Abstract:
OBJECTIVE:To determine the incremental cost-effectiveness of a quality improvement depression intervention (enhanced care) in primary care settings relative to usual care. DESIGN:Following stratification, we randomized 12 primary care practices to enhanced or usual care conditions and followed patients for 12 months. SETTING:Primary care practices located in 10 states across the United States. PATIENTS/PARTICIPANTS:Two hundred eleven patients beginning a new treatment episode for major depression. INTERVENTIONS:Training the primary care team to assess, educate, and monitor depressed patients during the acute and continuation stages of their depression treatment episode over 1 year. MEASUREMENTS AND MAIN RESULTS:Cost-effectiveness was measured by calculating incremental (enhanced minus usual care) costs and quality-adjusted life years (QALYs) derived from SF-36 data. The mean incremental cost-effectiveness ratio in the main analysis was US dollars 15463 per QALY. The mean incremental cost-effectiveness ratios for the sensitivity analyses ranged from US dollars 11341 (using geographic block variables to control for pre-intervention service utilization) to US dollars 19976 (increasing the cost estimates by 50%) per QALY. CONCLUSIONS:This quality improvement depression intervention was cost-effective relative to usual care compared to cost-effectiveness ratios for common primary care interventions and commonly cited cost-effectiveness ratio thresholds for intervention implementation.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Pyne JM,Rost KM,Zhang M,Williams DK,Smith J,Fortney Jdoi
10.1046/j.1525-1497.2003.20611.xsubject
Has Abstractpub_date
2003-06-01 00:00:00pages
432-41issue
6eissn
0884-8734issn
1525-1497pii
jgi20611journal_volume
18pub_type
临床试验,杂志文章,多中心研究,随机对照试验abstract:BACKGROUND:Clinician's knowledge of a woman's cancer family history (CFH) and counseling about health-related behaviors (HRB) is necessary for appropriate breast cancer care. OBJECTIVE:To evaluate whether clinicians solicit CFH and counsel women on HRB; to assess relationship of well visits and patient risk perception...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-006-0087-y
更新日期:2007-03-01 00:00:00
abstract:BACKGROUND:Patient navigator (PN) programs can improve breast cancer screening in low income, ethnic/racial minorities. Refugee women have low breast cancer screening rates, but it has not been shown that PN is similarly effective. OBJECTIVE:Evaluate whether a PN program for refugee women decreases disparities in brea...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-013-2491-4
更新日期:2013-11-01 00:00:00
abstract:OBJECTIVE:To assess the effect of a program that encourages teamwork between physicians and pharmacists on attempts to lower total cholesterol levels and to meet recommended goals proposed by the National Cholesterol Education Program (NCEP). DESIGN:A single-blind, randomized, controlled trial lasting 6 months. SETTI...
journal_title:Journal of general internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s11606-006-5023-7
更新日期:1997-03-01 00:00:00
abstract:BACKGROUND:The opioid epidemic has disproportionately affected rural areas, where a limited number of health care providers offer medication-assisted treatment (MAT), the mainstay of treatment for opioid use disorder (OUD). Rural residents with OUD may face multiple barriers to engagement in MAT including long travel d...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-04943-6
更新日期:2019-06-01 00:00:00
abstract::General Internal Medicine research evolves in response to the needs of the patients to whom we provide care. Currently, many studies exclude older adults who deeply affect the clinical care of this population. With the number of older adults increasing, creating research protocols that include older adults with multip...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-013-2719-3
更新日期:2014-06-01 00:00:00
abstract:BACKGROUND:Health literacy has been linked to health status in a variety of chronic diseases. However, evidence for a relationship between health literacy and mental health outcomes is sparse. OBJECTIVE:We hypothesized that low literacy would be associated with higher addiction severity, higher levels of depressive sy...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1111/j.1525-1497.2006.00533.x
更新日期:2006-08-01 00:00:00
abstract::Electronic Nicotine Delivery Systems (ENDS), commonly referred to as "e-cigs," were first introduced in the United States in 2007. Since then, their use has grown substantially, with the largest market among adolescents and young adults. ENDS are often perceived by the public as safe alternatives to traditional cigare...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05462-0
更新日期:2020-01-01 00:00:00
