National Healthcare Quality and Disparities Report
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Topics
- Access to Care (1)
- Adverse Drug Events (ADE) (2)
- Adverse Events (6)
- Ambulatory Care and Surgery (1)
- Arthritis (1)
- Asthma (1)
- Blood Clots (2)
- Cancer (6)
- Cancer: Breast Cancer (2)
- Cancer: Ovarian Cancer (1)
- Cardiovascular Conditions (1)
- Care Management (1)
- Catheter-Associated Urinary Tract Infection (CAUTI) (3)
- Children/Adolescents (8)
- Chronic Conditions (2)
- Clinical Decision Support (CDS) (2)
- Communication (1)
- Community-Based Practice (2)
- Comparative Effectiveness (2)
- Decision Making (1)
- Dental and Oral Health (2)
- Diabetes (2)
- Diagnostic Safety and Quality (2)
- Education (2)
- Elderly (1)
- Electronic Health Records (EHRs) (3)
- Emergency Department (1)
- Evidence-Based Practice (3)
- Falls (1)
- Family Health and History (1)
- Genetics (1)
- Guidelines (3)
- Healthcare-Associated Infections (HAIs) (8)
- Healthcare Costs (1)
- Healthcare Delivery (1)
- Healthcare Utilization (2)
- Health Information Exchange (HIE) (1)
- Health Information Technology (HIT) (5)
- Health Insurance (1)
- Health Promotion (1)
- Hospitalization (1)
- Infectious Diseases (2)
- Influenza (1)
- Inpatient Care (1)
- Lifestyle Changes (1)
- Long-Term Care (1)
- Medicaid (2)
- Medical Devices (1)
- Medical Errors (2)
- Medical Expenditure Panel Survey (MEPS) (1)
- Medication (4)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (1)
- Mortality (1)
- Nursing Homes (3)
- Nutrition (1)
- Obesity (5)
- Obesity: Weight Management (1)
- Outcomes (1)
- Patient-Centered Outcomes Research (2)
- Patient and Family Engagement (1)
- Patient Safety (10)
- Pneumonia (1)
- Practice Patterns (3)
- Pressure Ulcers (1)
- (-) Prevention (41)
- Primary Care (5)
- Provider: Health Personnel (1)
- Public Health (1)
- Quality Improvement (7)
- Quality of Care (3)
- Risk (2)
- Rural Health (1)
- Screening (5)
- Social Determinants of Health (1)
- Surgery (1)
- Teams (2)
- Telehealth (1)
- Tools & Toolkits (1)
- U.S. Preventive Services Task Force (USPSTF) (1)
- Uninsured (1)
- Urinary Tract Infection (UTI) (1)
- Vaccination (2)
- Web-Based (1)
- Women (2)
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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 41 Research Studies DisplayedVyas A, Madhavan S, Sambamoorthi U
Association between persistence with mammography screening and stage at diagnosis among elderly women diagnosed with breast cancer.
The objective of this study is to determine the association between persistence with mammography screening and stage at breast cancer (BC) diagnosis among elderly women. It found that, as compared to women who were not persistent with mammography screening, women who were persistent with mammography screening were significantly more likely to be diagnosed at earlier stages of BC.
AHRQ-funded; HS018622.
Citation: Vyas A, Madhavan S, Sambamoorthi U .
Association between persistence with mammography screening and stage at diagnosis among elderly women diagnosed with breast cancer.
Breast Cancer Res Treat 2014 Dec;148(3):645-54. doi: 10.1007/s10549-014-3204-3..
Keywords: Cancer, Cancer: Breast Cancer, Diagnostic Safety and Quality, Elderly, Prevention, Screening, Women
Cai L, Wu Y, Cheskin LI
Effect of childhood obesity prevention programmes on blood lipids: a systematic review and meta-analysis.
This study, the first systematic, quantitative study of childhood obesity prevention programs on blood lipids in high-income countries found that most interventions (70 percent) showed similar significant or no effects on adiposity- and lipid outcomes; 15 percent of interventions improved both adiposity- and lipids outcomes; 55 percent had no significant effects on either. These programs had a significant desirable effect on LDL-C and HDL-C.
AHRQ-funded; 290200710061I
Citation: Cai L, Wu Y, Cheskin LI .
