Which Complex Patients Should Be Referred for Intensive Care Management? A Mixed-Methods Analysis
AbstractBackgroundA large and increasing proportion of health care costs are spent caring for a small segment of medically and socially complex patients. To date, it has been difficult to identify which patients are best served by intensive care management.ObjectiveTo characterize factors that best identify which complex patients are most suited for intensive care management.DesignWe conducted a mixed-methods study involving 35 care managers (CMs; 10 licensed social workers and 25 registered nurses) working in intensive care management programs within Kaiser Permanente Northern California (KPNC) outpatient medical centers....
Source: Journal of General Internal Medicine - May 24, 2018 Category: Internal Medicine Source Type: research

Chronic Multisymptom Illness Among Iraq/Afghanistan-Deployed US Veterans and Their Healthcare Utilization Within the Veterans Health Administration
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - May 24, 2018 Category: Internal Medicine Source Type: research

Effect of Low Back Pain Risk-Stratification Strategy on Patient Outcomes and Care Processes: the MATCH Randomized Trial in Primary Care
ConclusionsA resource-intensive intervention to support stratified care for LBP in a US healthcare setting had no effect on patient outcomes or healthcare use.Trial RegistrationNational Clinical Trial Number NCT02286141. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - May 22, 2018 Category: Internal Medicine Source Type: research

Effect of Social Comparison Feedback on Laboratory Test Ordering for Hospitalized Patients: A Randomized Controlled Trial
ConclusionsPersonalized social comparison feedback on routine laboratory ordering did not change targeted behavior among physicians, although there was a significant decrease in orders among participants who deviated more from the peer rate.Trial registrationClinicaltrials.gov registration: #NCT02330289. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - May 22, 2018 Category: Internal Medicine Source Type: research

Review of clinical trial settings of drugs commonly used in primary care and approved between 2005 and 2012
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - May 18, 2018 Category: Internal Medicine Source Type: research

Can Growing Popular Support for Physician-Assisted Death Motivate Organized Medicine to Improve End-of-Life Care?
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - May 18, 2018 Category: Internal Medicine Source Type: research

The Form and Content of Cannabis Products in the United States
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - May 16, 2018 Category: Internal Medicine Source Type: research

Impact of Drug Overdose Deaths on Solid Organ Transplantation in the United States
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - May 15, 2018 Category: Internal Medicine Source Type: research

Effects of Race Are Rarely Included in Clinical Prediction Models for Cardiovascular Disease
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - May 15, 2018 Category: Internal Medicine Source Type: research

The Association of Food Insufficiency with Patient Activation Among Women Veterans Using Veterans Administration Healthcare: a Cross-Sectional Analysis
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - May 15, 2018 Category: Internal Medicine Source Type: research

Reduced Effectiveness of Interruptive Drug-Drug Interaction Alerts after Conversion to a Commercial Electronic Health Record
AbstractBackgroundDrug-drug interaction (DDI) alerts in electronic health records (EHRs) can help prevent adverse drug events, but such alerts are frequently overridden, raising concerns about their clinical usefulness and contribution to alert fatigue.ObjectiveTo study the effect of conversion to a commercial EHR on DDI alert and acceptance rates.DesignTwo before-and-after studies.Participants3277 clinicians who received a DDI alert in the outpatient setting.InterventionIntroduction of a new, commercial EHR and subsequent adjustment of DDI alerting criteria.Main MeasuresAlert burden and proportion of alerts accepted.Key R...
Source: Journal of General Internal Medicine - May 15, 2018 Category: Internal Medicine Source Type: research

Concise Research Report: The Future of Medicaid: State Legislator Views on Policy Waivers
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - May 15, 2018 Category: Internal Medicine Source Type: research

Measuring the Health of an Invisible Population: Lessons from the Colorado Transgender Health Survey
ConclusionsThe transgender community in Colorado faces significant disparities, especially around mental health. However, a transgender-inclusive provider is associated with improved mental and physical health and health behaviors. Further population-level research and provider education on transgender health should to be incorporated into national efforts to eliminate health disparities. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - May 15, 2018 Category: Internal Medicine Source Type: research

Differences in Physician Income by Gender in a Multiregion Survey
ConclusionsAdjustment for multiple possible confounders, including the number and composition of work hours, can explain approximately 70% of unadjusted income differences between male and female physicians; 30% remains unexplained. Additional study and dedicated efforts might be necessary to identify and address the causes of these unexplained differences. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - May 11, 2018 Category: Internal Medicine Source Type: research

