Journal of General Internal Medicine最新文献

{"title":"A Novel Intervention for Medicaid Beneficiaries with Complex Needs.","authors":"Luke Mueller, Neil Batlivala, Jonathan Palisoc, Connie Kim, Andrey Ostrovsky, Michael Ong, Nathan Favini","doi":"10.1007/s11606-025-09839-2","DOIUrl":"https://doi.org/10.1007/s11606-025-09839-2","url":null,"abstract":"<p><strong>Background: </strong>Case management interventions may improve outcomes for patients with complex medical and social needs, though previous research has shown mixed results. Enhanced Care Management (ECM), a central element of the California Advancing and Innovating Medi-Cal (CalAIM) initiative, aims to deliver an intensive case management solution for high-needs Medi-Cal (California's Medicaid program) members.</p><p><strong>Objective: </strong>To evaluate a novel intervention that combines ECM, telemedicine, and integrated social care delivery from community-based organizations.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Participants: </strong>Adult, ECM-eligible Medi-Cal members.</p><p><strong>Intervention: </strong>Enrollment with Pair Team, a California-based medical group and ECM provider that combines ECM, telemedicine, and integrated social care delivery from community-based organizations.</p><p><strong>Main measures: </strong>Engagement with program and healthcare, program implementation metrics, and mental health outcomes. Pre-post analyses compared data from the year post enrollment versus year prior.</p><p><strong>Key results: </strong>The study included 568 patients (395 [69.5%] female; average age 42.8 years). Patients averaged 3.3 program interactions per month over one year of enrollment; 17.8% of interactions were with an RN or NP. Patients engaged with Pair Team within 30 days of discharge from an ED or inpatient visit in 94.3% of visits. Post-enrollment, 300 (52.7%) patients had an HbA1c lab record (127 [22.3%] pre-enrollment, p < 0.001) and 465 (81.7%) had a blood pressure reading (423 [74.3%] pre-enrollment, p = 0.003). Post-enrollment, there was a 21% increase in outpatient visits (RR = 1.21, 95% CI 1.13-1.29), a 52% reduction in ED visits (RR = 0.48, 95% CI 0.42-0.55) and a 26% reduction in inpatient visits (RR = 0.74, 95% CI 0.55-0.99). PHQ-9 decreased by 4.0 points (p < 0.001) between intake and follow-up.</p><p><strong>Conclusions: </strong>Study participants receiving ECM services were highly engaged with the program and in their healthcare, and experienced reductions in acute care utilization and depressive symptoms. This highlights the Pair model's potential in improving care for patients with complex needs.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149282","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":"Bridging the Discharge Quality Gap by Focusing on the Fundamental Five.","authors":"Matthew Sakumoto, Michelle Knees, Marisha Burden","doi":"10.1007/s11606-025-09861-4","DOIUrl":"https://doi.org/10.1007/s11606-025-09861-4","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149295","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":"Leading Learning Health Systems: Strategies Used to Establish and Conduct a Learning Health System.","authors":"Dawn M Bravata, Cathy C Schubert, Amy M Kilbourne, Scotte R Hartronft, Ashley L Schwartzkopf, Jennifer L Myers, Mindy E Flanagan, Claire E Donnelly, Stanley E Taylor, Mathew J Reeves, Anthony J Perkins, Laura E Myers, Indrakshi Roy, Robert E Burke, Rachael A Beard, Marcos Montagnini, Shivani K Jindal, Greg Arling, Caroline Madrigal, Nicholas A Rattray","doi":"10.1007/s11606-025-09849-0","DOIUrl":"https://doi.org/10.1007/s11606-025-09849-0","url":null,"abstract":"<p><strong>Background: </strong>Learning health systems (LHS) improve patient and provider experiences, population health, and health system performance. LHS leaders develop LHS' social and scientific infrastructures and align the LHS with host organization's priorities. Although researchers have examined data infrastructure and Learning Community configurations, few studies have evaluated discrete strategies leaders deploy to construct a LHS.</p><p><strong>Objectives: </strong>We described methods used to establish the Department of Veterans Affairs (VA) Geriatric LHS (GLHS) supporting older Veterans transitioning from hospital to home and examined strategies GLHS leaders used to conduct LHS activities.</p><p><strong>Design: </strong>Qualitative methods were employed to review notes from all meetings and post-meeting debriefs from encounters with operational partners, Learning Community members, and Quantitative and Qualitative Data Core subcommittees. Member checking with Learning Community and Data Core representatives led to iterative refinement of findings. A seven-question survey examined Learning Community member satisfaction with the GLHS.</p><p><strong>Results: </strong>Ten of 16 Learning Community members (62.5%) completed surveys, indicating that the GLHS met Learning Community members' needs. The four key GLHS structural elements were (1) the imperative of maintaining an Idea Repository, (2) the value of notetaking and formal debriefs, (3) the cadence of meetings, and (4) the role of the newsletter to promote engagement. Five themes described core activities/perspectives GLHS operational leaders used: (1) listening to the Learning Community; (2) modifying analyses in response to Learning Community input; (3) including diverse perspectives; (4) managing organizational complexity; and (5) serving the healthcare system.