Abstract:
OBJECTIVES:We sought to assess the responses of providers to recommendations generated by a computer-management system for chronic heart failure (CHF). METHODS:This study is an analysis of primary care providers' responses to evidence-based computer-generated suggestions regarding patients with CHF at one center of a randomized trial. The trial randomized primary care providers from 2 VA Medical Centers to receive care suggestions regarding patients with CHF, with or without inclusion of patient symptom data obtained from pre-visit questionnaires. At one center, providers were asked to respond to the suggestions with hand-written comments and a numerical agreement scale. RESULTS:Providers responded to 774 care suggestions (62% of the 1246 delivered). They agreed with 41%, had major disagreements with 12%, and had minor disagreements with 22%. For 7% of the care suggestions, providers asked to not see it again for that patient. The most common reasons for major or minor disagreements were a belief that the suggestion was wrong or unnecessary (45%) or would not be tolerated by the patient (32%). External barriers to implementation of guidelines, lack of guideline awareness, or disagreement with guidelines were uncommon reasons cited by providers in this study. CONCLUSIONS:Providers agreed with less than half of computer-generated care suggestions from evidence-based CHF guidelines, most often because the suggestions were felt to be inapplicable to their patients or unlikely to be tolerated.
journal_name
Med Carejournal_title
Medical careauthors
Keeffe B,Subramanian U,Tierney WM,Udris E,Willems J,McDonell M,Fihn SDdoi
10.1097/01.mlr.0000160378.53326.f3keywords:
subject
Has Abstractpub_date
2005-05-01 00:00:00pages
461-5issue
5eissn
0025-7079issn
1537-1948pii
00005650-200505000-00006journal_volume
43pub_type
临床试验,杂志文章,多中心研究,随机对照试验相关文献
MEDICAL CARE文献大全abstract::This study was undertaken to determine if a measure of severity of illness for psychiatric patients, the Psychiatric Severity of Illness Index, could produce psychiatric case mix groups that are more homogeneous with respect to resource use than the diagnosis-related groups (DRGs). Psychiatric Severity of Illness data...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198901000-00007
更新日期:1989-01-01 00:00:00
abstract:BACKGROUND:Reference drug pricing (RP) is a cost-sharing strategy commonly used to control drug expenditures. Under RP, a benefit plan fully reimburses medications that are equally or less expensive than the reference price, and requires patients to pay the extra cost of therapeutically equivalent but higher priced dru...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000129497.10930.a2
更新日期:2004-07-01 00:00:00
abstract:OBJECTIVE:Understanding provider perceptions of and experiences with order entry and order checks (drug alerts) in an electronic prescribing system may help improve medication safety technology. DESIGN:Cross-sectional, national survey of Veterans Administration physicians practicing in various specialties. MEASUREMEN...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e318222a6f5
更新日期:2011-10-01 00:00:00
abstract::The differences between female and male general practitioners (GPs) were studied regarding three different factors: 1) Do female GPs see more female patients than their male colleagues in the same practice?; 2) Are female GPs confronted with different types of health problems from their male colleagues?; and 3) Do fem...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199303000-00004
更新日期:1993-03-01 00:00:00
abstract::Between 1989 and 1992, the Agency for Health Care Policy and Research (AHCPR) awarded funding to 14 special projects known as Patient Outcomes Research Teams (PORTs). These large, complex projects form the centerpiece of the first generation of research under the Medical Treatment Effectiveness Program. In carrying ou...
journal_title:Medical care
pub_type: 杂志文章
doi:
更新日期:1994-07-01 00:00:00
abstract::Previous research has neglected to delineate pediatric nurse practitioner (PNP) roles in tertiary care settings (TCS). New PNP roles have developed as TCS seek cost-effective solutions to providing quality patient care and to meeting new demands for outpatient care. The authors evaluated the roles of 11 PNPs in eight ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198604000-00005
更新日期:1986-04-01 00:00:00
abstract:BACKGROUND:Medicare and private plans are encouraging individuals to seek care at hospitals that are designated as centers of excellence. Few evaluations of such programs have been conducted. This study examines a large national initiative that designated hospitals as centers of excellence for knee and hip replacement....
