Using Smartphone Crowdsourcing to Redefine Normal and Febrile Temperatures in Adults: Results from the Feverprints Study
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - August 13, 2018 Category: Internal Medicine Source Type: research

Engaging High-Need Patients in Intensive Outpatient Programs: A Qualitative Synthesis of Engagement Strategies
ConclusionsPromising clinical, interpersonal, and population-based approaches to engaging high-need patients frequently deviate from standard practice and require creative and proactive staff with adequate time, resources, and flexibility to address patients ’ needs on patients’ terms. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - August 10, 2018 Category: Internal Medicine Source Type: research

Screening Positive for Cognitive Impairment: Impact on Healthcare Utilization and Provider Action in Primary and Specialty Care Practices
AbstractBackgroundAlzheimer ’s disease, the most common cause of dementia, goes unrecognized in half of patients presenting to healthcare providers and is associated with increased acute care utilization. Routine cognitive screening of older adults in healthcare settings could improve rates of dementia diagnosis and patterns of healthcare utilization.ObjectiveTo evaluate the impact of screening positive for cognitive impairment on provider action in primary and specialty care practices and patient healthcare utilization.DesignIndividuals asymptomatic for cognitive impairment completed cognitive screening with the Min...
Source: Journal of General Internal Medicine - August 10, 2018 Category: Internal Medicine Source Type: research

How Do Gender Differences in Quality of Care Vary Across Medicare Advantage Plans?
ConclusionsWomen generally experienced better quality of care than men. However, women experienced poorer care for cardiovascular disease-related intermediate outcomes and potentially harmful drug-disease interactions. Quality improvement may be especially important for men in low-performing plans and for cardiovascular-related care and drug-disease interactions for women. Gender-stratified reporting could reveal gender gaps, identify plans for which care varies by gender, and motivate efforts to address faults and close the gaps in the delivery system. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - August 10, 2018 Category: Internal Medicine Source Type: research

Is There a Role for Internal Medicine Residency Preparation Courses in the Fourth Year Curriculum? A Single-Center Experience
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - August 9, 2018 Category: Internal Medicine Source Type: research

Racial Discrimination in Health Care and Utilization of Health Care: a Cross-sectional Study of California Adults
ConclusionsHealth care providers have an opportunity to improve the experiences of their patients, particularly those with publicly  sponsored coverage. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - August 8, 2018 Category: Internal Medicine Source Type: research

Addressing the Lack of Competition in Generic Drugs to Improve Healthcare Quality and Safety
This article outlines a roadmap to influence incentives, regulations, new drug development, and ultimately stakeholder (i.e., patients, providers, and drug makers) behavior to enhance competition, with the ultimate aim of improving the quality and safety of healthcare for our patients. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - August 8, 2018 Category: Internal Medicine Source Type: research

Important Steps Towards a Clinically Actionable Predictive Model of Opioid Overdose Among Patients on Long-term Opioid Therapy
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - August 8, 2018 Category: Internal Medicine Source Type: research

Randomized Trial of Personalized Breast Density and Breast Cancer Risk Notification
AbstractBackgroundDespite widespread implementation of mammographic breast density (MBD) notification laws, the impact of these laws on knowledge of MBD and knowledge of breast cancer risk is limited by the lack of tools to promote informed decision-making in practice.ObjectiveTo develop and evaluate whether brief, personalized informational videos following a normal mammogram in addition to a legislatively required letter about MBD result can improve knowledge of MBD and breast cancer risk compared to standard care (i.e., legislatively required letter about MBD included with the mammogram result).Design/ParticipantsProspe...
Source: Journal of General Internal Medicine - August 8, 2018 Category: Internal Medicine Source Type: research

Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system
ConclusionUptake of new team-based care delivery models is related to practices ’ ability to respond to change and to adapt team roles in workflow, influenced by both local leadership and stable staffing. Better performance on quality metrics may identify high uptake practices. Our findings can inform expectations for operational and policy leaders seeking to implement change in primary care practices. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - August 6, 2018 Category: Internal Medicine Source Type: research

