BACKGROUND Quality improvement (QI) is a core component of family medicine residency training, preparing physicians to lead system-level changes and deliver value-based care. However, there is no standardized curriculum or metric for evaluating success of residency QI projects and a lack of consensus on best practices for QI education and assessment in graduate medical education. We sought to characterize the current landscape of QI curricula in US family medicine residencies, including pedagogic methods, project requirements, faculty roles, and perceived markers of success and barriers. METHODS This study was part of the 2025 Council of Academic Family Medicine Educational Research Alliance cross-sectional survey of family medicine residency program directors. Survey question topics included QI training, project logistics, characteristics, and outcomes. We analyzed data by descriptive statistics and chi 2 analyses. RESULTS The response rate was 44.2% (321/726). Programs reported using a residency-developed (38.8%) or hybrid (46.8%) QI curriculum, and most oversight was provided by core faculty (54.2%). Residents' access to QI data was typically limited (44.6%) or full (27.6%), and QI projects were often structured in resident teams (45.2%). Graduate QI proficiency was mostly rated as intermediate (63.5%). Greater graduate proficiency was significantly associated with programs reporting hybrid curricula, fewer barriers to data access, continuity of projects, and greater dissemination and implementation of project outcomes (all P < .05). CONCLUSIONS Training and project characteristics linked to outcome measures, including resident proficiency and clinical practice change, highlight the need for more standardized and longitudinal approaches to QI training in family medicine residencies.
PURPOSE Social support is associated with improved outcomes for people with chronic pain and is an important but understudied component of biopsychosocial pain care. We sought to explore how group medical visits facilitate 4 distinct types of social support-emotional, appraisal, informational, and instrumental-among primary care patients with chronic pain. METHODS We collected qualitative data within a randomized trial of integrative group medical visits for chronic pain, focusing on 2 cohorts of English-speaking patients randomized to group medical visits. Data came from 16 observed group medical visits, 2 focus groups, and 12 semistructured interviews. The group medical visit intervention entailed 12 weekly sessions combining clinical care, pain education, mindfulness meditation, therapeutic movement, and facilitated discussion. We analyzed data using team-based flexible coding and codebook thematic analysis. RESULTS The 26 participating patients were predominantly low-income (80.8% had an annual household income of less than $50,000); 50.0% identified as Black or African American, 15.4% as Hispanic or Latine, and 23.1% as White. On average, they had severe pain with a mean intensity rating of 7.7 out of 10. All 4 social support types emerged through structured program components (curriculum, facilitation strategies, program structure) and interactions among peers and facilitators. Emotional support fostered belonging and countered isolation and stigma. Appraisal support normalized struggles and fostered self-compassion. Informational support combined interactive education with peer-to-peer knowledge exchange. Instrumental support provided concrete assistance. CONCLUSIONS Our findings illustrate how group medical visits for chronic pain mobilize 4 interwoven and reinforcing forms of social support as core therapeutic processes. They also highlight group medical visits as a potential model for biopsychosocial chronic pain management among primary care patients.
PURPOSE In 2024, Medicare introduced principal illness navigation peer support (PIN-PS) reimbursement codes, creating the first nationwide reimbursement mechanism specifically for peer-delivered support services under Medicare. Little is known about early implementation of these codes. This study identified barriers and facilitators to PIN-PS adoption across clinical, organizational, and policy settings. METHODS We conducted semi-structured, qualitative interviews with 20 participants representing physicians, certified peer support specialists and leaders, policy professionals, payer representatives, and behavioral health or recovery organizational leaders. Interviews were analyzed using the Rigorous and Accelerated Data Reduction technique and guided by the Consolidated Framework for Implementation Research. RESULTS Barriers included limited awareness of PIN-PS codes, administrative and billing complexity, cost-sharing requirements, and constraints in reimbursable service time. Facilitators included perceived benefits for care coordination and workflow, alignment with broader policy priorities, and organizational readiness to integrate peer support into care teams. Perspectives on implementation varied across clinical and organizational settings. CONCLUSIONS Early implementation of PIN-PS codes appears to be shaped by the interaction of perceived value and practical implementation challenges. Efforts to support adoption may benefit from reducing administrative burden, improving dissemination and guidance, and aligning reimbursement structures with the nature of peer support. These findings may inform ongoing implementation and policy refinement.
Growing up as an undocumented immigrant in North Carolina shaped not only the author's path to medicine, but also how they understand patients, systems, and belonging. In this reflective essay, they describe the fear, uncertainty, and exclusion that marked their medical training in the United States while undocumented, despite academic achievement and a longstanding desire to become a physician. Policies designed to limit opportunity repeatedly threatened their progression, not because they lacked ability, but because institutions often viewed undocumented trainees as a risk. Although Deferred Action for Childhood Arrivals (DACA) allowed them to continue training, instability and uncertainty persisted. Now practicing rural family medicine with obstetrics, the author recognizes similar fears and structural barriers in patients who delay or avoid care because of exclusion, vulnerability, or mistrust. This essay reflects on what being undocumented cost them, what it taught them about caring for patients at the margins of medicine and society, and what communities lose when systems confuse legality with worth.
BACKGROUND A novel teamlet (small team) care model was introduced in 2014 within Singapore polyclinics to improve care continuity and comprehensiveness for patients with chronic disease. Patients were enrolled in smaller teams comprising 2 family physicians, 1 nurse, and 1 care coordinator for coordinated team-based care. This study assessed 5-year outcomes focusing on clinical parameters, care adherence, health care utilization, and economic impact. METHODS We conducted a retrospective matched cohort study of patients with diabetes, hypertension, or hyperlipidemia enrolled in the teamlet program from 2014 to 2016. Outcomes were compared with matched control patients receiving usual care. We analyzed data from Singapore's Ministry of Health databases using difference-in-differences analysis, controlling for individual and cohort-time fixed effects. RESULTS The teamlet model achieved modest clinical improvements; glycated hemoglobin decreased by 0.1% for subgroups with nonincreasing HbA1c before empanelment, systolic blood pressure decreased by 0.65 mm Hg, and low-density lipoprotein cholesterol decreased by 0.03 mmol/L. However, diabetes screening adherence improved, with 16% more foot screenings and 6% more eye screenings compared with control patients. Health care utilization shifted toward primary care, with decreased inpatient hospitalizations (SGD $2,432 savings per person), decreased specialist outpatient visits (SGD $130 savings per person), fewer emergency department visits (SGD $49 savings per person), but increased polyclinic utilization cost (SGD $479 per person). Overall cost savings totaled SGD $2,186 per patient. CONCLUSIONS Restructuring polyclinic workforces into smaller collaborative teams improved care processes and decreased high-cost health care utilization. These findings suggest that scaling team-based care models in high-volume primary care settings might improve overall health care system efficiency and costs.
