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-level PCMH implementation was associated with higher HRQoL in multimorbid adults. DESIGN:A retrospective cohort study. PARTICIPANTS:Twenty-two thousand ninety-five multimorbid patients who received primary care at 944 Veterans Health Administration (VHA) clinics. MAIN MEASURES:Our exposure was the Patient Aligned Care Team Implementation Progress Index (PI2) for the clinic in 2012, a previously validated composite measure of PCMH implementation. Higher PI2 scores indicate better performance within eight PCMH domains. Outcomes were patient-reported HRQoL measured by the physical and mental component scores (PCS and MCS) from the Short Form-12 patient experiences survey in 2013-2014. Interaction of the outcomes with total hospitalizations and primary care visit count was also examined. Generalized estimating equations were used for main models after adjusting for patient and clinic characteristics. RESULTS:The cohort average age was 68 years, mostly male (96%), and had an average of 4.4 chronic diagnoses. Compared with patients seen at the lowest scoring clinics for PCMH implementation, care in the highest scoring clinics was associated with a higher adjusted marginal mean PCS (42.3 (95% CI 41.3-43.4) versus 40.3 (95% CI 39.1-41.5), P = 0.01), but a lower MCS (35.2 (95% CI 34.4-36.1) versus 36.0 (95% CI 35.3-36.8), P = 0.17). Patients with prior hospitalizations seen in clinics with higher compared with lower PI2 scores had a 2.7 point greater MCS (95% CI 0.6-4.8; P = 0.01). CONCLUSIONS:Multimorbid patients seen in clinics with greater PCMH implementation reported higher physical HRQoL, but lower mental HRQoL. The association between PCMH implementation and mental HRQoL may depend on complex interactions with disease severity and prior hospitalizations.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Schuttner L,Reddy A,Rosland AM,Nelson K,Wong ESdoi
10.1007/s11606-019-05429-1subject
Has Abstractpub_date
2020-01-01 00:00:00pages
119-125issue
1eissn
0884-8734issn
1525-1497pii
10.1007/s11606-019-05429-1journal_volume
35pub_type
杂志文章abstract:BACKGROUND/OBJECTIVE:Diet books dominate the New York Times Advice Best Seller list and consumers cite such books as an important source of nutrition information. However, the scientific support for nutrition claims presented as fact (nutrition facts) in diet books is not known. DESIGN/MEASUREMENTS:We assessed the qua...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2006.00501.x
更新日期:2006-07-01 00:00:00
abstract:BACKGROUND:Deficiencies in care for cancer survivors may result from unclear roles for primary care providers (PCPs) and oncology specialists in follow-up. OBJECTIVES:To compare cancer survivors' care to non-cancer controls. DESIGN:Retrospective, longitudinal, controlled study starting 366 days post-diagnosis. SUBJE...
journal_title:Journal of general internal medicine
pub_type: 临床试验,杂志文章
doi:10.1007/s11606-009-0903-2
更新日期:2009-04-01 00:00:00
abstract::Hospitalists provide a significant amount of direct clinical care in both academic and community hospitals. Peer feedback is a potentially underutilized and low resource method for improving clinical performance, which lends itself well to the frequent patient care handoffs that occur in the practice of hospital medic...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-020-06235-w
更新日期:2020-12-01 00:00:00
abstract::We surveyed employers of general internists at teaching hospitals to determine whether they prefer that new hires are graduates of general internal medicine (GIM) fellowships. We surveyed former GIM fellows who graduated between 1988 and 1994 to determine whether they found jobs with protected research time and whethe...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1998.00121.x
更新日期:1998-06-01 00:00:00
abstract::To investigate the value of home urine glucose testing in assessing chronic diabetic glucose control, the authors compared patients' glycosuria patterns with their mean blood glucose (MBG) levels calculated from glycosylated hemoglobin (Hb Alc). One hundred and twenty-one patients who regularly checked their urines re...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02596192
更新日期:1986-07-01 00:00:00
abstract:BACKGROUND:Thirty-day readmission penalties implemented with the Hospital Readmission Reduction Program (HRRP) place a larger burden on safety-net hospitals which treat a disproportionate share of racial minorities, leading to concerns that already large racial disparities in readmissions could widen. OBJECTIVE:To exa...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-04841-x
更新日期:2019-06-01 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:OBJECTIVE:To examine the association of clinic HIV-focused features and advanced HIV care experience with Pneumocystis carinii pneumonia (PCP) prophylaxis and development of PCP as the initial AIDS diagnosis. DESIGN:Nonconcurrent prospective study. SETTING:New York State Medicaid Program. PARTICIPANTS:Medicaid enrol...
