Lack of care coordination, poor teamwork, miscommunication, patient no-shows and bureaucratic mix-ups are the leading factors contributing to months-long delays in diagnosis and treatment, said a review of 111 outpatient cases analyzed by the Veterans Affairs National Center or Patient Safety.

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It is impossible for physicians to diagnose and treat patients who are unwilling to get recommended screening tests because they are scared of what the results might mean. Yet such behavior, which experts dub health-information avoidance, is common. Previous research has found, for example, that as many as 55% of people tested for HIV never return to learn the results.

A combination of factors drives this self-defeating behavior, health psychology researchers say. This “defensive avoidance” comes about because patients fear that test results would threaten their sense of self, make them feel bad or require lifestyle changes. But new research shows that prompting patients to first think about the potential implications of learning their risk of disease can improve their willingness to follow through with testing by about 50%, according to a study posted online July 10 in the journal Psychological Science.

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As physician payment increasingly shifts away from fee for service toward pay for improved quality outcomes, pressure is growing on small, independent doctor groups to keep pace with health-system owned practices.

One way to do that, suggests a study published in August, is for smaller practices to join together and pool resources for chronic disease-management services that can help doctors deliver better care for their patients.

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Use of imaging, narcotic painkillers and referrals to other physicians has skyrocketed in treatment of patients with acute back pain, despite clinical practice guidelines urging doctors to take a conservative approach to such cases. This trend in back-pain care is getting worse with time, said a study of nearly 24,000 spine-related visits between 1999 and 2010.

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Three states now have laws allowing physicians to prescribe lethal doses of medication to terminally ill patients. These laws in Oregon, Vermont and Washington — and similar proposals elsewhere — have generated heated debates about quality end-of-life care, medical ethics, patient autonomy and the sanctity of life.

Most of that conversation has centered on the physician’s role, the potential for elder abuse and whether patients seeking doctors’ aid in dying are mentally ill. Yet there is another health care setting — hospice care — that plays a central role in how death-with-dignity laws are enacted but that has been largely ignored, said an article in July’s Journal of Pain and Symptom Management.

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The YMCA’s evidence-based program is helping prediabetic patients eat right, get active and lose weight.

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A recent study found that a hospitalist-developed set of tools had success in preventing unplanned readmissions. The finding suggests that hospital-centered readmission-reduction initiatives can yield promising results, but health policy experts said that major cuts in rehospitalization rates may happen only when future efforts do a better job of addressing risk factors outside the walls of the hospital.

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States where it is easier for parents to exempt their children from immunization requirements have vaccine-skip rates nearly three times higher than states where the opt-out procedures are more complex, said a study published in July’s Health Affairs.

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