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3182699407
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:Incorporating patients' preferences into colorectal cancer (CRC) screening recommendations has been identified as a potential mechanism for increasing adherence. This study used conjoint analysis to describe variation in CRC screening preferences among racially/ethnically diverse primary care patients. METH...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e31817d932e
更新日期:2008-09-01 00:00:00
abstract:BACKGROUND:Many health plans have outreach programs aimed at appropriately screening, evaluating, and treating women experiencing fragility fractures; however, few programs exist for men. OBJECTIVE:The objective of this study was to develop, implement, and evaluate an osteoporosis outreach program for men with a recen...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001459
更新日期:2021-02-01 00:00:00
abstract:OBJECTIVE:Prior meta-analysis indicates that collaborative chronic care models (CCMs) improve mental and physical health outcomes for individuals with mental disorders. This study aimed to investigate the stability of evidence over time and identify patient and intervention factors associated with CCM effects to facili...
journal_title:Medical care
pub_type: 杂志文章,meta分析
doi:10.1097/MLR.0b013e3182a3e4c4
更新日期:2013-10-01 00:00:00
abstract::The health care left-a traditional source of critique and reform-has become intellectually less competent and politically less effective in carrying out its historic role in the continuing great debate over health policies and programs. Its credibility has diminished in recent years as it has come to operate on a seri...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198009000-00007
更新日期:1980-09-01 00:00:00
abstract:OBJECTIVES:The authors compare two generic measures of health status with disease-specific measures in a randomized controlled trial of transurethral resection of the prostate with laser vaporization prostatectomy for benign prostatic hypertrophy. METHODS:Patients entered into the trial completed the following questio...
journal_title:Medical care
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00005650-199711000-00003
更新日期:1997-11-01 00:00:00
abstract:BACKGROUND:Although patients readmitted to intensive care units (ICUs) typically have poor outcomes, ICU readmission rates have not been studied as a measure of hospital performance. OBJECTIVES:To determine variation in ICU readmission rates across hospitals and associations of readmission rates with other ICU-based m...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199904000-00009
更新日期:1999-04-01 00:00:00
abstract:OBJECTIVE:To evaluate the effectiveness of standardized, patient-centered label (PCL) instructions to improve comprehension of prescription drug use compared with typical instructions. METHODS:A total of 500 adult patients recruited from 2 academic and 2 community primary care clinics in Chicago, IL and Shreveport, LA...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3181f38174
更新日期:2011-01-01 00:00:00
abstract:OBJECTIVE:We evaluated the association of medication refill adherence with demographic and prescription characteristics to determine whether such factors could guide intervention strategies in an indigent rural population. METHODS:The study was conducted at a University-based internal medicine practice serving an indi...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200212000-00016
更新日期:2002-12-01 00:00:00
abstract::New drugs and other medical advances in organ transplantation are expected to increase the rate of retention of transplanted kidneys, or grafts, and therefore also raise patient survival rates. In particular, the immunosuppressive drug cyclosporine has been found to reduce the likelihood of rejection of a transplanted...