An Exercise in Clinical Reasoning: Do You Unpack?
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - May 9, 2018 Category: Internal Medicine Source Type: research

Association Between a Measure of Community Economic Distress and Medicare Patients ’ Health Care Utilization, Quality, Outcomes, and Costs
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - May 9, 2018 Category: Internal Medicine Source Type: research

Healthcare at the Crossroads: The Need to Shape an Organizational Culture of Humanistic Teaching and Practice
ConclusionsWhile healthcare has evolved rapidly, efforts to counteract the negative effects of changes in organizational and practice environments have largely focused on cultivating humanistic attributes in individuals. Our findings suggest that change at the organizational level is at least equally important. Physicians in our study described the characteristics of an organizational culture that supports and embraces humanism. We offer suggestions for organizational change that keep humanistic and compassionate patient care as its central focus. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - May 8, 2018 Category: Internal Medicine Source Type: research

Behavioral Economics Interventions to Improve Outpatient Antibiotic Prescribing for Acute Respiratory Infections: a Cost-Effectiveness Analysis
ConclusionsBehavioral economics interventions can be cost-effective strategies for reducing inappropriate antibiotic prescriptions by reducing healthcare resource utilization. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - May 8, 2018 Category: Internal Medicine Source Type: research

Rapid Evidence Review of Mobile Applications for Self-management of Diabetes
DiscussionLimited evidence suggests that use of some commercially available apps, when combined with additional support from a healthcare  provider or study staff, may improve some short-term diabetes-related outcomes. The impact of these apps on longer-term outcomes is unclear. More rigorous and longer-term studies of apps are needed.RegistrationThis review was funded by the Agency for Healthcare Research and Quality (AHRQ). The protocol is available at:http://www.effectivehealthcare.ahrq.gov/topics/diabetes-mobile-devices/research-protocol. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - May 8, 2018 Category: Internal Medicine Source Type: research

Interventions That Support or Involve Caregivers or Families of Patients with Traumatic Injury: a Systematic Review
DiscussionStudies showed mixed patterns of intervention effects on caregiver and patient outcomes; evidence about intervention impact is inconclusive. This review is the first to identify caregiving interventions for patients with TBI and polytrauma and extends past reviews about patients with PTSD. Limitations include a small evidence base, low study quality, disparate methods, varied outcome measures, and high heterogeneity. PROSPERO Registration CRD42017053516. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - May 7, 2018 Category: Internal Medicine Source Type: research

Racial and Ethnic Disparities in Diagnosis of Chronic Medical Conditions in the USA
ConclusionsIn a nationally representative cohort, Asians had higher rates of undiagnosed hypertension and diabetes, and all minorities were more likely to have undiagnosed diabetes compared to Whites. Healthcare utilization was associated with undiagnosed medical conditions. Our study showed that reliance on self-reported data may systemically underestimate the prevalence of chronic illnesses among minorities and further research is needed to understand the significance of healthcare utilization in health outcomes. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - May 7, 2018 Category: Internal Medicine Source Type: research

Factors Affecting Resident Satisfaction in Continuity Clinic —a Systematic Review
ConclusionsClinic structures that limit inpatient and outpatient conflict and enhance continuity, along with a dedicated outpatient faculty, are associated with greater resident satisfaction. Implications for further research are discussed. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - May 7, 2018 Category: Internal Medicine Source Type: research

The Conundrum and Challenge of Lung Cancer Screening Shared Decision-making Implementation
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - May 7, 2018 Category: Internal Medicine Source Type: research

A Coaching by Telephone Intervention on Engaging Patients to Address Modifiable Cardiovascular Risk Factors: a Randomized Controlled Trial
AbstractBackgroundA large proportion of deaths and chronic illnesses can be attributed to three modifiable risk factors: tobacco use, overweight/obesity, and physical inactivity.ObjectiveTo test whether telephone-based health coaching after completion of a comprehensive health risk assessment (HRA) increases patient activation and enrollment in a prevention program compared to HRA completion alone.DesignTwo-arm randomized trial at three sites.SettingPrimary care clinics at Veterans Affairs facilities.ParticipantsFour hundred seventeen veterans with at least one modifiable risk factor (BMI  ≥ 30,
Source: Journal of General Internal Medicine - May 7, 2018 Category: Internal Medicine Source Type: research

Capsule Commentary on Kovacs et al. Systematic Review and Meta-analysis of the Effectiveness of Implementation Strategies for Non-communicable Disease Guidelines in Primary Health Care
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - May 7, 2018 Category: Internal Medicine Source Type: research

