Abstract:
BACKGROUND:Differences among hospitals in the use of inpatient consultation may contribute to variation in outcomes and costs for hospitalized patients, but basic epidemiologic data on consultations nationally are lacking. OBJECTIVE:The purpose of the study was to identify physician, hospital, and geographic factors that explain variation in rates of inpatient consultation. DESIGN:This was a retrospective observational study. SETTING AND PARTICIPANTS:This work included 3,118,080 admissions of Medicare patients to 4,501 U.S. hospitals in 2009 and 2010. MAIN MEASURES:The primary outcome measured was number of consultations conducted during the hospitalization, summarized at the hospital level as the number of consultations per 1,000 Medicare admissions, or "consultation density." KEY RESULTS:Consultations occurred 2.6 times per admission on average. Among non-critical access hospitals, use of consultation varied 3.6-fold across quintiles of hospitals (933 versus 3,390 consultations per 1,000 admissions, lowest versus highest quintiles, p < 0.001). Sicker patients received greater intensity of consultation (rate ratio [RR] 1.18, 95% CI 1.17-1.18 for patients admitted to ICU; and RR 1.19, 95% CI 1.18-1.20 for patients who died). However, even after controlling for patient-level factors, hospital characteristics also predicted differences in rates of consultation. For example, hospital size (large versus small, RR 1.31, 95% CI 1.25-1.37), rural location (rural versus urban, RR 0.78, CI 95% 0.76-0.80), ownership status (public versus not-for-profit, RR 0.94, 95% CI 0.91-0.97), and geographic quadrant (Northeast versus West, RR 1.17, 95% CI 1.12-1.21) all influenced the intensity of consultation use. CONCLUSIONS:Hospitals exhibit marked variation in the number of consultations per admission in ways not fully explained by patient characteristics. Hospital "consultation density" may constitute an important focus for monitoring resource use for hospitals or health systems.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Stevens JP,Nyweide D,Maresh S,Zaslavsky A,Shrank W,Howell MD,Landon BEdoi
10.1007/s11606-015-3216-7subject
Has Abstractpub_date
2015-07-01 00:00:00pages
992-9issue
7eissn
0884-8734issn
1525-1497journal_volume
30pub_type
杂志文章abstract:BACKGROUND:Physician opinion can influence the prospects for health care reform, yet there are few recent data on physician views on reform proposals or access to medical care in the United States. OBJECTIVE:To assess physician views on financing options for expanding health care coverage and on access to health care....
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-009-0916-x
更新日期:2009-04-01 00:00:00
abstract:OBJECTIVE:To assess a new technique for the detection of free pleural fluid. DESIGN:118 consecutive inpatients with radiologic evidence of free pleural fluid and a control group of 175 randomly selected inpatients were examined over a three-year period in a prospective blind study by auscultatory percussion (AP) for e...
journal_title:Journal of general internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/BF02600204
更新日期:1994-02-01 00:00:00
abstract:BACKGROUND:The high prevalence of comorbid physical and mental illnesses among veterans is well known. Therefore, ensuring effective communication between primary care (PC) and mental health (MH) clinicians in the Veterans Affairs (VA) health care system is essential. The VA's Patient Aligned Care Teams (PACT) initiati...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-013-2731-7
更新日期:2014-07-01 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:Extension for Community Healthcare Outcomes (ECHO) and related models of medical tele-education are rapidly expanding; however, their effectiveness remains unclear. This systematic review examines the effectiveness of ECHO and ECHO-like medical tele-education models of healthcare delivery in terms of improve...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05291-1
更新日期:2019-12-01 00:00:00
abstract:OBJECTIVE:To compare the prevalence of major medical problems in homeless and nonhomeless patients. PATIENTS:All 475 persons seeking care at an ambulatory clinic serving the medically indigent for one calendar year. INTERVENTION:None. MEASUREMENTS AND MAIN RESULTS:Demographic and clinical data were collected by stru...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02598086
更新日期:1992-05-01 00:00:00
abstract:BACKGROUND:Despite advances in pharmacologic therapy and invasive management strategies for patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS), these patients still suffer substantial morbidity and mortality. OBJECTIVE:The objective of this study was to analyze independent predictors of 1-year ...
