Potentially Preventable Spending Among High-Cost Medicare Patients: Implications for Healthcare Delivery
AbstractBackgroundHigh-cost patients account for a disproportionate share of healthcare spending. The proportion and distribution of potentially preventable spending among subgroups of high-cost patients are largely unknown.ObjectiveTo examine the distribution of potentially preventable spending among high-cost Medicare patients overall and potentially preventable spending associated with each high-cost category.DesignA cross-sectional study. We merged Medicare claims and social determinants of health data to group patients into high-cost categories and quantify potentially preventable spending.PatientsA total of 556,053 M...
Source: Journal of General Internal Medicine - February 26, 2020 Category: Internal Medicine Source Type: research

Instability in End-of-Life Care Preference Among Heart Failure Patients: Secondary Analysis of a Randomized Controlled Trial in Singapore
ConclusionThe study provides evidence of instability in HF patients ’ stated EOL care preference. This undermines the value of an ACP document recorded months before EOL decisions are made unless a strategy exists for easily updating this preference.Trial RegistrationClinicalTrials.gov:NCT02299180 (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 26, 2020 Category: Internal Medicine Source Type: research

The Role of Spirituality in Patients Undergoing Hematopoietic Stem Cell Transplantation: a Systematic Mixed Studies Review
DiscussionFew medical institutions currently offer spiritual healing, although HSCT patients with different cultural backgrounds may have different spiritual experiences and spiritual coping styles. Psychotherapists or nurses should be considered to provide spiritual care for patients undergoing HSCT, to help patients cope with disease pressures, promote HSCT patients ’ comfort, and improve their quality of life. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 24, 2020 Category: Internal Medicine Source Type: research

Effect Modification of Multimorbidity on the Association Between Regularity of General Practitioner Contacts and Potentially Avoidable Hospitalisations
ConclusionsWeakening of the association between regularity and PAHs with increasing levels of multimorbidity suggests a need to improve primary care support to prevent PAHs for patients with multimorbidity. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 24, 2020 Category: Internal Medicine Source Type: research

The Challenges, Joys, and Career Satisfaction of Women Graduates of the Robert Wood Johnson Clinical Scholars Program 1973 –2011
ConclusionsWomen CSP graduates who stayed in academic medicine are proud to have pursued meaningful work despite challenges and uncertain futures. They thrived by remaining flexible and managing change while remaining true to their values. We likely captured the voices of long-term survivors in academic medicine. Although transferability of these findings is uncertain, these voices add to the national discussion about retaining clinical researchers and keeping women academics productive and engaged. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 24, 2020 Category: Internal Medicine Source Type: research

Effect of the Patient-Centered Medical Home on Racial Disparities in Quality of Care
AbstractBackgroundResearch demonstrates that the patient-centered medical home (PCMH) is associated with improved clinical outcomes and quality of care, and the populations that can most benefit from this model require long-term management, e.g., persons with chronic illness and behavioral health conditions. However, different populations may not benefit equally from the PCMH, and empirical evidence about the effects of this model on racial disparities is limited.ObjectiveEstimate the association between enrollment in National Committee for Quality Assurance (NCQA)-recognized PCMHs and racial disparities in quality of care...
Source: Journal of General Internal Medicine - February 24, 2020 Category: Internal Medicine Source Type: research

National Burnout Trends Among Physicians Working in the Department of Veterans Affairs
ConclusionsVA physician burnout was lower than previously described in many non-VA studies and was relatively stable over time. These findings may be due to unique characteristics of the VA practice environment. Nonetheless, with over a third of VA physicians reporting burnout, organizational interventions are needed. Primary care physicians and those practicing at small, rural sites have higher rates of burnout and may warrant more focused attention. Our results can guide targeted interventions to promote VA physician well-being and inform efforts to address burnout in diverse clinical settings. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 24, 2020 Category: Internal Medicine Source Type: research

Factors Associated with Physician Moral Distress Caring for Hospitalized Elderly Patients Needing a Surrogate Decision-maker: a Prospective Study
ConclusionsPhysician moral distress occurs more frequently when the physician is male, the patient is older or requires decisions about life-sustaining treatments. These findings may help target interventions to support physicians. Prior discussions about patient wishes is associated with lower distress and may be a target for patient-centered interventions. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 24, 2020 Category: Internal Medicine Source Type: research

Life-Sustaining Treatment Decisions Initiative: Early Implementation Results of a National Veterans Affairs Program to Honor Veterans ’ Care Preferences
ConclusionsLST decisions were documented for veterans at high risk of hospitalization or death. While few expressed a preference for cure, half desire, cardiopulmonary resuscitation. Predictors of documentation were generally consistent with existing literature. Opportunities to reduce observed disparities exist by leveraging available VA resources and programs. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 24, 2020 Category: Internal Medicine Source Type: research

Off-Label Coverage of High-Cost Drugs by Independent Charity Patient Assistance Programs
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 24, 2020 Category: Internal Medicine Source Type: research

Why Mental Health –Related Stigma Matters for Physician Wellbeing, Burnout, and Patient Care
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 24, 2020 Category: Internal Medicine Source Type: research

