Journal of General Internal Medicine最新文献

{"title":"Association Between Medical Debt and Vaccine Uptake in the USA, 2021-2022.","authors":"Kathryn E W Himmelstein, Amir M Mohareb","doi":"10.1007/s11606-024-09183-x","DOIUrl":"10.1007/s11606-024-09183-x","url":null,"abstract":"<p><strong>Background: </strong>Many individuals do not receive recommended vaccines, increasing infectious disease morbidity and mortality. It is unknown whether the financial practices of US healthcare institutions contribute to vaccine hesitancy.</p><p><strong>Objective: </strong>To determine whether medical debt is associated with low vaccine uptake.</p><p><strong>Design: </strong>Cross-sectional analysis of the association between medical debt and vaccine receipt.</p><p><strong>Subjects: </strong>56,373 adult participants in the 2021-2022 National Health Interview Survey.</p><p><strong>Interventions: </strong>Presence of medical debt at the time of survey administration.</p><p><strong>Main measures: </strong>We used logistic regression models to assess whether medical debt was associated with recent vaccine receipt, adjusting for sociodemographic, health, and access-to-care variables. We performed a sensitivity analysis restricted to individuals with health insurance and conducted a falsification test of the hypothesis that current medical debt would not be associated with remote prior vaccination (i.e., > 1 year prior, likely before debt acquisition).</p><p><strong>Key results: </strong>Individuals with medical debt were less likely than those without such debt to receive any recent vaccine (adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI] 0.76-0.91), including influenza vaccination (aOR 0.83, 95% CI 0.75-0.91) or COVID-19 vaccination (aOR 0.79, 95% CI 0.69-0.91). Analyses limited to insured individuals had similar findings (aOR for any recent vaccination 0.79, 95% CI 0.72-0.88). In the falsification test, current medical debt was not associated with remote prior vaccination (aOR 1.04, 95% CI 0.93-1.16).</p><p><strong>Conclusions: </strong>Current medical debt is associated with lower likelihood of recent vaccine receipt in both insured and uninsured individuals. Policies that minimize medical debt may improve vaccine coverage.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1851-1858"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Preferences for Code Status Discussions: A Randomized Trial of Information- vs. Patient Values-Centered Frameworks.","authors":"Christopher Joshi, Sehrish Malik, Wei Wang, Kei Ouchi","doi":"10.1007/s11606-024-09243-2","DOIUrl":"10.1007/s11606-024-09243-2","url":null,"abstract":"<p><strong>Background: </strong>Helping patients make decisions about their preferences for cardiopulmonary resuscitation (i.e., code status) is an important way to respect patient autonomy in the hospital. There is a gap in understanding which framework of discussion patients prefer for this decision-making.</p><p><strong>Objective: </strong>To determine which of two frameworks to code status discussions-information-centered or patient values-centered-make patients feel more heard and understood about their preferences regarding cardiopulmonary resuscitation (CPR).</p><p><strong>Design: </strong>Prospective, randomized study comparing two different frameworks to CPR discussion.</p><p><strong>Participants: </strong>We enrolled adult patients with one or more serious illnesses who were recently discharged from an urban, tertiary care, academic medical center in Boston, MA.</p><p><strong>Interventions: </strong>Subjects were randomized to receive either the information-centered framework, in which their likelihood of recovery following CPR was shared, or the patient values-centered framework, in which their personal values were elicited and used to make a recommendation.</p><p><strong>Main measures: </strong>Subject-reported heard and understood rating with regard to their preferences for CPR.</p><p><strong>Key results: </strong>Of the 46 subjects enrolled, 25 (54.3%) were male, 42 (91.3%) were White, and 3 (6.5%) were Black. Mean age was 66.4 ± 11.8 years. Subjects reported feeling more \"heard and understood\" about their preferences for CPR with the patient values-centered framework compared with after the information-centered framework (p = 0.033). When asked, 89% of subjects \"definitely\" or \"probably\" wanted to hear their doctor's personalized recommendation about CPR (p < 0.001).</p><p><strong>Conclusion: </strong>Patients, in line with palliative care experts, largely support a patient values-centered framework to CPR, including a recommendation made by the clinician based on the patient's expressed values.