Abstract:
BACKGROUND:Development of electronic health record (EHR) prediction models to improve palliative care delivery is on the rise, yet the clinical impact of such models has not been evaluated. OBJECTIVE:To assess the clinical impact of triggering palliative care using an EHR prediction model. DESIGN:Pilot prospective before-after study on the general medical wards at an urban academic medical center. PARTICIPANTS:Adults with a predicted probability of 6-month mortality of ≥ 0.3. INTERVENTION:Triggered (with opt-out) palliative care consult on hospital day 2. MAIN MEASURES:Frequencies of consults, advance care planning (ACP) documentation, home palliative care and hospice referrals, code status changes, and pre-consult length of stay (LOS). KEY RESULTS:The control and intervention periods included 8 weeks each and 138 admissions and 134 admissions, respectively. Characteristics between the groups were similar, with a mean (standard deviation) risk of 6-month mortality of 0.5 (0.2). Seventy-seven (57%) triggered consults were accepted by the primary team and 8 consults were requested per usual care during the intervention period. Compared to historical controls, consultation increased by 74% (22 [16%] vs 85 [63%], P < .001), median (interquartile range) pre-consult LOS decreased by 1.4 days (2.6 [1.1, 6.2] vs 1.2 [0.8, 2.7], P = .02), ACP documentation increased by 38% (23 [17%] vs 37 [28%], P = .03), and home palliative care referrals increased by 61% (9 [7%] vs 23 [17%], P = .01). There were no differences between the control and intervention groups in hospice referrals (14 [10] vs 22 [16], P = .13), code status changes (42 [30] vs 39 [29]; P = .81), or consult requests for lower risk (< 0.3) patients (48/1004 [5] vs 33/798 [4]; P = .48). CONCLUSIONS:Targeting hospital-based palliative care using an EHR mortality prediction model is a clinically promising approach to improve the quality of care among seriously ill medical patients. More evidence is needed to determine the generalizability of this approach and its impact on patient- and caregiver-reported outcomes.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Courtright KR,Chivers C,Becker M,Regli SH,Pepper LC,Draugelis ME,O'Connor NRdoi
10.1007/s11606-019-05169-2subject
Has Abstractpub_date
2019-09-01 00:00:00pages
1841-1847issue
9eissn
0884-8734issn
1525-1497pii
10.1007/s11606-019-05169-2journal_volume
34pub_type
杂志文章abstract:OBJECTIVE:To describe how medical residents discuss do-not-resuscitate (DNR) orders with patients. DESIGN:Prospective observational study. SETTING:Inpatient medical wards of one university tertiary care center, one urban city public hospital, and one Veterans Affairs medical center. PARTICIPANTS:Thirty-one medical r...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599915
更新日期:1995-08-01 00:00:00
abstract:BACKGROUND:Developing a definition of what constitutes high need among Medicare beneficiaries using administrative data is an important prerequisite to evaluating value-based payment reforms. While various definitions of high need exist, their predictive validity for different patient outcomes in the following year has...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-018-4781-3
更新日期:2019-03-01 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:Disorders of sex development (DSD) are a heterogeneous group of rare genetic disorders of sex determination or differentiation. Evidence-based guidelines concerning gender assignment and surgical and hormonal treatment are limited for many DSD entities, and health care is highly fragmented across various sub...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-014-2917-7
更新日期:2014-08-01 00:00:00
abstract:BACKGROUND:Genomics will play an increasingly prominent role in clinical medicine. OBJECTIVE:To describe how primary care physicians (PCPs) discuss and make clinical recommendations about genome sequencing results. DESIGN:Qualitative analysis. PARTICIPANTS:PCPs and their generally healthy patients undergoing genome ...
