Characterizing Potentially Preventable Admissions: A Mixed Methods Study of Rates, Associated Factors, Outcomes, and Physician Decision-Making.

Abstract:

BACKGROUND:Potentially preventable admissions are a target for healthcare cost containment. OBJECTIVE:To identify rates of, characterize associations with, and explore physician decision-making around potentially preventable admissions. DESIGN:A comparative cohort study was used to determine rates of potentially preventable admissions and to identify associated factors and patient outcomes. A qualitative case study was used to explore physicians' clinical decision-making. PARTICIPANTS:Patients admitted from the emergency department (ED) to the general medicine (GM) service over a total of 4 weeks were included as cases (N = 401). Physicians from both emergency medicine (EM) and GM that were involved in the cases were included (N = 82). APPROACH:Physicians categorized admissions as potentially preventable. We examined differences in patient characteristics, admission characteristics, and patient outcomes between potentially preventable and control admissions. Interviews with participating physicians were conducted and transcribed. Transcriptions were systematically analyzed for key concepts regarding potentially preventable admissions. KEY RESULTS:EM and GM physicians categorized 22.2% (90/401) of admissions as potentially preventable. There were no significant differences between potentially preventable and control admissions in patient or admission characteristics. Potentially preventable admissions had shorter length of stay (2.1 vs. 3.6 days, p < 0.001). There was no difference in other patient outcomes. Physicians discussed several provider, system, and patient factors that affected clinical decision-making around potentially preventable admissions, particularly in the "gray zone," including risk of deterioration at home, the risk of hospitalization, the cost to the patient, and the presence of outpatient resources. Differences in provider training, risk assessment, and provider understanding of outpatient access accounted for differences in decisions between EM and GM physicians. CONCLUSIONS:Collaboration between EM and GM physicians around patients in the gray zone, focusing on patient risk, cost, and outpatient resources, may provide an avenues for reducing potentially preventable admissions and lowering healthcare spending.

journal_name

J Gen Intern Med

authors

Daniels LM,Sorita A,Kashiwagi DT,Okubo M,Small E,Polley EC,Sawatsky AP

doi

10.1007/s11606-017-4285-6

subject

Has Abstract

pub_date

2018-05-01 00:00:00

pages

737-744

issue

5

eissn

0884-8734

issn

1525-1497

pii

10.1007/s11606-017-4285-6

journal_volume

33

pub_type

杂志文章
  • Accuracy of ovarian and colon cancer risk assessments by U.S. physicians.

    abstract:BACKGROUND:Studies have shown a mismatch between published cancer screening and genetic counseling referral recommendations and physician-reported screening and referral practices. Inaccurate cancer risk assessment is one potential cause of this mismatch. OBJECTIVE:To assess U.S. physicians' ability to accurately dete...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,随机对照试验

    doi:10.1007/s11606-014-2768-2

    authors: Baldwin LM,Trivers KF,Andrilla CH,Matthews B,Miller JW,Lishner DM,Goff BA

    更新日期:2014-05-01 00:00:00

  • "Everything I know I learned from my mother...Or not": perspectives of African-American and white women on decisions about tubal sterilization.

    abstract:BACKGROUND:African-American women have had higher rates of female sterilization compared to white women since its emergence as a contraceptive method. The reasons underlying this observed racial difference are unknown. OBJECTIVES:The goals of this study were to (1) explore what factors shape black and white women's de...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-008-0887-3

    authors: Borrero S,Nikolajski C,Rodriguez KL,Creinin MD,Arnold RM,Ibrahim SA

    更新日期:2009-03-01 00:00:00

  • Providers' perceptions of relationships and professional roles when caring for patients who leave the hospital against medical advice.

    abstract:BACKGROUND:Patients who leave hospitals against medical advice (AMA) may be at risk for adverse health outcomes. Their decision to leave may not be clearly understood by providers. This study explored providers' experiences with and attitudes toward patients who leave the hospital AMA. OBJECTIVE:To explore providers' ...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-008-0728-4

    authors: Windish DM,Ratanawongsa N

    更新日期:2008-10-01 00:00:00

  • Where should hospitalists sit within the academic medical center?

    abstract::One of the most significant changes in US hospitals over the past decade has been the emergence of hospitalists as key providers of inpatient care. The number of hospitalists in both community and teaching hospitals is growing rapidly, and as the field burgeons, many are questioning where hospitalists should reside wi...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-008-0682-1

    authors: Flanders SA,Saint S,McMahon LF,Howell JD

    更新日期:2008-08-01 00:00:00

  • Clinician Referrals for Non-opioid Pain Care Following Discontinuation of Long-term Opioid Therapy Differ Based on Reasons for Discontinuation.