Effect of childhood obesity prevention programmes on blood lipids: a systematic review and meta-analysis.
Obes Rev. 2014 Dec;15(12):933-44. doi: 10.1111/obr.12227..
Keywords: Children/Adolescents, Obesity, Prevention, Outcomes, Social Determinants of Health
Shaikh U, Nettiksimmons J, Joseph JG
Collaborative practice improvement for childhood obesity in rural clinics: the Healthy Eating Active Living Telehealth Community of Practice (HEALTH COP).
The authors assessed the impact of participation in a virtual quality improvement (QI) learning network on adherence to clinical guidelines for childhood obesity prevention in rural clinics. They found that children who received care from clinicians who led the implementation of the intervention at their clinic showed significant improvements in nutrition and physical activity. Virtual QI learning networks in geographically dispersed clinics can significantly increase clinicians' adherence to guidelines for childhood obesity and improve access to recommended care for rural and underserved children.
AHRQ-funded; HS018567.
Citation: Shaikh U, Nettiksimmons J, Joseph JG .
Collaborative practice improvement for childhood obesity in rural clinics: the Healthy Eating Active Living Telehealth Community of Practice (HEALTH COP).
Am J Med Qual 2014 Nov-Dec;29(6):467-75. doi: 10.1177/1062860613506252.
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Keywords: Children/Adolescents, Evidence-Based Practice, Health Information Technology (HIT), Lifestyle Changes, Nutrition, Obesity, Prevention, Quality Improvement, Rural Health, Telehealth
Aldrich H, Gance-Cleveland B, Schmiege S
Identification and assessment of childhood obesity by school-based health center providers.
The authors evaluated obesity care assessment practices of school-based health center (SBHC) providers prior to completing training on obesity guidelines. They found that most providers reported using BMI to assess weight, reported screening for hypertension 100% of the time and cardiovascular disease 93.9% of the time, and approximately two thirds reported requesting total cholesterol and lipid profile laboratory assessments.
AHRQ-funded; HS018646.
Citation: Aldrich H, Gance-Cleveland B, Schmiege S .
Identification and assessment of childhood obesity by school-based health center providers.
J Pediatr Health Care 2014 Nov-Dec;28(6):526-33. doi: 10.1016/j.pedhc.2014.05.002.
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Keywords: Children/Adolescents, Guidelines, Education, Obesity, Prevention
Aldrich H, Gance-Cleveland B, Schmiege S
School-based health center providers' treatment of overweight children.
The purpose of this study was to determine self-reported treatment practices of school-based health center (SBHC) providers when caring for overweight/obese children. SBHC providers reported patient/parent barriers to be more significant to treatment than clinician/setting barriers. Most providers (97%) indicated childhood overweight needs treatment, yet only 36% indicated that they initiate treatment in children who do not want to control their weight. SBHC providers also did not commonly refer these children to specialists.
AHRQ-funded; HS018646.
Citation: Aldrich H, Gance-Cleveland B, Schmiege S .
School-based health center providers' treatment of overweight children.
J Pediatr Nurs 2014 Nov-Dec;29(6):521-7. doi: 10.1016/j.pedn.2014.05.007.
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Keywords: Care Management, Children/Adolescents, Education, Obesity, Prevention, Obesity: Weight Management
Young RS, Gobel BH, Schumacher M
Use of the modified early warning score and serum lactate to prevent cardiopulmonary arrest in hematology-oncology patients: a quality improvement study.
The authors aimed to improve the early identification of clinically deteriorating hematology-oncology patients in order to prevent the development of critical illness and to facilitate timely intensive care unit (ICU) transfers. They used a protocol employing the Modified Early Warning Score and found that implementation of this protocol reduced codes and preventable codes without an associated increase in ICU transfers.
AHRQ-funded; HS000078.
Citation: Young RS, Gobel BH, Schumacher M .
Use of the modified early warning score and serum lactate to prevent cardiopulmonary arrest in hematology-oncology patients: a quality improvement study.
Am J Med Qual 2014 Nov-Dec;29(6):530-7. doi: 10.1177/1062860613508305.
