Journal of General Internal Medicine最新文献

{"title":"Reduction in the Concomitant Ordering of Erythrocyte Sedimentation Rate and C-Reactive Protein Within a Large Academic Medical Center.","authors":"Ruchi Desai, Ray Zhang, Nainesh Shah, Maria Bacalao, Haidy Galous, David R Karp, Puneet Bajaj","doi":"10.1007/s11606-025-09632-1","DOIUrl":"https://doi.org/10.1007/s11606-025-09632-1","url":null,"abstract":"<p><strong>Background: </strong>Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are two laboratory tests often ordered simultaneously to assess for inflammation. Studies show that CRP is superior to ESR, and co-ordering ESR and CRP increases expenditures and phlebotomy without demonstrable patient benefit.</p><p><strong>Objective: </strong>Our quality improvement project aimed to reduce ESR/CRP co-ordering and total ESR orders in a safety-net health setting (health system 1) and a university setting (health system 2) within an academic medical center.</p><p><strong>Design/interventions: </strong>Using plan, do, study, act (PDSA) methodology, we developed education and electronic health record (EHR) interventions, which included education to all rheumatology providers, targeted education to rheumatology providers with the highest ESR/CRP co-orders, removal of ESR from the rheumatology order set at health system 2, and implementation of a non-intrusive clinical decision support (CDS) change at both hospitals.</p><p><strong>Main measures: </strong>We compared ESR/CRP co-orders, ESR-only orders, and CRP-only orders between pre- and post-intervention periods, as well as weekly average orders per 1000 patient days in the inpatient setting and per 1000 patient encounters in the outpatient setting and rheumatology clinics.</p><p><strong>Key results: </strong>In health system 1, average weekly ESR/CRP co-orders decreased by 25%, ESR-only orders decreased by 26%, and CRP-only orders increased by 11%. In health system 2, average weekly ESR/CRP co-orders decreased by 36%, ESR-only orders decreased by 47%, and CRP-only orders increased by 65%. Most of the change was seen in the outpatient setting, with >80% reduction in ESR/CRP co-ordering by the rheumatology division in both health systems. Using ESR and CRP Medicare reimbursement rates, estimated payer savings system-wide were $59,354.33 over 1 year.</p><p><strong>Conclusion: </strong>Specialty-led and targeted educational interventions and non-intrusive simple EHR CDS changes are effective in reducing redundant laboratory testing to provide higher value care.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174125","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":"Supporting Patients Through Benzodiazepine Tapering: A New Joint Clinical Practice Guideline.","authors":"Aleksandra E Zgierska, Maureen P Boyle, Joseph Conigliaro","doi":"10.1007/s11606-025-09634-z","DOIUrl":"https://doi.org/10.1007/s11606-025-09634-z","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174127","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":"\"I Don't Want to Die on the Street\": Patient and Practitioner Perspectives on Street-Based Care for Older Adults Experiencing Unsheltered Homelessness.","authors":"Anuva Mittal, Enya Lowe, Corinne Feldman, Alexis Coulourides Kogan","doi":"10.1007/s11606-025-09591-7","DOIUrl":"https://doi.org/10.1007/s11606-025-09591-7","url":null,"abstract":"<p><strong>Background: </strong>Unsheltered older adults experiencing homelessness constitute the fastest-growing segment of the US unhoused population. Research shows that older unsheltered adults have more chronic health conditions and experience accelerated aging. Little is known about the unique considerations in providing care and support for this population.</p><p><strong>Objective: </strong>To explore the experiences of aging and managing serious illness from people experiencing unsheltered homelessness and from the street medicine team members who care for them.</p><p><strong>Design: </strong>Qualitative, semi-structured in-depth individual interviews.</p><p><strong>Participants: </strong>Street medicine team members and patients receiving street medicine in Los Angeles.</p><p><strong>Approach: </strong>Interviews were guided by a semi-structured interview guide developed by the team, audio-recorded, and transcribed verbatim. Field notes supplemented transcripts. Transcripts and field notes were analyzed by two independent coders following a thematic analysis approach rooted in grounded theory.