Steven R Brown

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Scholarly Contributions

Journals/Publications

• Brown, S. R. (2022). Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics, 150(3). doi:10.1542/peds.2022-058859
• Brown, S. R. (2021). Physicians Should Refuse Pharmaceutical Industry Gifts.. American family physician, 104(4), 348-350.
• Brown, S. R. (2021). Sepsis calculator for neonatal early onset sepsis. The Journal of Maternal-Fetal & Neonatal Medicine, 35(25), 7070-7070. doi:10.1080/14767058.2021.1941853
• Brown, S. R., & Fugh-Berman, A. (2021). Changing Pharmaceutical Industry Interaction in US Family Medicine Residencies: A CERA Study. Journal of the American Board of Family Medicine : JABFM, 34(1), 105-112.
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  Pharmaceutical interaction in US residencies is common. This study explores the extent and type of learner interactions in US family medicine residencies with the pharmaceutical industry and compares interactions from 2008, 2013, and 2019.
• Espinosa, K., & Brown, S. R. (2021). Serum Lactate Testing to Predict Mortality in Patients with Sepsis.. American family physician, 103(5), 309-310.
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  Management of patients with sepsis is challenging and mortality is high. Early diagnosis and prompt initiation of therapy are essential. Higher lactate levels correlate with increased risk of mortality, particularly with lactate levels greater than 4.0 mmol per L and in the setting of hypotension.
• Hester, C. M., Fernald, D. H., & Brown, S. R. (2021). Why Family Medicine Program Directors Leave Their Position.. Family medicine, 53(5), 347-354. doi:10.22454/fammed.2021.746153
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  Family medicine residency program directors (PD) oversee the training of every new family physician in the United States. The median tenure of family medicine PDs is 4.5 years, and factors relating to length of tenure and reasons for departure are not well known. This exploratory study examined why family medicine PDs leave their position..We conducted in-depth interviews with family medicine PDs who recently left their director position. Semistructured and structured questions asked about their PD experience and factors contributing to stepping away from the PD role. We analyzed answers quantitatively and qualitatively..When comparing cases with longer (>6 years) and shorter tenures (≤6 years), 25 PDs described differing pathways but few major differences in why they left the position. The two groups were distinguished more by their similarities than their differences. The majority left voluntarily due to a combination of factors, not a single factor. Most PDs left the position because of their desire and opportunities to move up, move over, or move on, and not because of dissatisfaction with the job. Succession plans helped with PD decisions to leave the position, knowing that the program was in good hands..Family medicine PDs left the position due to multiple factors primarily related to career pathway choices and not solely due to demands of the job. Additional research with PDs of very short tenures and long tenures may yield further details about sustaining PDs in residency education to successfully train the next generation of family physicians.
• Anderson, J., Anderson, J., Leubner, J., Leubner, J., & Brown, S. R. (2020). EHR Overtime: An Analysis of Time Spent After Hours by Family Physicians.. Family medicine, 52(2), 135-137. doi:10.22454/fammed.2020.942762
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  Time spent in the electronic health record (EHR), away from direct patient care, is associated with physician burnout. Yet there is a lack of evidence quantifying EHR use among family physicians. The purpose of the study was to describe a method for quantifying habits and duration of use within the electronic health record in family medicine residents and faculty with particular attention paid to time spent after hours..We audited EHR time for family medicine residents and faculty using an EHR vendor-provided, web-based tracking system. We collected and analyzed the number of patient encounters, total time in the EHR per patient, total time in the EHR after hours by physicians for a 6-month time period..Over the 6-month period reviewed, family medicine trainees and faculty saw between one and 164 patients monthly, spent between 17 and 217 minutes in the EHR per patient, and spent between 0 and 33 hours in the EHR after hours per month..Family medicine residents spend a significant amount of time completing EHR tasks after hours. Objective EHR data can be used by family medicine residency programs to devise interventions to decrease inefficient use of the EHR, decrease after-hours EHR use, and improve well-being.
• Brown, S. R. (2020). Placental Alpha Macroglobulin-1 (PartoSure) Immunoassay to Assess the Risk of Spontaneous Preterm Birth. American family physician, 102(5), 269-270.
