Abstract:
OBJECTIVE:To evaluate the association between chronic illness with complexity (CIC) and optimal glycemic control. PARTICIPANTS:Cross-sectional and longitudinal analyses of Diabetes Epidemiologic Cohort database of Veterans Health Administration (VHA) users with diabetes, less than 75 years old, with HbA1c tests in fiscal year (FY) 1999 and 2000, alive at FY2000 end (N = 95,423). DESIGN/MEASUREMENTS:Outcomes were HbA1c < 7% in each FY. CIC included three domains: nondiabetes physical illness, diabetes-related, and mental illness/substance abuse conditions. Other independent variables included age, gender, race, marital status, VHA priority status, and diabetes severity. Longitudinal analyses were restricted to patients with HbA1c >or= 7% in FY1999 and included hospitalizations between final HbA1c's in FY1999 and FY2000. Multiple logistic regressions examined associations between CIC categories and HbA1c. RESULTS:In FY1999, 33% had HbA1c <7%. In multivariate analyses, patients with nondiabetes physical illness and mental illness/substance abuse were more likely to have HbA1c <7% in FY1999 [adjusted odds ratios for cancer (AOR), 1.31; 95% CI (1.25-1.37); mental illness only, 1.18; 95% CI (1.14-1.22)]. Those with diabetes-related complications were less likely to have HbA1c <7% in FY1999. Associations generally held in FY2000. However, conditions in the mental illness/substance abuse complexity domain were less strongly associated with HbA1c <7%. Macrovascular-related hospitalizations were positively associated with HbA1c <7% [AOR, 1.41; 95% CI (1.34-1.49)]. CONCLUSIONS:The association between CIC and HbA1c <7% is heterogeneous and depends on the domain of complexity. The varying associations of CIC categories with optimal glycemic control suggest the need for appropriate risk adjustment when using HbA1c <7% as a valid performance measure for diabetes quality of care.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Meduru P,Helmer D,Rajan M,Tseng CL,Pogach L,Sambamoorthi Udoi
10.1007/s11606-007-0310-5subject
Has Abstractpub_date
2007-12-01 00:00:00pages
408-18eissn
0884-8734issn
1525-1497journal_volume
22 Suppl 3pub_type
杂志文章abstract:BACKGROUND:Data on patients with coronavirus disease 2019 (COVID-19) who return to hospital after discharge are scarce. Characterization of these patients may inform post-hospitalization care. OBJECTIVE:To describe clinical characteristics of patients with COVID-19 who returned to the emergency department (ED) or requ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-020-06120-6
更新日期:2020-10-01 00:00:00
abstract::Community health centers (CHCs) provide primary care for underserved children and adults. The Patient Protection and Affordable Care Act (ACA) aimed to strengthen the CHC network by increasing federal funds and expanding Medicaid eligibility. The ACA also aimed to boost preventive and mental health services and to red...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05571-w
更新日期:2020-04-01 00:00:00
abstract::Topic development and structuring a systematic review of diagnostic tests are complementary processes. The goals of a medical test review are to identify and synthesize evidence to evaluate the impacts alternative testing strategies on health outcomes and to promote informed decision making. A common challenge is that...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-012-2007-7
更新日期:2012-06-01 00:00:00
abstract::Older adults often have multiple chronic conditions that may decrease additional life expectancy. Research evaluating the benefits and harms of screening must include consideration of competing morbidities and patient heterogeneity (beyond age), potentially increased harms of screening, and patient preferences. Other ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-012-2227-x
更新日期:2013-02-01 00:00:00
abstract:BACKGROUND:Obesity and diabetes family history are the two strongest risk factors for type 2 diabetes (T2D). Prior work shows that an individual's obesity risk is associated with obesity in social contacts, but whether T2D risk follows similar patterns is unknown. OBJECTIVE:We aimed to estimate the relationship betwee...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-016-3723-1
更新日期:2016-10-01 00:00:00
abstract:OBJECTIVE:To compare the efficacies and cost-effectiveness of four strategies for the management of suspected pedal osteomyelitis in the setting of vascular impairment: 1) therapeutic trial of short-term antibiotics for presumed cellulitis without osteomyelitis (short); 2) technetium bone scanning followed by either sh...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599133
更新日期:1994-01-01 00:00:00
abstract:BACKGROUND:Numerous interventions are available to boost medication adherence, but the targeting of these interventions often relies on crude measures of poor adherence. Group-based trajectory models identify individuals with similar longitudinal prescription filling patterns. Identifying distinct adherence trajectorie...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-016-3747-6
更新日期:2016-09-01 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::To evaluate the performance of serum iron studies as a diagnostic test for iron-deficiency anemia in a county hospital, the authors identified retrospectively all general medicine patients who had had bone-marrow aspirates for the work-up of non-macrocytic anemias from 1978 through 1983. Re-reading a sample of aspirat...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02596144
更新日期:1987-05-01 00:00:00
abstract:BACKGROUND:In a prior study, we found patient satisfaction was associated with mortality. However, that study included few deaths, yielding wide confidence intervals, was criticized for possible morbidity under-adjustment, and lacked power to explore sociodemographic moderation. OBJECTIVE:To revisit the satisfaction-m...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05058-8
更新日期:2019-08-01 00:00:00