From the Editors ’ Desk: Truth Rules, or the Upside of Bureaucracy
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - May 7, 2018 Category: Internal Medicine Source Type: research

Systematic Review and Meta-analysis of the Effectiveness of Implementation Strategies for Non-communicable Disease Guidelines in Primary Health Care
This study aimed to evaluate the effect of intervention methods on the guideline adherence of primary care providers (PCPs).MethodsThe studies selected through a systematic search in Medline and Embase were categorised according to intervention schemes and outcome indicator categories. Harvest plots and forest plots were applied to integrate results.ResultsThe 36 studies covered six intervention schemes, with single interventions being the most effective and distribution of materials the least. The harvest plot displayed 27 groups having no effect, 14 a moderate and 21 a strong effect on the outcome indicators in the categ...
Source: Journal of General Internal Medicine - May 4, 2018 Category: Internal Medicine Source Type: research

Capsule commentary on Geller et al., National estimates of emergency department visits for antibiotic adverse events among adults —United States, 2011–2015
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - May 3, 2018 Category: Internal Medicine Source Type: research

Physician-Assisted Suicide: Why Neutrality by Organized Medicine Is Neither Neutral Nor Appropriate
AbstractIt has been proposed that medical organizations adopt neutrality with respect to physician-assisted suicide (PAS), given that the practice is legal in some jurisdictions and that membership is divided. We review developments in end-of-life care and the role of medical organizations with respect to the legalization of PAS since the 1990s. We argue that moving from opposition to neutrality is not ethically neutral, but a substantive shift from prohibited to optional. We argue that medical organizations already oppose many practices that are legal in many jurisdictions, and that unanimity among membership has not been...
Source: Journal of General Internal Medicine - May 2, 2018 Category: Internal Medicine Source Type: research

Acetaminophen or Tylenol? A Retrospective Analysis of Medication Digital Communication Practices
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - May 1, 2018 Category: Internal Medicine Source Type: research

Improving Outcomes After Hospitalization: A Prospective Observational Multicenter Evaluation of Care Coordination Strategies for Reducing 30-Day Readmissions to Maryland Hospitals
AbstractBackgroundPatients frequently experience suboptimal transitions from the hospital to the community, which can increase the likelihood of readmission. It is not known which care coordination services can lead to improvements in readmission rates.ObjectiveTo evaluate the effects of two care coordination interventions on 30-day readmission rates.DesignProspective multicenter observational study of hospitalized patients eligible for two care coordination services between January 1, 2013, and October 31, 2015. Readmission rates were compared for patients who received each care coordination intervention versus those who ...
Source: Journal of General Internal Medicine - April 21, 2018 Category: Internal Medicine Source Type: research

An Unusual Cause of Horner Syndrome
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - April 21, 2018 Category: Internal Medicine Source Type: research

Terry ’s Nails: Clinical Correlations in Adult Outpatients
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - April 17, 2018 Category: Internal Medicine Source Type: research

Capsule Commentary on Dalal et al., The Impact of Automated Notification on Follow-up of Actionable Tests Pending at Discharge: a Cluster-Randomized Controlled Trial
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - April 17, 2018 Category: Internal Medicine Source Type: research

Focused Evidence Review: Psychometric Properties of Patient-Reported Outcome Measures for Chronic Musculoskeletal Pain
ConclusionsIn this focused evidence review, the most evidence on key psychometric properties in chronic musculoskeletal pain populations was found for the ODI, RMDQ, SF-36 BPS, NRS, and VAS. Key limitations in the field include substantial variation in methods of estimating psychometric properties, defining chronic musculoskeletal pain, and reporting patient demographics.Trial RegistrationRegistered in the PROSPERO database: CRD42017056610 (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - April 16, 2018 Category: Internal Medicine Source Type: research

Clinical Policy Recommendations from the VHA State-of-the-Art Conference on Non-Pharmacological Approaches to Chronic Musculoskeletal Pain
AbstractAs a large national healthcare system, Veterans Health Administration (VHA) is ideally suited to build on its work to date and develop a safe, evidence-based, and comprehensive approach to the care of chronic musculoskeletal pain conditions that de-emphasizes opioid use and emphasizes non-pharmacological strategies. The VHA Office of Health Services Research and Development (HSR&D) held a state-of-the-art (SOTA) conference titled “Non-pharmacological Approaches to Chronic Musculoskeletal Pain Management” in November 2016. Goals of the conference were (1) to establish consensus on the current state o...
Source: Journal of General Internal Medicine - April 16, 2018 Category: Internal Medicine Source Type: research