abstract:OBJECTIVE:To determine whether internists in the United States and China have different ideas and behaviors regarding informing patients of terminal diagnoses and HIV/AIDS, the role of the family in end-of-life decision making, and assisted suicide. DESIGN:Structured questionnaire of clinical vignettes followed by mul...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1999.06318.x
更新日期:1999-08-01 00:00:00
abstract:BACKGROUND:Approximately 25 million people in the USA are limited English proficient (LEP). When LEP patients receive care from physicians who are truly language concordant, some evidence show that language disparities are reduced, but others demonstrate worse outcomes. We conducted a systematic review of the literatur...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-04847-5
更新日期:2019-08-01 00:00:00
abstract:BACKGROUND:National guidelines indicate that healthcare providers should routinely screen women of reproductive age for experience of intimate partner violence. We know little about intimate partner violence (IPV) screening and disclosure experience among women older than reproductive age. OBJECTIVE:To examine the per...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-05947-3
更新日期:2020-09-01 00:00:00
abstract::There is reason for pessimism about the incorporation of prevention into medical education. In addition to what might be called the standard reasons for resistance to prevention, there are at least three other structural barriers: the destabilization of the health care system, the loss of interest in careers in primar...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02600854
更新日期:1990-09-01 00:00:00
abstract:BACKGROUND:The double-blind placebo-controlled design is commonly considered the gold standard in research methodology; however, subject expectation bias could subvert blinding. OBJECTIVE:The primary aim of this study was to examine the impact of expectation bias. Specifically, we examined perceived treatment assignme...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-008-0656-3
更新日期:2008-09-01 00:00:00
abstract:BACKGROUND:Adverse drug events after hospital discharge are common and often serious. These events may result from provider errors or patient misunderstanding. OBJECTIVE:To determine the prevalence of medication reconciliation errors and patient misunderstanding of discharge medications. DESIGN:Prospective cohort stu...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-012-2168-4
更新日期:2012-11-01 00:00:00
abstract::To understand the effect that termination of an established physician-patient relationship has on patient attendance patterns in a medical clinic, appointment scheduling and patient attendance were measured for 210 patients before and after 11 senior resident physicians left the clinic. There was no significant change...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599811
更新日期:1986-03-01 00:00:00
abstract::Academic departments of family medicine and divisions of general internal medicine and general pediatrics exist in the majority of medical schools in the United States and have important roles in generalist medical education. The major organizational issues facing these units concern institutional influence, faculty d...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/BF02598123
更新日期:1994-04-01 00:00:00
abstract::This report examines alternative methods of paying for clinical preventive care services. First, the extent of coverage of preventive health care services in public and private health insurance plans is reviewed. Included in this review are Medicare, Medicaid, health maintenance organizations, and private health insur...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02600851
更新日期:1990-09-01 00:00:00
abstract:CONTEXT:To date, research regarding the influence of conflicts of interest on the presentation of findings by researchers has been limited. OBJECTIVE:To evaluate the sources of funding for published manuscripts, and association between reported findings and conflicts of interest. METHODS:Data from both print and elec...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2004.30617.x
更新日期:2004-01-01 00:00:00
abstract:MAIN RESULTS:Compared with younger patients, patients aged 50 years or older were less likely to have acquired HIV via intravenous drug use or homosexual contact (p = .0001). Older patients were more likely to have comorbid diseases (12% vs 4%; p = .0001), had more frequent neurologic findings on admission (19% vs 9%; ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599026
更新日期:1996-10-01 00:00:00
abstract:BACKGROUND:To practice Evidence-Based Medicine (EBM), physicians must quickly retrieve evidence to inform medical decisions. Internal Medicine (IM) residents receive little formal education in electronic database searching, and have identified poor searching skills as a barrier to practicing EBM. OBJECTIVE:To design a...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-007-0387-x