journal_title:Journal of general internal medicine
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1046/j.1525-1497.1998.00003.x
更新日期:1998-01-01 00:00:00
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 be...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05169-2
更新日期:2019-09-01 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 determine whether a Bayesian method of lung scan (LS) reporting could influence the management of patients with suspected pulmonary embolism (PE). DESIGN:1) A descriptive study of the diagnostic process for suspected PE using the new reporting method; 2) a non-experimental evaluation of the reporting meth...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02600392
更新日期:1990-07-01 00:00:00
abstract:BACKGROUND:Health systems are increasingly implementing remote telephone and Internet refill systems to enhance patient access to medication refills. Remote refill systems may provide an effective approach for improving medication non-adherence, but more research is needed among patients with limited English proficienc...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-015-3500-6
更新日期:2016-03-01 00:00:00
abstract:OBJECTIVE:The objective of the study was to identify potential explanatory factors for racial differences in blood pressure (BP) control. DESIGN:The design of the study was a cross-sectional study PATIENTS/PARTICIPANTS:The study included 608 patients with hypertension who were either African American (50%) or white (...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-008-0547-7
更新日期:2008-05-01 00:00:00
abstract:PURPOSE:Anxiety is thought to affect test performance. Studies have shown that students with low levels of test anxiety achieve higher scores on multiple choice question (MCQ) examinations than those with high anxiety levels. Female students have been shown to have higher test anxiety levels than male students. Standar...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2006.00419.x
更新日期:2006-05-01 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 the impact of an episode of serious cardiovascular disease on smoking behavior and to identify factors associated with smoking cessation in this setting. DESIGN:Prospective observational study in which smokers admitted to a coronary care unit (CCU) were followed for one year after hospital disch...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02597426
更新日期:1991-07-01 00:00:00
abstract:BACKGROUND:The 2016 presidential election and the controversial policy agenda of its victor have raised concerns about how the election may have impacted mental health. OBJECTIVE:Assess how mental health changed from before to after the November 2016 election and how trends differed in states that voted for Donald Tru...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-06328-6
更新日期:2020-10-31 00:00:00
abstract::Physicians and patients increasingly use social media technologies, such as Facebook, Twitter, and weblogs (blogs), both professionally and personally. Amidst recent reports of physician misbehavior online, as well as concerns about social media's potential negative effect on trust in the medical profession, several n...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-012-2251-x
更新日期:2013-02-01 00:00:00
abstract:BACKGROUND:Discharge planning is an important component of hospital care. The Blaylock Risk Assessment Screening Score (BRASS) index is an instrument used to identify patients requiring complex discharge planning. OBJECTIVES:(1) Evaluate the ability of the original BRASS index to predict the risk of complex discharge ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-018-4405-y
更新日期:2018-07-01 00:00:00
abstract::Academic departments of family medicine and divisions of general internal medicine and general pediatrics exist in the majority of medical schools in the United States and have important roles in generalist medical education. The major organizational issues facing these units concern institutional influence, faculty d...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/BF02598123
更新日期:1994-04-01 00:00:00
abstract:BACKGROUND:Pay-for-performance (P4P) has been used expansively to improve quality of care delivered by physicians. However, to what extent P4P works through the provision of information versus financial incentives is poorly understood. OBJECTIVE:To determine whether an increase in information feedback without changes ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05004-8
更新日期:2019-09-01 00:00:00
abstract:BACKGROUND:Understanding the impact of the COVID-19 pandemic on healthcare workers (HCW) is crucial. OBJECTIVE:Utilizing a health system COVID-19 research registry, we assessed HCW risk for COVID-19 infection, hospitalization, and intensive care unit (ICU) admission. DESIGN:Retrospective cohort study with overlap pro...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-06171-9
更新日期:2020-11-01 00:00:00
abstract:BACKGROUND:To appropriately manage uncontrolled hypertension, clinicians must decide whether blood pressure (BP) is above goal due to a need for additional medication or to medication nonadherence. Yet, clinicians are poor judges of adherence, and uncertainty about adherence may promote inertia with respect to medicati...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-016-3757-4
更新日期:2016-11-01 00:00:00
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
更新日期:2008-08-01 00:00:00
abstract:OBJECTIVE:Patients' self-management practices have substantial consequences on morbidity and mortality in diabetes. While the quality of patient-physician relations has been associated with improved health outcomes and functional status, little is known about the impact of different patient-physician interaction styles...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.2002.10905.x
更新日期:2002-04-01 00:00:00
abstract:OBJECTIVE:To examine the impact of the New Haven Community Health Care Van (CHCV), a mobile needle exchange-based health care delivery system, in reducing emergency department (ED) use among out-of-treatment injection drug users (IDUs) between January 1, 1996 and December 31, 1998. DESIGN:A pre-post comparison of ED u...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:
更新日期:2002-05-01 00:00:00
abstract:BACKGROUND:Many primary care physicians (PCPs) are ill-equipped to provide screening and counseling for inherited breast cancer. OBJECTIVE:To evaluate the outcomes of an interactive web-based genetics curriculum versus text curriculum for primary care physicians. DESIGN:Randomized two-group design. PARTICIPANTS:121 ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-014-3113-5
更新日期:2015-03-01 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:This study explores the alignment between physicians' confidence in their diagnoses and the "correctness" of these diagnoses, as a function of clinical experience, and whether subjects were prone to over-or underconfidence. DESIGN:Prospective, counterbalanced experimental design. SETTING:Laboratory study co...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1525-1497.2005.30145.x
更新日期:2005-04-01 00:00:00
abstract:OBJECTIVE:To determine whether the results of the Internal Medicine In-Training Examination (ITE) can predict subsequent performance on the American Board of Internal Medicine certifying examination (ABIMCE). DESIGN:Retrospective data review. SETTING:A mixture of six community hospital and university-based internal m...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599105
更新日期:1992-01-01 00:00:00