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1829-1835"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reframing Micronutrient Deficiencies for Modern times: A Review.","authors":"Azadeh Lankarani-Fard, Maria Romanova, Zhaoping Li","doi":"10.1007/s11606-025-09481-y","DOIUrl":"10.1007/s11606-025-09481-y","url":null,"abstract":"<p><p>Micronutrient deficiencies are often discounted in as an entity of the past when access to quality nutrition was scarce. However modern-day conditions such as hemodialysis, complex medication interactions, parenteral nutrition, gastrointestinal resections, institutional living, and substance use can place patients at risk. The metabolic demands of critical illness during prolonged hospitalization may provide added stressors. Food insecurity with reliance on inexpensive calorie-rich, nutrient poor diet may lead to deficiency without overt evidence of malnutrition. Moreover, clinical presentation may be subtle and easily attributed to other diagnoses. Increased awareness of current risk factors is essential for detection and treatment.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1735-1741"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unbanked Status Among Individuals with Diabetes: Exploring Reasons, Correlates, and Implications for Financial and Health Outcomes.","authors":"Minal R Patel","doi":"10.1007/s11606-024-09245-0","DOIUrl":"10.1007/s11606-024-09245-0","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1933-1935"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Tool to Measure Potentially Inappropriate Inter-Hospital Transfer (IHT): The POINT Study.","authors":"Stephanie K Mueller, Caitlin Kelly, Stephanie Singleton, Luci K Leykum, James D Harrison, Andrew Auerbach, Jeffrey Schnipper","doi":"10.1007/s11606-024-09221-8","DOIUrl":"10.1007/s11606-024-09221-8","url":null,"abstract":"<p><strong>Background: </strong>Although inter-hospital transfer (IHT, the transfer of patients between acute care hospitals) aims at matching patients' care needs to appropriate sites of care, IHT practices are variable leaving some patients vulnerable to risks of discontinuity of care without clear benefit. Identifying which patients may not need IHT can help to prevent inappropriate care and improve patient outcomes.</p><p><strong>Study overview: </strong>The POINT Study, \"Identification and Prevention of Potentially Inappropriate Inter-Hospital Transfers,\" is a 5-year study (AHRQ-R01HS028621) that aims to define potentially inappropriate IHT using key stakeholder input, evaluate the incidence and patient safety impact of potentially inappropriate IHT across a nationally representative sample of 18 hospitals, and develop an intervention toolkit to reduce potentially inappropriate IHT. In this paper, we report on the development of a standardized adjudication process to capture potentially inappropriate IHT using results generated from the first 2 years of this project.</p><p><strong>Development of the adjudication tool: </strong>Development of the adjudication tool to measure potentially inappropriate IHT involved a multi-step process, including (1) conducting focus groups of key stakeholders involved in IHT to generate a consensus definition of \"potentially inappropriate IHT;\" (2) translating this definition into an adjudication tool for use during retrospective chart review; and (3) conducting rigorous training among all adjudicators to ensure reliability of the adjudication process.</p><p><strong>Next steps: </strong>Next steps include launching sites to conduct adjudications with a goal of 1800 total transfer case adjudications across the 18 sites. We will support the adjudication process with monthly tracking and case review meetings among other supports. The results of this work will lead to a foundational understanding of the prevalence, risk factors, and patient safety impact of potentially inappropriate IHT.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1917-1923"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-Sectional Evaluation of State-Level Protections, Medical Debt, and Deferred Care Among Sexual and Gender Minority People.","authors":"Emily Lupton Lupez, Steffie Woolhandler, David U Himmelstein, Samuel Dickman, Elizabeth Schrier, Lenore S Azaroff, Chris Cai, Danny McCormick","doi":"10.1007/s11606-024-09258-9","DOIUrl":"10.1007/s11606-024-09258-9","url":null,"abstract":"<p><strong>Background: </strong>Millions of Americans have medical debt and/or defer care due to cost. Few studies have examined the association of such health-related financial problems with sexual orientation or gender identity, and whether state-level policies protecting sexual and gender minority (SGM) people affect disparities in such problems.</p><p><strong>Objective: </strong>To examine the relationships between SGM status, state-level SGM protections, and health-related financial problems.