Journal of General Internal Medicine最新文献

{"title":"Association of Social Vulnerability and Access to Higher Quality Medicare Advantage Plans.","authors":"Hansoo Ko, Ghaida Alsadah, Gilbert Gimm","doi":"10.1007/s11606-024-09252-1","DOIUrl":"10.1007/s11606-024-09252-1","url":null,"abstract":"<p><strong>Background: </strong>With more than half of all beneficiaries enrolled in Medicare Advantage (MA) plans, ensuring access to high-quality MA plans is a key concern for policymakers. Access to high-quality MA plans may be limited in certain areas if private insurers are not willing to offer high-quality MA plans in local areas with greater unmet health-related social needs.</p><p><strong>Objective: </strong>This study examined the association of a market-level social vulnerability index (SVI) score with the number of high-quality MA plans.</p><p><strong>Design: </strong>This study conducted a retrospective cross-sectional study.</p><p><strong>Participants: </strong>Our analysis included 3113 USA counties in 2020.</p><p><strong>Main measures: </strong>Our primary outcome measure, the availability of high-quality MA plans at the market level, was defined by counting the raw number of 5-star plans, plans with 4.5 or higher stars, and plans with 4 or higher stars. We also counted the number of all MA plans at the market level as an outcome measure to explore private insurers' market entry and participation decisions.</p><p><strong>Results: </strong>We found evidence that fewer high-quality MA plans are available in markets with greater unmet social needs (higher SVI scores). Compared to the least vulnerable markets, the most vulnerable markets had 1.5 fewer MA plans overall [95%CI -2.9, -0.1]. The most vulnerable markets also had 1.1 fewer 4 or higher star plans [95%CI -1.9, -0.3] than the least vulnerable markets. Furthermore, this negative association was concentrated in the southern region, which has a greater proportion of Black/African Americans in its market-level populations.</p><p><strong>Conclusion: </strong>As historically marginalized groups are more likely to reside in markets with greater unmet social needs, disparities in access to high-quality MA plans may widen existing health disparities. Therefore, monitoring the availability of high-quality MA plans in areas with greater unmet social needs is needed to improve health equity for MA beneficiaries.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1869-1876"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872275","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":"Characteristics and Acute Care Utilization in Patients with Food Insecurity by Z Code Assignment from a Large Private Health Plan: A Longitudinal Analysis.","authors":"Jenny Jia, Raymond H Kang, Manisha Cherupally, David T Liss, Ronald T Ackermann, Matthew J O'Brien","doi":"10.1007/s11606-024-09261-0","DOIUrl":"10.1007/s11606-024-09261-0","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1957-1959"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872288","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":"Happy Days.","authors":"Eleanor R Menzin","doi":"10.1007/s11606-024-09327-z","DOIUrl":"10.1007/s11606-024-09327-z","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":"40 8","pages":"1929-1930"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173142","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":"Gender-Affirming Surgical Needs in a National Sample of Transgender and Gender Diverse Veterans.","authors":"Alyson J Littman, Amy Jeon, Jillian C Shipherd, Michael R Kauth, Hill L Wolfe, Tracy L Simpson","doi":"10.1007/s11606-024-09282-9","DOIUrl":"10.1007/s11606-024-09282-9","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1944-1946"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818253","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":"Trends in the Prevalence of Early-Onset Osteoarthritis in the United States, 1999-2018: An Observational Study.","authors":"Zhounan Zhou, Haowei Chen, Muhui Zeng, Qiyu Xie, Zhaohua Zhu","doi":"10.1007/s11606-024-09289-2","DOIUrl":"10.1007/s11606-024-09289-2","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1962-1965"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882253","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 Effects of Individual Ethical Frameworks on Clinician Moral Distress.","authors":"Sarah Rosenwohl-Mack, Elizabeth Dzeng","doi":"10.1007/s11606-024-09284-7","DOIUrl":"10.1007/s11606-024-09284-7","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1960-1961"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872316","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":"Engaging Patients in Discussions About Medication Deprescribing.","authors":"Jacquelyn Pendergast, Jolie B Wormwood, Kelly Stolzmann, Amy K Rosen, Katie Fitzgerald Jones, Christopher J Miller, Michael Still, Barbara Bokhour, Joseph T Hanlon, Steven R Simon, Amy M Linsky","doi":"10.1007/s11606-024-09346-w","DOIUrl":"10.1007/s11606-024-09346-w","url":null,"abstract":"<p><strong>Background: </strong>Deprescribing, intentional medication discontinuation or dose reduction, can reduce potentially inappropriate medication use and medication-related harms. Engaging patients in deprescribing discussions may increase likelihood of deprescribing and promote shared decision-making.</p><p><strong>Objective: </strong>To examine the impact of patient-directed educational brochures on patient engagement and deprescribing discussions with primary care providers (PCPs).</p><p><strong>Design: </strong>We mailed medication-specific brochures 2 weeks prior to each patient's PCP appointment (4/12/2021-10/7/2022), followed by a mailed survey 2 weeks after scheduled PCP visits.