Abstract：
BACKGROUND:The care of patients with complex illnesses requires careful management, but systems of care management (CM) vary in their structure and effectiveness. OBJECTIVE:To create a framework identifying components of broad-based CM interventions and validate the framework, including using this framework to evaluate the contribution of varying components on outcomes of patients with chronic illness. DESIGN:We create the framework using retrospective information about CM activities and services over 12 months and categorize it using cluster and factor analysis. We then validate this framework through content and criterion techniques. Content validity is assessed through a Delphi study and criterion validity through relationship of the dosage measures and patterns of care to process and outcomes measures. PARTICIPANTS:Patients with diabetes and/or cardiovascular disease receiving CM services in a model known as Care Management Plus implemented in primary care. RESULTS:Six factors of CM activity were identified, including a single dosage summary measure and 5 separate patterns of care. Of these, the overall dosage summary measure, face-to-face time, duration of follow-up, and breadth of services were all related to improved processes for hemoglobin A1c and LDL testing and control. Brief intense patterns of care and high face-to-face care manager time were also related to improved outcomes. CONCLUSIONS:Using this framework, we isolate components of a CM intervention directly related to improved process of care or patient outcomes. Current efforts to structure CM to include face-to-face time and multiple diseases are discussed.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Dorr DA,Wilcox A,Jones S,Burns L,Donnelly SM,Brunker CPdoi
10.1007/s11606-007-0138-zsubject
Has Abstractpub_date
2007-06-01 00:00:00pages
736-41issue
6eissn
0884-8734issn
1525-1497journal_volume
22pub_type
杂志文章abstract：:This Perspective discusses 12 key facts derived from 50 years of health services research and argues that this knowledge base can stimulate innovative thinking about how to make health care systems safer, more efficient, more cost effective, and more patient centered, even as they respond to the needs of diverse commu...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,评审
doi：10.1007/s11606-015-3298-2
更新日期：2015-10-01 00:00:00
abstract：BACKGROUND:Social connectedness exerts strong influences on health, including major depression and suicide. A major component of social connectedness is having individual relationships with close supports, romantic partners, and other trusted members of one's social network. OBJECTIVE:The objective of this study was t...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-020-05692-7
更新日期：2020-07-01 00:00:00
abstract：OBJECTIVE:To define the prevalence and detection rates of mental disorders among high utilizers as compared with typical utilizers, and to examine the effect of case-mix adjustment on these parameters. DESIGN:Cross-sectional study. SETTING:General internal medicine outpatient clinic associated with an urban, academic...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1046/j.1525-1497.1999.07238.x
更新日期：1999-07-01 00:00:00
abstract：BACKGROUND:There is growing interest in developing systems to overcome barriers for acquiring and interpreting family health histories in primary care. OBJECTIVE:To examine the capacity of three different electronic portals to collect family history from patients and deposit valid data in an electronic health record (...
