Journal of General Internal Medicine最新文献

{"title":"Intersectional Demographic Trends in Infective Endocarditis Among Adults in the US, 2012-2021.","authors":"Tamara Rushovich, Ana V Diez-Roux, Neal D Goldstein, Alina Schnake-Mahl","doi":"10.1007/s11606-025-09872-1","DOIUrl":"https://doi.org/10.1007/s11606-025-09872-1","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069691","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":"No Immunity From Having to Choose: An Exercise in Clinical Reasoning.","authors":"Grace Yi, Paige Brown, Tyler Larsen, Kelley Chuang, Andrew S Parsons, Inderpreet Saini, Satya Patel","doi":"10.1007/s11606-025-09799-7","DOIUrl":"https://doi.org/10.1007/s11606-025-09799-7","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040421","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":"Clinic Personnel Perspectives on Barriers to Video Visits for Patients with Non-English Language Preferences: A Qualitative Study.","authors":"Marianna Kong, Alicia Fernandez","doi":"10.1007/s11606-025-09864-1","DOIUrl":"https://doi.org/10.1007/s11606-025-09864-1","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040385","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":"Learning, Motivation to Study, and Patient Care Gains from the American Board of Internal Medicine's Longitudinal Knowledge Assessment.","authors":"Bradley M Gray, Benjamin J Chesluk, Brendan J Barnhart, Siddharta G Reddy, Heather L Heiman, Rebecca S Lipner","doi":"10.1007/s11606-025-09819-6","DOIUrl":"https://doi.org/10.1007/s11606-025-09819-6","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040387","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":"VA Clinicians' Perspectives on Low-Value Health Service Use in the Veterans Health Administration: A Qualitative Study.","authors":"Zachary A Cupler, Kristina L Hruska, Nicole M Beyer, Loren J Schleiden, Keri L Rodriguez, Liam Rose, Aimee N Pickering, Carolyn T Thorpe, Thomas R Radomski","doi":"10.1007/s11606-025-09838-3","DOIUrl":"https://doi.org/10.1007/s11606-025-09838-3","url":null,"abstract":"<p><strong>Background: </strong>Low-value health services adversely affect outcomes and unnecessarily increase the cost of care. Approximately 10% of Veterans receive at least one of 29 low-value services delivered or paid for by the Veterans Health Administration (VA) annually. However, determinants of and potential solutions to reduce low-value service delivery are poorly understood.</p><p><strong>Objective: </strong>To characterize the drivers of and approaches to reduce low-value service delivery across VA Medical Centers (VAMCs) from the perspective of VA clinicians.</p><p><strong>Design: </strong>Qualitative study using semi-structured interviews conducted from October 2022 to November 2023.</p><p><strong>Participants: </strong>65 VA clinicians, including 32 generalists and 33 medical and surgical specialists, at 46 VAMCs.</p><p><strong>Approach: </strong>We used deductive analysis based on a priori categories and definitions structured by the Theoretical Domains Framework to identify predominant themes related to drivers of low-value service delivery. We used inductive analysis to identify clinician-suggested approaches to reduce low-value services.</p><p><strong>Key results: </strong>We identified three overarching domains as drivers of low-value service delivery at VA: 1) environmental context and resources; 2) social influence; and 3) belief about consequences. Regarding key subthemes, social pressure from Veterans emerged among generalists and specialists. Generalists were more likely to identify referral parameters or requirements compared to specialists, while specialists were more like to identify negative consequences compared to generalists. We identified four overarching domains as approaches to reduce low-value service delivery at VA, which were consistently identified by both generalists and specialists: 1) improving quality and access to VA health care; 2) dissemination of best practices; 3) optimizing use of the electronic health record; and 4) instilling an organizational culture on value.</p><p><strong>Conclusions: </strong>We identified the most salient drivers of and approaches to reduce low-value services from the perspective of VA clinicians. These findings may inform the design of future de-implementation interventions and policy to reduce VA-delivered low-value services.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040342","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":"Effectiveness of the SHARE Approach for Improving Clinician Shared Decision Making Skills: A Trial in 12 Practices Located in Colorado, USA.","authors":"Laura D Scherer, Daniel Matlock, Christopher Knoepke, Robyn Wearner, Allyson Gottsman, Douglas Fernald, W Perry Dickinson, L Miriam Dickinson, Monica McNulty, Mark Gritz","doi":"10.1007/s11606-025-09465-y","DOIUrl":"https://doi.org/10.1007/s11606-025-09465-y","url":null,"abstract":"<p><strong>Background: </strong>The SHARE Approach Model and training curriculum was developed by the Agency for Healthcare Research and Quality (AHRQ) to teach clinicians practicing in diverse settings how to engage in more effective Shared Decision Making (SDM).</p><p><strong>Objective: </strong>To determine the effectiveness of the SHARE Approach at improving SDM in practices located across Colorado, USA.</p><p><strong>Design: </strong>A longitudinal study with pre- and post-intervention observations.</p><p><strong>Participants: </strong>Primary care and cardiology practices were recruited from across Colorado. All practice staff were invited to participate in the SHARE Approach training. Patients and providers from these practices participated in SDM assessments.</p><p><strong>Intervention: </strong>The 4-h SHARE Approach training was led by a practice facilitator and consisted of didactic lectures, demonstration videos, group discussion, and group activities.</p><p><strong>Main measures: </strong>Primary outcome measures included (1) evaluation of the training and confidence/understanding in doing SDM using a survey questionnaire of practice staff, (2) patient and clinician-reported SDM occurring in clinical encounters, and (3) SDM captured in audio recordings of a subset of clinical encounters. SDM was hypothesized to improve at post-intervention and maintain gains at follow-up.