Abstract:
OBJECTIVE:Determine patient and hospital-level variation in proportions of low-severity admissions. DESIGN:Retrospective cohort study. SETTING:Thirty hospitals in a large metropolitan region. PATIENTS:A total of 43,209 consecutive eligible patients discharged in 1991 through 1993 with congestive heart failure (n = 25,213) or pneumonia (n = 17,995). MEASUREMENTS AND MAIN RESULTS:Admission severity of illness was measured from validated multivariable models that estimated the risk of in-hospital death; models were based on clinical data abstracted from patients' medical records. Admissions were categorized as "low severity" if the predicted risk of death was less than 1%. Nearly 15% of patients (n = 6,382) were categorized as low-severity admissions. Compared with other patients, low-severity admissions were more likely (p < .001) to be nonwhite and to have Medicaid or be uninsured. Low-severity admissions had shorter median length of stay (4 vs 7 days; p < .001), but accounted for 10% of the total number of hospital days. For congestive heart failure, proportions of low-severity admissions across hospitals ranged from 10% to 25%; 12 hospitals had rates that were significantly different (p < .01) than the overall rate of 17%. For pneumonia, proportions ranged from 3% to 22%; 12 hospitals had rates different from the overall rate of 12%. Variation across hospitals remained after adjusting for patient sociodemographic factors. CONCLUSIONS:Rates of low-severity admissions for congestive heart failure and pneumonia varied across hospitals and were higher among nonwhite and poorly insured patients. Although the current study does not identify causes of this variability, possible explanations include differences in access to ambulatory services, decisions to admit patients for clinical indications unrelated to the risk of hospital mortality, and variability in admission practices of individual physicians and hospitals. The development of protocols for ambulatory management of low-severity patients and improvement of access to outpatient care would most likely decrease the utilization of more costly hospital services.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Rosenthal GE,Harper DL,Shah A,Covinsky KEdoi
10.1046/j.1525-1497.1997.00073.xsubject
Has Abstractpub_date
1997-07-01 00:00:00pages
416-22issue
7eissn
0884-8734issn
1525-1497journal_volume
12pub_type
杂志文章,多中心研究abstract:BACKGROUND:Despite significant investment in colorectal cancer (CRC) screening, 40% of US adults are not up-to-date. Commitment devices, which are psychologically tailored approaches to enforce health goals, may be an effective method to increase CRC screening. OBJECTIVE:Compare the effectiveness of a commitment devic...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-06392-y
更新日期:2021-01-20 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:OBJECTIVE:We examined the clinical utility of supplementing type 2 diabetes mellitus (DM) risk counseling with DM genetic test results and counseling. RESEARCH DESIGN AND METHODS:In this randomized controlled trial, non-diabetic overweight/obese veteran outpatients aged 21 to 65 years received DM risk estimates for li...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-015-3315-5
更新日期:2015-11-01 00:00:00
abstract:BACKGROUND:Many employers offer worksite wellness programs, including financial incentives to achieve goals. Evidence supporting such programs is sparse. OBJECTIVE:To assess whether diabetes and cardiovascular risk factor control in employees improved with financial incentives for participation in disease management a...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-016-3686-2
更新日期:2016-08-01 00:00:00
abstract::The study examined the relative contribution of caregivers' conduct and physical conditions of the hospital setting to patients' global satisfaction with health care, while controlling for self-assessed health status. The study was performed in the Soroka Medical Center, which is the only inpatient facility for a popu...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02598274
更新日期:1996-05-01 00:00:00
abstract:BACKGROUND:The double-blind placebo-controlled design is commonly considered the gold standard in research methodology; however, subject expectation bias could subvert blinding. OBJECTIVE:The primary aim of this study was to examine the impact of expectation bias. Specifically, we examined perceived treatment assignme...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-008-0656-3
更新日期:2008-09-01 00:00:00
abstract:OBJECTIVE:Methods of assessing humanism in internal medicine residents have not been completely designed or evaluated. This study used patient satisfaction as a measure of humanism, and assessed the validity of using faculty physicians to evaluate residents' humanistic behavior. Residents' ability to assess themselves ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599551
更新日期:1989-11-01 00:00:00
abstract:BACKGROUND:Many seniors rely on paid non-familial caregivers to maintain their independence at home. Caregivers often assist with medication reminding and activities of daily living. No prior studies have examined the health literacy levels among paid non-familial caregivers. OBJECTIVES:To determine health literacy le...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-010-1596-2
更新日期:2011-05-01 00:00:00
abstract:OBJECTIVE:To evaluate patient-provider agreement on whether weight and related behaviors were discussed during routine visits. DESIGN:Post-visit survey assessments of patients and providers. PARTICIPANTS:Obese patients make up the majority of all patients seen in primary care (PC). The patients and physicians were re...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-008-0553-9
更新日期:2008-05-01 00:00:00