</p><p><strong>Participants: </strong>Patients from three Veterans Affairs facilities with scheduled PCP appointments eligible for one of three medication-based cohorts (proton pump inhibitor, gabapentin, diabetes-hypoglycemia risk).</p><p><strong>Main measures: </strong>Our primary outcome was patient-reported deprescribing discussions with their PCP (yes/no). Descriptive statistics characterized engagement with and reactions to the brochure. Multivariable logistic regression models determined associations of patient characteristics, attitudes, and brochure-engagement with reported deprescribing discussions.</p><p><strong>Key results: </strong>Adjusting only for patient characteristics, discussions were less likely if respondents were Black (vs. White: OR 0.47, 95% CI 0.29-0.78) and more likely with higher education level (e.g., advanced degree vs. high school or less: OR 2.39, 95% CI 1.53-3.73), and adequate health literacy (OR 1.84, 95% CI 1.16-2.92). After further adjusting for general deprescribing attitudes and brochure engagement, discussions were more likely if respondents completed brochure activities (vs. did not read brochures: OR 2.23, 95% CI 1.39-3.59), contacted their PCPs prior to their visits (OR 2.47, 95% CI 1.34, 4.58), or discussed the brochure with family/friends (OR 1.72, 95% CI 1.22-2.41) or a healthcare provider (OR 3.18, 95% CI 2.08-4.85).</p><p><strong>Conclusions: </strong>Patient characteristics and brochure engagement were associated with deprescribing discussions. Patient-centered deprescribing brochures can foster patient engagement and inclusion of patient perspectives into deprescribing decisions. Future studies should explore implementation strategies that promote greater deprescribing reach and adoption among patients with lower health literacy.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1811-1819"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066002","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":"Rate of AI-Generated Text in Medical School Applicants' Personal Comments Essays.","authors":"Linda S Nield, John Nguyen, Emily Nguyen, Manuel C Vallejo","doi":"10.1007/s11606-024-09247-y","DOIUrl":"10.1007/s11606-024-09247-y","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1936-1937"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801104","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":"Antisemitism in American Healthcare: A Survey Study of Reported Experiences.","authors":"Kelly N Michelson, Alexandra C Fishman, Eve C Feinberg, Sheri Ross, Hedy S Wald, Charles Auerbach, Steven Roth","doi":"10.1007/s11606-024-09159-x","DOIUrl":"10.1007/s11606-024-09159-x","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1940-1943"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807259","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":"Barriers and Facilitators to Cross-Institutional Referrals: System Configuration Analysis of VA Staff Experiences.","authors":"April Savoy, Frances M Weaver, Himalaya Patel, Amanda Taylor, Diana J Govier, Denise M Hynes","doi":"10.1007/s11606-025-09450-5","DOIUrl":"10.1007/s11606-025-09450-5","url":null,"abstract":"<p><strong>Background: </strong>In 2014 and 2018, respectively, Congress passed the Veterans Access, Choice, and Accountability Act (Choice Act) and the Maintaining Internal Systems and Strengthening Integrated Outside Networks Act (MISSION Act), which expanded eligibility for and use of cross-institutional referrals among U.S. Veterans enrolled in the Veterans Health Administration.</p><p><strong>Objective: </strong>To identify facilitators and barriers to patient information sharing for cross-institutional, outpatient referrals resulting from policy changes.</p><p><strong>Design: </strong>Applying the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 framework, we conducted work system and configural analyses of semi-structured interviews.</p><p><strong>Participants: </strong>Clinical and administrative staff in six Department of Veterans Affairs (VA) facility community care liaison program offices.</p><p><strong>Approach: </strong>Interviews focused on barriers and facilitators to sharing patients' information across healthcare institutions. Transcripts were summarized by domain and coded to consensus, followed by directed content analysis and visualization using configural diagrams.</p><p><strong>Key results: </strong>From 19 interviews, we characterized a nine-step, ad hoc referral process. Barriers were reported in four of nine referral steps: scheduling, coordination, sending of pre-visit clinical records, and receipt of post-visit records. Low adoption of new technology, strained relationships with CCN clinicians, and inconsistent policies were commonly reported barriers. Largely, perceived barriers were classified as technology, people, or organization factors. The COVID-19 pandemic and a transition between third-party administrators were reported as notable environment factors.</p><p><strong>Conclusions: </strong>VA staff perceived increases in patient care delays and staff workload associated with social and technical barriers to sharing patients' information across healthcare institutions. In the cross-institutional referral process, we identified the primary configuration or combination of work system factors-technology, people, and organization- related to prevalent barriers. System-level interventions are needed to enhance relationships with clinicians across healthcare institutions, implement policies that guide patient information exchange, and design supportive technologies for efficient clinician communication during cross-institutional referrals.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1888-1899"},"PeriodicalIF":4.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597204","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}