Journal of General Internal Medicine最新文献

{"title":"County-Level Determinants of the Loss of the Hispanic Mortality Advantage in the United States.","authors":"Bongeka Z Zuma, Zahra Azizi, Sara King, Ashish Sarraju, Summer Ngo, David Scheinker, Fatima Rodriguez","doi":"10.1007/s11606-025-09705-1","DOIUrl":"https://doi.org/10.1007/s11606-025-09705-1","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic disproportionately impacted the Hispanic population in the United States, leading to an unprecedented decline in the longstanding Hispanic mortality advantage (HMA) and highlighting the need to better understand the sociodemographic and structural factors driving these trends.</p><p><strong>Objective: </strong>To evaluate the association between county-level determinants (including demographic, socioeconomic, behavioral, healthcare, and structural factors) and declines in the HMA during COVID-19 pandemic.</p><p><strong>Participants: </strong>Data on non-Hispanic White (NHW) and Hispanic individuals were obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research and the Robert Wood Johnson Foundation County Health Rankings databases.</p><p><strong>Exposures: </strong>County-level sociodemographic and structural factors.</p><p><strong>Main measures: </strong>In this cross-sectional analysis of national county-level mortality data from 2019 to 2020, the primary outcome was the change in the HMA between 2019 and 2020. All-cause age-adjusted mortality rates (AAMRs) at the county level were used to calculate the HMA (NHW AAMR - Hispanic AAMR). Coronavirus disease 2019 (COVID-19)-specific AAMRs and county-level factors were identified.</p><p><strong>Key results: </strong>We analyzed 619 US counties with complete and reliable mortality and sociodemographic data from a total of 3193 counties. From 2019 to 2020, the mean AAMR per 100,000 persons increased by 12.5% for NHW, from 765.4 to 861.0, and by 30.3% for Hispanic populations, from 554.5 to 722.3. On average, the HMA per 100,000 persons decreased by 34.2%, from 210.9 to 138.7, with 71.5% counties experiencing a decline in the HMA. County-level factors that were associated with a decline in the HMA included the percentage of Hispanic individuals aged > 65 years, segregation index, percentage of uninsured individuals, and COVID-19 AAMRs for 2020.</p><p><strong>Conclusions: </strong>From 2019 to 2020, there was a significant decline in the HMA across a large sample of US counties. Addressing the related county-level factors may mitigate the impact of future health crises on Hispanic populations.</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":"145130997","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":"Enhancing Patient-Dedicated Time in Clinical Encounters: A Systematic Review and Meta-analysis of Intervention Strategies.","authors":"Clement P Buclin, Nils Bürgisser, Amandine Berner, André Juillerat, Caroline Blanc, Matteo Coen, Pauline Darbellay Farhoumand, Violène Porto, Jessie Porzi, Jean-Luc Reny, Delphine S Courvoisier, Thomas Agoritsas","doi":"10.1007/s11606-025-09843-6","DOIUrl":"https://doi.org/10.1007/s11606-025-09843-6","url":null,"abstract":"<p><strong>Background: </strong>Hospitals' institutional programs designed to protect or increase the time dedicated to interactions between patients and healthcare professionals, while growing in popularity, often lack formal evaluation. This study aims to quantify the effectiveness of programs designed to protect or enhance the quality or quantity of clinical encounter time between hospitalized patients and healthcare professionals.</p><p><strong>Methods: </strong>A systematic literature review and random-effects meta-analysis were performed on Cochrane Library, Embase, and Web of Science databases. Studies had to include ≥ 80% adult inpatients in acute care, compare groups, and assess at least one of the following outcomes: patient satisfaction, length of stay, home discharge, or 30-day readmission. Screening, data extraction, and risk of bias assessment were performed independently and in duplicate. Risk of bias was assessed using the ROBINS-I tool for non-randomized trials, and the Cochrane 2.0 instrument for randomized trials.