journal_title：Journal of general internal medicine
pub_type： 临床试验,杂志文章,多中心研究
doi：10.1007/s11606-013-2442-0
更新日期：2013-12-01 00:00:00
abstract：OBJECTIVE:To determine whether students who take ambulatory rotations in internal medicine are more likely to choose internal medicine careers. DESIGN:National survey. SETTING AND PARTICIPANTS:The intended sample was 1,650 senior U.S. medical students from 16 medical schools, of whom 1,244 (76%) responded. Representa...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,多中心研究
doi：10.1007/BF02640362
更新日期：1995-10-01 00:00:00
abstract：BACKGROUND:Many national guidelines recommend the use of patient provider agreements (PPAs) when prescribing opioids for chronic pain. There are no standards for PPA content, readability, or administration processes. OBJECTIVE:Conduct a national survey of providers who use PPAs to describe the process of administering...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-020-06364-2
更新日期：2021-01-08 00:00:00
abstract：INTRODUCTION:Obesity stigma is common in our society, and a general stigma towards obesity has also been documented in physicians. We hypothesized that physician respect for patients would be lower in patients with higher body mass index (BMI). METHODS:We analyzed data from the baseline visit of 40 physicians and 238 ...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,随机对照试验
doi：10.1007/s11606-009-1104-8
更新日期：2009-11-01 00:00:00
abstract：BACKGROUND:Decisions to forgo life-sustaining medical treatments in terminally ill patients are challenging, but ones that all doctors must face. Few studies have evaluated the impact of medical training on medical students' attitudes towards end-of-life decisions and none have compared them with an age-matched group o...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-008-0713-y
更新日期：2008-10-01 00:00:00
abstract：BACKGROUND:Residents have a major role in teaching students, yet little has been written about the effects of resident work hour restrictions on medical student education. OBJECTIVE:Our objective was to determine the effects of resident work hour restrictions on medical student education. DESIGN:We compared student r...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-007-0196-2
更新日期：2007-07-01 00:00:00
abstract：IMPORTANCE:Patients are increasingly being given access to their test results, but little is known about how preferences vary with the test under consideration or the results of the test (normal or abnormal). OBJECTIVE:This study was conducted to examine preferences for test result communication. DESIGN, SETTING, AND...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-015-3344-0
更新日期：2015-11-01 00:00:00
abstract：:Current healthcare systems and guidelines are not designed to adapt to care for the large and growing number of patients with complex care needs and those with multimorbidity. Minimally disruptive medicine (MDM) is an approach to providing care for complex patients that advances patients' goals in health and life whil...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,评审
doi：10.1007/s11606-017-4117-8
更新日期：2017-10-01 00:00:00
abstract：OBJECTIVE:Assess impact of a computer-based patient support system on quality of life in younger women with breast cancer, with particular emphasis on assisting the underserved. DESIGN:Randomized controlled trial conducted between 1995 and 1998. SETTING:Five sites: two teaching hospitals (Madison, Wis, and Chicago, I...
journal_title：Journal of general internal medicine
pub_type： 临床试验,杂志文章,多中心研究,随机对照试验
doi：10.1046/j.1525-1497.2001.016007435.x
更新日期：2001-07-01 00:00:00
abstract：BACKGROUND:Disclosure of medical errors is encouraged, but research on how patients respond to specific practices is limited. OBJECTIVE:This study sought to determine whether full disclosure, an existing positive physician-patient relationship, an offer to waive associated costs, and the severity of the clinical outco...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,随机对照试验
doi：10.1111/j.1525-1497.2006.00465.x
更新日期：2006-07-01 00:00:00
abstract：:Evaluations of intensive care have largely focused on survival, cost, or functional status; however, these may not be the only outcomes of interest to patients, families, and health care providers. Quality of life is an important consideration in evaluating intensive care because it influences decisions about the use ...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/BF02596335
更新日期：1988-05-01 00:00:00
abstract：BACKGROUND:The Veterans Access, Choice and Accountability Act (hereafter, Choice Program) seeks to improve access to care by enabling eligible Veterans to receive care from community providers. Veterans Affairs (VA) primary care providers (PCPs) play a key role in making referrals to community specialists, but their fr...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-018-4810-2
更新日期：2019-04-01 00:00:00
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journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1111/j.1525-1497.2004.30065.x
更新日期：2004-05-01 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：BACKGROUND:eConsult programs have been instituted to increase access to specialty expertise. Opt-in choice eConsult programs maintain primary care physician (PCP) autonomy to decide whether to utilize eConsults versus traditional specialty referrals, but little is known about how this intervention may impact PCP eConsu...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-020-06101-9
