Abstract:
BACKGROUND:Despite recent reductions in national unplanned readmission rates, we have relatively little understanding of which hospital strategies are most associated with changes in risk-standardized readmission rates (RSRR). OBJECTIVE:We examined associations between the change in hospital 30-day RSRR for patients with heart failure and the uptake of strategies over 12-18 months in a national sample of hospitals. DESIGN:We conducted a prospective study of hospitals using a Web-based survey at baseline (November 2010-May 2011, n = 599, 91.0% response rate) and 12-18 months later (November 2011-October 2012, n = 501, 83.6% response rate), with RSRR measured at the same time points. The final analytic sample included 478 hospitals. PARTICIPANTS:The study included hospitals participating in the Hospital-to-Home (H2H) and State Action on Avoidable Rehospitalizations (STAAR) initiatives. MAIN MEASURES:We examined associations between change in hospital 30-day RSRR for patients with heart failure and the uptake of strategies previously demonstrated to have increased between baseline and follow-up, using unadjusted and adjusted linear regression. KEY RESULTS:The average number of strategies taken up from baseline to follow-up was 1.6 (SE = 0.06); approximately one-quarter (25.3%) of hospitals took up at least three new strategies. Hospitals that adopted the strategy of routinely discharging patients with a follow-up appointment already scheduled experienced significant reductions in RSRR (reduction of 0.63 percentage point, p value < 0.05). Hospitals that took up three or more strategies had significantly greater reductions in RSRR compared to hospitals that took up only zero to two strategies (reduction of 1.29 versus 0.57 percentage point, p value < 0.05). Among the 117 hospitals that took up three or more strategies, 93 unique combinations of strategies were used. CONCLUSIONS:Although most individual strategies were not associated with RSRR reduction, hospitals that took up any three or more strategies showed significantly greater reduction in RSRR compared to hospitals that took up fewer than three strategies.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Bradley EH,Sipsma H,Horwitz LI,Ndumele CD,Brewster AL,Curry LA,Krumholz HMdoi
10.1007/s11606-014-3105-5subject
Has Abstractpub_date
2015-05-01 00:00:00pages
605-11issue
5eissn
0884-8734issn
1525-1497journal_volume
30pub_type
杂志文章,多中心研究abstract:OBJECTIVE:Online learning has changed medical education, but many "educational" websites do not employ principles of effective learning. This article will assist readers in developing effective educational websites by integrating principles of active learning with the unique features of the Web. DESIGN:Narrative revie...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1111/j.1525-1497.2004.30029.x
更新日期:2004-06-01 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:OBJECTIVE:One of the major factors influencing length of stay for patients with community-acquired pneumonia is the timing of conversion from intravenous to oral antibiotics. We measured physician attitudes and beliefs about the antibiotic switch decision and assessed physician characteristics associated with practice ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.2001.016009599.x
更新日期:2001-09-01 00:00:00
abstract:BACKGROUND:The permanent supported housing model is known to improve housing outcomes, but there has been sparse research on the effects of supported housing on physical health. Various organizations including the National Academy of Sciences have called for research in this area. OBJECTIVE:This observational multi-si...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-019-05070-y
更新日期:2019-09-01 00:00:00
abstract:BACKGROUND:Multi-faceted depression care programs based within the healthcare system have been found to be effective, but may not fully address the needs of African American Intimate Partner Violence (IPV) survivors, many of whom are not seeking depression care in healthcare settings. OBJECTIVES:To develop and evaluat...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-012-2270-7
更新日期:2013-04-01 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: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::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: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:BACKGROUND:As healthcare reimbursement shifts from being volume to value-focused, new delivery models aim to coordinate care and improve quality. The patient-centered medical home (PCMH) model is one such model that aims to deliver coordinated, accessible healthcare to improve outcomes and decrease costs. It is unclear...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-019-05594-3
更新日期:2020-04-01 00:00:00
abstract:BACKGROUND:Standardized means to identify patients likely to benefit from language assistance are needed. OBJECTIVE:To evaluate the accuracy of the U.S. Census English proficiency question (Census-LEP) in predicting patients' ability to communicate effectively in English. DESIGN:We investigated the sensitivity and sp...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-008-0693-y
更新日期:2008-10-01 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: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:The greater the severity of illness of a patient, the more likely the patient will have a poor hospital outcome. However, hospital-wide severity of illness scores that are simple, widely available, and not diagnosis-specific are still needed. Laboratory tests could potentially be used as an alternative to es...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05282-2
更新日期:2020-03-01 00:00:00
abstract:BACKGROUND:African Americans suffer more than non-Hispanic whites from type 2 diabetes, but diabetes self-management education (DSME) has been less effective at improving glycemic control for African Americans. Our objective was to determine whether a novel, culturally tailored DSME intervention would result in sustain...