• Hoffman, M. R., Herzog, A., Brown, S. R., & Adriano, F. D. (2020). Highlights from the Innovation Showcase (AFMRD).. Annals of family medicine, 18(4), 378-379. doi:10.1370/afm.2575
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  Leaders of family medicine residency programs often feel torn between the desire to innovate and the need to stay within the structure based on the requirements of the American Board of Family Medicine (ABFM) and the Accreditation Council on Graduate Medical Education (ACGME). Innovation is
• Brown, S. R. (2019). Should Adults with Prediabetes Be Prescribed Metformin to Prevent Diabetes Mellitus? No: Evidence Does Not Show Improvements in Patient-Oriented Outcomes. American family physician, 100(3), 136-138.
• Brown, S. R., & Gerkin, R. (2019). Family Medicine Program Director Tenure: 2011 Through 2017. Family medicine, 51(4), 344-347.
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  The program director (PD) position is challenging. PDs are faced with many competing priorities and risk of burnout. Short PD tenure may contribute to training program challenges. The tenure of family medicine residency directors has not been rigorously studied. Our objective was to study family medicine program director tenure and change in tenure over time, and compare these to available Accreditation Council for Graduate Medical Education (ACGME) data.
• Brown, S. R., Bodenheimer, T., & Kong, M. (2019). HIGH-PERFORMING PRIMARY CARE RESIDENCY CLINICS: A COLLABORATION. Annals of family medicine, 17(5), 470-471.
• Brown, S. R., & Irwin, G. (2018). MEASURING AND IMPROVING CONTINUITY IN RESIDENCY PRIMARY CARE PRACTICE. Annals of Family Medicine, 16(3), 273-274. doi:10.1370/afm.2250
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  Continuity relationships with the patients that we serve are a cornerstone of Family Medicine. Physician-patient continuity has been shown to be valued by patients, decrease overuse of unnecessary tests, decrease overall cost of care, and improve patient outcomes.[1][1] Frustration with a lack of
• Brown, S. R., Roy, T. K., Barr, W. B., Brown, S. R., Roy, T. K., & Barr, W. B. (2018). ADVOCACY IN FAMILY MEDICINE: FAMILY MEDICINE ADVOCACY SUMMIT. Annals of Family Medicine, 16(6), 570-570. doi:10.1370/afm.2093
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  Many factors that influence residency education cannot be controlled on a program level. Advocating for our programs, our patients, our communities, and our learners on a regional, state, and national level should be an essential part of the life of a family physician and educator. The feeling that
• Brown, S. R., & Miser, W. F. (2017). MEETING SCHOLARLY ACTIVITY REQUIREMENTS IN A FAMILY MEDICINE RESIDENCY PROGRAM. Annals of family medicine, 15(5), 487-488.
• Evans, K. L., & Brown, S. R. (2017). Many sample closet medications are expired. Journal of the American Board of Family Medicine : JABFM, 25(3), 394-5.
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  Samples are widely used in office practice. It is not known how many sample medications are expired and therefore not useful to patients.
• Evans, K. L., Brown, S. R., & Smetana, G. W. (2017). Sample closet medications are neither novel nor useful. Journal of the American Board of Family Medicine : JABFM, 26(4), 380-7.
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  Many physicians dispense drug samples in their offices, but this practice may not benefit patients. We analyzed the novelty and usefulness of the medications most commonly found in sample closets in primary care practices.
• Brown, S. R. (2016). The Why and How of High-Value Prescribing. American family physician, 93(4), 262-3.
• Brown, S. R., & Siwek, J. (2016). AFP Goes Audio: Introducing the American Family Physician Podcast. American family physician, 93(3), 174.
• Evans, D. V., Waters, R. C., Olsen, C., Stephens, M. B., & Brown, S. R. (2016). Residency Curricula on Physician-Pharmaceutical Industry Interaction: A CERA Study. Family medicine, 48(1), 44-8.
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  Physician interaction with pharmaceutical representatives results in less evidence-based prescribing and increased costs. Many organizations have called for strong conflict of interest policies in academic institutions. Implementing policy without educational interventions may not adequately address the influence of industry on physician prescribing patterns. The objective of this study is to assess the implementation and content of family medicine residency curricula on the physician-pharmaceutical industry relationship.
• Kirk, K., & Brown, S. R. (2016). PHYSICIAN WELLNESS: CHANGING THE CULTURE. Annals of family medicine, 14(6), 586-587.