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Keywords: Adverse Events, Cancer, Diagnostic Safety and Quality, Prevention, Quality Improvement
Beil H, Rozier RG, Preisser JS
Effects of early dental office visits on dental caries experience.
This study determined the association between timing of a first dentist office visit before age 5 and dental disease in kindergarten. It found that children with early dental visits (before age 2) had higher rates of tooth decay than those who had later visits (between ages 3 and 5).
AHRQ-funded; HS018076.
Citation: Beil H, Rozier RG, Preisser JS .
Effects of early dental office visits on dental caries experience.
Am J Public Health. 2014 Oct;104(10):1979-85. doi: 10.2105/AJPH.2013.301325..
Keywords: Dental and Oral Health, Children/Adolescents, Access to Care, Medicaid, Prevention
Fakih MG, Krein SL, Edson B
AHRQ Author: Battles JB
Engaging health care workers to prevent catheter-associated urinary tract infection and avert patient harm.
This article discusses catheter-associated urinary tract infection (CAUTI) prevention efforts, describes the national collaboration between different organizations, briefly reviews the technical and socio-adaptive components of the program, and specifically describes an approach to engaging health care workers as an essential part of CAUTI prevention and averting patient harm.
AHRQ-authored; AHRQ-funded; 290201000025I; 29032001T
Citation: Fakih MG, Krein SL, Edson B .
Engaging health care workers to prevent catheter-associated urinary tract infection and avert patient harm.
Am J Infect Control. 2014 Oct;42(10 Suppl):S223-9. doi: 10.1016/j.ajic.2014.03.355..
Keywords: Adverse Events, Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Patient Safety, Prevention, Practice Patterns, Quality Improvement
Fakih MG, Krein SL, Edson B
AHRQ Author: Battles JB
Engaging health care workers to prevent catheter-associated urinary tract infection and avert patient harm.
The "On the CUSP: Stop CAUTI" initiative represents the single largest national effort to mitigate urinary catheter risk. The program brings together key organizations to assist hospitals by providing education and coaching support. Continuity is secured by integrating the process into the health care worker's daily routine activities.
AHRQ-authored; AHRQ-funded; 290201000025I; 29032001T.
Citation: Fakih MG, Krein SL, Edson B .
Engaging health care workers to prevent catheter-associated urinary tract infection and avert patient harm.
Am J Infect Control 2014 Oct;42(10 Suppl):S223-9. doi: 10.1016/j.ajic.2014.03.355.
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Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Patient Safety, Prevention, Practice Patterns
Laiteerapong N, Kirby J, Gao Y
AHRQ Author: Kirby J, Ngo-Metzger Q
Health care utilization and receipt of preventive care for patients seen at federally funded health centers compared to other sites of primary care.
The investigators compared utilization and preventive care receipt among patients of federal Section 330 health centers (HCs) versus patients of other settings. They found that HC patients had fewer office visits and hospitalizations, were more likely to receive breast cancer screening, had fewer outpatient and emergency room visits, and were more likely to receive dietary advice compared to non-HC patients.
AHRQ-authored.
Citation: Laiteerapong N, Kirby J, Gao Y .
Health care utilization and receipt of preventive care for patients seen at federally funded health centers compared to other sites of primary care.
Health Serv Res 2014 Oct;49(5):1498-518. doi: 10.1111/1475-6773.12178.
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Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Utilization, Prevention, Community-Based Practice, Healthcare Delivery
Campbell LJ, Li Q, Li Y
Healthcare worker influenza vaccination in Oregon nursing homes: correlates of facility characteristics.
The authors identified nursing home (NH) characteristics that may be associated with employee influenza vaccination rates (EVRs). They concluded that, as NHs generally have low EVRs, it may be necessary to target low-performing facilities to achieve substantial improvements.
AHRQ-funded; HS000044.
Citation: Campbell LJ, Li Q, Li Y .
Healthcare worker influenza vaccination in Oregon nursing homes: correlates of facility characteristics.
J Am Med Dir Assoc 2014 Oct;15(10):768-72. doi: 10.1016/j.jamda.2014.06.005.
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Keywords: Provider: Health Personnel, Influenza, Nursing Homes, Prevention, Vaccination
Battles JB, Cleeman JI, Kahn KL
AHRQ Author: Battles JB
Introduction to "preventing healthcare-associated infections: results and lessons learned from AHRQ's HAI program".
