Journal of General Internal Medicine最新文献

{"title":"Exclusion of Older Adults from Obesity Treatment Pivotal Trials of GLP-1RAs and GIP/GLP-1RAs.","authors":"Alissa S Chen, Yixuan Liang, Kasia J Lipska, Joseph S Ross, Reshma Ramachandran","doi":"10.1007/s11606-025-09769-z","DOIUrl":"https://doi.org/10.1007/s11606-025-09769-z","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Care Provider Continuity in Traditional Medicare and Medicare Advantage.","authors":"Wendy Y Xu, Eli Raver, Sheldon M Retchin, Jeah Jung","doi":"10.1007/s11606-025-09738-6","DOIUrl":"https://doi.org/10.1007/s11606-025-09738-6","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glow.","authors":"Sam Woodworth","doi":"10.1007/s11606-025-09761-7","DOIUrl":"https://doi.org/10.1007/s11606-025-09761-7","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coaching Our Learners to Success.","authors":"Stacy Higgins, Rachel Bonnema","doi":"10.1007/s11606-025-09747-5","DOIUrl":"https://doi.org/10.1007/s11606-025-09747-5","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Collaborative Care: The Importance of Community Partnerships in Hospital Medicine.","authors":"Christine Santiago, Kevin Schulman, Neera Ahuja, Jason Hom, Jonathan G Shaw, Alexandria Blacker","doi":"10.1007/s11606-025-09768-0","DOIUrl":"https://doi.org/10.1007/s11606-025-09768-0","url":null,"abstract":"<p><p>In the evolving landscape of healthcare, hospital medicine is expanding beyond traditional boundaries to address social drivers of health (SDOHs), which necessitates increased community partnership and engagement. At Stanford Medicine, the Division of Hospital Medicine has pioneered initiatives to enhance patient outcomes by addressing critical SDOH such as housing and food insecurity. Within our academic hospitalist division, the establishment of a Director of Community Partnership role in 2024 marked a significant step in recognizing and addressing the SDOH needs of hospitalized patients. Collaborative efforts with local Medicaid plans, county systems, and private non-profit organizations have facilitated improved care transitions, specialty care access, and support services. For instance, partnerships with Santa Clara County and Mom's Meals have, respectively, enabled the provision of permanent supportive housing and medically tailored meals to vulnerable patients. These initiatives underscore the importance of community-academic partnerships in fostering health equity, studying the impacts of various interventions, and improving patient care. Despite challenges posed by evolving Centers for Medicare & Medicaid Services policies (e.g., proposed rule changes include removing SDOH screening metrics), the commitment to building sustainable, bidirectional relationships with community organizations remains crucial. Hospitalists, despite being focused on inpatient care, should engage in these partnerships, as they can significantly impact health outcomes. This perspective highlights the transformative potential of community-academic partnerships in hospital medicine and calls for continued efforts to integrate SDOH considerations into patient care.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Decision Support to Increase Naloxone Co-prescribing from the Inpatient Setting.","authors":"Jacob A Lebin, Kaitlin Mitchell, Katy E Trinkley, Susan L Calcaterra, Zhixin Lun, Colin Hensen, Jason A Hoppe","doi":"10.1007/s11606-025-09772-4","DOIUrl":"https://doi.org/10.1007/s11606-025-09772-4","url":null,"abstract":"<p><strong>Background: </strong>Co-prescribing naloxone alongside opioid prescriptions reduces fatal opioid overdose risk in patients discharged from inpatient care, yet its adoption remains limited. Clinical decision support (CDS) tools are effective in increasing naloxone co-prescribing in emergency and primary care settings, but data from the inpatient setting is sparse.</p><p><strong>Objective: </strong>To evaluate the effectiveness of an electronic health record (EHR)-integrated CDS tool on rates of naloxone co-prescribing for patients discharged from inpatient care with high-risk opioid prescriptions.</p><p><strong>Design: </strong>This observational, pre-post study evaluated an EHR-embedded CDS tool implemented within an integrated health system between July 10, 2011, and July 15, 2023.</p><p><strong>Study sample: </strong>Adult patients discharged from inpatient care with opioid prescriptions that met the Centers for Disease Control and Prevention high-risk criteria for opioid prescribing.</p><p><strong>Interventions: </strong>A multidisciplinary team designed an interruptive CDS best practice alert to identify high-risk opioid prescriptions. The CDS offered prescribers a one-click option to add a naloxone co-prescription.</p><p><strong>Main measures: </strong>Outcomes are organized under the RE-AIM implementation science framework, with the primary outcome, Effectiveness, measured by the proportion of patients receiving a naloxone prescription. Secondary outcomes include patient Reach, clinician Adoption, and fidelity to Implementation. Bayesian structural time-series models were used to evaluate differences in outcomes.</p><p><strong>Key results: </strong>During the study period, there were 355,465 inpatient discharges. In the post-intervention period, the CDS was triggered in 2.2% (7799/355,465) of all discharges and 6.36% (7799/122,643) of all discharge opioid prescriptions. Compared to the pre-implementation period, CDS was associated with a weekly increase in inpatient naloxone co-prescribing by 4.7 prescriptions per 100 opioid prescriptions (95% CI 4.3-5, p = 0.001).</p><p><strong>Conclusions: </strong>Implementation of an EHR-embedded CDS was associated with increased naloxone co-prescribing for high-risk opioid prescriptions in the inpatient setting. This finding demonstrates the potential of targeted, interruptive CDS tools to enhance opioid safety efforts in the inpatient setting.