abstract:BACKGROUND:Many academic hospitals have implemented overnight hospitalists to supervise house staff and improve outcomes, but few studies have described the impact of this role. OBJECTIVE:To investigate the effect of an overnight academic hospitalist program on patient-level outcomes. Secondary objectives were to desc...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-015-3389-0
更新日期:2015-12-01 00:00:00
abstract:OBJECTIVE:To identify gender differences in social and behavioral factors associated with antiretroviral adherence. DESIGN:Prospective cohort study. SETTING:Methadone maintenance program. PARTICIPANTS:One hundred thirteen HIV-seropositive current or former opioid users. MEASUREMENTS AND MAIN RESULTS:Participants we...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2004.30445.x
更新日期:2004-11-01 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 transition from pediatric to adult care is a critical period for young adults with childhood-onset conditions. General internists are tasked with participating in the care of this vulnerable population. Existing guidelines regarding transition do not fully address structural or organizational characteris...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-019-05226-w
更新日期:2019-10-01 00:00:00
abstract:BACKGROUND:Sudden death is a public health problem with major impact on society. Coronary artery disease (CAD) is believed to underlie 60-80% of these deaths. While deaths from CAD have decreased in the recent decades, sudden death rates remain unacceptably high. OBJECTIVE:We aimed to assess the prevalence of CAD and ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05486-6
更新日期:2020-02-01 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:OBJECTIVE:To determine the prevalence and frequency of mastalgia and its association with psychiatric conditions and unexplained pain syndromes. DESIGN, SETTING, AND PARTICIPANTS:Cross-sectional mailed survey completed by 1,219 female veterans enrolled at the VA Puget Sound Health Care System in 1998. MEASUREMENTS:Br...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2006.00378.x
更新日期:2006-03-01 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:BACKGROUND:Antibiotics are often prescribed for hospitalized patients with chronic obstructive pulmonary disease (COPD) exacerbations. The use of procalcitonin (PCT) in the management of pneumonia has safely reduced antibiotic durations, but limited data on the impact of PCT guidance on the management of COPD exacerbat...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-018-4312-2
更新日期:2018-05-01 00:00:00
abstract:BACKGROUND:Use of electronic health records (EHRs) is associated with physician stress and burnout. While emergency departments and subspecialists have used scribes to address this issue, little is known about the impact of scribes in academic primary care. OBJECTIVE:Assess the impact of a scribe on physician and pati...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-018-4434-6
更新日期:2018-07-01 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::Several population health big data projects have been initiated in the USA recently. These include the County Health Rankings & Roadmaps (CHR) initiated in 2010, the 500 Cities Project initiated in 2016, and the City Health Dashboard project initiated in 2017. Such projects provide data on a range of factors that dete...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-05869-0
更新日期:2020-11-01 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::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:BACKGROUND:Studies on forgoing treatment often ignore treatments that are continued until death. OBJECTIVE:To investigate how often specific treatments are withdrawn or withheld before death and to describe the associated patient, physician, and care characteristics. DESIGN:National mortality follow-back study in Swi...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05344-5
更新日期:2020-01-01 00:00:00
abstract:BACKGROUND:The association between pharmaceutical industry promotion and physician opioid prescribing is poorly understood. Whether the influence of industry gifts on prescribing varies by specialty is unknown. OBJECTIVE:To examine the relationship between opioid-related gifts to physicians and opioid prescribing in t...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05470-0
更新日期:2020-08-01 00:00:00
abstract::Attempts to explain the high cost of care in teaching hospitals have yielded conflicting results. This study was conducted to compare hospital charges and lengths of stay for two groups of patients: one cared for by a resident team and the other cared for by attending physicians. The study was conducted at a universit...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02602350
更新日期:1989-03-01 00:00:00
abstract::The study of expressed proteins in neoplasia is undergoing a revolution with the advent of proteomic analysis. Unlike genomic studies where individual changes may have no functional significance, protein expression is closely aligned with cellular activity. This perspective will review proteomics as a method of detect...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-007-0411-1
更新日期:2008-01-01 00:00:00
abstract::Patients with medically unexplained symptoms (MUS) have little or no demonstrable disease explanation for the symptoms, and comorbid psychiatric disorders are frequent. Although common, costly, distressed, and often receiving ill-advised testing and treatments, most MUS patients go unrecognized, which precludes effect...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-006-0067-2
更新日期:2007-05-01 00:00:00
abstract:OBJECTIVES:Among patients unlikely to attend a scheduled colonoscopy, we examined the impact of peer coach versus educational brochure support and compared these with concurrent patients who did not receive support. METHODS:From health system data, we identified 275 consecutive patients aged >50 who kept <75% of visit...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-007-0445-4
更新日期:2008-01-01 00:00:00