Prior evaluation at our hospital demonstrated that, compared to White patients, Black and Latinx patients with congestive heart failure (CHF) were less likely to be admitted to the cardiology service rather than the general medicine service (GMS). Patients admitted to GMS (compared to cardiology) had inferior rates of cardiology follow-up and 30-day readmission. To develop and...
Clinical algorithms that incorporate race as a modifying factor to guide clinical decision-making have recently been criticized for propagating racial bias in medicine. Equations used to calculate lung or kidney function are examples of clinical algorithms that have different diagnostic parameters depending on an individual’s race. While these clinical measures have multiple...
We present the case of a young woman admitted for diabetic ketoacidosis with persistent, asymptomatic lactic acid (LA) elevation during the evolving COVID-19 pandemic. Cognitive biases in interpreting an elevated LA in this patient’s care resulted in an extensive infectious workup instead of the low-cost and potentially diagnostic provision of empiric thiamine. We discuss...
The delivery of primary healthcare in the USA is threatened on multiple fronts. To preserve and strengthen this critical part of the healthcare delivery system, a rapid and broadly accepted change in the basic payment strategy is needed. This paper describes the changes in the delivery of primary health services that demand additional population-based funding and the need to...
Infertility care is provided to Veterans through the Veterans Health Administration (VHA) medical benefits package and includes infertility evaluation and many infertility treatments. Our objective was to examine the incidence and prevalence of infertility diagnoses and the receipt of infertility healthcare among Veterans using Veterans Health Administration (VHA) healthcare from...
Little is known about whether diabetes increases the risk of COVID-19 infection and whether measures of diabetes severity are related to COVID-19 outcomes. Investigate diabetes severity measures as potential risk factors for COVID-19 infection and COVID-19 outcomes. In integrated healthcare systems in Colorado, Oregon, and Washington, we identified a cohort of adults on February...
Compared to white individuals, Black and Hispanic individuals have higher rates of COVID-19 hospitalization and death. Less is known about racial/ethnic differences in post-acute sequelae of SARS-CoV-2 infection (PASC). Examine racial/ethnic differences in potential PASC symptoms and conditions among hospitalized and non-hospitalized COVID-19 patients. Retrospective cohort study...
Shadow coaching, a type of one-on-one provider counseling by trained peers, is an effective strategy for improving provider behaviors and patient interactions, but its effects on improving patient experience for English- and Spanish-preferring patients is unknown. Assess effects of shadow coaching on patient experience for English- and for Spanish-preferring patients. We analyzed...
Attention-deficit hyperactivity disorder is a common disorder that affects both children and adults. However, for adults, little is known about ADHD-attributable medical expenditures. To estimate the medical expenditures associated with ADHD, stratified by age, in the US adult population. Using a two-part model, we analyzed data from Medical Expenditure Panel Survey for 2015 to...
Physician burnout increased during the COVID-19 pandemic. To evaluate the effectiveness of a multimodal workplace intervention designed to reduce hospitalist burnout. Participants and setting: Our intervention group was composed of internal medicine hospitalists at Providence Portland Medical Center (64 providers including 58 physicians and 6 nurse practitioners). Our control was...
In 2021, the National Academy of Science, Engineering, and Medicine Committee on Implementing High-Quality Primary Care published its recommendations to expand the provision of high-quality primary care in the USA. These include paying for primary care teams to care for people, ensuring that high-quality primary care is available, training primary care teams where people live and...
Non-arrivals to scheduled ambulatory visits are common and lead to a discontinuity of care, poor health outcomes, and increased subsequent healthcare utilization. Reducing non-arrivals is important given their association with poorer health outcomes and cost to health systems. To develop and validate a prediction model for ambulatory non-arrivals. Retrospective cohort study...