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insurance Status Among Asian Americans with Cancer: A Disaggregated Analysis.","authors":"Lilac Nguyen, Isabella Nguyen, Emily Feng, Eric Feng, Erin Jay Garbes Feliciano, Edward Christopher Dee","doi":"10.1007/s11606-025-09718-w","DOIUrl":"https://doi.org/10.1007/s11606-025-09718-w","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Pilot Program to Improve H. pylori Screening and Treatment in the US Immigrant and Refugee Population.","authors":"Ramya Radhakrishnan, Robert C Lowe, Sarah L Kimball, Charles M Bliss, Laura S Chiu","doi":"10.1007/s11606-025-09777-z","DOIUrl":"https://doi.org/10.1007/s11606-025-09777-z","url":null,"abstract":"<p><strong>Introduction: </strong>The refugee community in the US is an understudied population that presents with the unique challenge of having endemic health morbidities, yet is screened under guidelines for the undifferentiated US population.</p><p><strong>Objective: </strong>This pilot study aims to improve Helicobacter pylori testing and treatment prescribing practice via a curriculum consisting of four interactive core modules presented to clinical trainees/educators.</p><p><strong>Design: </strong>The case-based workshop curriculum consisted of four interactive core modules delivered through PowerPoint presentation to medical trainees working in the Immigrant and Refugee Health Center (IRHC). Participants were surveyed before and after each session using an internally developed questionnaire. Pre- and post-test data were analyzed using paired T-test analysis. The number of patients who were ordered for and completed H. pylori stool or breath testing and antibiotic therapy was identified before and after the educational intervention, and compared using paired T-test analysis.</p><p><strong>Participants: </strong>A total of 51 participants were observed. Participants were clinical trainees and educators, including 38 internal medicine residents, 6 attendings, and 7 medical students working in the clinic.</p><p><strong>Key results: </strong>A paired T-test analysis comparing pre- vs. post-survey questionnaire accuracy per knowledge category showed a statistically significant increase in knowledge transfer for 5 out of the 6 survey questions. A statistically significant difference in the average percentage of patients appropriately ordered for H. pylori testing when comparing pre- vs. post-intervention period was observed (5.9% vs. 11.0%, p-value = 0.019).</p><p><strong>Conclusion: </strong>This study demonstrates the feasibility of implementing a novel pilot program to address disparities in H. pylori screening and treatment in the refugee community. This intervention can serve as a pilot for future quality-based programs in refugee clinics in other high-risk hospital systems.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smarter Screening and Treatment (S3T): Mitigating Harm via Age- and Prostate-Specific Antigen-Stratified Screening.","authors":"James Nie, Nynikka R Palmer, Rena J Pasick, Maria Byron, Claire M de la Calle, Samuel L Washington, Coleen Kivlahan, Michael B Potter, Matthew R Cooperberg","doi":"10.1007/s11606-025-09737-7","DOIUrl":"https://doi.org/10.1007/s11606-025-09737-7","url":null,"abstract":"<p><strong>Introduction: </strong>Consensus on optimal prostate cancer screening remains elusive. Prostate-specific antigen (PSA) testing of patients in their 40-50 s is highly predictive of aggressive disease, yet remains underutilized; Black patients face excess mortality burden, particularly at younger ages. We describe a novel age and baseline PSA-stratified protocol to mitigate harms of overdiagnosis and reduce burden of disease, particularly for Black patients, with implementation by primary care providers (PCPs) in an academic healthcare system.</p><p><strong>Methods: </strong>We developed an evidence-based, age- and baseline PSA-stratified protocol and disseminated it to PCPs via talks and written materials beginning in 2016, with implementation as a health maintenance banner in the electronic health record (EHR) in 2019. EHR data were searched for rates of PSA screening within the prior 5 years in patients aged 40-90 from 2015 to 2021. We examined associations between age and race with receipt of PSA testing over time. Multivariable hierarchical mixed effects regression was performed to identify testing predictors, with clinic and provider included as nested random effects.</p><p><strong>Results: </strong>Across 99,994 encounters, guideline-concordant PSA screening increased from 32.7 to 45.8% from 2015 to 2021 (p < 0.001) despite COVID-19. PSA screening among Black patients aged 40-75 increased from 29.7 to 52.8% by 2021, with notable gains among younger Black patients. In a mixed effects model, Black patients were more likely to undergo PSA screening (OR 1.35, 95% CI 1.29-1.42). Screening was less likely in geriatric clinics, and there was a wide range in screening (0-75%) rates across individual PCPs.</p><p><strong>Conclusions: </strong>Multidisciplinary collaboration, PCP outreach, and an EHR-based intervention improved PSA-based screening, particularly for younger Black patients. Significant provider variation in screening rates persists, suggesting the need for continued PCP engagement.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trigeminal Trophic Syndrome of the Forehead: The Art of Observation in Clinical Diagnosis.","authors":"Thomas Le, James Vu, Adrienne Atencio","doi":"10.1007/s11606-025-09753-7","DOIUrl":"https://doi.org/10.1007/s11606-025-09753-7","url":null,"abstract":"<p><p>A female patient with a history of herpes zoster ophthalmicus presented with a chronic, right-sided facial ulcer consistent with trigeminal trophic syndrome (TTS), triggered by wound-picking due to concurrent anxiety and depression. TTS is a rare disorder diagnosed clinically and managed with behavioral modification alongside medical treatment.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}