Inter-hospital patient transfers to hospitals with greater resource availability and expertise may improve clinical outcomes. However, there is little guidance regarding how patient transfer requests should be prioritized when hospital resources become scarce. To understand the experiences of healthcare workers involved in the process of accepting inter-hospital patient transfers...
Clinical trials indicate continuous glucose monitor (CGM) use may benefit adults with type 2 diabetes, but CGM rates and correlates in real-world care settings are unknown. We sought to ascertain prevalence and correlates of CGM use and to examine rates of new CGM prescriptions across clinic types and medication regimens. Retrospective cohort using electronic health records in a...
Lack of experienced faculty to supervise internal medicine (IM) residents is a significant barrier to establishing a medical procedure service (MPS). Describe the development and 10-year outcomes of an MPS led by IM chief residents. University-based IM residency program affiliated with a county and Veterans Affairs hospital. Categorical IM interns (n=320) and 4th-year IM chief...
Decreasing low-value colonoscopy is critical to optimizing access for high-need patients, particularly in resource-constrained environments such as those created by the COVID-19 pandemic. We hypothesized that rates of screening colonoscopy overuse would decline during COVID compared to pre-COVID due to enhanced procedural scrutiny and prioritization in the setting of constrained...
Although many studies assess predictors of provider burnout, few analyses provide high-quality, consistent evidence on the impact of provider burnout on patient outcomes exist, particularly among behavioral health providers (BHPs). To assess the impact of burnout among psychiatrists, psychologists, and social workers on access-related quality measures in the Veterans Health...
Little is known about patient or provider experience and perceptions of stopping surveillance among older adults with a history of colon polyps. While guidelines recommend ceasing routine colorectal cancer screening in adults > 75 years and those with limited life expectancy, guidance for ceasing surveillance colonoscopy in those with prior colon polyps suggests individualizing...
Medical debt affects one in five adults in the USA and may disproportionately burden postpartum women due to pregnancy-related medical costs. To evaluate the association between childbirth and medical debt, and the correlates of medical debt among postpartum women, in the USA. Cross-sectional. We analyzed female “sample adults” 18–49 years old in the 2019–2020 National Health...
The Department of Veterans Affairs (VA) healthcare system routinely screens Veterans for food insecurity, housing instability, and intimate partner violence, but does not systematically screen for other health-related social needs (HRSNs). To (1) develop a process for systematically identifying and addressing Veterans’ HRSNs, (2) determine reported prevalence of HRSNs, and (3...
Primary care practitioners (PCPs) play a key role in cancer screening decisions for older adults (≥ 65 years), but recommendations vary by cancer type and jurisdiction. To examine the factors influencing PCPs’ recommendations for breast, cervical, prostate, and colorectal cancer screening for older adults. MEDLINE, Pre-Medline, EMBASE, PsycINFO, and CINAHL, searched from 1...
For the 5 million persons living with dementia (PLWD) in the USA, telemedicine may improve access to specialty care from their homes. To elicit informal caregiver perceptions of tele-dementia care provided during COVID-19. Qualitative, observational study using grounded theory. Informal caregivers aged 18 + who cared for an older adult who received tele-dementia services at two...
Appointment no shows are prevalent in safety-net healthcare systems. The efficacy and equitability of using predictive algorithms to selectively add resource-intensive live telephone outreach to standard automated reminders in such a setting is not known. To determine if adding risk-driven telephone outreach to standard automated reminders can improve in-person primary care...
It is important to identify older adults at high risk of functional disability and to take preventive measures for them at an early stage. To our knowledge, there are no studies that predict functional disability among community-dwelling older adults using machine learning algorithms. To construct a model that can predict functional disability over 5 years using basic machine...
Alcohol use disorder (AUD) is the most prevalent substance use disorder, but evidence-based medications to treat AUD (MAUD), including naltrexone and acamprosate, are substantially underutilized. Hospitalization provides an opportunity to start MAUD for patients who may not otherwise seek treatment. Addiction consultation services (ACSs) have been increasingly utilized to ensure...
Telehealth services, specifically telemedicine audio-video and audio-only patient encounters, expanded dramatically during the COVID-19 pandemic through temporary waivers and flexibilities tied to the public health emergency. Early studies demonstrate significant potential to advance the quintuple aim (patient experience, health outcomes, cost, clinician well-being, and equity...
Women’s health care has evolved significantly since it was first acknowledged as an integral part of internal medicine training more than two decades ago. To update and clarify core competencies in sex- and gender-based women’s health for general internists, the Society of General Internal Medicine (SGIM) Women and Medicine Commission prepared the following Position Paper...
The Veterans Health Administration (VA) serves Veterans in the nation’s largest integrated healthcare system. VA seeks to provide high quality of healthcare to Veterans, but due to the VA Choice and MISSION Acts, VA increasingly pays for care outside of its system in the community. This systematic review compares care provided in VA and non-VA settings, and includes published...
International guidelines provide heterogenous guidance on use of corticosteroids for community-acquired pneumonia (CAP). We performed a systematic review of randomized controlled trials examining corticosteroids in hospitalized adult patients with suspected or probable CAP. We performed a pairwise and dose-response meta-analysis using the restricted maximum likelihood (REML...
Antipsychotic medications do not alter the incidence or duration of delirium, but these medications are frequently prescribed and continued at transitions of care in critically ill patients when they may no longer be necessary or appropriate. The purpose of this study was to identify and describe relevant domains and constructs that influence antipsychotic medication prescribing...
Health services research can benefit from frontline clinician input across all stages of research, yet their key perspectives are often not meaningfully engaged. How can we improve clinician engagement in research? Convenience sampling and semi-structured interviews followed by descriptive content analysis with an inductive approach, followed by group participatory listening...