Impact of Teaching Intensity and Sociodemographic Characteristics on CMS Hospital Compare Quality Ratings
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - April 16, 2018 Category: Internal Medicine Source Type: research

Peer Review of Abstracts Submitted to An Internal Medicine National Meeting: Is It a Predictor of Future Publication?
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - April 16, 2018 Category: Internal Medicine Source Type: research

Empirical Comparison of Publication Bias Tests in Meta-Analysis
This study compares seven commonly used publication bias tests (i.e., Begg ’s rank test, trim-and-fill, Egger’s, Tang’s, Macaskill’s, Deeks’, and Peters’ regression tests) based on 28,655 meta-analyses available in the Cochrane Library.ResultsEgger ’s regression test detected publication bias more frequently than other tests (15.7% in meta-analyses of binary outcomes and 13.5% in meta-analyses of non-binary outcomes). The proportion of statistically significant publication bias tests was greater for larger meta-analyses, especially for Begg’ s rank test and the trim-and-fill ...
Source: Journal of General Internal Medicine - April 16, 2018 Category: Internal Medicine Source Type: research

Development and validation of a simplified BRASS index to screen hospital patients needing personalized discharge planning
ConclusionThe new, simplified BRASS index showed a slightly better performance in predicting the risk of complex discharge and hospital mortality than the original tool and takes less time to be applied. These results were also confirmed in the validation set. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - April 16, 2018 Category: Internal Medicine Source Type: research

Empathy and Burnout in Medicine —Acknowledging Risks and Opportunities
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - April 16, 2018 Category: Internal Medicine Source Type: research

Gender identity disparities in Pap test use in a sample of binary and non-binary transmasculine adults
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - April 13, 2018 Category: Internal Medicine Source Type: research

Addressing social determinants of health in an ambulatory setting: quasi-experimental controlled study of a curricular intervention for residents
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - April 13, 2018 Category: Internal Medicine Source Type: research

Scientific abstracts
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - April 13, 2018 Category: Internal Medicine Source Type: research

Performance of the 2015 US Preventive Services Task Force Screening Criteria for Prediabetes and Undiagnosed Diabetes
AbstractBackgroundIn 2015, The US Preventive Services Task Force (USPSTF) recommended screening for prediabetes and undiagnosed diabetes (collectively called dysglycemia) among adults aged 40 –70 years with overweight or obesity. The recommendation suggests that clinicians consider screening earlier in people who have other diabetes risk factors.ObjectiveTo compare the performance of limited and expanded screening criteria recommended by the USPSTF for detecting dysglycemia among US adults.DesignCross-sectional analysis of survey and laboratory data collected from nationally representative samples of the civilia...
Source: Journal of General Internal Medicine - April 12, 2018 Category: Internal Medicine Source Type: research

Dermoscopy of Concerning Pigmented Lesions and Primary Care Providers ’ Referrals at Intervals After Randomized Trial of Mastery Learning
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - April 10, 2018 Category: Internal Medicine Source Type: research

Correlates of Use and Perceived Effectiveness of Non-pharmacologic Strategies for Chronic Pain Among Patients Prescribed Long-term Opioid Therapy
ConclusionsNPT use was associated with higher pain disability and younger age for both clinician-directed and self-directed NPTs and higher education for self-directed NPTs. These strategies were rated as helpful by those that used them. These results can inform intervention implementation and be used to increase engagement in NPTs for chronic pain. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - April 9, 2018 Category: Internal Medicine Source Type: research

Effectiveness of Models Used to Deliver Multimodal Care for Chronic Musculoskeletal Pain: a Rapid Evidence Review
DiscussionMultimodal chronic pain care delivery models coupling decision support with proactive treatment monitoring consistently provide clinically relevant improvement in pain and function. Wider implementation of these models should be accompanied by further evaluation of clinical and implementation effectiveness. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - April 9, 2018 Category: Internal Medicine Source Type: research

How Can the Intractable Problem of Chronic Musculoskeletal Pain (CMP) Be Effectively Managed? The Need for a Well-Integrated Systems Approach
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - April 9, 2018 Category: Internal Medicine Source Type: research

Clinician Referrals for Non-opioid Pain Care Following Discontinuation of Long-term Opioid Therapy Differ Based on Reasons for Discontinuation
ConclusionsThese findings highlight the variability in referral rates for different types of non-opioid pain treatments and challenges accessing specific types of pain care. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - April 9, 2018 Category: Internal Medicine Source Type: research