Electronic physician notifications to improve guideline-based anticoagulation in atrial fibrillation: a randomized controlled trial
ConclusionsElectronic physician notification did not increase anticoagulation in patients with atrial fibrillation at elevated stroke risk. Primary care physicians did not prescribe anticoagulants because they perceived the bleeding risk was too high or stroke risk was too low.Trial RegistrationClinicalTrials.gov identifier NCT02950285 (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - August 3, 2018 Category: Internal Medicine Source Type: research

Experiences of Community Violence Among Adults with Chronic Conditions: Qualitative Findings from Chicago
ConclusionsPatients often struggled to balance the challenges imposed by community violence with the demands of living with and managing their chronic conditions. Emergent themes may inform practical targets for addressing community violence as a social determinant of health in vulnerable populations. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - August 3, 2018 Category: Internal Medicine Source Type: research

Multi-level Influences on Breast Cancer Screening in Primary Care
ConclusionsAfter accounting for woman-level characteristics, the remaining variation in breast cancer screening was largely due to provider and health system variation. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - August 3, 2018 Category: Internal Medicine Source Type: research

Experience of Childhood Abuse and Military Sexual Trauma Among Women Veterans with Fibromyalgia
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - August 3, 2018 Category: Internal Medicine Source Type: research

Outpatient Complex Case Management: Health System-Tailored Risk Stratification Taxonomy to Identify High-Cost, High-Need Patients
ConclusionsUse of risk stratification taxonomy for super-utilizers can identify patients most likely to benefit from case management. Future studies must further examine which OPCM components drive improvements in select outcome for specific populations. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - August 3, 2018 Category: Internal Medicine Source Type: research

Longitudinal Continuity Learning Experiences and Primary Care Career Interest: Outcomes from an Innovative Medical School Curriculum
DiscussionSCOPE appears to promote and maintain primary care career interest in participants and has transferability to other institutions. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - August 3, 2018 Category: Internal Medicine Source Type: research

Treat the Patient, Not the Pain: Using a Multidimensional Assessment Tool to Facilitate Patient-Centered Chronic Pain Care
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - August 1, 2018 Category: Internal Medicine Source Type: research

On the Value of the Primary Care Physician
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - August 1, 2018 Category: Internal Medicine Source Type: research

Estimated Impact of US Preventive Services Task Force Recommendations on Use and Cost of Statins for Cardiovascular Disease Prevention
ConclusionsNew USPSTF recommendations may result in decreased out-of-pocket costs and expanded access to statins. Previous research has shown that eliminating copayments increased adherence and decreased rates of ASCVD events without increasing overall healthcare costs. Future research will determine whether the USPSTF ’s recommendations will result in similar findings. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - August 1, 2018 Category: Internal Medicine Source Type: research

Gout and Hypothyroidism in the Elderly: an Observational Cohort Study Using U.S. Medicare Claims Data
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - August 1, 2018 Category: Internal Medicine Source Type: research

Patient-Centered Pain Management Communication from the Patient Perspective
ConclusionsFindings highlight the importance of the patient-provider relationship in patient-centered care and offer patient-centered care communication tools for practitioners to utilize, such as solution-oriented messages and communicating trust, especially when interacting with patients about pain. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - August 1, 2018 Category: Internal Medicine Source Type: research

Design and Interpretation of Noninferiority Trials
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - August 1, 2018 Category: Internal Medicine Source Type: research

Capsule Commentary on Waitzfelder et al., Treatment Initiation for New Episodes of Depression in Primary Care Settings
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - August 1, 2018 Category: Internal Medicine Source Type: research

Design and Interpretation of Noninferiority Trials
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - August 1, 2018 Category: Internal Medicine Source Type: research

How Do Women View Risk-Based Mammography Screening? A Qualitative Study
ConclusionSome women thought risk-based screening made sense. Willingness to abandon traditional screening for the new paradigm was mixed. Broad acceptability of risk-based screening will require clearer communication about its rationale and feasibility and consistent messages from the health care team. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 31, 2018 Category: Internal Medicine Source Type: research