This article introduces a special issue with 18 articles emanating from a synthesis of an AHRQ-funded healthcare-associated infections (HAI) project conducted by IMPAQ International and the RAND Corporation. The articles identify the major results and lessons learned from project documents including final reports, peer-reviewed literature, and HAI-prevention tool kits.
AHRQ-authored.
Citation: Battles JB, Cleeman JI, Kahn KL .
Introduction to "preventing healthcare-associated infections: results and lessons learned from AHRQ's HAI program".
Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S1-2. doi: 10.1086/677817..
Keywords: Healthcare-Associated Infections (HAIs), Patient Safety, Prevention
Ali KJ, Farley DO, Speck K
Measurement of implementation components and contextual factors in a two-state healthcare quality initiative to reduce ventilator-associated pneumonia.
The authors sought to develop and field test an implementation assessment tool for assessing progress of hospital units in implementing improvements for the prevention of ventilator-associated pneumonia (VAP) in a two-state collaborative. They found that a relatively small number of barriers were found to have important negative effects on implementation progress, including barriers related to workload and time issues. They modified coaching provided to the unit teams to reinforce training in weak spots that the interviews identified.
AHRQ-funded; 290201000027I.
Citation: Ali KJ, Farley DO, Speck K .
Measurement of implementation components and contextual factors in a two-state healthcare quality initiative to reduce ventilator-associated pneumonia.
Infect Control Hosp Epidemiol 2014 Oct;35 Suppl 3:S116-23. doi: 10.1086/677832.
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Keywords: Healthcare-Associated Infections (HAIs), Patient Safety, Pneumonia, Prevention, Quality Improvement
Rosenman MB, Szucs KA, Finnell SM
Nascent regional system for alerting infection preventionists about patients with multidrug-resistant gram-negative bacteria: implementation and initial results.
The authors sought to build and to begin evaluating a regional automated system to notify infection preventionists (IPs) when a patient with a history of gram-negative rod multidrug-resistant organism (GNRMDRO) is admitted to an emergency department (ED) or inpatient setting. They found it feasible to create a regional microbiology-based alert system and observed substantial crossover between institutions. They concluded that this system, if it contributes to timely isolation, may help reduce the spread of GNRMDROs.
AHRQ-funded; HS020014.
Citation: Rosenman MB, Szucs KA, Finnell SM .
Nascent regional system for alerting infection preventionists about patients with multidrug-resistant gram-negative bacteria: implementation and initial results.
Infect Control Hosp Epidemiol 2014 Oct;35 Suppl 3:S40-7. doi: 10.1086/677833.
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Keywords: Emergency Department, Infectious Diseases, Inpatient Care, Patient Safety, Prevention
Freedman JL, Faerber JI, Kang TI
Predictors of antiemetic alteration in pediatric acute myeloid leukemia.
The purpose of this study was to gain better knowledge of patient and cancer treatment factors associated with nausea/vomiting (NV) in order to enhance prophylaxis in children being treated for acute myeloid leukemia (AML). It found that treatment-related NV, as evidenced by antiemetic alterations, is more prevalent with increasing age.
AHRQ-funded; HS018425
Citation: Freedman JL, Faerber JI, Kang TI .
Predictors of antiemetic alteration in pediatric acute myeloid leukemia.
Pediatr Blood Cancer. 2014 Oct;61(10):1798-805. doi: 10.1002/pbc.25108..
Keywords: Adverse Drug Events (ADE), Adverse Events, Cancer, Children/Adolescents, Medication, Prevention
Chung S, Azar KM, Baek M
Reconsidering the age thresholds for type II diabetes screening in the U.S.
In order to examine the optimal age cut-point for opportunistic universal screening (as opposed to targeted screening), the researchers used a nationally representative sample from the National Health and Nutrition Examination Survey (2007-2010) and other resources. They found that opportunistic screening among individuals 35 years of age and older could greatly reduce the prevalence of undiagnosed diabetes or pre-diabetes.
AHRQ-funded; HS019815; HS019815.
Citation: Chung S, Azar KM, Baek M .
Reconsidering the age thresholds for type II diabetes screening in the U.S.