</p><p><strong>Key results: </strong>Eight street medicine team members with varying experience caring for patients experiencing homelessness (1-16 years) and from multidisciplinary backgrounds were interviewed. Team members were, on average, 39 years old (SD 7.4 years), 63% female, and 50% white. Eight patients were interviewed and identified as male (63%), having 3 + chronic health conditions (100%), and aged on average 56 years (range 50-71; SD 4.7 years). Thematic analysis of the interviews revealed two major themes on challenges and considerations for the following: (1) Caring for older adults experiencing unsheltered homelessness (subthemes: Medical, Interpersonal, Environmental, and Systemic), and (2) Shelter, long-term care, and end-of-life planning among older adults experiencing unsheltered homelessness (subthemes: Permanent shelter, Rehabilitative and institutional care, and End-of-life care planning).</p><p><strong>Conclusions: </strong>Team member and patient perspectives offered insight into significant challenges faced when trying to apply conventional healthcare practices to the unique circumstances of the unsheltered setting. Findings suggest actionable strategies with implications for both policy and practice to better meet the needs of unsheltered homeless older adults.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159461","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":"Pain Management Among People with Limited English Proficiency Treated by Emergency Medical Services.","authors":"Marissa L Ding, Christopher E Warrington, Chad P Liedl, Jennifer M Manggaard, M Carson Rogerson, Jane W Njeru, Rozalina G McCoy","doi":"10.1007/s11606-025-09621-4","DOIUrl":"https://doi.org/10.1007/s11606-025-09621-4","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159516","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":"Association Between Precarious Employment and Cognitive Decline: A Longitudinal Study of Middle-Aged and Older Workers in Korea.","authors":"Seong-Uk Baek, Jin-Ha Yoon","doi":"10.1007/s11606-025-09617-0","DOIUrl":"https://doi.org/10.1007/s11606-025-09617-0","url":null,"abstract":"<p><strong>Background: </strong>Globally, many countries are experiencing rapid aging of their working populations. Moreover, older workers are particularly susceptible to poor employment conditions, which can contribute to health inequalities.</p><p><strong>Objective: </strong>We explored the association between precarious employment (PE) and cognitive decline.</p><p><strong>Design: </strong>A longitudinal analysis of a cohort of Korean workers.</p><p><strong>Participants: </strong>We included a nationwide sample of Korean adults aged ≥45 years (n = 2137), with repeated measurements conducted biennially from 2006 to 2020 (6290 observations).</p><p><strong>Main measures: </strong>PE was assessed based on three dimensions: employment insecurity, income inadequacy, and a lack of rights and protection. A summative score was used to categorize an individual's PE into quartiles (lowest, low, high, and highest). Cognitive decline was defined as a decrease in the Mini-Mental State Examination score by ≥3 after a 2-year follow-up. Generalized estimating equations were used to determine the association between PE and cognitive decline. We estimated odds ratios (ORs) and 95% confidence intervals (CIs).</p><p><strong>Key results: </strong>The mean age was 51.6 years, and the mean baseline MMSE score was 28.7. During the study period, cognitive decline was observed in 15.1% of the observations over a 2-year follow-up. Regarding each PE element, workers with the lowest wage (<60% of the median) was associated with increased odds of experiencing cognitive decline (OR, 1.45; 95% CI, 1.02-2.06). Based on a summative score, workers with high or the highest PE levels had increased odds of experiencing cognitive decline (OR, 1.38; 95% CI, 1.07-1.77 for high PE and OR, 1.51; 95% CI, 1.14-1.99 for the highest PE) compared with workers with the lowest PE level.</p><p><strong>Conclusions: </strong>This study suggests that PE is a risk factor for cognitive decline in workers. Enhancing employment conditions for older adults is crucial for promoting healthy aging.