Abstract:
BACKGROUND:Process measures of healthcare quality are usually formulated as the number of patients who receive evidence-based treatment (numerator) divided by the number of patients in the target population (denominator). When the systems being evaluated can influence which patients are included in the denominator, it is reasonable to wonder if improvements in measured quality are driven by expanding numerators or contracting denominators. OBJECTIVE:In 2003, the US Department of Veteran Affairs (VA) based executive compensation in part on performance on a substance use disorder (SUD) continuity-of-care quality measure. The first goal of this study was to evaluate if implementing the measure in this way resulted in expected improvements in measured performance. The second goal was to examine if the proportion of patients with SUD who qualified for the denominator contracted after the quality measure was implemented, and to describe the facility-level variation in and correlates of denominator contraction or expansion. DESIGN:Using 40 quarters of data straddling the implementation of the performance measure, an interrupted time series design was used to evaluate changes in two outcomes. PARTICIPANTS:All veterans with an SUD diagnosis in all VA facilities from fiscal year 2000 to 2009. MAIN MEASURES:The two outcomes were 1) measured performance-patients retained/patients qualified and 2) denominator prevalence-patients qualified/patients with SUD program contact. KEY RESULTS:Measured performance improved over time (P < 0.001). Notably, the proportion of patients with SUD program contact who qualified for the denominator decreased more rapidly after the measure was implemented (p = 0.02). Facilities with higher pre-implementation denominator prevalence had steeper declines in denominator prevalence after implementation (p < 0.001). CONCLUSIONS:These results should motivate the development of measures that are less vulnerable to denominator management, and also the exploration of "shadow measures" to monitor and reduce undesirable denominator management.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Harris AH,Chen C,Rubinsky AD,Hoggatt KJ,Neuman M,Vanneman MEdoi
10.1007/s11606-015-3558-1subject
Has Abstractpub_date
2016-04-01 00:00:00pages
21-7eissn
0884-8734issn
1525-1497pii
10.1007/s11606-015-3558-1journal_volume
31 Suppl 1pub_type
杂志文章abstract:OBJECTIVE:To use spatial and epidemiologic analyses to understand disparities in mammography use and to formulate interventions to increase its uptake in low-income, high-recent immigration areas in Toronto, Canada. DESIGN:We compared mammography rates in four income-immigration census tract groups. Data were obtained...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2004.30270.x
更新日期:2004-09-01 00:00:00
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 universit...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02602350
更新日期:1989-03-01 00:00:00
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: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::A lack of access to critical drugs in the USA, either due to exorbitant prices or shortages, has become a troubling norm that threatens the quality and safety of healthcare. In 2017, there were shortages of 146 commonly used drugs including electrolytes, chemotherapy, cardiovascular, and antibiotic agents. For example...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-018-4548-x
更新日期:2018-11-01 00:00:00
abstract:OBJECTIVE:To assess the relationship between gender, background, and brief training and physicians' detection of and treatment for woman abuse. DESIGN:Quasi-experimental and correlational designs, plus control for background factors. SETTING:Two residency training programs: general internal medicine and family practi...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599714
更新日期:1993-11-01 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:Physician Orders for Life-Sustaining Treatment (POLST) is a tool that facilitates the elicitation and continuity of life-sustaining care preferences. POLST was implemented in California in 2009, but how well it disseminated across a large, racially diverse population is not known and has implications for end...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-016-3728-9
更新日期:2016-10-01 00:00:00
abstract:BACKGROUND:Health-related quality of life (HRQoL) has become an important facet of HIV/AIDS research. Typically, the unit of analysis is either the total instrument score or subscale score. Developing a typology of responses across various HRQoL measures, however, may advance understating of patients' perspectives. ME...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2006.00645.x
更新日期:2006-12-01 00:00:00
abstract:BACKGROUND:In an effort to prevent medical errors, it has been recommended that all healthcare organizations implement a standardized approach to communicating patient information during transitions of care between providers. Most research on these transitions has been conducted in the inpatient setting, with relativel...
