ijgm.s153887..
Keywords: Cancer: Colorectal Cancer, Cancer: Prostate Cancer, Primary Care, Practice Patterns, Screening
McCreedy EM, Kane RL, Gollust SE
Patient-centered guidelines for geriatric diabetes care: potential missed opportunities to avoid harm.
Clinicians strive to deliver individualized, patient-centered care. However, these intentions are understudied. This research explored how patient characteristics associated with a high risk-to-benefit ratio with hypoglycemia medications affected decision making by primary care clinicians. The investigators found that primary care clinicians often chose to intensify glycemic control despite individual patient factors that warranted higher glycemic targets based on existing guidelines.
AHRQ-funded; HS000011.
Citation: McCreedy EM, Kane RL, Gollust SE .
Patient-centered guidelines for geriatric diabetes care: potential missed opportunities to avoid harm.
J Am Board Fam Med 2018 Mar-Apr;31(2):192-200. doi: 10.3122/jabfm.2018.02.170141..
Keywords: Diabetes, Elderly, Patient-Centered Healthcare, Guidelines, Evidence-Based Practice, Shared Decision Making, Medication, Primary Care, Practice Patterns, Provider: Physician, Provider: Clinician, Provider
Lapham GT, Lee AK, Caldeiro RM
Frequency of cannabis use among primary care patients in Washington state.
This study describes the prevalence and frequency of past-year cannabis use among primary care patients assessed for use during a primary care visit. The study concluded that cannabis use was common in adult primary care patients, especially among younger patients and those with behavioral health conditions. Results highlight the need for primary care approaches to address cannabis use.
AHRQ-funded; HS023173.
Citation: Lapham GT, Lee AK, Caldeiro RM .
Frequency of cannabis use among primary care patients in Washington state.
J Am Board Fam Med 2017 Nov/Dec;30(6):795-805. doi: 10.3122/jabfm.2017.06.170062..
Keywords: Complementary and Alternative Medicine, Primary Care, Practice Patterns
Linder JA, Meeker D, Fox CR
Effects of behavioral interventions on inappropriate antibiotic prescribing in primary care 12 months after stopping interventions.
This study examines the persistence of effects 12 months after stopping behavioral interventions on inappropriate antibiotic prescribing. In the 12 months after removing behavioral interventions, inappropriate antibiotic prescribing for acute respiratory infections (ARIs) increased relative to control practices—whose inappropriate prescribing rates continued to decrease.
AHRQ-funded; HS019913.
Citation: Linder JA, Meeker D, Fox CR .
Effects of behavioral interventions on inappropriate antibiotic prescribing in primary care 12 months after stopping interventions.
JAMA 2017 Oct 10;318(14):1391-92. doi: 10.1001/jama.2017.11152.
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Keywords: Antibiotics, Practice Patterns, Primary Care, Comparative Effectiveness, Respiratory Conditions
Halbert CH, Jefferson M, Melvin CL
Provider advice about weight loss in a primary care sample of obese and overweight patients.
In this study the investigators examined receipt of provider advice to lose weight among primary care patients who were overweight and obese. The investigators found that patient beliefs about their weight status and perceptions about shared decision-making are important to receiving provider advice about weight loss/management among primary care patients.
AHRQ-funded; HS023047.
Citation: Halbert CH, Jefferson M, Melvin CL .
Provider advice about weight loss in a primary care sample of obese and overweight patients.
J Prim Care Community Health 2017 Oct;8(4):239-46. doi: 10.1177/2150131917715336..
Keywords: Shared Decision Making, Obesity, Obesity: Weight Management, Practice Patterns, Primary Care
Misra-Hebert AD, Hu B, Klein EA
Prostate cancer screening practices in a large, integrated health system: 2007-2014.
The researchers assessed prostate cancer screening practices in primary care since the initial United States Preventive Services Task Force (USPSTF) recommendation against prostate-specific antigen (PSA) testing for older men. Prostate cancer screening declined from 2007 to 2014 even in higher-risk groups and follow-up screening rates were not related to previous PSA level.
AHRQ-funded; HS024128.
Citation: Misra-Hebert AD, Hu B, Klein EA .
Prostate cancer screening practices in a large, integrated health system: 2007-2014.
BJU Int 2017 Aug;120(2):257-64. doi: 10.1111/bju.13793.
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Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Prostate Cancer, Screening, Primary Care, Practice Patterns
Tai-Seale M, Olson CW, Li J
Electronic health record logs indicate that physicians split time evenly between seeing patients and desktop medicine.