Am J Prev Med. 2014 Oct;47(4):375-81. doi: 10.1016/j.amepre.2014.05.012..
Keywords: Diabetes, Screening, Prevention, Chronic Conditions
Heintzman J, Marino M, Hoopes M
Using electronic health record data to evaluate preventive service utilization among uninsured safety net patients.
This study used EHR data to compare the preventive service utilization of uninsured patients receiving care at Oregon community health centers (CHCs) in 2008 through 2011 with that of continuously insured patients at the same CHCs in the same period. The results showed that CHCs provided many preventive services to uninsured patients, but that uninsured patients were less likely than continuously insured patients to receive 5 of 11 preventive services. The authors concluded that lack of insurance is a barrier to preventive service utilization, even in patients who can access care at a CHC.
AHRQ-funded; HS021522.
Citation: Heintzman J, Marino M, Hoopes M .
Using electronic health record data to evaluate preventive service utilization among uninsured safety net patients.
Prev Med 2014 Oct;67:306-10. doi: 10.1016/j.ypmed.2014.08.006.
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Keywords: Community-Based Practice, Electronic Health Records (EHRs), Healthcare Utilization, Prevention, Uninsured
Arling PA, Abrahamson K, Miech EJ
Communication and effectiveness in a US nursing home quality-improvement collaborative.
The investigators explored the relationship between changes in resident health outcomes, practitioner communication patterns, and practitioner perceptions of group effectiveness within a quality-improvement collaborative of nursing home clinicians. They found that reductions in fall rates were highest in facilities where respondents experienced the highest levels of communication with collaborative members outside of scheduled meetings. Clinician and practitioner observations were discussed.
AHRQ-funded; HS018464.
Citation: Arling PA, Abrahamson K, Miech EJ .
Communication and effectiveness in a US nursing home quality-improvement collaborative.
Nurs Health Sci 2014 Sep;16(3):291-7. doi: 10.1111/nhs.12098.
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Keywords: Communication, Falls, Nursing Homes, Quality of Care, Prevention, Quality Improvement
Barnes SL, Morgan DJ, Harris AD
Preventing the transmission of multidrug-resistant organisms: modeling the relative importance of hand hygiene and environmental cleaning interventions.
The authors investigated the relative impact of hand hygiene and environmental cleaning in order to assess resource allocation. They concluded that hand hygiene should remain a priority for infection control programs, but environmental cleaning can have significant benefit for hospitals or individual hospital units that have either high hand hygiene compliance levels or low terminal cleaning thoroughness.
AHRQ-funded; HS018111.
Citation: Barnes SL, Morgan DJ, Harris AD .
Preventing the transmission of multidrug-resistant organisms: modeling the relative importance of hand hygiene and environmental cleaning interventions.
Infect Control Hosp Epidemiol 2014 Sep;35(9):1156-62. doi: 10.1086/677632.
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Keywords: Healthcare-Associated Infections (HAIs), Methicillin-Resistant Staphylococcus aureus (MRSA), Prevention
Goldsweig AM, Reid KJ, Gosch K
Contemporary use of dual antiplatelet therapy for preventing cardiovascular events.
The authors examined dual antiplatelet therapy (DAPT) use in contemporary clinical practice after publication of the results of the landmark randomized clinical trial CHARISMA. They found that use of DAPT is modest in patients with established cardiovascular disease, for whom the CHARISMA trial suggested decreased major adverse cardiovascular events (MACEs), and prescription rates have remained stable over time; use of DAPT in patients with multiple risk factors only, for whom CHARISMA suggested that DAPT may lead to increased MACEs, was low and decreased over time.
AHRQ-funded; HS018781.
Citation: Goldsweig AM, Reid KJ, Gosch K .
Contemporary use of dual antiplatelet therapy for preventing cardiovascular events.
Am J Manag Care 2014 Aug;20(8):659-65.
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Keywords: Cardiovascular Conditions, Medication, Prevention, Practice Patterns, Risk
Huang LC, Conley D, Lipsitz S
The Surgical Safety Checklist and teamwork coaching tools: a study of inter-rater reliability.
