PURPOSE Continuity of care is a defining characteristic of primary care associated with lower costs and improved health equity and care quality. However, we lack provider-level measures of primary care continuity amenable to value-based payment, including the Medicare Quality Payment Program (QPP). We created 4 physician-level, claims-based continuity measures and tested their associations with health care expenditures and hospitalizations. METHODSWe used Medicare claims data for 1,448,952 beneficiaries obtaining care from a nationally representative sample of 6,551 primary care physicians to calculate continuity scores by 4 established methods. Patient-level continuity scores attributed to a single physician were averaged to create physician-level scores. We used beneficiary multilevel models, including beneficiary controls, physician characteristics, and practice rurality to estimate associations with total Medicare Part A & B expenditures (allowed charges, logged), and any hospitalization. RESULTSOur continuity measures were highly correlated (correlation coefficients ranged from 0.86 to 0.99), with greater continuity associated with similar outcomes for each. Adjusted expenditures for beneficiaries cared for by physicians in the highest Bice-Boxerman continuity score quintile were 14.1% lower than for those in the lowest quintile ($8,092 vs $6,958; β = -0.151; 95% CI, -0.186 to -0.116), and the odds of hospitalization were 16.1% lower between the highest and lowest continuity quintiles (OR = 0.839; 95% CI, 0.787 to 0.893).CONCLUSIONS All 4 continuity scores tested were significantly associated with lower total expenditures and hospitalization rates. Such indices are potentially useful as QPP measures, and may also serve as proxy resource-use measures, given the strength of association with lower costs and utilization.

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scribe patient deaths included expired, hospice, and passed away. Thus, 97 of 392 (24.7%) patient deaths were misclassified as injury or malfunction events.Discussion | We found a substantial misclassification of patient deaths in the FDA's MAUDE database for the Sapien 3 and MitraClip devices, which resulted in the underreporting of deaths. Our findings raise concerns about the accuracy of adverse-event reports for high-risk devices. The results complement recent news reports that the FDA allowed device manufacturers to file reports of malfunctions in a hidden database, known as alternative summary reporting. 6 Both the miscategorization of deaths in FDA adverse-event reporting and hidden adverse-events reports can lead to inaccurate public and physician perception of the safety of medical devices and can compromise informed decisionmaking. Given the increased reliance on postmarketing surveillance, improving the accuracy and clarity of adverseevent reporting should be a high priority for both the FDA and industry.

Lack of medical care in North Korea and vulnerability to human trafficking during their migration increase risks of cervical cancer among North Korean refugees. To better understand factors influencing Pap test use, we conducted a qualitative study of 8 North Korean refugees in South Korea. Individual barriers were limited knowledge, lack of perceived need for preventive services, and concerns about costs. Environmental facilitators included having female providers, receiving family support, and free screenings. Refugees’ health outlook, including viewing cancers as fatal diseases, hindered seeking Pap tests. Multi-faceted approaches to address individual and environmental factors in promoting Pap tests are warranted.

The effects of ability performance goals, normative performance goals, and mastery goals on anxiety, interest, and performance were examined in a series of experiments. Challenging problem-solving tasks that would demonstrate the effects of each performance goal more clearly were designed. Groups of early adolescents (Study 1) and college students in Korea (Studies 2 and 3) participated in similar experiments to strengthen the generalizability of the findings. Across the 3 studies, students assigned to the ability-goal condition exhibited significantly higher anxiety and lower interest compared with those in the normative- and mastery-goal conditions, except that the anxiety between the 2 performance-goal conditions did not differ after experiencing failure in Study 3. The ability-goal students persisted for significantly less time than did those in the other 2 conditions (Study 1) and demonstrated significantly lower challenge appraisal and weaker reengagement intention compared with those in the normative-goal condition (Study 2). The effects of achievement goals on problem-solving performance varied across the studies.

IMPORTANCE Oral health care faces ongoing workforce challenges that affect patient access and outcomes. While the Medicare program provides an estimated $14.6 billion annually in graduate medical education (GME) payments to teaching hospitals, including explicit support for dental and podiatry programs, little is known about the level or distribution of this public investment in the oral health and podiatry workforce.OBJECTIVE To examine Medicare GME payments to teaching hospitals for dental and podiatry residents from 1998 to 2018, as well as the distribution of federal support among states, territories, and the District of Columbia. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study was conducted using data from 1252 US teaching hospitals. Data were analyzed from May through August 2020. EXPOSURES Dental and podiatry residency training. MAIN OUTCOMES AND MEASURES Medicare dental and podiatry GME payments were examined. RESULTS Among 1252 teaching hospitals, Medicare provided nearly $730 million in dental and podiatry GME payments in 2018. From 1998 to 2018, the number of residents supported more than doubled, increasing from 2340 residents to 4856 residents, for a 2.1-fold increase, while Medicare

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