更新日期：2020-11-01 00:00:00
abstract：OBJECTIVE:The use of aspirin for primary prevention of cardiovascular events in the general population is controversial. The purpose of this study was to create a versatile model to evaluate the effects of aspirin in the primary prevention of cardiovascular events in patients with different risk profiles. DESIGN:A Mar...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1046/j.1525-1497.1998.00246.x
更新日期：1998-12-01 00:00:00
abstract：BACKGROUND:Entry into general internal medicine (GIM) has declined. The effect of the inpatient general medicine rotation on medical student career choices is uncertain. OBJECTIVE:To assess the effect of student satisfaction with the inpatient general medicine rotation on pursuit of a career in GIM. DESIGN:Multicente...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,多中心研究
doi：10.1111/j.1525-1497.2006.00429.x
更新日期：2006-05-01 00:00:00
abstract：:While the association between abuse in childhood and adverse adult health outcomes is well established, this link is infrequently acknowledged in the general medical literature. This paper has 2 purposes: (1) to provide a broad overview of the research on the long-term effects of child abuse on mental and physical hea...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,评审
doi：10.1046/j.1525-1497.2003.20918.x
更新日期：2003-10-01 00:00:00
abstract：BACKGROUND:Lower socioeconomic status is associated with excess disease burden from diabetes. Diabetes self-management support interventions are needed that are effective in engaging lower income patients, addressing competing life priorities and barriers to self-care, and facilitating behavior change. OBJECTIVE:To pi...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,随机对照试验
doi：10.1007/s11606-011-1689-6
更新日期：2011-09-01 00:00:00
abstract：OBJECTIVE:To measure and compare patient satisfaction with care in resident and attending physician internal medicine ambulatory care clinics. DESIGN:A cross-sectional survey using a questionnaire derived from the Visit-Specific Satisfaction Questionnaire (VSQ) and Patient Satisfaction Index (PSI) distributed from Mar...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1111/j.1525-1497.2001.91005.x
更新日期：2001-11-01 00:00:00
abstract：OBJECTIVE:To develop a patient-based classification system to describe the clinical content of ambulatory medicine practices. DESIGN:A system of 100 diagnosis clusters was developed based on retrospective review of computerized problem lists of patients from a university practice, and then applied to the problem lists...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/BF02599394
更新日期：1991-01-01 00:00:00
abstract：OBJECTIVES:The telephone can facilitate medical care but also result in adverse outcomes leading to telephone-related malpractice suits. Analyzing claims might identify errors amenable to prevention. The objective of the study was to describe medical errors involving the telephone in patient-clinician encounters that s...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-007-0491-y
更新日期：2008-05-01 00:00:00
abstract：BACKGROUND:Racial and ethnic disparities in opioid prescribing in the emergency department (ED) are well described, yet the influence of socioeconomic status (SES) remains unclear. OBJECTIVES:(1) To examine the effect of neighborhood SES on the prescribing of opioids for moderate to severe pain; and (2) to determine i...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-013-2516-z
更新日期：2013-12-01 00:00:00
abstract：BACKGROUND:Despite the benefits of influenza vaccination, each year more than half of adults in the United States do not receive it. OBJECTIVE:To evaluate the association between an active choice intervention in the electronic health record (EHR) and changes in influenza vaccination rates. DESIGN:Observational study....
journal_title：Journal of general internal medicine
pub_type： 杂志文章,多中心研究
doi：10.1007/s11606-017-4046-6
更新日期：2017-07-01 00:00:00
abstract：OBJECTIVE:To determine the relevance of the initial certifying examination to the practice of internal medicine and the suitability of items used in initial certification for recertification. DESIGN:Using a matrix-sampling approach, items from the 1991 Certifying Examination were assigned to two sets of judges: direct...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/BF02599989
更新日期：1993-02-01 00:00:00
abstract：OBJECTIVE:To determine the effectiveness and costs of alternative management strategies for patients infected with the human immunodeficiency virus (HIV) who present with pulmonary symptoms. DESIGN:Decision analysis comparing initial testing (arterial blood gas analysis, induced sputum analysis, or bronchoscopy with b...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,评审
doi：10.1007/BF02598081
更新日期：1992-05-01 00:00:00
abstract：:Moral distress is the experience of cognitive-emotional dissonance that arises when one feels compelled to act contrary to one's moral requirements. Moral distress is common, but under-recognized in medical education and training, and this relative inattention may undermine educators' efforts to promote empathy, ethic...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,评审
doi：10.1007/s11606-013-2665-0
更新日期：2014-02-01 00:00:00