Impact of Practice Facilitation in Primary Care on Chronic Disease Care Processes and Outcomes: a Systematic Review
The objective is to evaluate the impact of practice facilitation on chronic disease outcomes in the primary care setting.MethodsThis systematic review examined North American studies from PubMed, EMBASE, and Web of Science (database inception to August 2017). Investigators independently extracted and assessed the quality of the data on chronic disease process and clinical outcome measures. Studies implemented practice facilitation and reported quantifiable care processes and patient outcomes for chronic disease. Each study and their evidence were assessed for risk of bias and quality according to the Cochrane Collaboration...
Source: Journal of General Internal Medicine - July 31, 2018 Category: Internal Medicine Source Type: research

Real-World Implications of Changing Blood Pressure Targets in Urban Primary Care
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 31, 2018 Category: Internal Medicine Source Type: research

The Potential Impact of Scribes on Medical School Applicants and Medical Students with the New Clinical Documentation Guidelines
AbstractThe presence of scribes in various specialties, including internal medicine, is being heralded as a way to decrease clinician documentation time and burnout. Many medical school applicants become scribes to understand life as a doctor and gain clinical experience. Scribing is already perceived by some as a new key to successfully gaining entrance to medical school. One season of our admissions data showed that scribes were more likely to be admitted (OR  = 1.61). Scribes may also inadvertently make it harder for medical schools to secure clinical placements for medical students. While trained scribes ...
Source: Journal of General Internal Medicine - July 31, 2018 Category: Internal Medicine Source Type: research

Putting Schemas to the Test: An Exercise in Clinical Reasoning
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 31, 2018 Category: Internal Medicine Source Type: research

The prevalence and implications of copy and paste: internal medicine program director perspectives
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 31, 2018 Category: Internal Medicine Source Type: research

Time to Filling of New Prescriptions for Chronic Disease Medications Among a Cohort of Elderly Patients in the USA
ConclusionsNearly 20% of patients do not fill a new chronic disease prescription within 30  days. Patients with fewer recent fills and higher out-of-pocket costs are at higher risk of primary nonadherence. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 27, 2018 Category: Internal Medicine Source Type: research

Metasynthesis of Patient Attitudes Toward Bone Densitometry
ConclusionMinimal knowledge exists of patient perceptions and experiences of DXA among those who are fracture na ïve: Prior research has focused primarily on secondary fracture prevention contexts. Our metasynthesis reveals patients’ significant reliance, given their limited risk appraisal and knowledge, upon primary care providers in decision-making. We urge colleagues to conduct qualitative research on DX A barriers among general primary care population in order to facilitate health care delivery systems better equipped to diagnose and treat patientsbefore their first fracture. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 27, 2018 Category: Internal Medicine Source Type: research

Prevalence and Costs of Discharge Diagnoses in Inpatient General Internal Medicine: a Multi-center Cross-sectional Study
ConclusionsGIM services care for a markedly heterogeneous population but the most common conditions were similar across 7 hospitals. The diversity of conditions cared for in GIM may be challenging for healthcare delivery and quality improvement. Initiatives that cut across individual diseases to address processes of care, patient experience, and functional outcomes may be more relevant to a greater proportion of the GIM population than disease-specific efforts. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 27, 2018 Category: Internal Medicine Source Type: research

Variability in Care Management Programs in Medicare ACOs: A Survey of Medical Directors
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 27, 2018 Category: Internal Medicine Source Type: research

Early Effects of the ACA on Women ’s Health Measures
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 27, 2018 Category: Internal Medicine Source Type: research

Anemia in Scurvy
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 27, 2018 Category: Internal Medicine Source Type: research

EMR implementation of default opioid prescription quantities
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 27, 2018 Category: Internal Medicine Source Type: research

Capsule Commentary on Fredericksen et al. “Development and Content Validation of a Patient-Reported Sexual Risk Measure for Use in Primary Care”
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 27, 2018 Category: Internal Medicine Source Type: research

