Corresponding Author: Heather J. Baer, ScD, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, 1620 Tremont St, Boston, MA 02120 (hbaer@bwh.harvard.edu).
Accepted for Publication: September 8, 2020.
Author Contributions: Dr Baer had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Baer, Rozenblum, Metzler, McManus, Halperin, Aronne, Block, Bates.
Acquisition, analysis, or interpretation of data: Baer, De La Cruz, Orav, Wien, Nolido, Metzler, McManus, Halperin, Minero, Bates.
Drafting of the manuscript: Baer, Rozenblum, De La Cruz, Wien, Block.
Critical revision of the manuscript for important intellectual content: Baer, Rozenblum, Orav, Wien, Nolido, Metzler, McManus, Halperin, Aronne, Minero, Bates.
Statistical analysis: Baer, Orav, Wien.
Obtained funding: Baer, Bates.
Administrative, technical, or material support: Baer, Rozenblum, De La Cruz, Nolido, Metzler, McManus, Minero, Block, Bates.
Supervision: Baer, Halperin, Aronne, Bates.
Conflict of Interest Disclosures: Dr Rozenblum reported having an equity interest in Hospitech Respiration Ltd, which makes Airway Management Solutions. Dr Halperin reported receiving cash compensation and equity from Form Health Inc. Dr Aronne reported receiving consulting fees from and serving on advisory boards for Jamieson Laboratories, Boehringer Ingelheim, Pfizer, Novo Nordisk, Real Appeal, Janssen Pharmaceuticals, and Gelesis; receiving research funding from Aspire Bariatrics, Allurion, Eisai, Eli Lilly, AstraZeneca, Gelesis, Janssen Pharmaceuticals, and Novo Nordisk; having an equity interest in Intellihealth/BMIQ, ERX, Zafgen, Gelesis, MYOS, and Jamieson Laboratories; and serving on the board of directors for MYOS, Intellihealth/BMIQ, and Jamieson Laboratories. Ms Minero reported being employed and having an equity interest in Intellihealth/BMIQ. Dr Bates reported serving as a consultant for EarlySense, which makes patient safety monitoring systems; receiving cash compensation from CDI (Negev) Ltd, which is a not-for-profit incubator for health information technology start-ups; having equity interest in ValeraHealth (which makes software to help patients with chronic diseases), in Clew (which makes software to support clinical decision-making in intensive care), and in MDClone (which takes clinical data and produces deidentified versions of it); and receiving research funding from IBM Watson Health. No other disclosures were reported.
Funding/Support: The research was funded through award 14-092-1758 from the Patient-Centered Outcomes Research Institute (PCORI).
Role of the Funder/Sponsor: PCORI gave input on the design and conduct of the study, but all final decisions were made by the investigators. PCORI was not involved in the collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Disclaimer: The statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of PCORI, its board of governors, or its methodology committee.
Data Sharing Statement: See Supplement 3.
Additional Contributions: We thank the study participants, the physicians, and all of the other employees working at the Brigham and Women’s Hospital [BWH] primary care practices. We also thank the population health managers: Ihorma Breneus, RN (lead population health manager; worked at BWH during the study and was compensated for being the lead), Mary Merriam, RN (works at BWH), Charles Morris, MD (works at BWH), and Clark Davis, BS (works at BWH as a research assistant, created Figure 2, and was compensated for this work). We also thank the members of the patient and family advisory council for their support and partnership through all stages of this project and who received compensation for their advisory roles: Renee Blocker, BA, Alison Olson, BA, and Mary Reynolds, MSN.
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