更新日期:2007-12-01 00:00:00
abstract:OBJECTIVE:To determine the overdose rate of drugs that require renal dose adjustment and factors related with overdose. SUBJECTS:Total of 23,635,210 records of prescriptions and laboratory data of inpatients at a tertiary teaching hospital for the period from January 2002 to December 2005. METHODS:A clinical data mar...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0336-8
更新日期:2008-04-01 00:00:00
abstract::Endovascular infections are 1 cause of fever of unknown origin. We describe a diagnostically challenging case of cryptogenic abdominal aortitis from Streptococcus pneumoniae and Enterobacter aerogenes. A 72-year-old male presented with epigastric pain, fevers, and chills. A computed tomography scan demonstrated enlarg...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2006.00455.x
更新日期:2006-07-01 00:00:00
abstract:OBJECTIVE:To describe the clinical features of patients diagnosed with upper respiratory tract infections (URIs), and determine which clinical features are associated with antibiotic use. DESIGN:Prospective cohort study. SETTING:Three ambulatory care practices at a group-model HMO in the Denver metropolitan area. PA...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1999.00306.x
更新日期:1999-03-01 00:00:00
abstract:OBJECTIVE:One of the major factors influencing length of stay for patients with community-acquired pneumonia is the timing of conversion from intravenous to oral antibiotics. We measured physician attitudes and beliefs about the antibiotic switch decision and assessed physician characteristics associated with practice ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.2001.016009599.x
更新日期:2001-09-01 00:00:00
abstract:OBJECTIVE:To examine the characteristics and outcomes of physician-referred weight management patients relative to self-referred patients. DESIGN:Review of clinic records of all individuals contacting a weight control program during a 2-year period with follow-up throughout consecutive levels of treatment (i.e., enrol...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.2002.11028.x
更新日期:2002-08-01 00:00:00
abstract:OBJECTIVE:In a study conducted over 3 large symposia on intensive review of internal medicine, we previously assessed the features that were most important to course participants in evaluating the quality of a lecture. In this study, we attempt to validate these observations by assessing prospectively the extent to whi...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.2000.06439.x
更新日期:2000-06-01 00:00:00
abstract:OBJECTIVE:The Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) seeks to develop partnerships between VA health services researchers and clinical managers, with the goal of designing and evaluating interventions to improve the quality of VA health care. METHODS:In the present report we describe one...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-009-1155-x
更新日期:2010-01-01 00:00:00
abstract:OBJECTIVE:To assess the risks and benefits of surgery for herniated lumbar discs (discectomy) and to evaluate the methodologic quality of the literature. DESIGN:Literature synthesis. STUDY SELECTION AND DATA ANALYSIS: A structured MEDLINE search identified studies of standard, microsurgical, or percutaneous discectomy...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,meta分析
doi:10.1007/BF02600110
更新日期:1993-09-01 00:00:00
abstract:BACKGROUND:Developing a definition of what constitutes high need among Medicare beneficiaries using administrative data is an important prerequisite to evaluating value-based payment reforms. While various definitions of high need exist, their predictive validity for different patient outcomes in the following year has...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-018-4781-3
更新日期:2019-03-01 00:00:00
abstract:BACKGROUND:Identifying potential mechanisms that link depressed mood with worse health behaviors is important given the prevalence of depressed mood in patients with coronary heart disease (CHD) and its relationship with subsequent mortality. Perceived health competence is an individual's confidence in his/her ability ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-018-4767-1
更新日期:2019-07-01 00:00:00
abstract:OBJECTIVE:To compare the analgesic efficacy of valdecoxib with placebo and naproxen sodium for relieving menstrual cramping and pain due to primary dysmenorrhea. DESIGN:Single-center, double-blind study with a 4-period, 4-sequence crossover design. Patients assessed pain intensity and pain relief at regular intervals ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1111/j.1525-1497.2004.30052.x
更新日期:2005-01-01 00:00:00