</p><p><strong>Results: </strong>A total of 117 unique studies comprising 298,517 patients were included. Compared to their controls, interventions increased the proportion of satisfied patients (+ 8% [95% CI, + 4.7 to + 11.4%]; 26 studies, 20,456 patients), the proportion of patients discharged home (+ 2.6% [95% CI, + 0.3 to + 5.0%]; 21 studies, 61,539 patients), and reduced length of stay (- 1.07 days [95% CI, - 1.62 to - 0.52]; 58 studies, 160,080 patients) without significant difference in readmission rates (- 0.8% [95% CI - 1.8 to + 0.2%]; 49 studies, 177,677 patients). Most studies were at high risk of bias, even among randomized trials. Programs varied widely in interventions, contexts, and findings.</p><p><strong>Discussion: </strong>Programs enhancing or protecting clinical encounter time in acute care may improve patient experience, care quality, and discharge processes. Higher quality randomized controlled trials evaluating such interventions are warranted. Future programs may benefit from studies that draw on multi-disciplinary knowledge and implementation sciences to identify contextual factors impacting their success.</p><p><strong>Systematic review registration: </strong>Prospero CRD42023453402.</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":"145124725","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":"Use of Anatomic Inventory Fields in a Transgender and Gender Diverse Patient Cohort from an Academic Medical Center.","authors":"Jennifer Siegel, Meghan L Rieu-Werden, Suzanne Brodney, Michael J Barry, Alex McDowell","doi":"10.1007/s11606-025-09855-2","DOIUrl":"https://doi.org/10.1007/s11606-025-09855-2","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113418","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 Day in the Life of An Addiction Bridge Clinic.","authors":"Theresa W Kim","doi":"10.1007/s11606-025-09851-6","DOIUrl":"10.1007/s11606-025-09851-6","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113273","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":"All the Right Words, But Did They Think It? Reassessing Clinical Reasoning in the Age of AI.","authors":"Justin J Choi","doi":"10.1007/s11606-025-09844-5","DOIUrl":"https://doi.org/10.1007/s11606-025-09844-5","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113317","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":"There's No Place Like Home: Mitigating Delirium by Enhancing Sleep and Circadian Health in Home Hospital.","authors":"Mark É Czeisler, Ivo H Cerda, David M Levine","doi":"10.1007/s11606-025-09845-4","DOIUrl":"https://doi.org/10.1007/s11606-025-09845-4","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113242","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":"Pharmacists in Primary Care: Catalyzing Treatment For Substance Use Disorders.","authors":"Iraklis Erik Tseregounis, Clare C Landefeld, Tonya L Fancher","doi":"10.1007/s11606-025-09850-7","DOIUrl":"https://doi.org/10.1007/s11606-025-09850-7","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113276","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":"Comparative Analysis of Clinical Outcomes Related to Telehealth and In-Person Encounters Among Older Veterans with Diabetes.","authors":"Quratulain Syed, Gerald McGwin, Theodore Johnson, Lawrence S Phillips, Anjali Khakharia, Katharina V Echt, Mary Rhee, Camille P Vaughan","doi":"10.1007/s11606-025-09871-2","DOIUrl":"https://doi.org/10.1007/s11606-025-09871-2","url":null,"abstract":"<p><strong>Background: </strong>In older adults with diabetes mellitus, there are limited studies of telehealth for chronic disease management.</p><p><strong>Objective: </strong>To compare outcomes of those receiving hybrid telehealth care with those receiving in-person care.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Participants: </strong>Adults aged ≥ 70 with diabetes (n = 410,640) in Veterans Health Administration during 2019 and 2021. A subgroup analysis included high-need high-risk (HNHR) Veterans (n = 18,414).</p><p><strong>Interventions: </strong>Telehealth-based care in addition to in-person care (hybrid telehealth).</p><p><strong>Main measures: </strong>Co-primary outcomes included glycated hemoglobin (HbA1c), hospitalizations, and emergency department (ED) visits.</p><p><strong>Key results: </strong>Entire cohort: The hybrid telehealth group comprised 51% of the entire cohort. The hybrid telehealth group had higher mean encounters in 2019 [telehealth 6.2 (6.7) and in-person 10.6 (8)] vs the in-person group [4.9 (4.1)] p < 0.001. After adjustment, although mean HbA1c levels of the hybrid group compared to the in-person group remained statistically higher in 2021 (7.19% [95% CI 7.06-7.32] vs 7.13% [95% CI 7.0-7.26] p < 0.001), the difference was clinically negligible. Hybrid telehealth had higher rates of hospitalizations (RR [CI] of 1.22 [1.20-1.24]) and ED visits (RR of 1.24 [1.21-1.27]) in 2021 compared to in-person care.