    abstract:BACKGROUND:Little is known about pain care offered to patients discontinued from long-term opioid therapy (LTOT) by their prescriber due to aberrant behaviors versus other reasons. OBJECTIVE:This study aimed to compare rates of non-opioid analgesic pharmacotherapy initiation and clinician referrals for non-pharmacolog...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-018-4329-6

    authors: Lovejoy TI,Morasco BJ,Demidenko MI,Meath THA,Dobscha SK

    更新日期:2018-05-01 00:00:00

  • Efficacy of a one-month training block in psychosocial medicine for residents: a controlled study.

    abstract:STUDY OBJECTIVE:To determine the efficacy of a comprehensive, one-month psychosocial training program for first-year medical residents. DESIGN:Nonrandomized, controlled study with immediate pre/post evaluation. Limited evaluation of some residents was also conducted an average of 15 months after teaching. SETTING:Com...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/BF02598223

    authors: Smith RC,Osborn G,Hoppe RB,Lyles JS,Van Egeren L,Henry R,Sego D,Alguire P,Stoffelmayr B

    更新日期:1991-11-01 00:00:00

  • Which advance directive do patients prefer?

    abstract::This study examined patient acceptance of two different advance directives. Outpatients completed the two directives and a 12-item acceptability questionnaire for each, and then stated their directive preferences. Of 128 patients enrolled, 97 (76%) responded. Overall, 47% of the respondents were satisfied with the Let...

    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/BF02599143

    authors: Reinders M,Singer PA

    更新日期:1994-01-01 00:00:00

  • Effect of problem-solving-based diabetes self-management training on diabetes control in a low income patient sample.

    abstract:BACKGROUND:Lower socioeconomic status is associated with excess disease burden from diabetes. Diabetes self-management support interventions are needed that are effective in engaging lower income patients, addressing competing life priorities and barriers to self-care, and facilitating behavior change. OBJECTIVE:To pi...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,随机对照试验

    doi:10.1007/s11606-011-1689-6

    authors: Hill-Briggs F,Lazo M,Peyrot M,Doswell A,Chang YT,Hill MN,Levine D,Wang NY,Brancati FL

    更新日期:2011-09-01 00:00:00

  • Reimbursement for preventive services: can we construct an equitable system?

    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

    authors: Davis K,Bialek R,Parkinson M,Smith J,Vellozzi C

    更新日期:1990-09-01 00:00:00

  • Chronic obstructive pulmonary disease: less common causes--an algorithm for the primary care physician.

    abstract::The clinical features and distinguishing characteristics of the less common causes of chronic airflow obstruction have been reviewed. Clearly, the majority of patients have cigarette-induced chronic bronchitis and/or emphysema. However, for those patients with chronic airflow obstruction who are younger than 40 years ...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,评审

    doi:10.1007/BF02599641

    authors: St John RC,Gadek JE,Pacht ER

    更新日期:1993-10-01 00:00:00

  • "Stealth" alerts to improve warfarin monitoring when initiating interacting medications.

    abstract:BACKGROUND:As electronic health records (EHRs) become widely adopted, alerts and reminders can improve medication safety, but excessive alerts may irritate or overwhelm clinicians, thereby reducing their effectiveness. We developed a novel "stealth" alert in an EHR to improve anticoagulation monitoring for patients pre...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-012-2137-y

    authors: Koplan KE,Brush AD,Packer MS,Zhang F,Senese MD,Simon SR

    更新日期:2012-12-01 00:00:00

  • Use of complementary and alternative medicine and self-rated health status: results from a national survey.

    abstract:BACKGROUND:Despite the absence of conclusive evidence of effectiveness, complementary and alternative medicine (CAM) is used by 4 of 10 adults in the US; little is known about the association between CAM use and health status. OBJECTIVE:To determine the relation between CAM use and self-reported health status and heal...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-010-1542-3

    authors: Nguyen LT,Davis RB,Kaptchuk TJ,Phillips RS

    更新日期:2011-04-01 00:00:00

  • Impact of patient race on patient experiences of access and communication in HIV care.

    abstract:BACKGROUND:Patient-centered care--including the domains of access and communication--is an important determinant of positive clinical outcomes. OBJECTIVE:To explore associations between race and HIV-infected patients' experiences of access and communication. DESIGN:This was a cross-sectional survey. PARTICIPANTS:Nin...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1007/s11606-008-0788-5

    authors: Korthuis PT,Saha S,Fleishman JA,McGrath MM,Josephs JS,Moore RD,Gebo KA,Hellinger J,Beach MC,HIV Research Network.