The authors assessed the inter-rater reliability (IRR) of two novel observation tools for measuring surgical safety checklist performance and teamwork. They found that both the Checklist Coaching Tool and the Surgical Teamwork Tool demonstrated substantial IRR and required limited training to use, indicating that both instruments may be used to observe checklist performance and teamwork in the operating room. They recommended that further refinement and calibration of observer expectations, particularly in rating teamwork, could improve the utility of the tools.
AHRQ-funded; HS019631.
Citation: Huang LC, Conley D, Lipsitz S .
The Surgical Safety Checklist and teamwork coaching tools: a study of inter-rater reliability.
BMJ Qual Saf 2014 Aug;23(8):639-50. doi: 10.1136/bmjqs-2013-002446.
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Keywords: Patient Safety, Surgery, Tools & Toolkits, Teams, Adverse Events, Medical Errors, Prevention
Perry LM, Winthrop KL, Curtis JR
Vaccinations for rheumatoid arthritis.
The goal of this paper is to highlight the most recent literature on the key vaccines and the specific considerations for the rheumatologist and their rheumatoid arthritis (RA) patients, with a particular focus on influenza, pneumococcal, and herpes zoster vaccines. It is important for rheumatologists to understand which vaccines are live and what potential contraindications exist for giving vaccines to RA patients.
AHRQ-funded; HS018517
Citation: Perry LM, Winthrop KL, Curtis JR .
Vaccinations for rheumatoid arthritis.
Curr Rheumatol Rep. 2014 Aug;16(8):431. doi: 10.1007/s11926-014-0431-x..
Keywords: Arthritis, Vaccination, Prevention
Heintzman J, Bailey SR, Hoopes MJ
Agreement of Medicaid claims and electronic health records for assessing preventive care quality among adults.
The researchers sought to compare the agreement of electronic health records (EHR) data versus Medicaid claims data in documenting adult preventive care. For services performed in the primary care setting, EHR data compared favorably to Medicaid claims in documenting the percentage of patients with service receipt; services that were referred out were less frequently observed in the EHR.
AHRQ-funded; HS021522
Citation: Heintzman J, Bailey SR, Hoopes MJ .
Agreement of Medicaid claims and electronic health records for assessing preventive care quality among adults.
J Am Med Inform Assoc. 2014 Jul-Aug;21(4):720-4. doi: 10.1136/amiajnl-2013-002333..
Keywords: Electronic Health Records (EHRs), Health Insurance, Medicaid, Prevention, Primary Care
Raebel MA, Ellis JL, Schroeder EB
Intensification of antihyperglycemic therapy among patients with incident diabetes: a Surveillance Prevention and Management of Diabetes Mellitus (SUPREME-DM) study.
The aim of this study was to characterize antihyperglycemic intensification during the first year after initiating oral antihyperglycemic therapy among adult patients with incident diabetes. The researchers found that 43.5 percent of patients with diabetes had treatment intensified within 1 year of starting antihyperglycemic medication. HbA1c of less than 7 percent was achieved in a very high proportion of patients (65.1 percent).
AHRQ-funded; HS019859
Citation: Raebel MA, Ellis JL, Schroeder EB .
Intensification of antihyperglycemic therapy among patients with incident diabetes: a Surveillance Prevention and Management of Diabetes Mellitus (SUPREME-DM) study.
Pharmacoepidemiol Drug Saf, 2014 Jul;23(7):699-710. doi: 10.1002/pds.3610..
Keywords: Diabetes, Prevention, Medication
Atlas SJ, Zai AH, Ashburner JM
Non-visit-based cancer screening using a novel population management system.
The authors evaluated whether involving primary care providers (PCPs) in a visit-independent population management IT application led to more effective cancer screening. They found that involving PCPs in a visit-independent population management IT application resulted in similar cancer screening rates compared with an automated reminder system, but fewer patients were sent reminder letters, suggesting that PCPs were able to identify and exclude from contact patients who would have received automated reminder letters but not undergone screening.
AHRQ-funded; HS018161.
Citation: Atlas SJ, Zai AH, Ashburner JM .
Non-visit-based cancer screening using a novel population management system.
J Am Board Fam Med 2014 Jul-Aug;27(4):474-85. doi: 10.3122/jabfm.2014.04.130319.
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Keywords: Cancer, Health Information Technology (HIT), Prevention, Primary Care, Screening