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/s11606-019-04894-y
更新日期:2019-07-01 00:00:00
abstract:BACKGROUND:Primary care providers (PCPs) vary in skills to effectively treat depression. Key features of evidence-based collaborative care models (CCMs) include the availability of depression care managers (DCMs) and mental health specialists (MHSs) in primary care. Little is known, however, about the relationships bet...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-014-2807-z
更新日期:2014-07-01 00:00:00
abstract:BACKGROUND:Doctor rating websites are a burgeoning trend, yet little is known about their content. OBJECTIVE:To explore the content of Internet reviews about primary care physicians. DESIGN:Qualitative content analysis of 712 online reviews from two rating websites. We purposively sampled reviews of 445 primary care ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-011-1958-4
更新日期:2012-06-01 00:00:00
abstract:BACKGROUND:Health literacy has been linked to health status in a variety of chronic diseases. However, evidence for a relationship between health literacy and mental health outcomes is sparse. OBJECTIVE:We hypothesized that low literacy would be associated with higher addiction severity, higher levels of depressive sy...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1111/j.1525-1497.2006.00533.x
更新日期:2006-08-01 00:00:00
abstract:BACKGROUND:The University of California, Los Angeles (UCLA)/Charles R. Drew University Medical Education Program was developed to train physicians for practice in underserved areas. The UCLA/Drew Medical Education Program students receive basic science instruction at UCLA and complete their required clinical rotations ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0154-z
更新日期:2007-05-01 00:00:00
abstract:BACKGROUND:Deficiencies in care for cancer survivors may result from unclear roles for primary care providers (PCPs) and oncology specialists in follow-up. OBJECTIVES:To compare cancer survivors' care to non-cancer controls. DESIGN:Retrospective, longitudinal, controlled study starting 366 days post-diagnosis. SUBJE...
journal_title:Journal of general internal medicine
pub_type: 临床试验,杂志文章
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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:Hypertensive urgencies and emergencies are common clinical occurrences in hypertensive patients. Treatment practices vary considerably to because of the lack of evidence supporting the use of one therapeutic agent over another. This paper was designed to review the evidence for various pharmacotherapeutic re...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1046/j.1525-1497.2002.20389.x
更新日期:2002-12-01 00:00:00
abstract:BACKGROUND:Racial and ethnic minority groups have lower levels of leisure-time physical activity (LTPA) than whites, but it is unclear how much of this is explained by differences in socioeconomic status and health. OBJECTIVE:To examine differences in LTPA, work-related physical activity (WRPA; heavy household chores ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2005.40198.x
更新日期:2005-03-01 00:00:00
abstract::Chronic eosinophilic pneumonia (CEP) is a rare interstitial lung disease characterized by subacute dyspnea, peripheral infiltrates on imaging, and pulmonary eosinophilia. We report a case of a 48-year-old man who presented to a "minute clinic" with cough and dyspnea. After improvement on a short course of steroids for...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-012-2316-x
更新日期:2013-07-01 00:00:00
abstract:BACKGROUND:Despite the importance of professionalism, little is known about how burnout relates to professionalism among practicing physicians. OBJECTIVE:To evaluate the relationship between burnout and professional behaviors and cost-conscious attitudes. DESIGN AND PARTICIPANTS:Cross-sectional study in a national sa...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05376-x
更新日期:2020-05-01 00:00:00
abstract:OBJECTIVE:To assess the impact of informed consent on elderly patients' colorectal cancer (CRC) screening preferences. DESIGN:Randomized, controlled trial. SETTING:Four general internal medicine practices. PATIENTS:We studied 399 elderly patients visiting their primary care provider for routine office visits. INTER...
journal_title:Journal of general internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1046/j.1525-1497.2000.01079.x
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND:Despite significant investment in colorectal cancer (CRC) screening, 40% of US adults are not up-to-date. Commitment devices, which are psychologically tailored approaches to enforce health goals, may be an effective method to increase CRC screening. OBJECTIVE:Compare the effectiveness of a commitment devic...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-06392-y
更新日期:2021-01-20 00:00:00
abstract::We surveyed employers of general internists at teaching hospitals to determine whether they prefer that new hires are graduates of general internal medicine (GIM) fellowships. We surveyed former GIM fellows who graduated between 1988 and 1994 to determine whether they found jobs with protected research time and whethe...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1998.00121.x
更新日期:1998-06-01 00:00:00
abstract:OBJECTIVE:To evaluate patient-provider agreement on whether weight and related behaviors were discussed during routine visits. DESIGN:Post-visit survey assessments of patients and providers. PARTICIPANTS:Obese patients make up the majority of all patients seen in primary care (PC). The patients and physicians were re...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-008-0553-9
更新日期:2008-05-01 00:00:00
abstract:OBJECTIVE:To observe and evaluate the performance of primary care internal medicine residents within the outpatient clinic milieu. DESIGN:Longitudinal descriptive study. PATIENTS/PARTICIPANTS:48 internal medicine resident encounters with two standardized patients at the University of Wisconsin General Internal Medici...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599266
更新日期:1993-04-01 00:00:00