</p><p><strong>Conclusions: </strong>The GLHS illustrates the importance of active listening, collaborative engagement, and responsive adaptation to advance LHS objectives. LHS leadership strategies such as an Idea Repository and iterative feedback mechanisms fostered stakeholder participation and informed data-driven improvements.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149238","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":"Impact of PREVENT Cardiovascular Risk Equations on Statin Eligibility by Subgroup and Risk Thresholds: A Cross-Sectional Study.","authors":"Aileen P Wright, Allison B McCoy, Kimberly Garcia, Peter J Embí, Walter K Clair, MacRae F Linton, Adam T Wright","doi":"10.1007/s11606-025-09858-z","DOIUrl":"https://doi.org/10.1007/s11606-025-09858-z","url":null,"abstract":"<p><strong>Background: </strong>Replacing the pooled cohort equations (PCEs) with the Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equations for atherosclerotic cardiovascular disease (ASCVD) risk is projected to reduce statin eligibility, prompting discussion of lowering the risk threshold used with PREVENT. The potential impact on statin eligibility in different subgroups is unknown.</p><p><strong>Objective: </strong>To assess the impact of replacing PCEs with PREVENT equations on statin eligibility for a real-world population of primary care patients, incorporating social deprivation index (SDI) and lowering the ASCVD risk thresholds for statin eligibility.</p><p><strong>Design: </strong>Cross-sectional analysis comparing 10-year ASCVD risk scores and statin eligibility using the PCEs and PREVENT equations within a primary care population. Subgroup analyses were conducted by age, sex, and race. Risk thresholds for statin eligibility were varied to assess the effect on eligibility.</p><p><strong>Participants: </strong>Adult patients who visited a Vanderbilt primary care clinic in 2023.</p><p><strong>Main measures: </strong>Estimated 10-year ASCVD risk and proportion of patients eligible for statin therapy using the PCEs vs. PREVENT equations.</p><p><strong>Key results: </strong>In 50,123 patients, the mean 10-year ASCVD risk was significantly lower with PREVENT compared to the PCEs (3.6 vs. 7.5, p < 0.0001). In 36,430 patients not on statins, PREVENT reduced statin eligibility by 78.2%, with the largest reductions in women (82.6%), patients aged 40-49 (97.8%), and Black patients (81.2%). Lowering the statin eligibility threshold from 7.5 to 3% led to a 27.5% overall increase in eligibility rather than 78.2% reduction. However, gaps between subgroups expanded, and younger and Black patients retained relative reductions in eligibility (e.g., 4.7% decrease in statin eligibility among Black patients compared to a 32.7% increase among White patients).</p><p><strong>Conclusions: </strong>In a real-world primary care population, replacing the PCEs with the PREVENT equations would significantly reduce statin eligibility at the 7.5% threshold. Lowering the risk threshold would increase overall eligibility but disproportionately affect eligibility within certain subgroups.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149331","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":"Call to Make Equity Actionable in Frontline Practice in Learning Health Systems Using Implementation Science.","authors":"Michelle S Wong, Jennifer L Bryan, Evelyn T Chang, Mackenzie L Shanahan, Donna L Washington, Derrecka Boykin","doi":"10.1007/s11606-025-09877-w","DOIUrl":"https://doi.org/10.1007/s11606-025-09877-w","url":null,"abstract":"<p><p>Advancing health equity is the fifth and newest addition to the Quintuple Aims guiding learning health systems (LHS). A promising way to achieve this goal is by applying an equity lens to implementation science-a foundational LHS method. Despite a recent proliferation of equity-focused implementation theories, models, and frameworks, there is a dearth of guidance on practical applications of equity-focused implementation science in frontline practice. This perspectives article provides recommendations on actionable steps to build broader capacity for health equity in front-line clinical practice using implementation science. It presents two quality improvement projects within the Veterans Health Administration, a national LHS. The first project incorporated a health equity adaptation to Evidence-Based Quality Improvement, an implementation strategy fostering multi-level, inter-professional engagement. This adapted method was applied to implement evidence-based practices into primary care to manage Veterans at high risk for hospitalization. The second project leveraged clinical operations partnerships and an equity-focused implementation framework to improve equitable delivery of a skills-based psychotherapy group for Veterans with a history of any sexual violence in their lifetimes. The article concludes with recommendations as to how researchers can structure their intervention programs and implementation strategies to prioritize equity at the frontlines of care in LHS.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149246","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":"Nudges for Naloxone in the Opioid Epidemic.","authors":"Donald A Redelmeier, Jonathan S Zipursky","doi":"10.1007/s11606-025-09873-0","DOIUrl":"https://doi.org/10.1007/s11606-025-09873-0","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137870","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":"Impact of mHealth-Based Lifestyle Interventions on Weight Loss in Overweight/Obese Adults: A Systematic Meta-Analysis.","authors":"Yuting Tang, Xian Guo, Xinyuan Liu, Junqiang Qiu, Junchao Yang","doi":"10.1007/s11606-025-09841-8","DOIUrl":"https://doi.org/10.1007/s11606-025-09841-8","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a global health challenge and increases the risk of chronic diseases. Mobile health technologies (mHealth) have emerged as a personalized and multimodal intervention for weight management. This meta-analysis evaluated the effectiveness of mHealth-based lifestyle interventions on weight loss and BMI reduction in overweight and obese adults.