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159535","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 the Associations of Cultural Sensitivity, Technology, and Patient Empowerment with Patient-Centered Care: A Mixed-Methods Study in UAE Rehabilitation Healthcare Centers.","authors":"Wenxing Xue, Rui Hou, Aixu Duan, Yanhua Zhao, Murad Awad","doi":"10.1007/s11606-025-09401-0","DOIUrl":"https://doi.org/10.1007/s11606-025-09401-0","url":null,"abstract":"<p><strong>Background: </strong>Patient-centered care is a healthcare priority, particularly in diverse settings like the United Arab Emirates. Understanding the factors influencing its delivery is essential for effective care.</p><p><strong>Objective: </strong>This study examines the association between cultural sensitivity, technology, and patient empowerment with patient-centered care in UAE rehabilitation healthcare centers.</p><p><strong>Design: </strong>A mixed-methods approach was employed, integrating quantitative and qualitative data collection. Quantitative data was analyzed using correlation and regression analyses, while qualitative data was explored through thematic analysis to identify key patterns.</p><p><strong>Participants: </strong>The study involved 100 healthcare providers (internists, nurses, rehabilitation therapists) working in licensed rehabilitation healthcare centers in the UAE. Additionally, 200 patients recruited through purposive sampling from both inpatient and outpatient settings. Patients, aged 18-54, represented diverse socio-economic backgrounds and health conditions, including musculoskeletal, neurological, and chronic illnesses.</p><p><strong>Approach: </strong>Quantitative data was collected using a structured questionnaire comprising 12 items measured on a 5-point Likert scale, focusing on healthcare providers' and patients' perceptions of cultural sensitivity, technology integration, and patient empowerment. Qualitative data from semi-structured interviews was transcribed, coded, and analyzed to explore detailed perspectives on how cultural practices, technological tools, and empowerment strategies influence care delivery.</p><p><strong>Key results: </strong>Cultural sensitivity demonstrated a strong positive correlation with patient-centered care (PCC) (r = 0.938, p < 0.001), as did patient empowerment (r = 0.965, p < 0.001). Regression analysis revealed that patient empowerment was the most influential factor (B = 0.800, p < 0.001), followed by cultural sensitivity (B = 0.110, p = 0.041). Thematic analysis of qualitative data highlighted the significance of cultural practices, adaptability of technology, and patient-driven strategies in shaping positive care experiences.</p><p><strong>Conclusion: </strong>The findings align with existing research, underscoring the importance of cultural competence, technological integration, and patient empowerment in delivering effective patient-focused care.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159507","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":"What Makes for a Positive Patient Experience in Chronic Pain Care? A Qualitative Evaluation of Factors Affecting Veteran Patient Satisfaction Across Two Individualized Pain Care Interventions in VA Primary Care.","authors":"Natalie Purcell, Beth M DeRonne, Hope A Salameh, Erin E Krebs, Karen H Seal, William C Becker, Hildi J Hagedorn","doi":"10.1007/s11606-025-09630-3","DOIUrl":"https://doi.org/10.1007/s11606-025-09630-3","url":null,"abstract":"<p><strong>Background: </strong>Veterans are at high risk for pain-related disability, medication overdose, and opioid-related deaths. In response, Veterans Affairs (VA) healthcare systems are working to implement innovative, multimodal pain care. Recently, the Veterans' Pain Care Organizational Improvement Comparative Effectiveness (VOICE) study compared two interventions that provide individualized pain care and opioid tapering-an interdisciplinary integrated pain team (IPT) and pharmacist collaborative management (PCM).</p><p><strong>Objective: </strong>Informed by VOICE qualitative interview data, this paper examines patient experiences with IPT and PCM and identifies factors that affected patient satisfaction across both interventions.</p><p><strong>Approach: </strong>We conducted qualitative, semi-structured interviews with 63 veteran patients who participated in VOICE. The first set of interviews (n = 32) examined patients' experience with the VOICE interventions and solicited suggestions for improvement. The second set (n = 31) examined patients' experiences with telehealth in VOICE and inquired about changes to pain-care access and delivery associated with the COVID-19 pandemic. We used rapid analysis procedures to identify themes across both sets of interviews.