Abstract:
BACKGROUND:Racial/ethnic minority patients are more likely to report experiences with discrimination in the healthcare setting, potentially leading to reduced access to appropriate care; however, few studies evaluate reports of discrimination with objectively measured quality of care indicators. OBJECTIVE:To evaluate whether patient-reported racial/ethnic discrimination by healthcare providers was associated with evidence of poorer quality care measured by medication intensification. RESEARCH DESIGN AND PARTICIPANTS:Baseline data from the Diabetes Study of Northern California (DISTANCE), a random, race-stratified sample from the Kaiser Permanente Diabetes Registry from 2005-2006, including both survey and medical record data. MAIN MEASURES:Self-reported healthcare provider discrimination (from survey data) and medication intensification (from electronic prescription records) for poorly controlled diabetes patients (A1c ≥9.0%; systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg; low-density lipoprotein (LDL) ≥130 mg/dl). KEY RESULTS:Of 10,409 eligible patients, 21% had hyperglycemia, 14% had hyperlipidemia, and 32% had hypertension. Of those with hyperglycemia, 59% had their medications intensified, along with 40% with hyperlipidemia, 33% with hypertension, and 47% in poor control of any risk factor. In adjusted log-binomial GEE models, discrimination was not associated with medication intensification [RR = 0.96 (95% CI: 0.74, 1.24) for hyperglycemia, RR = 1.23 (95% CI: 0.93, 1.63) for hyperlipidemia, RR = 1.06 (95% CI: 0.69, 1.61) for hypertension, and RR = 1.08 (95% CI: 0.88, 1.33) for the composite cohort]. CONCLUSIONS:We found no evidence that patient-reported healthcare discrimination was associated with less medication intensification. While not associated with this technical aspect of care, discrimination could still be associated with other aspects of care (e.g., patient-centeredness, communication).
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Lyles CR,Karter AJ,Young BA,Spigner C,Grembowski D,Schillinger D,Adler Ndoi
10.1007/s11606-011-1729-2subject
Has Abstractpub_date
2011-10-01 00:00:00pages
1138-44issue
10eissn
0884-8734issn
1525-1497journal_volume
26pub_type
杂志文章,随机对照试验abstract::To investigate the value of home urine glucose testing in assessing chronic diabetic glucose control, the authors compared patients' glycosuria patterns with their mean blood glucose (MBG) levels calculated from glycosylated hemoglobin (Hb Alc). One hundred and twenty-one patients who regularly checked their urines re...
journal_title:Journal of general internal medicine
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更新日期:1986-07-01 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
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doi:10.1007/s11606-014-3172-7
更新日期:2015-07-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 临床试验,杂志文章
doi:10.1046/j.1525-1497.2003.20410.x
更新日期:2003-05-01 00:00:00
abstract:OBJECTIVE:To determine patient knowledge about life-sustaining treatments and physician understanding of patient preferences for proxies and treatments after outpatient discussions about advance directives. DESIGN:Cross-sectional interview-based and questionnaire-based survey. SETTING:Two university general internal ...
journal_title:Journal of general internal medicine
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doi:10.1046/j.1525-1497.1998.00133.x
更新日期:1998-07-01 00:00:00
abstract:OBJECTIVE:To determine whether echocardiography affects the decisions to use beta blockers or to recommend bacterial endocarditis prophylaxis in patients suspected of having mitral valve prolapse (MVP). DESIGN:Retrospective review of echocardiograms and clinical records. SETTING:Military tertiary care hospital. PATI...
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更新日期:1990-11-01 00:00:00
abstract:BACKGROUND:The patient-centered medical home (PCMH) is a primary care delivery model predicated on shared responsibility for patient care among members of an interprofessional team. Effective task sharing may reduce burnout among primary care providers (PCPs). However, little is known about the extent to which PCPs sha...
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doi:10.1007/s11606-017-4188-6
更新日期:2018-01-01 00:00:00
abstract:OBJECTIVES:1) To describe the prevalence of eight injury-prone behaviors (IPBs) and the associations of these behaviors with ten standard chronic disease and sociodemographic risk factors (CDSRFs) among internal medicine patients and 2) to identify a subset of patients with multiple IPBs who might be at particularly hi...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599194
更新日期:1992-11-01 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:OBJECTIVE:To determine whether there are differences between men and women patients who have chronic fatigue syndrome (CFS) and, if so, to ascertain whether a gender-related pattern exists. DESIGN:A descriptive study of demographic, clinical, and psychosocial measures, the results of which were prospectively collected...
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pub_type: 杂志文章
doi:10.1007/BF02629522
更新日期:1994-07-01 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...
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更新日期:2020-08-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-017-4030-1
更新日期:2017-08-01 00:00:00
abstract:BACKGROUND:Teamwork is important for improving care across transitions between providers and for increasing patient safety. OBJECTIVE:This review's objective was to assess the characteristics and efficacy of published curricula designed to teach teamwork to medical students and house staff. DESIGN:The authors searche...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-008-0600-6
更新日期:2008-06-01 00:00:00
abstract:BACKGROUND:Lack of regular physical activity is highly prevalent in U.S. adults and significantly increases mortality risk. OBJECTIVE:To examine the clinical impact of a newly implemented program ("Exercise as a Vital Sign" [EVS]) designed to systematically ascertain patient-reported exercise levels at the beginning o...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-013-2693-9
更新日期:2014-02-01 00:00:00
abstract:OBJECTIVES:To examine how practice constraints contribute to barriers in the health care of persons with dementia and their families, particularly with respect to behavioral aspects of care. DESIGN:Cross-sectional qualitative interview study of primary care physicians. SETTING:Physicians' offices. PARTICIPANTS:Forty...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0317-y
更新日期:2007-11-01 00:00:00
abstract:BACKGROUND:Many seniors rely on paid non-familial caregivers to maintain their independence at home. Caregivers often assist with medication reminding and activities of daily living. No prior studies have examined the health literacy levels among paid non-familial caregivers. OBJECTIVES:To determine health literacy le...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-010-1596-2
更新日期:2011-05-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2004.40126.x
更新日期:2004-12-01 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:OBJECTIVE:To describe how medical residents discuss do-not-resuscitate (DNR) orders with patients. DESIGN:Prospective observational study. SETTING:Inpatient medical wards of one university tertiary care center, one urban city public hospital, and one Veterans Affairs medical center. PARTICIPANTS:Thirty-one medical r...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599915
更新日期:1995-08-01 00:00:00
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pub_type: 杂志文章
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更新日期:2009-11-01 00:00:00
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更新日期:2017-03-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
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journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
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更新日期:2011-06-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
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更新日期:1999-06-01 00:00:00
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pub_type: 杂志文章
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更新日期:2020-11-01 00:00:00
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pub_type: 杂志文章
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更新日期:2019-06-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
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更新日期:2010-06-01 00:00:00
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pub_type: 杂志文章
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更新日期:2010-05-01 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2008-06-01 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...
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更新日期:2020-09-01 00:00:00
abstract:BACKGROUND:Few data have evaluated the relationship between caregiving and cardiovascular disease (CVD) risk. OBJECTIVE:The purpose of this study was to determine the prevalence and predictors of caregiver strain and to evaluate the association between caregiving and CVD lifestyle and psychosocial risk factors among f...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-008-0852-1
更新日期:2009-01-01 00:00:00