The researchers used data on physicians' time allocation patterns captured by over thirty-one million EHR transactions in the period 2011-14 recorded by 471 primary care physicians, who collectively worked on 765,129 patients' EHRs. Their results suggest that the physicians logged an average of 3.08 hours on office visits and 3.17 hours on desktop medicine each day.
AHRQ-funded; HS019167.
Citation: Tai-Seale M, Olson CW, Li J .
Electronic health record logs indicate that physicians split time evenly between seeing patients and desktop medicine.
Health Aff 2017 Apr;36(4):655-62. doi: 10.1377/hlthaff.2016.0811.
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Keywords: Clinician-Patient Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Practice Patterns
Raji MY, Chen NW, Raji M
Factors associated with seeking physician care by Medicare beneficiaries who receive all their primary care from nurse practitioners.
The authors sought to examine rate and correlates of switching from exclusive nurse practitioner (NP) primary care to receiving some or all primary care from physicians. The study group consisted of Medicare beneficiaries with diabetes, congrestive heart failure, or chronic obstructive pulmonary disease. The researchers found that about half of Medicare patients under exclusive NP primary care switched to physicians for some or all primary care over a 3-year period.
AHRQ-funded; HS022134; HS020642.
Citation: Raji MY, Chen NW, Raji M .
Factors associated with seeking physician care by Medicare beneficiaries who receive all their primary care from nurse practitioners.
J Prim Care Community Health 2016 Oct;7(4):249-57. doi: 10.1177/2150131916659674.
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Keywords: Elderly, Medicare, Primary Care, Practice Patterns
Penti B, Liebschutz JM, Kopcza B
Novel peer review method for improving controlled substance prescribing in primary care.
The authors sought to determine if peer feedback through a chart review tool (CRT) can impact opioid prescribing for patients with chronic noncancer pain in an outpatient family medicine clinic at an urban, safety-net teaching hospital. They reviewed 99 patient charts from 14 physicians over 1 year. They found that the mean dose of opioids decreased 2.6 mg morphine equivalent dose (MED)/day from time of chart review until the end of the project, compared to a 6.9 mg MED/day increase that occurred from 12 months prior to chart review to the time of chart review, and 14 patients were taken off of opioids after the chart review.
AHRQ-funded; HS022242.
Citation: Penti B, Liebschutz JM, Kopcza B .
Novel peer review method for improving controlled substance prescribing in primary care.
J Opioid Manag 2016 Jul-Aug;12(4):269-79. doi: 10.5055/jom.2016.0342.
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Keywords: Adverse Drug Events (ADE), Medication, Opioids, Primary Care, Practice Patterns
Renati S, Linder JA
Necessity of office visits for acute respiratory infections in primary care.
The researchers measured the proportion of primary care acute respiratory infection (ARI) visits that may not require an office visit. They concluded that about two-thirds of primary care ARI visits may not be necessary for appropriate antibiotic management.
AHRQ-funded; HS018419.
Citation: Renati S, Linder JA .
Necessity of office visits for acute respiratory infections in primary care.
Fam Pract 2016 Jun;33(3):312-7. doi: 10.1093/fampra/cmw019.
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Keywords: Shared Decision Making, Medication, Primary Care, Practice Patterns, Respiratory Conditions
Chung S, Zhao B, Lauderdale D
Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.
The researchers examined patterns and predictors of initiation of treatment for incident diabetes in an ambulatory care setting in the US. They found that only half of patients were treated during the first year following diabetes incidence, and only 20% of patients received both medication prescription and lifestyle modification interventions.
AHRQ-funded; HS019815.
Citation: Chung S, Zhao B, Lauderdale D .
Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.
Prim Care Diabetes 2015 Feb;9(1):23-30. doi: 10.1016/j.pcd.2014.04.005..
Keywords: Ambulatory Care and Surgery, Care Management, Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Practice Patterns
Gidengil CA, Linder JA, Beach S
Using clinical vignettes to assess quality of care for acute respiratory infections.
Overprescribing of antibiotics for acute respiratory infections (ARIs) is common. The objective of this study was to develop and validate a vignette-based method to estimate clinician ARI antibiotic prescribing. The researchers concluded that responses to 3 clinical vignettes can identify clinicians with relatively poor quality ARI antibiotic prescribing. Vignettes may be a mechanism to target clinicians for quality improvement efforts.
AHRQ-funded; HS018419.
Citation: Gidengil CA, Linder JA, Beach S .
Using clinical vignettes to assess quality of care for acute respiratory infections.
