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 of patients in a community practice. Chart review of a 5% random sample (n = 184) of university practice patients who had problem lists was carried out to assess the accuracy of the computerized problem lists. SETTING:A university ambulatory medicine practice and a community ambulatory medicine practice. PATIENTS/PARTICIPANTS:For the same one-year period, all 4,490 patients seen in the university practice and all 1,294 patients seen two or more times in the community practice. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Of the 27,634 problems listed for university patients and the 5,648 problems listed for community patients, 22,629 (82%) and 4,924 (87%), respectively, were assigned to diagnosis clusters. For the university and community practices, the mean numbers of problems per patient were 6.1 (SD 5.4) and 4.4 (SD 3.7), and the mean numbers of diagnosis clusters per patient were 4.5 (SD 3.7) and 3.6 (SD 3.0), respectively. Among the ten most common diagnosis clusters in both practices were HYPERTENSION, SYMPTOM OR SIGN, OBESITY, and DIABETES. Only 18% (SD 3%) of patient problem lists in the university practice omitted one or more chronic, important medical problems (e.g., hypertension, dementia, COPD). CONCLUSIONS:This system of diagnosis clusters effectively and efficiently described the clinical content of two types of internal medicine practices, and has important applications in medical education, epidemiology, clinical and health services research, and public policy.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Williams BC,Philbrick JT,Becker DM,McDermott A,Davis RC,Buncher PCdoi
10.1007/BF02599394subject
Has Abstractpub_date
1991-01-01 00:00:00pages
57-63issue
1eissn
0884-8734issn
1525-1497journal_volume
6pub_type
杂志文章abstract:BACKGROUND:Despite evidence-based guidelines, high-quality diabetes care is not always achieved. Identifying factors associated with the quality of management in primary care may inform service improvements, facilitating the tailoring of quality improvement interventions to practice needs and resources. METHODS:We sea...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-020-05676-7
更新日期:2020-06-01 00:00:00
abstract:OBJECTIVE:To identify the communication factors that are significantly associated with appropriate short-term follow-up of abnormal mammograms. DESIGN:Prospective longitudinal study involving medical record review and patient survey. SETTING:Ten academically affiliated ambulatory medical practices in the Boston metro...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1525-1497.2004.30357.x
更新日期:2004-04-01 00:00:00
abstract::The authors evaluated the financial and health implications of treatment choices for three serious classes of infection: hospital-acquired pneumonia, intra-abdominal infection, and sepsis of unknown origin. Data were obtained from a systematic review of clinical literature and published data bases, by written question...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02596417
更新日期:1986-11-01 00:00:00
abstract:BACKGROUND:Early in medical education, physicians must develop competencies needed for tobacco dependence treatment. OBJECTIVE:To assess the effect of a multi-modal tobacco dependence treatment curriculum on medical students' counseling skills. DESIGN:A group-randomized controlled trial (2010-2014) included ten U.S. ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1007/s11606-015-3508-y
更新日期:2016-02-01 00:00:00
abstract:OBJECTIVE:To compare specialist and primary care physician participation in California's Medicaid fee-for-service and managed care programs. DESIGN:Cross-sectional survey. PARTICIPANTS:A probability sample stratified by county and by race of 962 specialist physicians and 713 primary care physicians practicing in the ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:
更新日期:2001-12-01 00:00:00
abstract:BACKGROUND:Inappropriate antibiotic use contributes to the emergence and spread of drug resistant infections. Though injection drug users are at increased risk for drug resistant infections, few studies have examined antibiotic use in this population. OBJECTIVE:To understand patterns and determinants of antibiotic use...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-008-0859-7
更新日期:2009-02-01 00:00:00
abstract:BACKGROUND:Many medical schools have incorporated the Stages of Change Model into their curricula with specific application to tobacco cessation. OBJECTIVE:This study examined the extent to which medical students were prepared to provide stage-based interventions to treat nicotine dependence. DESIGN:Using a quasi-exp...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-006-0040-0
更新日期:2007-02-01 00:00:00
abstract:INTRODUCTION:Imperfect sign-out of patient information between providers has been shown to contribute to medical error, but there are no standardized curricula to teach sign-out skills. At our institution, we identified several deficiencies in skills and a lack of any existing training. AIM:To develop a sign-out curri...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0331-0
更新日期:2007-10-01 00:00:00
abstract::This paper deals with the varied sites and teachers that can and should be used in educating residents and medical students in ambulatory care. A basic premise is that sites other than academic medical centers and teachers other than physician faculty members should be among those used. The paper describes how institu...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02600436
更新日期:1990-01-01 00:00:00
abstract:BACKGROUND:Delivery of comprehensive care for persons with human immunodeficiency virus (HIV) infection in rural and low prevalence settings presents many challenges. We developed and evaluated a telehealth collaborative care (TCC) program for persons with HIV in a rural area. OBJECTIVE:To determine the feasibility of...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-013-2385-5
更新日期:2013-09-01 00:00:00
abstract:PURPOSE:Middle-aged men are at high risk of suicide. While about half of those who kill themselves visit a primary care clinician (PCC) shortly before death, in current practice, few spontaneously disclose their thoughts of suicide during the visits, and PCCs seldom inquire about such thoughts. In a randomized controll...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-05769-3
更新日期:2020-07-01 00:00:00
abstract:BACKGROUND:Global health measures represent an attractive option for researchers and clinicians seeking a brief snapshot of a patient's overall perspective on his or her health. Because scores on different global health measures are not comparable, comparative effectiveness research (CER) is challenging. OBJECTIVE:To ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-015-3453-9
