Abstract:
OBJECTIVE:To determine the impact of prospective payment by diagnosis-related groups (DRGs) on length of stay in the hospital, ambulatory status, and level of post-hospital care needed for patients hospitalized with hip fracture. DESIGN:Retrospective chart review of a consecutive series of cases before and after the reference date of implementation of the prospective payment system (PPS). SETTING:Academic, tertiary-care hospital. PATIENTS/PARTICIPANTS:181 patients 69 years of age or older admitted with International Classification of Diseases (ICD) or DRG codes for hip fracture. RESULTS:Length of stay was shorter by 1.37 days in the post-PPS era (p = 0.05). Poorer discharge ambulation was found in the post-PPS group (p = 0.089). At one year, differences in ambulation and nursing home residence were found to be related not to the implementation of PPS, but rather to the nursing home to which the patient was discharged. Patients discharged to a facility with active physical rehabilitation were less likely to remain institutionalized (p = 0.0025) than those in "ordinary" nursing homes and ambulated more independently (p = 0.05). CONCLUSIONS:The PPS did not have a significant long-term impact on hip fracture outcome. Post-hospital care may be of crucial importance to the future quality of life of hip fracture patients.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Gerety MB,Soderholm-Difatte V,Winograd CHdoi
10.1007/BF02599687subject
Has Abstractpub_date
1989-09-01 00:00:00pages
388-91issue
5eissn
0884-8734issn
1525-1497journal_volume
4pub_type
杂志文章abstract::Three currently used screening methods are aimed at detecting colorectal cancer when it is asymptomatic and curable, and at detecting polyps so that they can be removed before they can progress to cancer. Digital rectal examinations are relatively cheap and easy but can detect only a small fraction of large-bowel canc...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02600836
更新日期:1990-09-01 00:00:00
abstract::Elderly veterans who visit our Veterans Affairs (VA) Medical Center primary care clinic often mention they are enrolled in HMOs. Approximately 20% of patients hospitalized at our facility report health insurance coverage. Of 1,000 hospitalizations during a 6-month period in which veterans reported insurance coverage, ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1997.012004247.x
更新日期:1997-04-01 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: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:To examine changes in the quality of primary care experienced and reported by Medicare beneficiaries from 1998 to 2000. DESIGN:Longitudinal observational study. SETTING:Thirteen states with large, mature Medicare HMO markets. PARTICIPANTS:Probability sample of noninstitutionalized Medicare beneficiaries ag...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2004.30381.x
更新日期:2004-10-01 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
abstract::The purpose of this paper is to address why the three dominant alternatives to compensating physicians (fee-for-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home, and the relevance of such payment reforms as pay-for-performance and episo...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-010-1295-z
更新日期:2010-06-01 00:00:00
abstract::Three hundred ninety-one cases of chronic lymphocytic leukemia (CLL) from the Tumour Registry of Manitoba, spanning a 20-year period from January 1960 to December 1979, were reviewed. Survival curves were developed using the staging systems of Rai and Binet. A clear separation in survival was found utilizing the syste...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02596118
更新日期:1988-03-01 00:00:00
abstract::While great strides have been made recently in improving end-of-life care in the United States, people with dementia often die with inadequate pain control, with feeding tubes in place, and without the benefits of hospice care. In this paper, we discuss the most important and persistent challenges to providing excelle...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1111/j.1525-1497.2004.30329.x
更新日期:2004-10-01 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:There is no available evidence from randomized trials that early detection of prostate cancer improves health outcomes, but the prostate-specific antigen (PSA) test is commonly used to screen men for prostate cancer. OBJECTIVE:The objective of the study is to see if screening with PSA decreases mortality fr...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0479-7
更新日期:2008-03-01 00:00:00
abstract:CONTEXT:Understanding students' perceptions of and responses to lapses in professionalism is important to shaping students' professional development. OBJECTIVE:Utilize realistic, standardized professional dilemmas to obtain insight into students' reasoning and motivations in "real time." DESIGN:Qualitative study usin...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2003.21247.x
更新日期:2003-12-01 00:00:00
abstract:PURPOSE:To evaluate the acceptance rate and motivation for acceptance of hepatitis B virus (HBV) vaccine among preclinical medical and physician assistant (PA) students in comparison with similar data obtained from resident and staff physicians. METHODS:A cross-sectional survey of all second-year medical and PA studen...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599567
更新日期:1995-01-01 00:00:00
abstract:BACKGROUND:Medication guides are required documents to be distributed to patients in order to convey serious risks associated with certain prescribed medicines. Little is known about the effectiveness of this information to adequately inform patients on safe use. OBJECTIVE:To examine the readability, suitability, and ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-012-2068-7
更新日期:2012-12-01 00:00:00
abstract:PURPOSE:Recent reports have emphasized the importance of delivery systems in improving health care quality. However, few prior studies have assessed differences in primary care quality between physician groups that differ in size and organizational configuration. We examined whether larger physician group size and affi...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0234-0
更新日期:2007-10-01 00:00:00
abstract:BACKGROUND:Medicare has selected 10 hospital-acquired conditions for which it will not reimburse hospitals unless the condition was documented as "present on admission." This "no pay for errors" rule may have a profound effect on the clinical practice of physicians. OBJECTIVE:To determine how physicians might change t...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-010-1395-9
更新日期:2010-10-01 00:00:00
abstract:OBJECTIVE:To examine the association of clinic HIV-focused features and advanced HIV care experience with Pneumocystis carinii pneumonia (PCP) prophylaxis and development of PCP as the initial AIDS diagnosis. DESIGN:Nonconcurrent prospective study. SETTING:New York State Medicaid Program. PARTICIPANTS:Medicaid enrol...