Design and Implementation of an Interactive Curriculum on Telemetry Use and Interpretation for Medicine Interns: a Survey Study
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 24, 2020 Category: Internal Medicine Source Type: research

Capsule Commentary on Glod et al., Clerkship Roles and Responsibilities in a Rapidly Changing Landscape: a National Survey of Internal Medicine Clerkship Directors
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 24, 2020 Category: Internal Medicine Source Type: research

Student Education About Pre-exposure Prophylaxis (PrEP) Varies Between Regions of the United States
ConclusionsThere are marked differences in education regarding PrEP both between academic programs and regions of the USA. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 20, 2020 Category: Internal Medicine Source Type: research

Addressing Social Determinants of Health Within Healthcare Delivery Systems: a Framework to Ground and Inform Health Outcomes
AbstractSocial determinants of health (SDoH) are the conditions in which people live and work that shape access to essential social and economic resources. Calls for healthcare systems to intervene onunmet social needs have stimulated several large-scale initiatives across the country. Yet, such activities are underway in the absence of a unifying conceptual framework outlining the potential mechanisms by which healthcare-based unmet social need interventions can improve health outcomes. Drawing on theoretical foundations and empirical evidence about the relationship between unmet social needs and health, the authors devel...
Source: Journal of General Internal Medicine - February 19, 2020 Category: Internal Medicine Source Type: research

Digital Engagement: How Serious Are Hospitals?
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 19, 2020 Category: Internal Medicine Source Type: research

A Novel Resident and Medical Student Curriculum in Refugee Health
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 19, 2020 Category: Internal Medicine Source Type: research

Federal Barriers to Addressing the Opioid Epidemic
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 19, 2020 Category: Internal Medicine Source Type: research

A Decade of Modest Convergence in Geographic Variation in Per Capita Medicare Fee-for-Service Expenditures: Taxation Without Representation Is Not Sustainable; Is It Time for Taxpayer and Consumer Engagement?
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 19, 2020 Category: Internal Medicine Source Type: research

Bridging the Language Gap in Patient Portals: An Evaluation of Google Translate
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 19, 2020 Category: Internal Medicine Source Type: research

The Effects of Student Demographic Characteristics in a Primary Care Encounter: a Randomized Experiment
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 19, 2020 Category: Internal Medicine Source Type: research

Challenges of Measuring Costs of Care for US Practices
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 19, 2020 Category: Internal Medicine Source Type: research

Psychiatric Comorbidities Increase Cost and Length of Hospitalization in Adolescents and Young Adults with Chronic Medical Conditions
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 19, 2020 Category: Internal Medicine Source Type: research

Assessment of Longitudinal Clinical Outcome Measures for Chronic Low Back Pain over 12  Months
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 19, 2020 Category: Internal Medicine Source Type: research

Capsule Commentary on Young et al., Effects of Physician Experience, Specialty Training, and Self Referral on Inappropriate Diagnostic Imaging
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 19, 2020 Category: Internal Medicine Source Type: research

Capsule Commentary on Kata et al., Advance Care Planning Prior to Death in Older Adults with Hip Fracture
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 19, 2020 Category: Internal Medicine Source Type: research

Capsule Commentary on Rinne et al., National Burnout Trends Among Physicians Working in the Department of Veterans Affairs
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 19, 2020 Category: Internal Medicine Source Type: research

Capsule Commentary on Saha et al., Impact of Physician Race on Patient Decision-making and Ratings of Physicians
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 19, 2020 Category: Internal Medicine Source Type: research

Capsule Commentary on Kurani et al., Use of Potentially Nephrotoxic Medications by U.S. Adults with Chronic Kidney Disease: NHANES, 2011 –2016
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 19, 2020 Category: Internal Medicine Source Type: research

Capsule Commentary on Gunn et al. “Acceptability of an Interactive Computer-Animated Agent to Promote Patient-Provider Communication about Breast Density: a Mixed-Methods Pilot Study”
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 19, 2020 Category: Internal Medicine Source Type: research

Capsule Commentary on Weber et al. ’s Development and Establishment of Initial Validity Evidence for a Novel Tool for Assessing Trainee Admission Notes
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 19, 2020 Category: Internal Medicine Source Type: research

Capsule Commentary on Agana et al., a Novel Approach to Characterizing Readmission Patterns Following Hospitalization for Ambulatory Care-Sensitive Conditions
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 19, 2020 Category: Internal Medicine Source Type: research

Capsule Commentary on Gahier et al., a Simple Scale for Screening Lower-Extremity Arterial Disease as a Possible Cause of Low Back Pain. A Cross Sectional Study Among 542 Subjects
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 19, 2020 Category: Internal Medicine Source Type: research

SAPHO Syndrome from Hidradenitis Suppurativa
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 19, 2020 Category: Internal Medicine Source Type: research

Predicting Mortality and Adverse Outcomes: Comparing the Frailty Index to General Prognostic Indices
ConclusionsA deficit-accumulation frailty index performs as well as prognostic indices for mortality prediction, and better predicts ADL disability and falls in community-dwelling older adults. Frailty assessment offers a unifying approach to risk stratification for key health outcomes relevant to older adults. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 18, 2020 Category: Internal Medicine Source Type: research