abstract:BACKGROUND:Guidelines recommend administration of antibiotics with activity against methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa for treatment of healthcare-associated pneumonia (HCAP). It is unclear if this therapy improves outcomes for patients with HCAP. OBJECTIVE:To determine if ad...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-012-2011-y
更新日期:2012-07-01 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:OBJECTIVE:To assess whether newer antipsychotic medications are associated with weight gain and development of diabetes. DESIGN:Retrospective cohort study. SETTING:Data from a comprehensive electronic medical record serving an urban public hospital and a citywide network of mental health clinics. PATIENTS/PARTICIPAN...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2004.40126.x
更新日期:2004-12-01 00:00:00
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
更新日期:2002-10-01 00:00:00
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
更新日期:2008-09-01 00:00:00
abstract:BACKGROUND:Whether patients' reports of gaps in care coordination reflect clinically significant problems is unclear. OBJECTIVE:To determine any association between patient-reported gaps in care coordination and patient-reported preventable adverse outcomes. DESIGN AND PARTICIPANTS:We administered a cross-sectional s...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-06047-y
更新日期:2020-12-01 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:In 2005 the Spoken Knowledge in Low Literacy in Diabetes scale (SKILLD) was introduced as a diabetes knowledge test. The SKILLD has not been validated since its introduction. OBJECTIVE:To perform a validation analysis on the SKILLD. DESIGN AND PARTICIPANTS:Cross-sectional observational study of 240 patient...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-011-1900-9
更新日期:2012-02-01 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:BACKGROUND:Clinician's knowledge of a woman's cancer family history (CFH) and counseling about health-related behaviors (HRB) is necessary for appropriate breast cancer care. OBJECTIVE:To evaluate whether clinicians solicit CFH and counsel women on HRB; to assess relationship of well visits and patient risk perception...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-006-0087-y
更新日期:2007-03-01 00:00:00
abstract:BACKGROUND:Few data have evaluated the relationship between caregiving and cardiovascular disease (CVD) risk. OBJECTIVE:The purpose of this study was to determine the prevalence and predictors of caregiver strain and to evaluate the association between caregiving and CVD lifestyle and psychosocial risk factors among f...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-008-0852-1
更新日期:2009-01-01 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:OBJECTIVE:To compare the prevalence of major medical problems in homeless and nonhomeless patients. PATIENTS:All 475 persons seeking care at an ambulatory clinic serving the medically indigent for one calendar year. INTERVENTION:None. MEASUREMENTS AND MAIN RESULTS:Demographic and clinical data were collected by stru...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02598086
更新日期:1992-05-01 00:00:00
abstract:BACKGROUND:As healthcare reimbursement shifts from being volume to value-focused, new delivery models aim to coordinate care and improve quality. The patient-centered medical home (PCMH) model is one such model that aims to deliver coordinated, accessible healthcare to improve outcomes and decrease costs. It is unclear...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-019-05594-3
更新日期:2020-04-01 00:00:00
abstract:BACKGROUND:Patient-centered medical home (PCMH) models of primary care have the potential to expand access, improve population health, and lower costs. Federally qualified health centers (FQHCs) were early adopters of PCMH models. OBJECTIVE:We measured PCMH capabilities in a diverse nationwide sample of FQHCs and asse...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-017-4078-y
更新日期:2017-09-01 00:00:00
abstract:BACKGROUND:National guidelines indicate that healthcare providers should routinely screen women of reproductive age for experience of intimate partner violence. We know little about intimate partner violence (IPV) screening and disclosure experience among women older than reproductive age. OBJECTIVE:To examine the per...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-05947-3
更新日期:2020-09-01 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:BACKGROUND:Beta-blockers have been shown to improve survival in patients with congestive heart failure (CHF). However, few studies have looked at the effects of these medications specifically in women. OBJECTIVE:To determine the effectiveness of beta-blockers in women with CHF. PATIENTS:We conducted a retrospective c...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0197-1
更新日期:2007-07-01 00:00:00
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
更新日期:2012-12-01 00:00:00
abstract:BACKGROUND:Not all primary care clinics are prepared to implement care coordination services for chronic conditions, such as diabetes. Understanding true capacity to coordinate care is an important first-step toward establishing effective and efficient care coordination. Yet, we could identify no diabetes-specific inst...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-013-2566-2
更新日期:2014-01-01 00:00:00
abstract::To describe the determinants of patient satisfaction with medical care, self-administered questionnaires were given to a consecutive sample of 237 patients coming to an ambulatory care practice for the treatment of upper respiratory infections (URIs). Patients' most important goal was to obtain a diagnosis (57%). They...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599162
更新日期:1992-07-01 00:00:00