</p><p><strong>Methods: </strong>A total of 42 randomized controlled trials were identified and included from five major databases. Analyses were conducted using RevMan 5.4. Primary and secondary outcomes were changes in body weight and BMI, respectively.</p><p><strong>Results: </strong>The meta-analysis showed that mHealth-based lifestyle interventions significantly reduced body weight (MD =  - 1.79 kg, p < 0.00001) and BMI (MD =  - 0.65 kg/m², p < 0.00001). Subgroup analyses revealed that mobile applications interventions significantly declined both body weight (MD =  - 1.97 kg, p < 0.00001) and BMI (MD =  - 1.20 kg/m², p = 0.002). Wearable-based technologies interventions also significantly reduced body weight (MD =  - 1.08 kg, p = 0.0006) and BMI (MD =  - 0.44 kg/m², p < 0.00001). Web-based technologies interventions significantly decreased body weight loss (MD =  - 1.99 kg, p < 0.00001), but no BMI (MD =  - 0.44 kg/m², p = 0.09). Health education based on mHealth interventions significantly lowered body weight (MD =  - 0.78 kg, p = 0.01) and BMI (MD =  - 0.44 kg/m², p = 0.0003). Furthermore, intelligent management based on mHealth interventions significantly dropped body weight (MD =  - 0.70 kg, p < 0.0001) and BMI (MD =  - 0.38 kg/m², p < 0.00001). No significant difference was found between mHealth-based online interventions and face-to-face interventions for body weight (MD =  - 1.73 kg, p = 0.11) or BMI (MD =  - 0.88 kg/m², p = 0.10).</p><p><strong>Conclusion: </strong>mHealth-based lifestyle interventions are effective in reducing body weight and BMI in overweight and obese adults. Further optimization is needed to enhance long-term effectiveness and user adherence.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124694","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":"Drawings from the Epilepsy Monitoring Unit.","authors":"Sujal Manohar","doi":"10.1007/s11606-025-09602-7","DOIUrl":"https://doi.org/10.1007/s11606-025-09602-7","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130993","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":"Changes in Use, Cost, and Value of Breast Cancer Screening Among Older Women in the US.","authors":"Ilana Richman, Jessica B Long, Meghan E Lindsay, A Mark Fendrick, Kelly Kyanko, Cary P Gross","doi":"10.1007/s11606-025-09778-y","DOIUrl":"https://doi.org/10.1007/s11606-025-09778-y","url":null,"abstract":"<p><strong>Background: </strong>The clinical and economic impact of breast cancer screening varies based on the modality, frequency, and age of the screened population.</p><p><strong>Objective: </strong>To characterize changes in use and cost of breast cancer screening for older women.</p><p><strong>Design: </strong>Serial cross-sectional study using data from SEER-Medicare, 2009-2019.</p><p><strong>Participants: </strong>Women 67 and older enrolled in Medicare fee-for-service.</p><p><strong>Main measures: </strong>Screening use and cost by age, frequency, and modality. We further categorized screening as cost-effective or cost-ineffective based on published economic analyses rather than guidelines. Cost-effective screening included biennial mammography among women < age 80, while cost-ineffective screening included annual mammography, addition of digital breast tomosynthesis (DBT), screening ultrasound, and any screening among women 80 and older. We estimated total annual spending on screening in Medicare fee-for-service, inflated to 2019 dollars.</p><p><strong>Key results: </strong>Our sample included a mean of 229,683 (range 222,400- 244,793) Medicare beneficiaries annually. Biennial screening was stable among women 65-79, at 11.2% (95% CI 11.0-11.4) in 2009 and 11.9% (95% CI 11.7-12.0) in 2019. Annual screening was also stable at 32.5% (95% CI 32.3-32.7) in 2009 and 30.0% (95% CI 29.8-30.2) in 2019. Among women 80 and older, screening (annual or biennial) declined from 19% (95% CI 18.8-19.3) to 12.9% (95% CI 12.7-13.2). Between 2009-2019, use of DBT rose from 0% to 70.3% of screened women. Total spending on cost-effective screening rose from $569 million per year to $735 million per year, a 29% increase. Spending on cost-ineffective screening rose from $548 million to $1.025 billion, an 87% increase. By 2019, spending on cost-ineffective screening accounted for 58% of total spending.</p><p><strong>Conclusions: </strong>Screening costs for older women have risen, driven by expenditures on technologies that may not be cost-effective. Reducing use of low value screening could result in savings that could be reallocated toward high value screening and follow up testing.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131045","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":"Beyond the Clinic Walls: Hospitalists' Role in Addressing Intimate Partner Violence and Social Drivers of Health.","authors":"Christine Santiago, Emily Murphy, Rebecca Dougherty","doi":"10.1007/s11606-025-09853-4","DOIUrl":"https://doi.org/10.1007/s11606-025-09853-4","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124663","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}