Journal of General Internal Medicine最新文献

{"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":"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":"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":"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":"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}

{"title":"Identifying Core Functions and Forms of \"Discharge by Noon\" Interventions.","authors":"Jigisha Patel, Sachita Shrestha, Ruby Marr, Paul Caseley, Megan Mack, Vijay Singh, David Paje, Robert Chang, Stephanie Parks Taylor","doi":"10.1007/s11606-024-09257-w","DOIUrl":"10.1007/s11606-024-09257-w","url":null,"abstract":"<p><strong>Background: </strong>Many hospitals have implemented Discharge by Noon (DBN) programs to improve hospital throughput but have had mixed results.</p><p><strong>Objective: </strong>Use a complex health intervention framework to define core functions and forms of DBN interventions.</p><p><strong>Design: </strong>Qualitative study combined with scoping review.</p><p><strong>Setting: </strong>Two hospitals in Michigan, USA.</p><p><strong>Participants: </strong>Multidisciplinary stakeholders (n = 22) involved in the development and implementation of a DBN program.</p><p><strong>Measurements: </strong>We conducted (1) stakeholder surveys and (2) a scoping review of the DBN literature. We integrated quantitative and qualitative data to develop a DBN functions and forms matrix.</p><p><strong>Results: </strong>Qualitative thematic analysis of the stakeholder survey identified six core functions addressing five motivating needs for a DBN program, and the scoping review identified one additional core function addressing one additional motivating need. We identified 17 eligible studies for the scoping review, of which 15 (88%) found an improvement in DBN associated with the intervention and two (12%) did not. Compared with ineffective interventions, a greater proportion of effective ones enabled multi-disciplinary participation (76% vs 0%), provided a structured platform for communication (65% vs 0%), and enabled pre-identification of patients (59% vs 0%). Cross-case analysis revealed that programs that included either enablement of multi-disciplinary participation or structured platform for communication covered 100% of effective interventions and no ineffective ones.</p><p><strong>Conclusion: </strong>Successful DBN programs include specific core functions. Our findings can guide system recommendations about optimal DBN intervention structures to maximize effectiveness and resource stewardship.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1910-1916"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006577","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":"Changes in Healthcare Professionals' Practice Behaviors Through an Educational Intervention Targeting Weight Bias.","authors":"Amanda Velazquez, Karen J Coleman, Robert F Kushner, Joseph F Nadglowski, Patricia M Nece, Jing Zhang, A Janet Tomiyama","doi":"10.1007/s11606-024-09212-9","DOIUrl":"10.1007/s11606-024-09212-9","url":null,"abstract":"<p><strong>Objective: </strong>Weight bias is pervasive in healthcare and leads to worse patient outcomes. A uniquely designed 4-h continuing medical education (CME) intervention was assessed for changing healthcare professionals' (HCPs') weight biases and clinical practice behaviors.</p><p><strong>Design: </strong>The intervention used a (1) pre/post design examining CME attendees' self-reported weight bias at baseline, after, and 4- and 12-month follow-up, and (2) post/post design examining obesity practice behaviors 12 months after intervention in attendees and non-attendees.</p><p><strong>Setting: </strong>Single medical center service area within Kaiser Permanente Southern California.</p><p><strong>Participants: </strong>All HCPs (n = 472) from the target service area were eligible to attend. Analyses were done with 218 HCPs who attended and 89 who did not.</p><p><strong>Methods and analysis: </strong>The intervention contained theory-based elements of changing attributions of responsibility of obesity, increasing empathy, creating self-awareness of weight bias, and creating a bias-free culture. For pre/post analyses, the primary outcome was self-reported weight bias. For comparative analyses of CME attendees and non-attendees, the outcomes were electronic medical record-confirmed rates of obesity diagnosis and referrals to evidence-based obesity treatments in the 12 months following the CME intervention.</p><p><strong>Results: </strong>Self-reported negative obesity stereotypes were significantly reduced compared to baseline while self-reported empathy and confidence in caring for patients with obesity were significantly increased immediately post intervention and were maintained at 4- and 12-month follow-up. After adjusting for years in practice, race/ethnicity, gender, profession type, practice type, and panel size, HCPs who attended the CME intervention had significantly increased odds (range 60-212%) of diagnosis and obesity-related referrals in the 12 months following the CME intervention when compared to HCPs who did not attend.</p><p><strong>Conclusion and relevance: </strong>This intervention has promise to be a scalable program that goes beyond impacting HCP's self-reported weight bias and also changes HCPs' clinical practice behaviors related to obesity treatment.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1720-1727"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854319","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-Provider Interactions and Access to Prescription Medications Among Adults with Chronic Pain in the United States, 2023.","authors":"S Michaela Rikard, Kristine M Schmit, Gery P Guy","doi":"10.1007/s11606-024-09271-y","DOIUrl":"10.1007/s11606-024-09271-y","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1954-1956"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872305","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":"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}