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/s11606-012-2206-2
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:A number of practice guidelines and recommendations call for the assessment of childhood abuse history among adult medical patients. The cultural sensitivity of screening questions, however, has not been examined. OBJECTIVE:To assess whether questions that inquire about childhood abuse history function diff...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-006-0026-y
更新日期:2007-03-01 00:00:00
abstract:BACKGROUND:Treatment guidelines recommend all HIV/HCV-co-infected persons be considered for hepatitis C virus (HCV) treatment, yet obstacles to testing and accessing treatment for HCV continue for women. OBJECTIVE:To assess awareness of HCV, and describe diagnostic referrals and HCV treatment among women in the Women'...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0395-x
更新日期:2007-12-01 00:00:00
abstract:BACKGROUND:Individualized selection of antiretroviral (ARV) therapy is complex, considering drug resistance, comorbidities, drug-drug interactions, and other factors. HIV-ASSIST (www.hivassist.com) is a free, online tool that provides ARV decision support. HIV-ASSIST synthesizes patient and virus-specific attributes to...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05531-4
更新日期:2020-05-01 00:00:00
abstract:OBJECTIVE:Addressing the epidemic of poor compliance with antihypertensive medications will require identifying factors associated with poor adherence, including modifiable psychosocial and behavioral characteristics of patients. DESIGN:Cross-sectional study, comparing measured utilization of antihypertensive prescrip...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.2002.00406.x
更新日期:2002-07-01 00:00:00
abstract::LM Montgomery's The Blue Castle was first published in 1926, yet contains many insights into medical practice that remain relevant today. The protagonist, Valancy, mistakenly receives a terminal diagnosis in a letter from her physician, who has sent her a note intended for another patient. Her interactions with the ph...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-010-1394-x
更新日期:2010-10-01 00:00:00
abstract:BACKGROUND:Consumer-directed health plans are increasingly common, yet little is known about their impact on physician decision-making and preventive service use. OBJECTIVE:To determine how patients' deductible levels and socioeconomic status may affect primary care physicians' recommendations for colorectal cancer sc...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-008-0714-x
更新日期:2008-10-01 00:00:00
abstract:BACKGROUND:The patient-centered medical home (PCMH) model has several components to improve care for patients with high comorbidity, including greater access to face-to-face primary care. OBJECTIVE:We examined whether high-comorbidity patients had larger increases in primary care provider (PCP) visits attributable to ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-016-3833-9
更新日期:2016-12-01 00:00:00
abstract::The safety net, a collection of public hospitals, federally qualified health centers (FQHCs), and publicly funded community-based healthcare entities, provides essential care to middle-aged and older adults with geriatric conditions. The role of the safety net for these adults will intensify over the next two decades ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-06010-x
更新日期:2020-11-01 00:00:00
abstract:OBJECTIVE:To lay the groundwork for a better understanding of patient views on medical confidentiality. DESIGN:Studies were found by searching medline, bioethicsline, and selected bibliographies. Articles concerning physician perspectives or implications of legal and administrative regulations were excluded. Only peer...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1046/j.1525-1497.2003.20823.x
更新日期:2003-08-01 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
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-016-3747-6
更新日期:2016-09-01 00:00:00
abstract:BACKGROUND:Race differences in the receipt of invasive cardiac procedures are well-documented but the etiology remains poorly understood. OBJECTIVE:We examined how social contextual variables were related to race differences in the likelihood of receiving cardiac catheterization in a sample of veterans who were recomm...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-010-1324-y
更新日期:2010-08-01 00:00:00
abstract:BACKGROUND:A lower proportion of patients with chronic heart failure receive palliative care compared to patients with advanced cancer. OBJECTIVE:We examined the relative need for palliative care in the two conditions by comparing symptom burden, psychological well-being, and spiritual well-being in heart failure and ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-009-0931-y
更新日期:2009-05-01 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::This paper deals with the varied sites and teachers that can and should be used in educating residents and medical students in ambulatory care. A basic premise is that sites other than academic medical centers and teachers other than physician faculty members should be among those used. The paper describes how institu...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02600436
更新日期:1990-01-01 00:00:00
abstract:OBJECTIVE:To determine the relevance of the initial certifying examination to the practice of internal medicine and the suitability of items used in initial certification for recertification. DESIGN:Using a matrix-sampling approach, items from the 1991 Certifying Examination were assigned to two sets of judges: direct...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599989
更新日期:1993-02-01 00:00:00
abstract:OBJECTIVE:To determine whether the addition of Quick Medical Reference (QMR) to usual educational tools improves an intern's performance in managing clinical cases that test diagnostic and investigative skills. DESIGN:Randomized, controlled, single-blinded crossover study. SETTING:Tertiary care teaching hospital. SU...
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/BF02600304
更新日期:1994-11-01 00:00:00
abstract:BACKGROUND:Entry into general internal medicine (GIM) has declined. The effect of the inpatient general medicine rotation on medical student career choices is uncertain. OBJECTIVE:To assess the effect of student satisfaction with the inpatient general medicine rotation on pursuit of a career in GIM. DESIGN:Multicente...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1525-1497.2006.00429.x
更新日期:2006-05-01 00:00:00
abstract:BACKGROUND:Medical students in the USA have negative perceptions of primary care careers, which are exacerbated by the hidden curriculum and medical school culture. Longitudinal integrated clerkships (LICs) have shown promise in ameliorating this situation by promoting student/preceptor continuity relationships and hel...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-018-4600-x
更新日期:2018-10-01 00:00:00
abstract:OBJECTIVE:In 1996, the Health Care Financing Administration (HCFA) introduced new evaluation and management (E&M) guidelines mandating more intensive supervision and documentation by attending physicians. We assessed the effects of the guidelines on inpatient teaching. DESIGN:Pretest-posttest, nonequivalent control gr...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1046/j.1525-1497.2000.07001.x
更新日期:2000-07-01 00:00:00