</p><p><strong>Hnhr subgroup: </strong>The hybrid telehealth group had higher mean encounters in 2019 [TH 11 (10) vs in-person 17 (11)] compared to the in-person group [9.7 (7.7)] p <0.001. After adjustment, there was no difference in mean HbA1c of hybrid telehealth compared to in-person care in 2021 (7.19 [95% CI 6.94-7.46] vs 7.17 [95% CI 6.90-7.44] p-0.51). While the rate of hospitalizations was higher for hybrid telehealth vs in-person group in 2021 (RR 1.11 [1.02-1.22]), there was no difference in regard to ED visits (RR 1.05 [1.00-1.12]).</p><p><strong>Conclusions: </strong>The high proportion of telehealth use among older adults with diabetes and complex care needs highlights the importance of this modality to promote better health outcomes.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124752","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":"Exploring Respect, Healthcare Utilization, and Affordability Among Transgender and Gender-Diverse Individuals: An All of Us Analysis.","authors":"Daniel P Swanson, Daniel H Nguyen, Jung Ae Lee, Ben S Gerber, Joy L Lee","doi":"10.1007/s11606-025-09859-y","DOIUrl":"https://doi.org/10.1007/s11606-025-09859-y","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086187","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":"Digital Pharmacist-Physician Collaborative Care Management of Hypertension for Medicare Patients.","authors":"Eboni G Price-Haywood, Susan Olet, Savita D Singh, Jeffrey Burton","doi":"10.1007/s11606-025-09823-w","DOIUrl":"https://doi.org/10.1007/s11606-025-09823-w","url":null,"abstract":"<p><strong>Background: </strong>Hypertension is a major driver of healthcare costs. Remote physiologic monitoring (RPM) combined with team-based chronic disease care management can improve blood pressure (BP) control and reduce risk of high-cost cardiovascular events.</p><p><strong>Objective: </strong>To examine whether a pharmacist-led Digital Medicine program improves BP control, medication adherence, healthcare utilization, and cost of care among racial subpopulations of Medicare patients.</p><p><strong>Design: </strong>Retrospective single-institution observational study conducted between January 1, 2019, and October 15, 2023.</p><p><strong>Participants: </strong>Medicare patients with hypertension enrolled in the intervention with ≥ 3 office-based BP readings within 6-month periods pre- and post-index event and their propensity score-matched controls.</p><p><strong>Intervention: </strong>Remote pharmacist-physician collaborative care employing RPM with lifestyle, medication, and care gap management.</p><p><strong>Main measures: </strong>Primary outcome was BP control (office-based). Secondary outcomes were medication adherence, service utilization, and cost of care. Outcomes were assessed at baseline, 3, 6, 12, and 18 months using difference-in-difference (DID) approach stratified by race.</p><p><strong>Key results: </strong>A total of 5057 patients were included in the analysis. At baseline, Black patients had lower proportions of BP control. By 18 months, intervention compared to controls had higher rates of BP control (Digital-Medicine vs control, Proportion [95%CI]: Black, 0.761[0.728, 0.795] vs. 0.687 [0.654, 0.721]; White, 0.777 [0.755, 0.799] vs. 0.727 [0.704, 0.750]) and greater reductions in average SBP (DID, mmHg [95%CI]: Black, - 1.74 [- 3.18, - 0.29]; White, - 3.22 [- 4.22, - 2.23]) across racial subgroups. Differences in average DBP reductions were only significant for White patients (DID: Black, - 0.45 [- 1.23, 0.32]; White, - 1.48 [- 2.02, - 0.95]). Intervention compared to controls had higher odds of medication adherence, lower rates of inpatient and emergency department utilization, and no significant changes in primary care visits. Minimal changes in cost were observed.</p><p><strong>Conclusion: </strong>Remote pharmacist-led care management increased BP control across racial subpopulations and improved medication adherence and acute care service utilization.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086193","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}