journal_title:Journal of general internal medicine
pub_type: 临床试验,杂志文章
doi:10.1007/s11606-017-4295-4
更新日期:2018-06-01 00:00:00
abstract:BACKGROUND:Quite often medical students or novice residents have difficulty in ruling out diseases even though they are quite unlikely and, due to this difficulty, such students and novice residents unnecessarily repeat laboratory or imaging tests. OBJECTIVE:To explore whether or not a carefully designed short trainin...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2004.30257.x
更新日期:2004-05-01 00:00:00
abstract:BACKGROUND:Despite the availability and demonstrated effectiveness of office-based buprenorphine maintenance treatment (BMT), the systematic examination of physicians' attitudes towards this new medical practice has been largely neglected. OBJECTIVE:To identify facilitators and barriers to the potential or actual impl...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-008-0881-9
更新日期:2009-02-01 00:00:00
abstract:OBJECTIVE:To identify the communication factors that are significantly associated with appropriate short-term follow-up of abnormal mammograms. DESIGN:Prospective longitudinal study involving medical record review and patient survey. SETTING:Ten academically affiliated ambulatory medical practices in the Boston metro...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1525-1497.2004.30357.x
更新日期:2004-04-01 00:00:00
abstract::The objective of this study was to assess reasons for physicians' noncompliance with computer-generated preventive care reminders. In an academic general internal medicine practice, a survey of physicians' reasons for noncompliance found that 55% of reminders were not complied with. Reasons included "not applicable" i...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599049
更新日期:1996-08-01 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::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 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:CONTEXT:To date, research regarding the influence of conflicts of interest on the presentation of findings by researchers has been limited. OBJECTIVE:To evaluate the sources of funding for published manuscripts, and association between reported findings and conflicts of interest. METHODS:Data from both print and elec...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2004.30617.x
更新日期:2004-01-01 00:00:00
abstract::We varied the softness and nodularity of silicone breast models to assess the effects of age-related breast tissue characteristics on lump detection. In two sets of six silicone breast models manufactured to simulate premenopausal and postmenopausal breast tissue, respectively, 82 internal medicine attending and house...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599588
更新日期:1996-02-01 00:00:00
abstract:BACKGROUND:Interpreter services for medical care increase physician-patient communication and safety, yet a "formal certification" process to demonstrate interpreter competence does not exist. Testing and training is left to individual health care facilities nationwide. Bilingual staff are often used to interpret, with...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0344-8
更新日期:2007-11-01 00:00:00
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
更新日期:2018-08-01 00:00:00
abstract:BACKGROUND:Heart disease is the leading cause of death for women in the United States, accounting for 24.5 % of all deaths among women. Earlier research has demonstrated racial/ethnic differences in prevalence of cardiovascular (CVD) risk factors. OBJECTIVE:To empirically examine the prevalence of CVD risk factors amo...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-012-2309-9
更新日期:2013-07-01 00:00:00
abstract:BACKGROUND:Medical weblogs ("blogs") have emerged as a new connection between health professionals and the public. OBJECTIVE:To examine the scope and content of medical blogs and approximate how often blog authors commented about patients, violated patient privacy, or displayed a lack of professionalism. DESIGN:We de...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-008-0726-6
更新日期:2008-10-01 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:OBJECTIVE:To assess the international health activities of departments of medicine, divisions of general medicine, and general medicine faculty and the interest among departments of medicine in joint international health ventures. DESIGN:15-item, mailed questionnaire. PARTICIPANTS:100 chiefs of divisions of general m...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599433
更新日期:1990-09-01 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:PURPOSE:To evaluate the acceptance rate and motivation for acceptance of hepatitis B virus (HBV) vaccine among preclinical medical and physician assistant (PA) students in comparison with similar data obtained from resident and staff physicians. METHODS:A cross-sectional survey of all second-year medical and PA studen...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599567
更新日期:1995-01-01 00:00:00
abstract:BACKGROUND:Primary care physicians are spending fewer hours in direct patient care, yet it is not known whether reduced hours are associated with differences in patient outcomes. OBJECTIVE:To determine whether patient outcomes vary with physicians' clinic hours. DESIGN:Cross-sectional retrospective design assessing p...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.2003.20401.x
更新日期:2003-09-01 00:00:00
abstract:BACKGROUND:Rapid antigen detection tests (RADT) are commonly used to guide appropriate antibiotic treatment of group A beta-hemolytic streptococcal (GABHS) pharyngitis. In adults, there is controversy about the need for routine backup testing of negative RADT. OBJECTIVE:Estimate the costs and benefits in adults of rou...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-012-2245-8
更新日期:2013-06-01 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::In 1989, the internal medicine residency training program at St. John's Episcopal Hospital changed from a standard one-in-four on-call system to a night float system of resident on call. Using a confidential questionnaire that assessed the opinions of medical nurses, the nurses were asked which system they preferred, ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599842
更新日期:1995-07-01 00:00:00
abstract::To understand the effect that termination of an established physician-patient relationship has on patient attendance patterns in a medical clinic, appointment scheduling and patient attendance were measured for 210 patients before and after 11 senior resident physicians left the clinic. There was no significant change...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599811
更新日期:1986-03-01 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:OBJECTIVES:To characterize prostate-specific antigen (PSA) testing practices in a hospital-based primary care clinic, and to determine the outcomes of PSA testing, including urology referrals, biopsies, cancers detected, and cancer treatments. DESIGN:Retrospective cohort study. Data were obtained from computerized Dep...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1998.00026.x
更新日期:1998-02-01 00:00:00
abstract:OBJECTIVE:To review the current information on medical complications, psychological implications, and legislative issues related to body piercing, a largely unregulated industry in the United States. METHODS:We conducted a MEDLINE search of English language articles from 1966 until May 1998 using the search terms "bod...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1046/j.1525-1497.1999.00357.x
更新日期:1999-06-01 00:00:00