Abstract：
:Starfield and colleagues have suggested four overarching attributes of good primary care: "first-contact access for each need; long-term person- (not disease) focused care; comprehensive care for most health needs; and coordinated care when it must be sought elsewhere." As this series on reinventing primary care highlights, there is a compelling need for new care delivery models that would advance these objectives. This need is particularly urgent for high-needs, high-cost (HNHC) populations. By definition, HNHC patients require extensive attention and consume a disproportionate share of resources, and as a result they strain traditional office-based primary care practices. In this essay, we offer a clinical vignette highlighting the challenges of caring for HNHC populations. We then describe two categories of primary care-based approaches for managing HNHC populations: complex case management, and specialized clinics focused on HNHC patients. Although complex case management programs can be incorporated into or superimposed on the traditional primary care system, such efforts often fail to engage primary care clinicians and HNHC patients, and proven benefits have been modest to date. In contrast, specialized clinics for HNHC populations are more disruptive, as care for HNHC patients must be transferred to a multidisciplinary team that can offer enhanced care coordination and other support. Such specialized clinics may produce more substantial benefits, though rigorous evaluation of these programs is needed. We conclude by suggesting policy reforms to improve care for HNHC populations.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Hochman M,Asch SMdoi
10.1007/s11606-016-3945-2subject
Has Abstractpub_date
2017-04-01 00:00:00pages
392-397issue
4eissn
0884-8734issn
1525-1497pii
10.1007/s11606-016-3945-2journal_volume
32pub_type
杂志文章abstract：BACKGROUND:Opioid-dependent patients often have co-occurring chronic illnesses requiring medications that interact with methadone. Methadone maintenance treatment (MMT) is typically provided separately from medical care. Hence, coordination of medical care and substance use treatment is important to preserve patient sa...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-009-1043-4
更新日期：2009-09-01 00:00:00
abstract：BACKGROUND:Increasing the use of electronic medical records (EMR) has been suggested as an important strategy for improving healthcare safety. OBJECTIVE:To sequentially measure, evaluate, and respond to safety culture and practice safety concerns following EMR implementation. DESIGN:Safety culture was assessed using ...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-012-2153-y
更新日期：2013-02-01 00:00:00
abstract：BACKGROUND:Despite evidence of inadequate physical examination skills among medical students, teaching these skills has declined. One method of enhancing inspection skills is teaching "visual literacy," the ability to reason physiology and pathophysiology from careful and unbiased observation. OBJECTIVE:To improve stu...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,随机对照试验
doi：10.1007/s11606-008-0667-0
更新日期：2008-07-01 00:00:00
abstract：OBJECTIVES:Shared medical appointments (SMAs) are an increasingly used system-redesign strategy for improving access to and quality of chronic illness care. We conducted a systematic review of the existing literature on SMA interventions for patients with diabetes in order to understand their impact on outcomes. DATA ...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,评审
doi：10.1007/s11606-014-2978-7
更新日期：2015-01-01 00:00:00
abstract：:Topic development and structuring a systematic review of diagnostic tests are complementary processes. The goals of a medical test review are to identify and synthesize evidence to evaluate the impacts alternative testing strategies on health outcomes and to promote informed decision making. A common challenge is that...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-012-2007-7
更新日期：2012-06-01 00:00:00
abstract：BACKGROUND:Fluid resuscitation is a widely used intervention that is mandated in the management of sepsis. While its use can be life-saving, its overuse is associated with harm. Despite this, the best means of assessing a need for fluid resuscitation in an acute medical setting is unclear. OBJECTIVE:To assess studies ...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-019-05073-9
更新日期：2019-09-01 00:00:00
abstract：BACKGROUND:With positive results from diabetes prevention studies, there is interest in convenient ways to incorporate screening for glucose intolerance into routine care and to limit the need for fasting diagnostic tests. OBJECTIVE:The aim of this study is to determine whether random plasma glucose (RPG) could be use...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-008-0524-1
更新日期：2008-05-01 00:00:00
abstract：OBJECTIVE:In primary prevention of atherosclerotic disease, it is difficult to decide when medical treatment should be initiated. The main goal of the study was to compare different guidelines for coronary heart disease (CHD) risk assessment and initiation of lipid-lowering therapy. DESIGN:Cross-sectional evaluation. ...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1046/j.1525-1497.2003.20207.x
更新日期：2003-03-01 00:00:00
abstract：BACKGROUND:Decisions to forgo life-sustaining medical treatments in terminally ill patients are challenging, but ones that all doctors must face. Few studies have evaluated the impact of medical training on medical students' attitudes towards end-of-life decisions and none have compared them with an age-matched group o...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-008-0713-y
更新日期：2008-10-01 00:00:00
abstract：BACKGROUND:Patient-provider sexual risk behavior discussions occur infrequently but may be facilitated by high-quality sexual risk screening tools. OBJECTIVE:To develop the Sexual Risk Behavior Inventory (SRBI), a brief computer-administered patient-reported measure. DESIGN:Qualitative item development/quantitative i...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,多中心研究
doi：10.1007/s11606-018-4496-5
更新日期：2018-10-01 00:00:00
abstract：OBJECTIVE:To assess, from the patient's perspective, selected aspects of the quality of inpatient hospital care in the United States. DESIGN:A cross-sectional survey, using telephone interviews of patients discharged from the medical services of a probability sample of 62 public and private, nonprofit, nonfederal acut...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/BF02602763
更新日期：1995-12-01 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：OBJECTIVE:To determine how accurately preventive care reported in the medical record reflects actual physician practice or competence. DESIGN:Scoring criteria based on national guidelines were developed for 7 separate items of preventive care. The preventive care provided by randomly selected physicians was measured p...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,多中心研究
doi：10.1046/j.1525-1497.2000.91007.x
更新日期：2000-11-01 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: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：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：OBJECTIVES:We examined the presence and correlates of Black/White racial disparities in adherence to guidelines for colorectal cancer screening (CRCS). METHODS:The sample included 328 Black and 1827 White patients age 50-75 from 24 VA medical facilities who responded to a mailed survey with phone follow-up (response r...