    更新日期:2008-12-01 00:00:00

  • Variation in primary care physicians' colorectal cancer screening recommendations by patient age and comorbidity.

    abstract:BACKGROUND:Screening patterns among primary care physicians (PCPs) may be influenced by patient age and comorbidity. Colorectal cancer (CRC) screening has little benefit among patients with limited life expectancy. OBJECTIVE:To characterize the extent to which PCPs modify their recommendations for CRC screening based ...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-012-2093-6

    authors: Haggstrom DA,Klabunde CN,Smith JL,Yuan G

    更新日期:2013-01-01 00:00:00

  • Explaining adherence to supplemental oxygen therapy: the patient's perspective.

    abstract:OBJECTIVES:To describe and explain the patterns of adherence to supplemental oxygen in individuals with hypoxemic chronic obstructive pulmonary disease (COPD). DESIGN:Qualitative study of a case-series of patients with COPD who use supplemental oxygen. SETTING:Denver, Colorado. PARTICIPANTS:Community-dwelling, Engli...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1046/j.1525-1497.2002.20218.x

    authors: Earnest MA

    更新日期:2002-10-01 00:00:00

  • The effect of competing direct-to-consumer advertising campaigns on the use of drugs for benign prostatic hyperplasia: time series analysis.

    abstract:BACKGROUND:Direct-to-consumer advertising (DTCA) remains a controversial issue, with concerns that it leads to unnecessary and inappropriate prescribing. Whether DTCA shifts prescribing from first-line (guideline-recommended) therapy to second-line drugs has not been studied. OBJECTIVE:The purpose of this study was to...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-014-3063-y

    authors: Skeldon SC,Kozhimannil KB,Majumdar SR,Law MR

    更新日期:2015-04-01 00:00:00

  • Association between Opioid Prescribing in Medicare and Pharmaceutical Company Gifts by Physician Specialty.

    abstract:BACKGROUND:The association between pharmaceutical industry promotion and physician opioid prescribing is poorly understood. Whether the influence of industry gifts on prescribing varies by specialty is unknown. OBJECTIVE:To examine the relationship between opioid-related gifts to physicians and opioid prescribing in t...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-019-05470-0

    authors: Hollander MAG,Donohue JM,Stein BD,Krans EE,Jarlenski MP

    更新日期:2020-08-01 00:00:00

  • Prevalence and Correlates of Disordered Eating Behaviors Among Young Adults with Overweight or Obesity.

    abstract:BACKGROUND:Clinical and community samples indicate that eating disorders (EDs) and disordered eating behaviors (DEBs) may co-occur among adolescents and young adults at a weight status classified as overweight or obese. OBJECTIVE:To determine the prevalence of EDs and DEBs among young adults at a weight status classif...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-018-4465-z

    authors: Nagata JM,Garber AK,Tabler JL,Murray SB,Bibbins-Domingo K

    更新日期:2018-08-01 00:00:00

  • The content of internal medicine residency training and its relevance to the practice of medicine: implications for primary care curricula.

    abstract::Using survey items from Kern et al. (1985), 192 former residents rated their preparation in, and the importance of, three content areas of their residency training ("basic skill and knowledge areas," "allied medical disciplines," and "areas related to the practice of medicine"). Mean ratings replicated those reported ...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/BF02597402

    authors: Martin GJ,Curry RH,Yarnold PR

    更新日期:1989-07-01 00:00:00

  • Impact of Procalcitonin Guidance on Management of Adults Hospitalized with Chronic Obstructive Pulmonary Disease Exacerbations.

    abstract:BACKGROUND:Antibiotics are often prescribed for hospitalized patients with chronic obstructive pulmonary disease (COPD) exacerbations. The use of procalcitonin (PCT) in the management of pneumonia has safely reduced antibiotic durations, but limited data on the impact of PCT guidance on the management of COPD exacerbat...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-018-4312-2

    authors: Bremmer DN,DiSilvio BE,Hammer C,Beg M,Vishwanathan S,Speredelozzi D,Moffa MA,Hu K,Abdulmassih R,Makadia JT,Sandhu R,Naddour M,Chan-Tompkins NH,Trienski TL,Watson C,Obringer TJ,Kuzyck J,Walsh TL

    更新日期:2018-05-01 00:00:00

  • Screening and Follow-Up Monitoring for Substance Use in Primary Care: An Exploration of Rural-Urban Variations.

    abstract:BACKGROUND:Rates of substance use in rural areas are close to those of urban areas. While recent efforts have emphasized integrated care as a promising model for addressing workforce shortages in providing behavioral health services to those living in medically underserved regions, little is known on how substance use ...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1007/s11606-015-3488-y

    authors: Chan YF,Lu SE,Howe B,Tieben H,Hoeft T,Unützer J

    更新日期:2016-02-01 00:00:00

  • Prevention in medical education: an uncertain future.