Capsule commentary on Kurtzman et al., Social incentives and gamification to promote weight loss: the LOSE IT randomized, controlled trial
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 27, 2018 Category: Internal Medicine Source Type: research

Patient, Family, and Community Advisory Councils in Health Care and Research: a Systematic Review
DiscussionPFACs engage communities through individual projects but evidence of their impact on outcomes is lacking. A paucity of randomized controlled trials or high-quality observational studies guide strategies for engagement through PFACs. Standardized measurement tools for engagement are needed. Strategies for PFAC recruitment should be investigated and reported. PFAC members can feasibly contribute to systematic reviews.Registration and Funding SourceA protocol for record eligibility was developed a priori and was registered in the PROSPERO database of systematic reviews (registration number CRD42016052817). The Depar...
Source: Journal of General Internal Medicine - July 26, 2018 Category: Internal Medicine Source Type: research

Administrator Perspectives on ICU-to-Ward Transfers and Content Contained in Existing Transfer Tools: a Cross-sectional Survey
ConclusionICU and ward administrators have similar perspectives of transfer practices and identified patient/family engagement and communication as priorities for improvement. Key information categories exist. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 26, 2018 Category: Internal Medicine Source Type: research

General Internists Versus Specialists as Attendings for General Internal Medicine Inpatients at a Canadian Hospital: a Cohort Study
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 26, 2018 Category: Internal Medicine Source Type: research

Association Between Team Learning Behavior and Reduced Burnout Among Medicine Residents
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 26, 2018 Category: Internal Medicine Source Type: research

Capsule Commentary on Magin et al., Changes in Australian Early-Career General Practitioners ’ Benzodiazepine Prescribing: a Longitudinal Analysis
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 26, 2018 Category: Internal Medicine Source Type: research

Does VA Health Care Still Measure Up?
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 25, 2018 Category: Internal Medicine Source Type: research

Changes in Australian Early-Career General Practitioners ’ Benzodiazepine Prescribing: a Longitudinal Analysis
AbstractBackgroundAustralian and international guidelines recommend benzodiazepines and related drugs (hereafter “benzodiazepines”) as second-line, short-term medications only. Most benzodiazepines are prescribed by general practitioners (GPs; family physicians). Australian GP registrars (“trainees” or “residents” participating in a post-hospital training, apprenticeship-like, practice-based vocati onal training program), like senior GPs, prescribe benzodiazepines at high rates. Education within a training program, and experience in general practice, would be expected to reduce benzodiaz...
Source: Journal of General Internal Medicine - July 23, 2018 Category: Internal Medicine Source Type: research

High Variability of Opioid Prescribing Within and Across Emergency Departments in the US Veterans Health Administration
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 23, 2018 Category: Internal Medicine Source Type: research

Professional Development Coaching for Residents: Results of a 3-Year Positive Psychology Coaching Intervention
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 23, 2018 Category: Internal Medicine Source Type: research

Accessing Care Through the Veterans Choice Program: The Veteran Experience
DiscussionMost Veterans who had received care through the VCP felt that it improved their access to care. However, accessing care through the VCP is a complex process that requires proactive Veterans and active support from the VA, third-party administrators, and availability of participating community providers. Veterans ’ abilities to navigate this process and the level of support provided varied widely. Even patients who did receive care through VCP found the process challenging. Greater support is needed for some Veterans to successfully access VCP care because Veterans who need care the most may be the least a b...
Source: Journal of General Internal Medicine - July 23, 2018 Category: Internal Medicine Source Type: research

Key Elements of Mammography Shared Decision-Making: a Scoping Review of the Literature
DiscussionThe findings underscore the importance of the relationship between the patient and clinician and the necessity of spelling out each step in the SDM process. The clinician needs to be explicit in telling a woman that she has a choice about whether to get a mammogram and the benefits and harms of screening mammography. Finally, clinicians need to be aware of sociocultural factors that can influence their relationships and their patients ’ decision-making processes and attempt to identify and address these factors. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - July 20, 2018 Category: Internal Medicine Source Type: research