Abstract:
Importance:Diabetic retinopathy (DR) is the leading cause of blindness in adults of working age in the United States. In the Los Angeles County safety net, a nonvertically integrated system serving underinsured and uninsured patients, the prevalence of DR is approximately 50%, and owing to limited specialty care resources, the average wait times for screening for DR have been 8 months or more. Objective:To determine whether a primary care-based teleretinal DR screening (TDRS) program reduces wait times for screening and improves timeliness of needed care in the Los Angeles County safety net. Design, Setting, and Participants:Quasi-experimental, pretest-posttest evaluation of exposure to primary care-based TDRS at 5 of 15 Los Angeles County Department of Health Services safety net clinics from September 1, 2013, to December 31, 2015, with a subgroup analysis of random samples of 600 patients before and after the intervention (1200 total). Exposure:Primary care clinic-based teleretinal screening for DR. Main Outcomes and Measures:Annual rates of screening for DR before and after implementation of the TDRS program across the 5 clinics, time to screening for DR in a random sample of patients from these clinics, and a description of the larger framework of program implementation. Results:Among the 21 222 patients who underwent the screening (12 790 female, 8084 male, and 348 other gender or not specified; mean [SD] age, 57.4 [9.6] years), the median time to screening for DR decreased from 158 days (interquartile range, 68-324 days) before the intervention to 17 days (interquartile range, 8-50 days) after initiation of the program (P < .001). Overall annual screening rates for DR increased from 5942 of 14 633 patients (40.6%) before implementation to 7470 of 13 133 patients (56.9%) after initiation of the program at all 15 targeted clinics (odds ratio, 1.9; 95% CI, 1.3-2.9; P = .002). Of the 21 222 patients who were screened, 14 595 (68.8%) did not require referral to an eye care professional, 4160 (19.6%) were referred for treatment or monitoring of DR, and 2461 (11.6%) were referred for other ophthalmologic conditions. Conclusions and Relevance:A digital TDRS program was successfully implemented for the largest publicly operated county safety net population in the United States, resulting in the elimination of the need for more than 14 000 visits to specialty care professionals, a 16.3% increase in annual rates of screening for DR, and an 89.2% reduction in wait times for screening. Teleretinal DR screening programs have the potential to maximize access and efficiency in the safety net, where the need for such programs is most critical.
journal_name
JAMA Intern Medjournal_title
JAMA internal medicineauthors
Daskivich LP,Vasquez C,Martinez C Jr,Tseng CH,Mangione CMdoi
10.1001/jamainternmed.2017.0204subject
Has Abstractpub_date
2017-05-01 00:00:00pages
642-649issue
5eissn
2168-6106issn
2168-6114pii
2612116journal_volume
177pub_type
杂志文章abstract:IMPORTANCE:Studies have shown that bisphosphonates may have antitumor and antimetastatic properties. Recently, observational studies have suggested a possible protective effect of bisphosphonates on breast cancer, but the effect of bisphosphonate use on risk of breast cancer has not been tested in randomized trials. O...
journal_title:JAMA internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1001/jamainternmed.2014.3634
更新日期:2014-10-01 00:00:00
abstract:Importance:Previous studies have shown that medical student mistreatment is common. However, few data exist to date describing how the prevalence of medical student mistreatment varies by student sex, race/ethnicity, and sexual orientation. Objective:To examine the association between mistreatment and medical student ...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2020.0030
更新日期:2020-05-01 00:00:00
abstract:Importance:Every day in the United States, more than 200 people are murdered or assaulted with a firearm. Little research has considered the role of interpersonal ties in the pathways through which gun violence spreads. Objective:To evaluate the extent to which the people who will become subjects of gun violence can b...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2016.8245
更新日期:2017-03-01 00:00:00
abstract:Importance:End-of-life care is costly, and decedents often experience overtreatment or low-quality care. Noninvasive ventilation (NIV) may be a palliative approach to avoid invasive mechanical ventilation (IMV) among select patients who are hospitalized at the end of life. Objective:To examine the trends in NIV and IM...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2020.5640
更新日期:2021-01-01 00:00:00
abstract:IMPORTANCE:The effect of strict blood pressure control on clinical outcomes in patients with chronic kidney disease (CKD) is unclear. OBJECTIVE:To compare the outcomes associated with a treated systolic blood pressure (SBP) of less than 120 mm Hg vs those associated with the currently recommended SBP of less than 140 ...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2014.3279
更新日期:2014-09-01 00:00:00
abstract:Importance:Initiatives to reduce sodium in packaged foods have been launched in the United States, yet corresponding changes in the amount of sodium that US households obtain from packaged foods have not been evaluated, to our knowledge. Objective:To assess 15-year changes in the amount of sodium that US households ac...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2017.1407
更新日期:2017-07-01 00:00:00
abstract:Importance:The electronic cigarette (EC) has become popular among smokers who wish to reduce their tobacco use levels or quit smoking, but its effectiveness as a cessation aid is uncertain. Objective:To examine the association of regular EC use with the number of cigarettes smoked per day, smoking cessation among curr...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2019.1483
更新日期:2019-07-15 00:00:00
abstract::BACKGROUND Early ambulatory palliative care (PC) is an emerging practice, and its key elements have not been defined. We conducted a qualitative analysis of data from a randomized controlled trial that demonstrated improved quality of life, mood, and survival in patients with newly diagnosed metastatic non-small cell ...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2013.1874
更新日期:2013-02-25 00:00:00
abstract:Importance:Urinary stone disease is a common presentation in the emergency department, and α-adrenergic receptor blockers, such as tamsulosin, are commonly used to facilitate stone passage. Objective:To determine if tamsulosin promotes the passage of urinary stones within 28 days among emergency department patients. ...