    abstract::There is reason for pessimism about the incorporation of prevention into medical education. In addition to what might be called the standard reasons for resistance to prevention, there are at least three other structural barriers: the destabilization of the health care system, the loss of interest in careers in primar...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/BF02600854

    authors: Fried RA

    更新日期:1990-09-01 00:00:00

  • Using value-of-information methods when the disease is rare and the treatment is expensive--the example of hemophilia A.

    abstract:BACKGROUND:Hemophilia A is a rare, sex-linked genetic disorder treated with intravenous administration of factor VIII (FVIII) to prevent bleeding; however, approaches vary across and within countries. Value-of-information (VOI) methods identify situations in which the cost-benefit evidence is sufficient to adopt one tr...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-014-2880-3

    authors: Abrahamyan L,Willan AR,Beyene J,Mclimont M,Blanchette V,Feldman BM,Canadian Hemophilia Primary Prophylaxis (CHPS) Study Group.

    更新日期:2014-08-01 00:00:00

  • The Impact of Medication-Based Risk Adjustment on the Association Between Veteran Health Outcomes and Dual Health System Use.

    abstract:BACKGROUND:Veterans commonly receive care from both Veterans Health Administration (VA) and non-VA sources (i.e., dual use). A major challenge in comparing health outcomes between dual users and VA-predominant users is applying an accurate method of risk adjustment. OBJECTIVE:To determine how different comorbidity ind...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-017-4064-4

    authors: Radomski TR,Zhao X,Thorpe CT,Thorpe JM,Naples JG,Mor MK,Good CB,Fine MJ,Gellad WF

    更新日期:2017-09-01 00:00:00

  • A Qualitative Study of Primary Care Providers' Experiences with the Veterans Choice Program.

    abstract:BACKGROUND:The Veterans Access, Choice and Accountability Act (hereafter, Choice Program) seeks to improve access to care by enabling eligible Veterans to receive care from community providers. Veterans Affairs (VA) primary care providers (PCPs) play a key role in making referrals to community specialists, but their fr...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-018-4810-2

    authors: Nevedal AL,Wagner TH,Ellerbe LS,Asch SM,Koenig CJ

    更新日期:2019-04-01 00:00:00

  • Breast Density Notification Legislation and Breast Cancer Stage at Diagnosis: Early Evidence from the SEER Registry.

    abstract:BACKGROUND:Twenty-eight states have passed breast density notification laws, which require physicians to inform women of a finding of dense breasts on mammography. OBJECTIVE:To evaluate changes in breast cancer stage at diagnosis after enactment of breast density notification legislation. DESIGN:Using a difference-in...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-016-3904-y

    authors: Richman I,Asch SM,Bendavid E,Bhattacharya J,Owens DK

    更新日期:2017-06-01 00:00:00

  • The accuracy of clinician perceptions of "usual" blood pressure control.

    abstract:BACKGROUND:The term "clinical inertia" is used to describe the failure to manage a chronic condition aggressively enough to bring it under control. The underlying mechanisms for clinical inertia remain poorly understood. OBJECTIVE:To describe one potential mechanism for clinical inertia, seen through the lens of clini...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1007/s11606-007-0464-1

    authors: Rose AJ,Shimada SL,Rothendler JA,Reisman JI,Glassman PA,Berlowitz DR,Kressin NR

    更新日期:2008-02-01 00:00:00

  • Usability of FDA-approved medication guides.

    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

    authors: Wolf MS,King J,Wilson EA,Curtis LM,Bailey SC,Duhig J,Russell A,Bergeron A,Daly A,Parker RM,Davis TC,Shrank WH,Lambert B

    更新日期:2012-12-01 00:00:00

  • Improving Rates of Outpatient Influenza Vaccination Through EHR Portal Messages and Interactive Automated Calls: A Randomized Controlled Trial.

    abstract:BACKGROUND:Patient reminders for influenza vaccination, delivered via electronic health record (EHR) patient portal messages and interactive voice response (IVR) calls, offer an innovative approach to improving patient care. OBJECTIVE:To test the effectiveness of portal and IVR outreach in improving rates of influenza...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,随机对照试验

    doi:10.1007/s11606-017-4266-9

    authors: Cutrona SL,Golden JG,Goff SL,Ogarek J,Barton B,Fisher L,Preusse P,Sundaresan D,Garber L,Mazor KM

    更新日期:2018-05-01 00:00:00

  • Revisiting the duration of vasomotor symptoms of menopause: a meta-analysis.

    abstract:BACKGROUND:Treatment decisions about menopause are predicated on a transient duration of vasomotor symptoms. However, evidence supporting a specific duration is weak. OBJECTIVE:To estimate the natural progression of vasomotor symptoms during the menopause transition by systematically compiling available evidence using...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,meta分析

    doi:10.1007/s11606-008-0655-4

    authors: Politi MC,Schleinitz MD,Col NF

    更新日期:2008-09-01 00:00:00