• Brown, S. R., Evans, D. V., & Fugh-Berman, A. (2015). Pharmaceutical industry interactions in family medicine residencies decreased between 2008 and 2013: a CERA study. Family medicine, 47(4), 279-82.
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  Most medical residents have some interaction with the pharmaceutical industry. It is not known if this interaction has changed over time. We determined whether interactions between family medicine residencies and the pharmaceutical industry have changed in the past 5 years.
• Brown, S. R. (2014). Should lung cancer screening with low-dose computed tomography be routine for smokers and former smokers? The evidence is insufficient to support routine low-dose CT in these patients.. Clinical advances in hematology & oncology, 12(10).
• Brown, S. R., & Kennelly, C. (2014). AAFP recommends universal screening for HIV infection beginning at age 18 years of age. American family physician, 89(8), 614-317.
• Kennelly, C., & Brown, S. R. (2014). AAFP should support HIV screening for all 15- to 17-year-olds. Author reply. American family physician, 90(10), 687.
• Brown, S. R., Newman, D. H., & Shreves, A. E. (2013). Potential harms of computed tomography: the role of informed consent. American family physician, 88(5), 294-6.
• Stachler, R. J., Chandrasekhar, S. S., Archer, S. M., Rosenfeld, R. M., Schwartz, S. R., Barrs, D. M., Brown, S. R., Fife, T. D., Ford, P., Ganiats, T. G., Hollingsworth, D. B., Lewandowski, C. A., Montano, J. J., Saunders, J. E., Tucci, D. L., Valente, M., Warren, B. E., Yaremchuk, K. L., & Robertson, P. J. (2012). Clinical practice guideline: sudden hearing loss.. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 146(3 Suppl), S1-35. doi:10.1177/0194599812436449
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  Sudden hearing loss (SHL) is a frightening symptom that often prompts an urgent or emergent visit to a physician. This guideline provides evidence-based recommendations for the diagnosis, management, and follow-up of patients who present with SHL. The guideline primarily focuses on sudden sensorineural hearing loss (SSNHL) in adult patients (aged 18 and older). Prompt recognition and management of SSNHL may improve hearing recovery and patient quality of life (QOL). Sudden sensorineural hearing loss affects 5 to 20 per 100,000 population, with about 4000 new cases per year in the United States. This guideline is intended for all clinicians who diagnose or manage adult patients who present with SHL..The purpose of this guideline is to provide clinicians with evidence-based recommendations in evaluating patients with SHL, with particular emphasis on managing SSNHL. The panel recognized that patients enter the health care system with SHL as a nonspecific, primary complaint. Therefore, the initial recommendations of the guideline deal with efficiently distinguishing SSNHL from other causes of SHL at the time of presentation. By focusing on opportunities for quality improvement, the guideline should improve diagnostic accuracy, facilitate prompt intervention, decrease variations in management, reduce unnecessary tests and imaging procedures, and improve hearing and rehabilitative outcomes for affected patients..The panel made strong recommendations that clinicians should (1) distinguish sensorineural hearing loss from conductive hearing loss in a patient presenting with SHL; (2) educate patients with idiopathic sudden sensorineural hearing loss (ISSNHL) about the natural history of the condition, the benefits and risks of medical interventions, and the limitations of existing evidence regarding efficacy; and (3) counsel patients with incomplete recovery of hearing about the possible benefits of amplification and hearing-assistive technology and other supportive measures. The panel made recommendations that clinicians should (1) assess patients with presumptive SSNHL for bilateral SHL, recurrent episodes of SHL, or focal neurologic findings; (2) diagnose presumptive ISSNHL if audiometry confirms a 30-dB hearing loss at 3 consecutive frequencies and an underlying condition cannot be identified by history and physical examination; (3) evaluate patients with ISSNHL for retrocochlear pathology by obtaining magnetic resonance imaging, auditory brainstem response, or audiometric follow-up; (4) offer intratympanic steroid perfusion when patients have incomplete recovery from ISSNHL after failure of initial management; and (5) obtain follow-up audiometric evaluation within 6 months of diagnosis for patients with ISSNHL. The panel offered as options that clinicians may offer (1) corticosteroids as initial therapy to patients with ISSNHL and (2) hyperbaric oxygen therapy within 3 months of diagnosis of ISSNHL. The panel made a recommendation against clinicians routinely prescribing antivirals, thrombolytics, vasodilators, vasoactive substances, or antioxidants to patients with ISSNHL. The panel made strong recommendations against clinicians (1) ordering computerized tomography of the head/brain in the initial evaluation of a patient with presumptive SSNHL and (2) obtaining routine laboratory tests in patients with ISSNHL.