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/s11606-010-1575-7
更新日期：2011-03-01 00:00:00
abstract：BACKGROUND:The Medicare Accountable Care Organization (ACO) programs encourage integration of providers into large groups and reward provider groups for improving quality, but not explicitly for reducing health care disparities. Larger group size and better overall quality may or may not be associated with smaller disp...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,随机对照试验
doi：10.1007/s11606-014-2900-3
更新日期：2014-09-01 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：: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:Little information exists regarding the impact of Medicare Part D on generic drug use. OBJECTIVE:To examine changes in the use of generic prescriptions attributable to Part D among a sample of Medicare beneficiaries. DESIGN, PARTICIPANTS, AND MEASUREMENTS:Difference-in-difference analysis of pharmacy claim...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-008-0742-6
更新日期：2008-10-01 00:00:00
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 ...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-015-3558-1
更新日期：2016-04-01 00:00:00
abstract：BACKGROUND:High-quality communication about end-of-life care results in greater patient and family satisfaction. End-of-life discussions should occur early during the patient's disease trajectory and yet is often addressed only when patients become severely ill. As a result, end-of-life discussions are commonly initiat...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-019-05615-1
更新日期：2020-04-01 00:00:00
abstract：OBJECTIVE:To identify gender differences in social and behavioral factors associated with antiretroviral adherence. DESIGN:Prospective cohort study. SETTING:Methadone maintenance program. PARTICIPANTS:One hundred thirteen HIV-seropositive current or former opioid users. MEASUREMENTS AND MAIN RESULTS:Participants we...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1111/j.1525-1497.2004.30445.x
更新日期：2004-11-01 00:00:00
abstract：BACKGROUND:The patient-centered medical home (PCMH) model aims to provide patient-centered care, lower costs, and improve health outcomes. Medical students have not been meaningfully integrated in this model. AIM:To test the feasibility of a longitudinal clerkship based on PCMH principles and anchored by PCMH educatio...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,多中心研究
doi：10.1007/s11606-013-2389-1
更新日期：2013-08-01 00:00:00
abstract：OBJECTIVE:Community physicians in the United States prescribe antibiotics to 80% to 90% of smokers with acute bronchitis. We performed a systematic review of the literature to determine the efficacy of antibiotics for smokers with acute bronchitis. DESIGN:A medline search was done using the keywords bronchitis, cough,...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,评审
doi：10.1046/j.1525-1497.2002.10405.x
更新日期：2002-03-01 00:00:00
abstract：:The community of health services researchers in general internal medicine has played an important role in affecting health policy at the national and state levels. Community-based participatory research (CBPR) offers health services researchers an opportunity to identify and address health policy questions at the loca...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-011-1878-3
更新日期：2011-12-01 00:00:00
abstract：:Writing a meaningful and valuable letter of reference is not an easy task. Several factors influence the quality of any letter of reference. First, the accuracy and reliability of the writer's impressions and judgment depend on how well he knows the individual being described. Second, the writer's frame of reference, ...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1111/j.1525-1497.2004.30142.x
更新日期：2004-05-01 00:00:00
abstract：:Errors in telephone communication can result in outcomes ranging from inconvenience and anxiety to serious compromises in patient safety. Although 25% of interactions between physicians and patients take place on the telephone, little has been written about telephone communication and medical mishaps. Similarly, train...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1111/j.1525-1497.2005.0199.x
更新日期：2005-10-01 00:00:00
abstract：OBJECTIVE:To characterize the informed consent process in routine, primary care office practice. DESIGN:Cross-sectional, descriptive evaluation of audiotaped encounters. SETTING:Offices of primary care physicians in Portland, Oregon. PARTICIPANTS:Internists (54%) and family physicians (46%), and their patients. MEA...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1046/j.1525-1497.1997.00057.x
更新日期：1997-06-01 00:00:00