</p><p><strong>Design: </strong>Cross-sectional analysis.</p><p><strong>Participants: </strong>Nationally-representative sample of U.S. adults in the 2021 National Financial Capability Study.</p><p><strong>Main measures: </strong>Prevalence of medical debt and/or deferred care; adjusted odds ratios (aORs) by SGM status and residence in a state with fewer SGM protections.</p><p><strong>Key results: </strong>Of 25,170 survey respondents, 3.7% were gay/bisexual men, 4.3% lesbian/bisexual women, and 0.6% transgender people. Among lesbian/bisexual women, 39.4% had medical debt, the highest proportion of any group. Accounting for sociodemographic and personal-financial factors, women and all lesbian/gay/bisexual persons (vs. straight men) more often experienced medical debt (aOR [95% CI]: straight women 1.28 [1.16, 1.41], gay/bisexual men 1.55 [1.23, 1.94], lesbian/bisexual women 1.80 [1.50, 2.10]) or deferred care (e.g., 1.80 [1.51, 2.16] for lesbian/bisexual women). Transgender people vs. cisgender men were more likely to defer care (aOR = 2.58 [1.54, 4.30]). Living in a state with fewer SGM protections was associated with higher rates of health-related financial problems for most groups, especially cisgender women and lesbian/bisexual women.</p><p><strong>Conclusions: </strong>Lesbian/gay/bisexual, female, and transgender adults experience more health-related financial problems, especially in states lacking SGM protections, underlining the importance of universal, comprehensive insurance coverage (including for services unique to SGM people), ending bans on gender-affirming care, and closing the male-female pay gap.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1859-1868"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-Reported Time-at-Bedside and Its Association with In-Training Examination Scores of Residents in Japan.","authors":"Kohta Katayama, Toshihiko Takada, Yuji Nishizaki, Kazuya Nagasaki, Taro Shimizu, Yu Yamamoto, Takashi Watari, Yasuharu Tokuda, Vineet Chopra, Yoshiyuki Ohira","doi":"10.1007/s11606-024-09244-1","DOIUrl":"10.1007/s11606-024-09244-1","url":null,"abstract":"<p><strong>Background: </strong>Time-at-bedside plays a central role in clinical medicine. However, the amount of time Japanese clinical residents spend at patients' bedsides remains unexplored.</p><p><strong>Objective: </strong>To quantify time-at-bedside and examine its association with in-training examination scores during clinical residency in Japan.</p><p><strong>Design: </strong>Nationwide multicenter cross-sectional study.</p><p><strong>Participants: </strong>First- and second-year postgraduate residents who took the General Medicine In-Training Examination at the end of the 2022 academic year.</p><p><strong>Interventions: </strong>Time-at-bedside was defined as the average time per day the residents spend providing care at patients' bedsides during their residency. Time-at-bedside was classified into six categories: C1 (10-20 min per day), C2 (30-50 min per day), C3 (60-80 min per day), C4 (90-110 min per day), C5 (120-140 min per day), and C6 (150 min or more per day). Data on time-at-bedside were collected through an electronic survey conducted immediately after the General Medicine In-Training Examination.</p><p><strong>Main measures: </strong>The primary outcome was the General Medicine In-Training Examination score. A multi-level analysis examined the association between self-reported time-at-bedside and the General Medicine In-Training Examination score.</p><p><strong>Key results: </strong>A total of 5344 residents were included in this study. Of these, 2760 were first-year residents, and 2584 were second-year residents. Of the 5334 residents, 66.9% reported spending less than 60 min at a patient's bedside. Compared to the C1, C2 (adjusted score difference [aSD] = 1.1, 95% confidence interval [95% CI] 0.48 to 1.79), C3 (aSD = 1.5, 95% CI 0.75 to 2.20), and C5 (aSD = 2.0, 95 CI 0.62 to 3.38) were positively associated with the General Medicine In-Training Examination score. However, C4 (aSD = 1.1, 95% CI - 0.15 to 2.26) and C6 (aSD = 0, 95% CI - 1.79 to 1.87) were not associated with the General Medicine In-Training Examination score.</p><p><strong>Conclusion: </strong>Self-reported time-at-bedside positively correlates with in-training examination scores among Japanese resident physicians.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1768-1775"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scholars in Health Equity: A Program of Structured Physician Faculty Development.","authors":"Jeffrey Ring, Daisy Torres, Rosio Ramos, Cristina M Gonzalez, Musarrat Nahid, Susana Morales, Erica Phillips","doi":"10.1007/s11606-024-09281-w","DOIUrl":"10.1007/s11606-024-09281-w","url":null,"abstract":"<p><strong>Background: </strong>Structured faculty development programs focused on integrating health equity into medical education curricula remain limited.