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 university-affiliated hospital in Portland, Oregon. An initial group of 5,451 admissions was examined, considering type of doctor (resident or attending), severity of illness, and patient demographic characteristics. A regression analysis revealed that total charges were similar in the two groups, but only 14% of the variance in log total charges was explained. A subgroup of 1,058 admissions in the eight most common diagnosis-related groups (DRGs) was further evaluated. In this analysis total charges for the resident patient group were 52% higher than charges for the patient group cared for by attending physicians. Forty-one per cent of the variance was explained, with type of doctor and severity of illness accounting for 5% and 10%, respectively. Further examination of one DRG indicated that additional factors not included in previous studies, such as extent of preadmission evaluation, ethical factors influencing treatment options, and patient expectations for care, may be important determinants of hospital charges. This study demonstrates that the high cost of resident care is not fully explained by currently available measures.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Dunn PM,Parker DF,Levinson W,Mullooly JPdoi
10.1007/BF02602350subject
Has Abstractpub_date
1989-03-01 00:00:00pages
115-20issue
2eissn
0884-8734issn
1525-1497journal_volume
4pub_type
杂志文章abstract：OBJECTIVE:To describe a novel method of time analysis for health care settings by quantifying internal medicine housestaff's work activities and contacts. DESIGN:Observational work sampling study based on random sampling technique. SETTING:General medicine service in a university hospital. PARTICIPANTS:All housestaf...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/BF02599655
更新日期：1994-05-01 00:00:00
abstract：BACKGROUND:The use of coronary computed tomographic angiography (CCTA) for evaluation of patients with suspected coronary artery disease (CAD) is growing rapidly, yet questions remain regarding its diagnostic accuracy and its impact on clinical decision-making and patient outcomes. METHODS:A systematic literature revi...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,评审
doi：10.1007/s11606-010-1556-x
更新日期：2011-03-01 00:00:00
abstract：OBJECTIVE:The objective of the study is to examine the association between ambulatory care sensitive hospitalizations (ACSH) and dual Medicare/Veteran Health Administration use. PARTICIPANTS:A nationally representative sample of Medicare beneficiaries, who participated in the Medicare Current Beneficiary Survey (MCBS)...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-011-1788-4
更新日期：2011-11-01 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：BACKGROUND:Pay for performance (P4P) programs have shown only modest improvements in outcomes and do not target patient behaviors. Many large employers and payers are turning to pay for performance for patients (P4P4P) to reduce health costs and improve the health of their covered populations. How these programs may be...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-008-0739-1
更新日期：2008-10-01 00:00:00
abstract：BACKGROUND:As electronic health records (EHRs) become widely adopted, alerts and reminders can improve medication safety, but excessive alerts may irritate or overwhelm clinicians, thereby reducing their effectiveness. We developed a novel "stealth" alert in an EHR to improve anticoagulation monitoring for patients pre...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-012-2137-y
更新日期：2012-12-01 00:00:00
abstract：BACKGROUND:The risk of readmission varies among hospitals. This variation has led the Centers of Medicare and Medicaid services to reduce payments to hospitals with excess readmissions. The contribution of patient characteristics, hospital characteristics and provider type to the variation in risk of readmission among ...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,多中心研究
doi：10.1007/s11606-013-2723-7
更新日期：2014-04-01 00:00:00
abstract：BACKGROUND:The patient-centered medical home (PCMH) model is being implemented in health centers (HCs) that provide comprehensive primary care to vulnerable populations. OBJECTIVE:To identify characteristics associated with HCs' PCMH capability. DESIGN:Cross-sectional analysis of a national dataset of Federally Quali...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-016-3729-8
更新日期：2016-09-01 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：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:Prevalence of unhealthy alcohol use among medical inpatients is high. OBJECTIVE:To characterize the course and outcomes of unhealthy alcohol use, and factors associated with these outcomes. DESIGN:Prospective cohort study. PARTICIPANTS:A total of 287 medical inpatients with unhealthy alcohol use. MAIN ME...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-010-1382-1
更新日期：2010-10-01 00:00:00
abstract：:Our aim was to improve clinical reasoning skills by applying an established theory of memory, cognition, and decision making (fuzzy-trace theory) to instruction in evidence-based medicine. Decision-making tasks concerning chest pain evaluation in women were developed for medical students and internal medicine resident...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1111/j.1525-1497.2001.00214.x
更新日期：2001-02-01 00:00:00
abstract：BACKGROUND:Few studies have examined the impact of inpatient interpreter use for limited English proficient (LEP) patients on length of stay (LOS), 30-day post discharge emergency department (ED) visits and 30-day hospital readmission rates for LEP patients. METHODS:A retrospective cohort analysis was conducted of all...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-015-3213-x
更新日期：2015-06-01 00:00:00
abstract：BACKGROUND:Many patient education materials (PEMs) available on the internet are written at high school or college reading levels, rendering them inaccessible to the average US resident, who reads at or below an 8(th) grade level. Currently, electronic health record (EHR) providers partner with companies that produce P...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,随机对照试验
doi：10.1007/s11606-012-2046-0
更新日期：2012-09-01 00:00:00
abstract：BACKGROUND:Previous studies indicate that medical trainees frequently experience discrimination by patients. Little is known about effective strategies to teach trainees to respond to this discrimination. AIM:To create a workshop for first-year residents utilizing standardized patients to improve skills in responding ...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-019-04881-3
更新日期：2019-05-01 00:00:00
abstract：BACKGROUND:Many have called for ambulatory training redesign in internal medicine (IM) residencies to increase primary care career outcomes. Many believe dysfunctional, clinic environments are a key barrier to meaningful ambulatory education, but little is actually known about the educational milieu of continuity clini...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-010-1437-3
更新日期：2011-01-01 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：BACKGROUND:Computerized physician order entry and clinical decision support systems are electronic prescribing strategies that are increasingly used to improve patient safety. Previous reviews show limited effect on patient outcomes. Our objective was to assess the impact of electronic prescribing strategies on medicat...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,meta分析
doi：10.1007/s11606-019-05236-8
更新日期：2019-10-01 00:00:00
abstract：INTRODUCTION:Whether the clinical vignettes presented at the Society of General Internal Medicine (SGIM) annual meeting could be of educational value to third year students in the Internal Medicine clerkship has not been studied. OBJECTIVE:To explore the relevance and learning value of clinical vignettes from the SGIM...