journal_title:Journal of general internal medicine
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1046/j.1525-1497.1998.00003.x
更新日期:1998-01-01 00:00:00
abstract:OBJECTIVE:Overall suicide mortality rates are higher among American Indians than in the general population and are particularly high among Indians residing in the upper Midwest. The identification, during encounters with health care providers, of individuals at high risk of suicide is a potential intervention strategy....
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599598
更新日期:1996-09-01 00:00:00
abstract:BACKGROUND:Implementation of evidence-based practices often requires tailoring implementation strategies to local contextual factors, including available resources, expertise, and cultural norms. Using an exemplar case, we describe how health systems engineering methods can be used to understand system-level variation ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-06121-5
更新日期:2020-08-31 00:00:00
abstract:BACKGROUND:Sexual dysfunction is an important issue that affects many cancer survivors who are increasingly being cared for by internists. OBJECTIVE:To examine the attitudes and reported practices of internists regarding survivorship care as it pertains to sexual dysfunction. DESIGN:Surveys were sent to 406 physician...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-009-1026-5
更新日期:2009-11-01 00:00:00
abstract:BACKGROUND:Not all primary care clinics are prepared to implement care coordination services for chronic conditions, such as diabetes. Understanding true capacity to coordinate care is an important first-step toward establishing effective and efficient care coordination. Yet, we could identify no diabetes-specific inst...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-013-2566-2
更新日期:2014-01-01 00:00:00
abstract::Academic departments of family medicine and divisions of general internal medicine and general pediatrics exist in the majority of medical schools in the United States and have important roles in generalist medical education. The major organizational issues facing these units concern institutional influence, faculty d...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/BF02598123
更新日期:1994-04-01 00:00:00
abstract:SPECIFIC AIM:Although the Department of Veterans Affairs (VA) has made significant organizational changes to improve diabetes care, diabetes self-management has received limited attention. The purpose of this study is to assess factors influencing diabetes self-management among veterans with poorly controlled diabetes....
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-006-0053-8
更新日期:2007-04-01 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:OBJECTIVE:To determine whether the results of the Internal Medicine In-Training Examination (ITE) can predict subsequent performance on the American Board of Internal Medicine certifying examination (ABIMCE). DESIGN:Retrospective data review. SETTING:A mixture of six community hospital and university-based internal m...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599105
更新日期:1992-01-01 00:00:00
abstract::This report examines alternative methods of paying for clinical preventive care services. First, the extent of coverage of preventive health care services in public and private health insurance plans is reviewed. Included in this review are Medicare, Medicaid, health maintenance organizations, and private health insur...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02600851
更新日期:1990-09-01 00:00:00
abstract:BACKGROUND:Despite growing emphasis on public reporting of health care quality data, available data are often ignored. OBJECTIVE:To evaluate the usefulness of web-based physician-level data for patients choosing a new primary care physician (PCP). DESIGN:Patients seeking a new PCP (n = 2225) were invited to view web-...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0278-1
更新日期:2007-10-01 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
abstract::To meet the demand by residents and to provide knowledge and skills important to the developing physician, global health (GH) training opportunities are increasingly being developed by United States (U.S.) residency training programs. However, many residency programs face common challenges of developing GH curricula, ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-016-3843-7
更新日期:2017-05-01 00:00:00
abstract:BACKGROUND:Decisions to limit use of life-sustaining treatment occur frequently during hospitalizations, and portable medical orders (also known as Portable Orders for Life-Sustaining Treatment (POLST)) can ensure that patient preferences regarding resuscitation are followed after discharge. OBJECTIVE:To determine the...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-05698-1
更新日期:2020-07-01 00:00:00