journal_title:JAMA internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamainternmed.2018.2259
更新日期:2018-08-01 00:00:00
abstract:IMPORTANCE:Up-front treatment of older men with low-risk prostate cancer can cause morbidity without clear survival benefit; however, most such patients receive treatment instead of observation. The impact of physicians on the management approach is uncertain. OBJECTIVE:To determine the impact of physicians on the man...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2014.3021
更新日期:2014-09-01 00:00:00
abstract:Importance:Reductions in sugar-sweetened beverage (SSB) intake can improve health, but are difficult for individuals to achieve on their own. Objectives:To evaluate whether a workplace SSB sales ban was associated with SSB intake and cardiometabolic health among employees and whether a brief motivational intervention ...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2019.4434
更新日期:2019-10-28 00:00:00
abstract:IMPORTANCE:In individuals with human immunodeficiency virus 1 (HIV-1) infection who are receiving antiretroviral therapy (ART), factors that promote full immune recovery are not well characterized. OBJECTIVE:To investigate the influence of the timing of ART relative to HIV-1 infection on normalization of CD4+ T-cell c...
journal_title:JAMA internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1001/jamainternmed.2014.4010
更新日期:2015-01-01 00:00:00
abstract::A global human immunodeficiency virus (HIV) epidemic persists despite data to support multiple effective and safe tools that prevent HIV transmission and acquisition. Human immunodeficiency virus preexposure prophylaxis (PrEP) for HIV-uninfected at-risk populations using tenofovir disoproxil fumarate emtricitabine is ...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2019.5456
更新日期:2019-11-18 00:00:00
abstract:IMPORTANCE:Additional information is needed about the role of dietary sodium on health outcomes in older adults. OBJECTIVE:To examine the association between dietary sodium intake and mortality, incident cardiovascular disease (CVD), and incident heart failure (HF) in older adults. DESIGN, SETTING, AND PARTICIPANTS:W...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2014.6278
更新日期:2015-03-01 00:00:00
abstract:Importance:The association between incretin-based drugs, such as dipeptidyl peptidase 4 (DPP-4) inhibitors and glucagon-like peptide 1 (GLP-1) agonists, and acute pancreatitis is controversial. Objective:To determine whether the use of incretin-based drugs, compared with the use of 2 or more other oral antidiabetic dr...
journal_title:JAMA internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1001/jamainternmed.2016.1522
更新日期:2016-10-01 00:00:00
abstract:Importance:Home health care workers care for community-dwelling adults and play an important role in supporting patients with confirmed and suspected coronavirus disease 2019 (COVID-19) who remain at home. These workers are mostly middle-aged women and racial/ethnic minorities who typically earn low wages. Despite bein...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2020.3930
更新日期:2020-08-04 00:00:00
abstract:IMPORTANCE:Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) may have different effects on cardiovascular (CV) events in patients with diabetes mellitus (DM). OBJECTIVE:To conduct a meta-analysis to separately evaluate the effects of ACEIs and ARBs on all-cause mortality, CV ...
journal_title:JAMA internal medicine
pub_type: 杂志文章,meta分析
doi:10.1001/jamainternmed.2014.348
更新日期:2014-05-01 00:00:00
abstract:Importance:Whether interventions to improve food access can reduce health care use is unknown. Objective:To determine whether participation in a medically tailored meal intervention is associated with fewer subsequent hospitalizations. Design, Setting, and Participants:A retrospective cohort study was conducted using...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2019.0198
更新日期:2019-06-01 00:00:00
abstract:IMPORTANCE:Biofeedback with device-guided lowering of breathing frequency could be an alternate nonpharmacologic treatment option for hypertension. Evidence from trials with high methodologic quality is lacking. OBJECTIVE:To evaluate the effects of device-guided lowering of breathing frequency on blood pressure in pat...