journal_title：Journal of general internal medicine
pub_type：
doi：10.1111/j.1525-1497.2006.00596.x
更新日期：2006-11-01 00:00:00
abstract：OBJECTIVE:Internet and other interactive technology-based programs offer great potential for practical, effective, and cost-efficient diabetes self-management (DSM) programs capable of reaching large numbers of patients. This study evaluated minimal and moderate support versions of an Internet-based diabetes self-manag...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,随机对照试验
doi：10.1007/s11606-010-1480-0
更新日期：2010-12-01 00:00:00
abstract：OBJECTIVE:To compare the abilities of two methods for rapid detection of pyuria and three methods of urinalysis to predict significant bacteriuria in symptomatic ambulatory women. DESIGN:Prospective simultaneous comparison of the results of dipstick urinalysis, standard microscopic urinalysis, and hemocytometric cell ...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/BF02598002
更新日期：1992-03-01 00:00:00
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. ...
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.1525-1497.2003.20611.x
更新日期：2003-06-01 00:00:00
abstract：BACKGROUND:Obese women experience higher postmenopausal breast cancer risk, morbidity, and mortality and may be less likely to undergo mammography. OBJECTIVES:To quantify the relationship between body weight and mammography in white and black women. DATA SOURCES AND REVIEW METHODS:We identified original articles eval...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,meta分析,评审
doi：10.1007/s11606-009-0939-3
更新日期：2009-05-01 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:Despite the 1984 United Nations's Convention Against Torture calling to train doctors to work with torture survivors, many physicians are unaware of their obligation and few are taught the requisite clinical skills. AIM:To describe the development, implementation, and evaluation of a curriculum to teach r...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-008-0592-2
更新日期：2008-07-01 00:00:00
abstract：OBJECTIVE:Although hospitalization patterns have been studied, little is known about hospital readmission among HIV-infected patients in the era of highly active antiretroviral therapy. We explored the risk factors for early readmission to a tertiary care inner-city hospital among HIV-infected patients with pneumonia i...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1046/j.1525-1497.2003.20720.x
更新日期：2003-04-01 00:00:00
abstract：BACKGROUND:Twenty-eight states have passed breast density notification laws, which require physicians to inform women of a finding of dense breasts on mammography. OBJECTIVE:To evaluate changes in breast cancer stage at diagnosis after enactment of breast density notification legislation. DESIGN:Using a difference-in...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-016-3904-y
更新日期：2017-06-01 00:00:00
abstract：:Initial reports on HemoQuant, a new quantitative test for occult gastrointestinal bleeding, suggest it is more sensitive than Hemoccult. Increased detection of upper gastrointestinal tract bleeding and dietary hemoglobin may reduce HemoQuant's specificity in the screening setting. The authors performed a cost effectiv...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/BF02596117
更新日期：1988-03-01 00:00:00
abstract：OBJECTIVE:To examine the impact of the New Haven Community Health Care Van (CHCV), a mobile needle exchange-based health care delivery system, in reducing emergency department (ED) use among out-of-treatment injection drug users (IDUs) between January 1, 1996 and December 31, 1998. DESIGN:A pre-post comparison of ED u...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：
更新日期：2002-05-01 00:00:00
abstract：OBJECTIVE:To examine experiences of older persons and their clinicians with shared decision making (SDM) and their willingness to use an SDM instrument. DESIGN:Qualitative focus group study. PARTICIPANTS:Four focus groups of 41 older persons and 2 focus groups of 11 clinicians, purposively sampled to encompass a rang...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1111/j.1525-1497.2005.0114.x
更新日期：2005-07-01 00:00:00