</p><p><strong>Key results: </strong>Veterans enrolled in both VOICE interventions described how they learned to better live with and self-manage pain. Across interventions, key factors that facilitated a positive patient experience included the opportunity to develop a long-term relationship with the clinician or care team, meaningful patient involvement in treatment planning and decision-making, adequate variety and accessibility of options for treatment and self-management, and ease of communication and care coordination.</p><p><strong>Conclusion: </strong>Although IPT and PCM are unique interventions with significant differences from one another, the fundamental factors that influenced patients' satisfaction were common to both interventions, including the opportunity to develop a therapeutic patient-clinician relationship, engagement in shared decision-making, adequate care access, and support for care coordination. These factors, which are relevant across different pain care interventions and contexts, should be key considerations as healthcare organizations design and implement pain care interventions.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159539","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":"Hospitalist and \"SNFist\" Clinician Perspectives on Frailty Assessment of Rehab Patients.","authors":"William C Lippert, Kathryn E Callahan, Brian N White, Erica L Frechman, Charles T Semelka","doi":"10.1007/s11606-025-09605-4","DOIUrl":"https://doi.org/10.1007/s11606-025-09605-4","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159511","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":"Geographic Trends in Opioid and Polysubstance Overdose Deaths in the US, 2014-2023.","authors":"William C Oles, Michael Liu, Sarah E Wakeman, Marc R Larochelle","doi":"10.1007/s11606-025-09589-1","DOIUrl":"https://doi.org/10.1007/s11606-025-09589-1","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119836","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":"Improving Discrimination in Predicting Level of Care Needed for Patients Admitted with Pneumonia.","authors":"David E Katz, Gideon Leibner, Nechama Kaufman, Yaakov Esayag, Shuli Brammli-Greenberg, Adam J Rose","doi":"10.1007/s11606-025-09610-7","DOIUrl":"https://doi.org/10.1007/s11606-025-09610-7","url":null,"abstract":"<p><strong>Background: </strong>Various risk stratification scores are used to predict outcomes among patients with pneumonia. We have developed a novel model that predicts the risk of death or intensive care unit transfer in internal medicine.</p><p><strong>Objective: </strong>To compare the ability of two prediction models to predict clinical outcomes in patients admitted for pneumonia, using information available at the time of admission.</p><p><strong>Design: </strong>Comparison of two prediction models.</p><p><strong>Participants: </strong>3856 pneumonia admissions to the internal medicine service of a tertiary medical center.</p><p><strong>Main measures: </strong>We compared the ability of two scores to predict in-hospital mortality and escalation of care (e.g., to the intensive care unit) among patients admitted for pneumonia. One was the CURB-65 score, which is currently in use at our hospital. The other score was one we developed, based on the Elixhauser case mix adjustment model with additional data, such as vital signs and laboratory values.</p><p><strong>Key results: </strong>11.8% of patients died in-hospital and 17.7% required an escalation of care. The most common CURB-65 score was 2 (44%), the lowest CURB-65 score ordinarily requiring admission. Our risk prediction score was better than CURB-65 at predicting mortality (c-statistic 0.846 vs. 0.724) and escalation (0.757 vs. 0.633). Our score was able to discriminate among patients classified as similar-risk by the CURB-65 score: of the 1681 patients with a (medium-risk) CURB-65 score of 2, our model placed 180 (11%) into the lowest-risk quintile of patients, and 309 (18%) into the highest-risk quintile.</p><p><strong>Conclusions: </strong>Our risk stratification tool is calculable with information available in the electronic medical record of most hospitals. The new score was much better able to predict the outcomes of in-hospital mortality and escalation of care among patients admitted for pneumonia, compared to CURB-65.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127405","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}