</p><p><strong>Key results: </strong>Ten primary care and two cardiology practices enrolled in the study, located across major regions of Colorado (e.g., Western slope; Eastern plains; front range) and representing diverse practice types (e.g., independent; health system; federally qualified health center). Trainee confidence and understanding of SDM and confidence in ability to engage in SDM improved at post-test and maintained gains at follow-up. Patient- and clinician-reported SDM occurring in clinical encounters did not improve significantly at post-intervention or follow-up. SDM observed on audio recordings did improve at the 6-month follow-up observation.</p><p><strong>Conclusions: </strong>This study reports the largest and most comprehensive evaluation of AHRQ's SHARE Approach training curriculum. The training was positively received by clinicians and may improve SDM behaviors in clinical practice.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033518","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":"Adult Reactive Infectious Mucocutaneous Eruption (RIME) from Concurrent Adenovirus and Mycoplasma pneumoniae Infections.","authors":"Jeffrey Li, Sasan D Noveir, Natalie Bouri, Kyle Cheng, Inderpreet Saini","doi":"10.1007/s11606-025-09827-6","DOIUrl":"https://doi.org/10.1007/s11606-025-09827-6","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033443","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":"Factors Associated with Loneliness Among Older Adults Who Experienced Homelessness: Results from the HOPE HOME Study.","authors":"Yeqing Yuan, Jennifer L Evans, Torsten B Neilands, Karen Valle, Cheyenne M Garcia, Margot B Kushel","doi":"10.1007/s11606-025-09818-7","DOIUrl":"https://doi.org/10.1007/s11606-025-09818-7","url":null,"abstract":"<p><strong>Background: </strong>Older homeless-experienced adults are at higher risk of loneliness than general older adults. Loneliness is associated with multiple adverse health and mental health outcomes. Less is known about factors contributing to loneliness among older adults who experience homelessness. This study aims to examine the relationship between relevant factors and loneliness.</p><p><strong>Methods: </strong>We used data collected from January 2015 to February 2023 from the Health Outcomes in People Experiencing Homelessness in Older Middle agE (HOPE HOME) study, an ongoing longitudinal cohort study of older adults, homeless at study entry, conducted in Oakland, CA. We used structural equation modeling (SEM) to investigate the relationships between trauma, mental health status, physical health and functional status, housing factors, social support, and substance use and loneliness.</p><p><strong>Results: </strong>Our analytic sample consisted of 385 participants who completed 2099 assessments. The majority of participants were men (74.8%), Black (82.1%), and not partnered (87.5%). At the first loneliness interview, 41.8% remained homeless, and 39.2% met the criteria for loneliness. Poor mental health and a lack of social support were associated with loneliness. Poor physical health and functional status had an indirect effect on increased loneliness through worsening mental health status. Experiences of trauma had an indirect effect on increased loneliness through worsening mental health status. The Shelter-In-Place mandate was associated with decreased loneliness. We found no association between regaining housing and decreased loneliness.</p><p><strong>Conclusion: </strong>In a longitudinal study of older adults, homeless at study entry, we found that mental health had direct impacts on loneliness, and other factors (i.e., trauma, physical health, and functional status) contributed to increased loneliness through their negative effects on mental health. Regaining housing was not associated with a decrease in loneliness. These findings highlight the need for interventions beyond housing, including mental healthcare, trauma-informed support, and social engagement opportunities.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033449","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":"Racial and Disaggregated Ethnic Disparities of Blood Pressure Control in Community Health Centers.","authors":"David Boston, Jun Hwang, Jennifer A Lucas, Miguel Marino, Zoe Larson, Evelyn Sun, Sophia Giebultowicz, Ana R Quiñones, Danielle M Crookes, Carlos J Rodriguez, John Heintzman","doi":"10.1007/s11606-025-09735-9","DOIUrl":"https://doi.org/10.1007/s11606-025-09735-9","url":null,"abstract":"<p><strong>Background: </strong>Hypertension is the most prevalent reversible risk for cardiovascular morbidity and mortality. Blood pressure (BP) control is poor nationally and varies by race/ethnicity, and there is minimal understanding of the impact of country of origin.</p><p><strong>Objective: </strong>To examine racial/ethnic disparities in BP control among high-risk patients and among Latino patients disaggregated by country of origin.</p><p><strong>Design, patients, main measures: </strong>Using electronic health record data from 1604 community-based clinics and employing logistic regression adjusted for patient-level covariates, control of final recorded BP (< 130/80) was assessed by race, ethnicity, language preference, and country of origin in 298,860 adult patients with at least one high-risk condition (diabetes, heart, vascular, chronic kidney disease) from 2012 to 2020. Data analysis was conducted from June 2023 to March 2024.</p><p><strong>Key results: </strong>40.5% of all patients had a final BP reading of < 130/80 (controlled BP). Compared with non-Latino White, non-Latino Black patients showed the lowest odds of BP control (0.69 [95% CI 0.68-0.71]) and Latino patients the highest (OR 1.19, 95% CI 1.17-1.22), with Spanish-preferring and foreign-born subgroups driving that advantage. Foreign-born Latino patients showed the highest odds of BP control compared with non-Latino White patients (OR 1.42 [95% CI 1.37-1.48]), ranging widely by country of origin.</p><p><strong>Conclusions: </strong>Race/ethnic disparities in BP control are evident in a multistate network of community-based health centers with significant variability by country of origin among Latino patients. Findings have vast implications for informing equitable clinical and public health strategies to treat patients with demonstrated difficulty achieving and maintaining BP control.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023510","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":"EBM BLS: Patients interested in Acupuncture for Chronic Sciatica may find it Reduces Pain and Disability.","authors":"Elizabeth Konon, Stephen Fuest","doi":"10.1007/s11606-025-09762-6","DOIUrl":"https://doi.org/10.1007/s11606-025-09762-6","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023472","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}