A History of Structural Violence
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 18, 2020 Category: Internal Medicine Source Type: research

Correction to: “Getting Everyone on the Same Page”: Interprofessional Team Training to Develop Shared Mental Models on Interprofessional Rounds
This capsule commentary, Capsule Commentary on Liaw et al., “Getting everyone on the same page”: interprofessional team training to develop shared mental models on interprofessional rounds,” was to have accompanied the article, DOI:https://doi.org/10.1007/s11606-019-05320-z, which appeared in the December 2019 issue (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 18, 2020 Category: Internal Medicine Source Type: research

Impact of Changes in Chain Restaurant Calories over Time on Obesity Risk
ConclusionsIncreased exposure to chain restaurant calories per capita was associated with increased weight gain among Black or Hispanic adults. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 14, 2020 Category: Internal Medicine Source Type: research

E-cigarette, or Vaping, Product Use-Associated Lung Injury
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 12, 2020 Category: Internal Medicine Source Type: research

A Quasi-Experimental Analysis of Lethal Means Assessment and Risk for Subsequent Suicide Attempts and Deaths
ConclusionsClinicians should expand the use of counseling on access to lethal means, along with co-occurring suicide prevention practices, to all patients who report suicide ideation. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 10, 2020 Category: Internal Medicine Source Type: research

Adherence to the SEP-1 Sepsis Bundle in Hospital-Onset v. Community-Onset Sepsis: a Multicenter Retrospective Cohort Study
AbstractBackgroundSepsis is the leading cause of in-hospital death. The SEP-1 sepsis bundle is a protocol for early sepsis care that requires providers to diagnose and treat sepsis quickly. Limited evidence suggests that adherence to the sepsis bundle is lower in cases of hospital-onset sepsis.ObjectiveTo compare sepsis bundle adherence in hospital-onset vs. community-onset sepsis.DesignRetrospective cohort study using multivariable analysis of clinical data.ParticipantsA total of 4658 inpatients age 18 or older were identified by diagnosis codes consistent with sepsis or disseminated infection.SettingFour university hospi...
Source: Journal of General Internal Medicine - February 10, 2020 Category: Internal Medicine Source Type: research

Underutilization of Portable Orders for Life-Sustaining Treatment at Discharge from Hospital: Observational Study at US Academic Trauma Center
ConclusionsDespite primary hospital providers engaging in conversations regarding resuscitation and entering DNR orders during hospitalization, the majority of patients in our study discharged to other care facilities without POLST orders. POLST orders are a simple palliative care tool available to primary hospital providers to help ensure continuity of plan of care at discharge for patients who wish to avoid invasive life-sustaining treatments and/or cardiopulmonary resuscitation. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 10, 2020 Category: Internal Medicine Source Type: research

Neighborhood Environment Characteristics and Control of Hypertension and Diabetes in a Primary Care Patient Sample
AbstractBackgroundHypertension control and diabetes control are important for reducing cardiovascular disease burden. A growing body of research suggests an association between neighborhood environment and hypertension or diabetes control among patients engaged in clinical care.ObjectiveTo investigate whether neighborhood conditions (i.e., healthy food availability, socioeconomic status (SES), and crime) were associated with hypertension and diabetes control.DesignCross-sectional analyses using electronic medical record (EMR) data, U.S. Census data, and secondary data characterizing neighborhood food environments. Multivar...
Source: Journal of General Internal Medicine - February 10, 2020 Category: Internal Medicine Source Type: research

Occupational Patterns of Opioid-Related Overdose Deaths Among Arizona Medicaid Enrollees, 2008 –2017
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 10, 2020 Category: Internal Medicine Source Type: research

The “Nuts and Bolts” of Opioid Marketing: Promotional Messages to Family Doctors in Sacramento, Vancouver, Montreal, and Toulouse
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 10, 2020 Category: Internal Medicine Source Type: research

“I Don’t Mind Doing What It Takes to be Safe.” Patient Perspectives of Urine Drug Testing for Pain
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 10, 2020 Category: Internal Medicine Source Type: research

Receipt of Disability Benefits and Prescription Opioid Prevalence
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 10, 2020 Category: Internal Medicine Source Type: research

Correction to: Cardiologists ’ Perception of Wearable Device Data in Patients with Heart Failure
This paper originally published with problems in the metadata, the original article has been corrected. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 10, 2020 Category: Internal Medicine Source Type: research

Capsule Commentary on Butler et al., “Ethical concerns in the care of patients with advanced kidney disease: a national retrospective study, 2000-2011”
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 10, 2020 Category: Internal Medicine Source Type: research

Understanding the Workflow of Home Health Care for Patients with Heart Failure: Challenges and Opportunities
ConclusionsOur findings suggest that HHC for HF patients occurs in discrete steps, each with different challenges. Rather than a one-size-fits-all approach, various interventions may be required to optimize HHC delivery for HF patients in the post-discharge period. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 5, 2020 Category: Internal Medicine Source Type: research