</p><p><strong>Aim: </strong>To describe an interdisciplinary faculty development program grounded in adult learning theory and to assess its impact on participants' professional growth.</p><p><strong>Setting and participants: </strong>Twenty-one faculty members across six academic-affiliated health systems.</p><p><strong>Program description: </strong>Fourteen 2-h monthly sessions were delivered over one full year. Course topics included health equity, adult learning theory, curriculum development, implicit bias, social determinants of health, racism, oppression, and collaborating with community partners. Educational strategies included reflections, small group discussions, logic models, and capstone development.</p><p><strong>Program evaluation: </strong>Using a Likert-type scale, participants rated all aspects of the program highly favorably, with median ratings ranging from 4 (agree) to 5 (strongly agree). Focus group results demonstrated that faculty experienced well-needed personal empowerment and professional growth in unexpected ways and identified several opportunities for programmatic growth.</p><p><strong>Discussion: </strong>Program strengths included its interdisciplinary nature, creating a space to address isolation experienced by faculty working to advance health equity within their departments, advancement of skills to integrate health equity into their teaching contexts, and the opportunity for participants to envision their scholarship as part of a more extensive approach within the social determinants of health, health equity, and community health framework.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1797-1802"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Readability Study: A Randomised Trial of Health Information Written at Different Grade Reading Levels.","authors":"Olivia Mac, Julie Ayre, Kirsten McCaffery, Farzaneh Boroumand, Katy Bell, Danielle M Muscat","doi":"10.1007/s11606-024-09200-z","DOIUrl":"10.1007/s11606-024-09200-z","url":null,"abstract":"<p><strong>Background: </strong>Despite increasing attention on health literacy and the inclusion of grade reading level recommendations in guidelines, it remains unclear if lowering the grade reading level of written health information to specific target grades improves patient-related outcomes.</p><p><strong>Objective: </strong>To assess whether grade reading level of written information affects knowledge, perceived reading ease, acceptability and trustworthiness of information and, to explore whether information written at a lower grade reading level reduces disparities in outcomes across health literacy levels.</p><p><strong>Design: </strong>We conducted a 4-arm online randomized trial with a community sample of adults living in Australia from 31 July to 20 September 2023.</p><p><strong>Experimental arms: </strong>Participants were randomised to one of four arms: Information about sciatica and knee osteoarthritis written at a grade 8, 10, 12 or 14 reading level. Readability was assessed using the SMOG Index and iteratively revised to each lower grade.</p><p><strong>Measures: </strong>Primary outcome was knowledge of health conditions. Secondary outcomes were brief knowledge, perceived reading ease, acceptability (i.e., perceived usefulness and likelihood to recommend) and trustworthiness of information.</p><p><strong>Results: </strong>2235 participants were randomised and included in the analysis. Mean age was 41 years and 54.5% identified as female. Low health literacy was identified in 28.2% of participants. We found no evidence of a main effect of grade reading level on knowledge (grade 8: 9.0 (SD = 2.7), grade 10: 9.1 (SD = 2.6), grade 12: 8.9, grade 14: 9.1 (SD = 2.7). Participants with high health literacy had higher knowledge scores overall, however, there was no evidence that health literacy modified the effect of grade reading level. There were no significant differences in any of the secondary outcomes.</p><p><strong>Conclusions: </strong>Our study showed no difference in knowledge when grade reading level was manipulated alone. Our findings indicate there is limited value in reducing grade reading level without attention to other health literacy principles.</p><p><strong>Anzctr trial registry number: </strong>ACTRN12623000224628p.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1820-1828"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should Medicaid Pay for Housing? Considering the Debate.","authors":"Rachel Bernard, Megan Mayer","doi":"10.1007/s11606-025-09485-8","DOIUrl":"10.1007/s11606-025-09485-8","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1885-1887"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}