Inquiry 2016 Apr 20;53:pii: 0046958016636531. doi: 10.1177/0046958016636531..
Keywords: Antibiotics, Antimicrobial Stewardship, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR), Medication, Practice Patterns, Primary Care, Quality of Care, Respiratory Conditions
Howard HA, Malouin R, Callow-Rucker M
Care managers and knowledge shift in primary care patient-centered medical home transformation.
Based on a health insurance company-sponsored primary care transformation project, this study explores the perceptions of care management from the perspective of providers and practice staff to examine shifts in knowledge and their broader implications for primary care. It demonstrates how the diffusion of clinical power and knowledge production redefine primary care relationships to patients, as traditional hierarchies shift to team-based care.
AHRQ-funded; HS020046; HS01795.
Citation: Howard HA, Malouin R, Callow-Rucker M .
Care managers and knowledge shift in primary care patient-centered medical home transformation.
Hum Organ 2016 Spring;75(1):10-20..
Keywords: Care Management, Patient-Centered Healthcare, Primary Care, Practice Patterns, Teams
Tan A, Zhou J, Kuo YF
Variation among primary care physicians in the use of imaging for older patients with acute low back pain.
The authors sought to estimate the variation among primary care providers (PCPs) in the use of diagnostic imaging for older patients with non-specific acute low back pain. They used Texas Medicare claims data and tracked whether each patient received lumbar imaging within 4 weeks of the initial visit. They found that the specific physician seen by a patient accounted for 25 % of the variability in whether imaging was performed and that the use of imaging by individual physicians was stable over time.
AHRQ-funded; HS022134.
Citation: Tan A, Zhou J, Kuo YF .
Variation among primary care physicians in the use of imaging for older patients with acute low back pain.
J Gen Intern Med 2016 Feb;31(2):156-63. doi: 10.1007/s11606-015-3475-3.
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Keywords: Back Health and Pain, Elderly, Imaging, Primary Care, Practice Patterns
Kuo YF, Goodwin JS, Chen NW
Diabetes mellitus care provided by nurse practitioners vs primary care physicians.
The study objective was to compare processes and cost of care of older adults with diabetes mellitus cared for by nurse practitioners (NPs) with processes and cost of those cared for by primary care physicians (PCPs). It concluded that nurse practitioners were similar to PCPs or slightly lower in their rates of diabetes mellitus guideline–concordant care.
AHRQ-funded; HS020642; HS022134.
Citation: Kuo YF, Goodwin JS, Chen NW .
Diabetes mellitus care provided by nurse practitioners vs primary care physicians.
J Am Geriatr Soc 2015 Oct;63(10):1980-8. doi: 10.1111/jgs.13662..
Keywords: Chronic Conditions, Diabetes, Elderly, Primary Care, Practice Patterns
Magnan EM, Gittelson R, Bartels CM
Establishing chronic condition concordance and discordance with diabetes: a Delphi study.
This study aimed to provide more information for the future research and clinical use of the concordant/discordant framework by increasing the number of conditions that can be characterized as concordant or discordant with diabetes. By finding that 12 conditions were concordant with diabetes care and 50 were discordant, the study significantly adds to the number of conditions for which there is information on concordance and discordance for diabetes care.
AHRQ-funded; HS018368; HS007646; HS021899.
Citation: Magnan EM, Gittelson R, Bartels CM .
Establishing chronic condition concordance and discordance with diabetes: a Delphi study.
BMC Fam Pract 2015 Mar 28;16:42. doi: 10.1186/s12875-015-0253-6..
Keywords: Chronic Conditions, Diabetes, Primary Care, Practice Patterns
Hendrix KS, Downs SM, Carroll AE
Pediatricians' responses to printed clinical reminders: does highlighting prompts improve responsiveness?
The authors tested whether selectively highlighting clinical decision support prompts in yellow would improve physicians' responsiveness. They found that highlighting reminder prompts did not increase physicians' responsiveness. They suggested possible explanations and offer alternative strategies to increasing physician responsiveness to prompts.
AHRQ-funded; HS020640; HS018453; HS017939.
Citation: Hendrix KS, Downs SM, Carroll AE .
Pediatricians' responses to printed clinical reminders: does highlighting prompts improve responsiveness?
Acad Pediatr 2015 Mar-Apr;15(2):158-64. doi: 10.1016/j.acap.2014.10.009.
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Keywords: Clinical Decision Support (CDS), Children/Adolescents, Primary Care, Practice Patterns, Quality Improvement