Does every woman who
has a miscarriage require a dilation and curettage (D&C)? Does every
patient with new-onset headache require a computed tomographic (CT)
scan? Does every child with otitis media need a 10-day course of
antibiotics? Does every woman with pelvic inflammatory disease (PID)
These are popular and appropriate questions to ask and investigate in
1999 but challenged conventional medical wisdom in the early to mid
1980s, when a group of practicing family physicians in the Ambulatory
Sentinel Practice Network (ASPN; http://www.aspn.denver.co.us) began a series of descriptive studies of current practices for common
clinical dilemmas they faced in everyday practice. Their early work
suggested that the then-current National Institutes of Health Consensus
Guidelines for use of CT scanning in new-onset headache were not being
followed and that the gap between practice and the guidelines led to no
measureable harm to patients1- 3 and to a considerable
reduction in health care costs.4 Subsequent studies further
questioned the appropriateness of routine D&C after uncomplicated
miscarriage,5 hospitalization of every woman with
PID,6 and the routine use of a 10-day course of antibiotics
for children with uncomplicated otitis media.7 In
conducting these early studies, ASPN pioneered methods for low-cost,
low-burden studies that collect high-quality data in busy primary care
practice settings4 and laid the groundwork for studying the
common phenomena of primary care. Future work will advance
understanding of appropriate care for these and other clinical
questions faced by primary care physicians in their daily work.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 91
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.