journal_title:JAMA internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamainternmed.2013.6883
更新日期:2013-07-22 00:00:00
abstract:IMPORTANCE:Healthcare overuse, the delivery of low-value services, is increasingly recognized as a critical problem. However, little is known about the comparative effectiveness of alternate formats for presenting benefits and harms information to patients as a strategy to reduce overuse. OBJECTIVE:To examine the effe...
journal_title:JAMA internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamainternmed.2015.7339
更新日期:2016-01-01 00:00:00
abstract:Importance:Approximately 1 million patients in the United States with type 2 diabetes mellitus and mild-to-moderate kidney disease do not receive guideline-directed therapy with metformin. This may reflect uncertainty regarding the risk of acidosis in patients with chronic kidney disease. Objective:To quantify the ass...
journal_title:JAMA internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1001/jamainternmed.2018.0292
更新日期:2018-07-01 00:00:00
abstract:Importance:As the rate of publication of new and sometimes conflicting medical research increases, clinicians rely heavily on clinical practice guidelines (CPGs) to inform practice. However, CPGs are of widely variable quality, and there are no existing objective measures to rate the quality of CPGs. Objective:To syst...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2018.7529
更新日期:2019-04-01 00:00:00
abstract:IMPORTANCE:Primary care provider (PCP) turnover is common and can disrupt patient continuity of care. Little is known about the effect of PCP turnover on patient care experience and quality of care. OBJECTIVE:To measure the effect of PCP turnover on patient experiences of care and ambulatory care quality. DESIGN, SET...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2015.1853
更新日期:2015-07-01 00:00:00
abstract:Importance:The safety of discharging adult patients recovering from critical illness directly home from the intensive care unit (ICU) is unknown. Objective:To compare the health care utilization and clinical outcomes for ICU patients discharged directly home from the ICU with those of patients discharged home via the ...
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pub_type: 杂志文章,多中心研究
doi:10.1001/jamainternmed.2018.3675
更新日期:2018-10-01 00:00:00
abstract:Importance:Lung cancer has become a leading cause of death among people living with human immunodeficiency virus (HIV) (PLWH). Over 40% of PLWH in the United States smoke cigarettes; HIV independently increases the risk of lung cancer. Objective:To project cumulative lung cancer mortality by smoking exposure among PLW...
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pub_type: 杂志文章
doi:10.1001/jamainternmed.2017.4349
更新日期:2017-11-01 00:00:00
abstract:BACKGROUND:The benefit of blood transfusion in patients with myocardial infarction is controversial, and a possibility of harm exists. METHODS:A systematic search of studies published between January 1, 1966, and March 31, 2012, was conducted using MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and Cochrane Central ...
journal_title:JAMA internal medicine
pub_type: 杂志文章,meta分析
doi:10.1001/2013.jamainternmed.1001
更新日期:2013-01-28 00:00:00
abstract:IMPORTANCE:The 2008 Physical Activity Guidelines for Americans recommended a minimum of 75 vigorous-intensity or 150 moderate-intensity minutes per week (7.5 metabolic-equivalent hours per week) of aerobic activity for substantial health benefit and suggested additional benefits by doing more than double this amount. H...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2015.0533
更新日期:2015-06-01 00:00:00
abstract:Importance:As cervical cancer screening transitions from Papanicolaou cytologic screening to primary human papillomavirus (HPV) testing worldwide, effective triage tests are needed to decide who among the HPV-positive women should receive further diagnostic evaluation to avoid unnecessary colposcopies and biopsies. Ob...
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pub_type: 杂志文章
doi:10.1001/jamainternmed.2019.0306
更新日期:2019-07-01 00:00:00
abstract:BACKGROUND:A challenge in intensive obesity treatment is making care scalable. Little is known about whether the outcome of physician-directed weight loss treatment can be improved by adding mobile technology. METHODS:We conducted a 2-arm, 12-month study (October 1, 2007, through September 31, 2010). Seventy adults (b...
journal_title:JAMA internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamainternmed.2013.1221
更新日期:2013-01-28 00:00:00
abstract:Importance:First-line behavioral and drug therapies for overactive bladder (OAB) symptoms in men are effective but not usually curative. Objective:To determine whether combining behavioral and drug therapies improves outcomes compared with each therapy alone for OAB in men and to compare 3 sequences for implementing c...
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pub_type: 杂志文章,随机对照试验
doi:10.1001/jamainternmed.2019.6398
更新日期:2020-03-01 00:00:00