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Recommendation Evidence Rating References Comments Patients who have a continuity relationship with a personal care physician have better health process measures and outcomes. 1 23,34,41,47,52 Continuity is most commonly associated with primary care, but cancer care, dialysis, and diabetes care are examples of specialty continuity. Multiple visits over time with the same provider create renewed opportunities to build management and teaching strategies tailored to individual progress and receptivity. 2 24,25,38,39,46,49,54,55 Neither primary care nor specialty care can meet their full potential if provided in a vacuum. All studies are challenged to evaluate any piece of the system in isolation from the context of specialty or other community services. Minorities become as likely as non-minorities to receive preventive screening and have their chronic conditions well managed in a medical home model. 2 19,20,22,26,27 Rigorous program evaluations, secondary population analyses, and observational comparison studies show consistent findings. In primary care, patients present at most visits with multiple problems. 1 06, 64,65 The use of each office visit to care for multiple problems is a property of primary care. Specialists generate more diagnostic hypotheses within their domain than outside and assign higher probabilities to diagnoses within that domain. 2 73,74 The interface between primary care and specialty care needs further research. The more attributes of the medical home demonstrated by a primary care practice, the more likely patients are to be up to date on screening, immunizations, and health habit counseling, and the less likely they are to use emergency rooms. 2 28,29,94,95,106,107,121 1 = consistent, good quality evidence; 2 = limited quality, patient-oriented evidence; 3 = consensus, usual practice, expert opinion, or case series.30
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