更新日期:2015-10-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Thyroid ultrasound (TUS) plays an important but limited role in the evaluation of some complaints related to the thyroid gland. This study was designed to examine how primary care physicians use TUS before referring patients to an endocrine clinic. DESIGN:We audited all charts of first-time r...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2005.0124.x
更新日期:2005-08-01 00:00:00
abstract:BACKGROUND:The shortage of primary care providers and the provisions of the Affordable Care Act (ACA) have spurred discussion about expanding the number, scope of practice (SOP), and independence of primary care nurse practitioners (NPs). Such discussions in the media and among professional organizations may insinuate ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-016-3896-7
更新日期:2017-03-01 00:00:00
abstract:OBJECTIVE:The presentation format of clinical trial results, or the "frame," may influence perceptions about the worth of a treatment. The extent and consistency of that influence are unclear. We undertook a systematic review of the published literature on the effects of information framing on the practices of physicia...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1046/j.1525-1497.1999.09038.x
更新日期:1999-10-01 00:00:00
abstract:OBJECTIVE:To assess, from the patient's perspective, selected aspects of the quality of inpatient hospital care in the United States. DESIGN:A cross-sectional survey, using telephone interviews of patients discharged from the medical services of a probability sample of 62 public and private, nonprofit, nonfederal acut...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02602763
更新日期:1995-12-01 00:00:00
abstract:BACKGROUND:The term "clinical inertia" is used to describe the failure to manage a chronic condition aggressively enough to bring it under control. The underlying mechanisms for clinical inertia remain poorly understood. OBJECTIVE:To describe one potential mechanism for clinical inertia, seen through the lens of clini...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-007-0464-1
更新日期:2008-02-01 00:00:00
abstract:OBJECTIVE:To explore colorectal cancer (CRC) screening knowledge, attitudes, barriers, and preferences among urban African Americans as a prelude to the development of culturally appropriate interventions to improve screening for this group. DESIGN:Qualitative focus group study with assessment of CRC screening prefere...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2005.00165.x
更新日期:2005-11-01 00:00:00
abstract::We present a 66-year-old woman with 2 months of visual hallucinations, unintentional weight loss, and short-term memory decline, whose clinical presentation and EEG supported a diagnosis of limbic encephalitis. Subsequent evaluation for a paraneoplastic etiology revealed a renal mass, which was resected and identified...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-014-3172-7
更新日期:2015-07-01 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::In rare cases, pancytopenia results from hormonal deficiencies that arise in the setting of panhypopituitarism. Here we describe the unusual case of a 60-year-old man who presented with progressive fatigue and polyuria, and whose laboratory workup revealed a deficiency of the five hormones associated with the action o...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-014-3161-x
更新日期:2015-05-01 00:00:00
abstract:BACKGROUND:Various stakeholders can have differing opinions regarding ethical review when introducing new procedures with patients. OBJECTIVE:This pilot study examines the way in which Research Ethics Boards (REBs; Institutional Review Boards) and clinical biochemists (CBs; laboratory medicine specialists) differ in t...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0410-2
更新日期:2008-01-01 00:00:00
abstract:BACKGROUND:Many physicians and professional leaders agree that community participation is an important professional role for physicians. Volunteerism has also received increasing attention in the national agenda for social change. Yet little is known about physicians' community volunteer activities. OBJECTIVE:To measu...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-008-0811-x
更新日期:2008-12-01 00:00:00
abstract:BACKGROUND:Women veterans are generally less healthy than their nonveteran female counterparts or male veterans. Accumulating evidence suggests there may be barriers to women veterans' access to and use of Veterans Health Administration (VHA) care. OBJECTIVE:To document perceived and/or actual barriers to care in a na...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2006.00370.x
更新日期:2006-03-01 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
abstract:BACKGROUND:The relationship between worklife factors, clinician outcomes, and time pressure during office visits is unclear. OBJECTIVE:To quantify associations between time pressure, workplace characteristics ,and clinician outcomes. DESIGN:Prospective analysis of data from the Healthy Work Place randomized trial. P...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05343-6
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:Patients with mental health conditions (MHCs) experience poor anticoagulation control when using warfarin, but we have limited knowledge of the association between specific mental illness and warfarin treatment outcomes. OBJECTIVE:To examine the relationship between the severity of MHCs and outcomes of anti...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-014-2784-2
更新日期:2014-06-01 00:00:00
abstract:OBJECTIVE:To determine time allocation and the perceived value to education and patient care of the weekday activities of internal medicine housestaff on inpatient rotations and to compare the work activities of interns and residents. DESIGN:An observational study. We classified activities along five dimensions (assoc...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1998.00164.x
更新日期:1998-08-01 00:00:00
abstract:BACKGROUND:The patient-centered medical home (PCMH) model aims to provide patient-centered care, lower costs, and improve health outcomes. Medical students have not been meaningfully integrated in this model. AIM:To test the feasibility of a longitudinal clerkship based on PCMH principles and anchored by PCMH educatio...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-013-2389-1
更新日期:2013-08-01 00:00:00
abstract:OBJECTIVE:Patients' self-management practices have substantial consequences on morbidity and mortality in diabetes. While the quality of patient-physician relations has been associated with improved health outcomes and functional status, little is known about the impact of different patient-physician interaction styles...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.2002.10905.x
更新日期:2002-04-01 00:00:00