• Wolfrey, J., Brown, S. R., Ebell, M. H., & Geng, J. (2012). Continuing education that matters: a successful, evidence-based course with minimal pharmaceutical funding. The Journal of continuing education in the health professions, 32(3), 212-4.
• Brown, S. R., & Brown, J. (2011). Why do physicians order unnecessary preoperative tests? A qualitative study. Family medicine, 43(5), 338-43.
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  Routine preoperative testing is ineffective and costly. We explored reasons for the continued use of unnecessary preoperative tests and approaches to limit such testing.
• Fugh-Berman, A., Brown, S. R., Trippett, R., Bell, A. M., Clark, P., Fleg, A., & Siwek, J. (2011). Closing the door on pharma? A national survey of family medicine residencies regarding industry interactions. Academic medicine : journal of the Association of American Medical Colleges, 86(5), 649-54.
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  To assess the extent and type of interactions U.S. family medicine residencies permit industry to have with medical students and residents.
• Brown, S. R. (2009). Disease mongering and excessive daytime sleepiness.. American family physician, 80(8), 775.
• Phan, K., & Brown, S. R. (2009). Decreased continuity in a residency clinic: a consequence of open access scheduling.. Family medicine, 41(1), 46-50.
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  Open access scheduling decreases waiting time to see physicians by using same-day appointment scheduling. In primary care residency training, continuity of care may be difficult to preserve with this method of scheduling because requirements for rotations often results in residents being unavailable in their primary clinic practice. Our objective was to examine continuity of care in a family medicine residency clinic during a 1-year period prior to implementation of open-access scheduling and during a 1-year period after open access scheduling started..Two indices to measure continuity were used: the Usual Provider Continuity Index (UPC) and the Modified Modified Continuity Index (MMCI). The Mann-Whitney test was used to determine differences in the UPC and MMCI between groups..The mean UPC and MMCI scores decreased with open access scheduling. Mean UPC was 0.59 with traditional scheduling versus 0.55 with open access scheduling. Mean MMCI was 0.51 for traditional scheduling and 0.44 with open access..Continuity of care decreased in our clinic after implementation of open access scheduling. Our results have implications for all primary care residency training programs since one of the hallmarks of primary care is maintaining continuity in the physician-patient relationship.
• Brown, S. R. (2006). Closing the sample closet.. Family practice management, 13(10), 16; author reply 21.
• Brown, S. R., Birnbaum, B., Brown, B., & B, B. (2005). Student and resident education and rural practice in the Southwest Indian Health Service: a physician survey.. Family medicine, 37(10), 701-5.
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  The Indian Health Service (IHS) is an educational rotation site for numerous medical students and residents. These IHS rotations may be an important factor in recruitment and retention of physicians to the IHS. We describe the combined number of student/resident rotations in the Southwest IHS and their influence on recruitment and retention. We also analyze factors related to choice of rural practice in the IHS..We conducted a survey of clinical directors and IHS physicians in Arizona and New Mexico..Twenty (87%) clinical director surveys and 289 (66%) physician surveys were returned. More than 400 students/residents participate in rotations annually in the IHS in Arizona and New Mexico. Eighty-four percent of clinical directors feel that educational programs are important to recruitment. Forty-five percent of current IHS physicians participated in IHS rotations as students or residents, and 87% feel that rotating influenced their decision to join the IHS. Eighty percent of IHS physicians who teach feel that working with students and residents improves their job satisfaction. Seventy-five percent of respondents practice in rural areas. Rural medical student and resident rotations are associated with subsequent rural practice..Many medical students and residents rotate in the Southwest IHS. Clinical directors state that these rotations are helpful to recruitment, and IHS physicians who rotated feel it was important in their decision to join the IHS. IHS clinicians feel that teaching improves job satisfaction.

Creative Productions

• Coles, S., Anderson, J., & Brown, S. (2019. The AFP Podcast (American Family Physician). Apple iTunes, onlineThe American Family Physician. https://www.aafp.org/journals/afp/explore/podcast.html