journal_title:Medical care
pub_type: 杂志文章
doi:
更新日期:1987-03-01 00:00:00
abstract:BACKGROUND:Changes in the demographic, specialty, and employment sector composition of medicine have altered physicians' jobs, limiting autonomy and reducing morale. Because physician job satisfaction has been linked to clinical variables, better measurement might help to ameliorate conditions linked to medical disaffe...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199911000-00010
更新日期:1999-11-01 00:00:00
abstract:BACKGROUND:Conceptual equivalence of measures is essential in research that compares health across diverse racial/ethnic groups. Cognitive interviews are pretest methods to explore the conceptual equivalence of survey items. Systematic approaches for using these methods are emerging. OBJECTIVE:We describe an interacti...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000245425.65905.1d
更新日期:2006-11-01 00:00:00
abstract:OBJECTIVE:An updated version of the SF-6D Classification System (SF-6Dv2) has been developed, and utility value sets are required. The aim of this study was to test the development of a United Kingdom SF-6Dv2 value set, and address limitations of the existing SF-6D value set (which results in a narrow range of utilitie...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001324
更新日期:2020-06-01 00:00:00
abstract:OBJECTIVES:To reapportion Veterans Health Administration (VA) annual expenditures into benefit categories for comparison with estimated payments by private sector providers. METHODS:Total expenditures for six VA medical centers for federal fiscal year 1999 were reapportioned by benefit category using the cost distribu...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.MLR.0000068422.03255.6B
更新日期:2003-06-01 00:00:00
abstract:BACKGROUND:Trend analyses of opioid-related inpatient stays depend on the availability of comparable data over time. In October 2015, the US transitioned diagnosis coding from International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to ICD-10-CM, increasing from ∼14,000 to 68,000 codes...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000805
更新日期:2017-11-01 00:00:00
abstract::A randomized clinical trial was performed to assess whether the results of a depression screening instrument, when provided to physicians, could influence their recognition and treatment of depression in a primary care setting. The intervention consisted of randomly informing or not informing physicians of the depress...
journal_title:Medical care
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00005650-199003000-00004
更新日期:1990-03-01 00:00:00
abstract:BACKGROUND:Young men who have sex with men (YMSM) have the highest rates of human immunodeficiency virus (HIV) infection in the United States. Decades into the HIV epidemic, the relationships that YMSM-serving health and social organizations have with one another has not been studied in depth. OBJECTIVES:The aim of th...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000595
更新日期:2017-02-01 00:00:00
abstract::Cataract surgery is the most frequently performed surgical procedure on Medicare beneficiaries, with an annual cost to the Medicare program of more than $3.4 billion. In this study, the relationship between demographic, environmental, and provider-related factors, and the likelihood that cataract surgery will be perfo...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199501000-00008
更新日期:1995-01-01 00:00:00
abstract::The burn problem in the United States, as reflected in published data, is serious. More than 2,000,000 people are injured in burn accidents each year; 70,000 are hospitalized, involving approximately 9,000,000 disability days; and an estimated 9,000 die from their injuries. In 1964, the National Burn Information Excha...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198002000-00006
更新日期:1980-02-01 00:00:00
abstract:BACKGROUND:Latinos make up the largest group of minority children in the United States. Despite great diversity among Latino children, studies have traditionally treated them as a monolithic group. Few studies have examined patterns and determinants of access to and use of health care for different subgroups of Latino ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e318190d9e4
更新日期:2009-06-01 00:00:00
abstract:BACKGROUND:Studies have documented that patients of female physicians receive higher levels of preventive services. However, most studies include patients of only one gender, examine mainly gender-specific screening services, and do not examine patient education and counseling. OBJECTIVES:This study tests both physici...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200112000-00004
更新日期:2001-12-01 00:00:00
abstract:OBJECTIVE:To examine variation in culture change to a person-centered care (PCC) model, and the association between culture change and a composite measure of quality in 107 Department of Veterans Affairs nursing homes. METHODS:We examined the relationship between a composite quality measure calculated from 24 quality ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3182763230
更新日期:2013-02-01 00:00:00
abstract:BACKGROUND:Many of the large ongoing national surveys of the US population contain a question that asks for the respondent's self-reported health status: "excellent," "very good," "good," "fair," or "poor." These surveys could be used to conduct cost-utility analyses of health care policies, treatments or other interve...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e31803dce05
更新日期:2007-07-01 00:00:00
abstract:BACKGROUND:Access to health care is a critical concept in the design, delivery, and evaluation of high quality care. Meaningful evaluation of access requires research evidence and the integration of perspectives of patients, providers, and administrators. OBJECTIVE:Because of high-profile access challenges, the Depart...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001177
更新日期:2019-10-01 00:00:00