Summary Background Data for front-line health-care workers and risk of COVID-19 are limited. We sought to assess risk of COVID-19 among front-line health-care workers compared with the general community and the effect of personal protective equipment (PPE) on risk. Methods We did a prospective, observational cohort study in the UK and the USA of the general community, including front-line health-care workers, using self-reported data from the COVID Symptom Study smartphone application (app) from March 24 (UK) and March 29 (USA) to April 23, 2020. Participants were voluntary users of the app and at first use provided information on demographic factors (including age, sex, race or ethnic background, height and weight, and occupation) and medical history, and subsequently reported any COVID-19 symptoms. We used Cox proportional hazards modelling to estimate multivariate-adjusted hazard ratios (HRs) of our primary outcome, which was a positive COVID-19 test. The COVID Symptom Study app is registered with ClinicalTrials.gov , NCT04331509 . Findings Among 2 035 395 community individuals and 99 795 front-line health-care workers, we recorded 5545 incident reports of a positive COVID-19 test over 34 435 272 person-days. Compared with the general community, front-line health-care workers were at increased risk for reporting a positive COVID-19 test (adjusted HR 11·61, 95% CI 10·93–12·33). To account for differences in testing frequency between front-line health-care workers and the general community and possible selection bias, an inverse probability-weighted model was used to adjust for the likelihood of receiving a COVID-19 test (adjusted HR 3·40, 95% CI 3·37–3·43). Secondary and post-hoc analyses suggested adequacy of PPE, clinical setting, and ethnic background were also important factors. Interpretation In the UK and the USA, risk of reporting a positive test for COVID-19 was increased among front-line health-care workers. Health-care systems should ensure adequate availability of PPE and develop additional strategies to protect health-care workers from COVID-19, particularly those from Black, Asian, and minority ethnic backgrounds. Additional follow-up of these observational findings is needed. Funding Zoe Global, Wellcome Trust, Engineering and Physical Sciences Research Council, National Institutes of Health Research, UK Research and Innovation, Alzheimer's Society, National Institutes of Health, National Institute for Occupational Safety and Health, and Massachusetts Consortium on Pathogen Readiness.

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PURPOSE Limited research exists examining the principles of the patient-centered medical home (PCMH) and improved outcomes. We examined whether PCMH principles (personal physician, physician-directed team, whole-person orientation, coordination of care, quality and safety, and enhanced access) are associated with receipt of preventive services. METHODSWe undertook cross-sectional analyses using baseline patient and practice member surveys and chart audits from a quality improvement trial in 24 primary care offi ces. Association of PCMH principles with preventive services (receipt of cancer screening, lipid screening, infl uenza vaccination, and behavioral counseling) was examined using hierarchical linear modeling. RESULTSHigher global PCMH scores were associated with receipt of preventive services (β = 2.3; P <.001). Positive associations were found with principles of personal physician (β = 3.7; P <.001), in particular, continuity with the same physician (β = 4.4; P = .002) and number of visits within 2 years (15% higher for patients with 13 or more visits; P <.001); and whole-person orientation (β = 5.6; P <.001), particularly, having a well-visit within 5 years (β = 12.3; P <.001) and being treated for chronic diseases (6% higher if more than 3 chronic diseases; P = .002). Having referral systems to link patients to community programs for preventive counseling (β = 8.0; P <.001) and use of clinical decision-support tools (β = 5.0; P = .04) were also associated with receipt of preventive services.CONCLUSIONS Relationship-centered aspects of PCMH are more highly correlated with preventive services delivery in community primary care practices than are information technology capabilities. Demonstration projects and tools that measure PCMH principles should have greater emphasis on these key primary care attributes. Ann Fam Med 2010;8:108-116. doi10.1370/afm.1080 INTRODUCTIONT he patient-centered medical home (PCMH) is being promoted as the future of primary care practice that will help reform the US health care system into one that is more accessible, effective, effi cient, safe, and economical. 1 The PCMH includes several principles: (1) an ongoing relationship with a personal physician for fi rst-contact, continuous, and comprehensive care; (2) a physician-directed team that collectively cares for the patient; (3) whole-person orientation, including acute, chronic, preventive, and end-of-life care; (4) coordinated care across all elements of the health care system and the patient's community; (5) quality and safety through evidence-based medicine and clinical decision-support tools, information technology, registries, and continuous quality improvement; (6) enhanced access, achieved through such systems as open scheduling, expanded hours, and new options for communication between patients, their physician, and practice staff; and (7) payment reform to refl ect the added value that a PCMH provides to patients. The evidence showing effectiveness of high-tech information technology in improving quality o...

Background Effective colorectal cancer screening depends on timely diagnostic evaluation in patients with abnormal fecal immunochemical tests (FIT). Although prior studies suggest low rates of follow-up colonoscopy, there is little information among patients in safety-net health systems and few data characterizing reasons for low follow-up rates. Aims Characterize factors contributing to lack of follow-up colonoscopy in a racially diverse and socioeconomically disadvantaged cohort of patients with abnormal FIT receiving care in an integrated safety-net health system. Methods We performed a retrospective electronic medical record review of patients aged 50-64 years with abnormal FIT at a population-based safety-net health system between January 2010 and July 2013. Review of electronic medical record focused on patients without follow-up colonoscopy to characterize patient-, provider-, and system-level reasons for lack of diagnostic evaluation. We used logistic regression analysis to identify predictors of follow-up colonoscopy within 12 months of abnormal FIT. Results Of 1267 patients with abnormal FIT, 536 (42.3%) failed to undergo follow-up colonoscopy within one year. Failure was attributable to patient-level factors in 307 (57%) cases, provider factors in 97 (18%) cases, system factors in 118 (22%) cases. In multivariate analysis, follow-up colonoscopy was less likely among those aged 61-64 years (OR 0.63, 95%CI 0.46–0.87) compared to 50-55 year-olds. Conclusions Nearly half (42%) of patients with abnormal FIT failed to undergo follow-up colonoscopy within one year. Lack of diagnostic evaluation is related to a combination of patient-, provider-, and system-level factors, highlighting the need for multi-level interventions to improve follow-up colonoscopy completion rates.