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/s11606-007-0498-4
更新日期:2008-03-01 00:00:00
abstract:BACKGROUND:Mind-body practices such as yoga are widely popular, but little is known about how such exercises impact health-related quality of life. OBJECTIVE:To measure changes in health-related quality of life associated with 3 months of mind-body training as practiced in community-based settings. DESIGN:Prospective...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2004.30011.x
更新日期:2004-07-01 00:00:00
abstract::Our institution has instituted "short-call" and "nightfloat" systems to reduce the number of admissions to the traditional "long-call" housestaff. However, the nightfloat system introduces increased discontinuity to patient care, and interns may spend less time with short-call patients because they are nor required to...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1997.012005308.x
更新日期:1997-05-01 00:00:00
abstract:OBJECTIVE:To measure primary care physicians' familiarity with, attitudes toward, and confidence in preventive care practice guidelines for the elderly and to determine whether their attitudes are associated with implementation of guidelines into clinical practice. DESIGN:A self-administered survey of physicians emplo...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599668
更新日期:1995-03-01 00:00:00
abstract:INTRODUCTION:We present a case of a foramen magnum meningioma that highlights the importance of the neurologic exam when evaluating a patient with dysphagia. A 58-year-old woman presented with an 18-month history of progressive dysphagia, chronic cough and 30-pound weight loss. Prior gastroenterologic and laryngologic ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0474-z
更新日期:2008-02-01 00:00:00
abstract::A number of new biological markers are being studied as predictors of disease or adverse medical events among those who already have a disease. Systematic reviews of this growing literature can help determine whether the available evidence supports use of a new biomarker as a prognostic test that can more accurately p...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-011-1899-y
更新日期:2012-06-01 00:00:00
abstract:OBJECTIVES:To develop and evaluate a web-based curriculum to introduce first year medical students to the knowledge and attitudes necessary for working with limited English proficient (LEP) patients through interpreters. METHOD:Six hundred and forty first year medical students over 4 consecutive years took this curric...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2005.0193.x
更新日期:2005-10-01 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: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::Several population health big data projects have been initiated in the USA recently. These include the County Health Rankings & Roadmaps (CHR) initiated in 2010, the 500 Cities Project initiated in 2016, and the City Health Dashboard project initiated in 2017. Such projects provide data on a range of factors that dete...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-05869-0
更新日期:2020-11-01 00:00:00
abstract:BACKGROUND:The patient-centered medical home (PCMH) has clinical benefits for chronic disease care, but the association with patient-reported outcomes such as health-related quality of life (HRQoL) is unexplored in patients with multimorbidity (two or more chronic diseases). OBJECTIVE:To examine if greater clinic-leve...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05429-1
更新日期:2020-01-01 00:00:00
abstract:OBJECTIVE:To study an office-based strategy for increasing influenza vaccine delivery to high-risk patients at a university hospital general medicine practice. DESIGN:Historically controlled study of physician practices in an outpatient general medicine setting. SETTING:A group practice with two separate offices: a f...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599008
更新日期:1994-12-01 00:00:00
abstract:BACKGROUND:Studies examining the effectiveness of pay-for-performance programs to improve quality of care primarily have been confined to bonus-type arrangements that reward providers for performance above a predetermined threshold. No studies to date have evaluated programs placing providers at financial risk for perf...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0185-5
更新日期:2007-06-01 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:INTRODUCTION:With the increasing number of women Veterans enrolling in the Veterans Health Administration (VA), there is growing demand for reproductive health services. Little is known regarding the on-site availability of reproductive health services at VA and how this varies by site location and type. OBJECTIVE:To ...
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:2013-07-01 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::Hospital discharges against medical advice (AMA) are common, costly, stigmatizing to patients, and are associated with excess morbidity and mortality. Achieving better quality care for patients discharged AMA has been limited both by the sparse research illuminating how best to care for this challenging patient popula...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-013-2540-z
更新日期:2013-12-01 00:00:00
abstract:OBJECTIVE:To quantify the magnitude of general medical and/or pharmacy claims expenditures for individuals who use behavioral health services and to assess future claims when behavioral service use persists. DESIGN:Retrospective cost trends and 24-month cohort analyses. SETTING:A Midwest health plan. PARTICIPANTS:Ov...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2005.40099.x
更新日期:2005-02-01 00:00:00
abstract:BACKGROUND:Little is known about how providers communicate recommendations when scientific uncertainty exists. OBJECTIVES:To compare provider recommendations to those in the scientific literature, with a focus on whether uncertainty was communicated. DESIGN:Qualitative (inductive systematic content analysis) and quan...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-016-3667-5
更新日期:2016-08-01 00:00:00
abstract::Despite improved knowledge about the benefits and harms of treatments for chronic back pain in the past several decades, there is a large and consequential mismatch between treatments found safe and effective and those routinely covered by health insurance. As a result, care for back pain has, if anything, deteriorate...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05099-z
更新日期:2019-09-01 00:00:00
abstract::Nicotine meets all critical criteria for an addictive drug. Furthermore, there is no evidence that there would be widespread compulsive use of tobacco without nicotine. These findings have led to consideration of the cigarette as a contaminated vehicle for an addictive drug (nicotine). Nevertheless, nicotine itself ma...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/BF02600847
更新日期:1990-09-01 00:00:00
abstract:OBJECTIVE:Examine patterns of alcohol use disorder (AUD) medication use and identify factors associated with prescription fill among commercially insured individuals with an index AUD visit. DESIGN:Using 2008-2018 claims data from a large national insurer, estimate days to first AUD medication using cause-specific haz...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-06073-w
更新日期:2020-11-01 00:00:00
abstract::We designed a questionnaire survey to study internal medicine residents' plans to use a chaperone during the pelvic, breast, rectal, and testicular examinations. We found chaperone use by male and female residents differed markedly, and neither group planned to use chaperones universally. When examining female patient...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.2000.10006.x
更新日期:2000-08-01 00:00:00
abstract:BACKGROUND:With the reorganization of primary care into Patient Aligned Care Teams (PACT) teams, the Veteran Affairs Health System (VA) aims to ensure all patients receive care based on patient-centered medical home (PCMH) principles. However, some patients receive the preponderance of care from specialty rather than p...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-013-2677-9
更新日期:2014-07-01 00:00:00