Journal of General Internal Medicine

http://link.springer.com/journal/11606

List of Papers (Total 1,986)

Economic Implications of Potential Changes to Regulatory and Reimbursement Policies for Medical Devices

Objective To evaluate the impact of regulatory scenarios on the financial viability of medical device companies. Design We developed a model to calculate the expected net present value of a hypothetical product throughout preclinical development, clinical testing, regulatory approval, and postmarketing. We tested 3 scenarios: (1) the current regulatory environment; (2) a scenario...

Programmable Infusion Pumps in ICUs: An Analysis of Corresponding Adverse Drug Events

Background Patients in intensive care units (ICUs) frequently experience adverse drug events involving intravenous medications (IV-ADEs), which are often preventable. Objectives To determine how frequently preventable IV-ADEs in ICUs match the safety features of a programmable infusion pump with safety software (“smart pump”) and to suggest potential improvements in smart-pump...

Performance of a Web-Based Clinical Diagnosis Support System for Internists

BACKGROUND Clinical decision support systems can improve medical diagnosis and reduce diagnostic errors. Older systems, however, were cumbersome to use and had limited success in identifying the correct diagnosis in complicated cases. OBJECTIVE To measure the sensitivity and speed of “Isabel” (Isabel Healthcare Inc., USA), a new web-based clinical decision support system designed...

Improving Sedative-Hypnotic Prescribing in Older Hospitalized Patients: Provider-Perceived Benefits and Barriers of a Computer-Based Reminder

BackgroundOlder adults are commonly prescribed sedative-hypnotic (SH) medications when hospitalized, yet these drugs are associated with important adverse effects such as falls and delirium.ObjectiveTo identify provider-perceived benefits or barriers of a computer-based reminder regarding appropriate use of SH medications.DesignQualitative study using semi-structured interviews...

Trial Registration for Public Trust: Making the Case for Medical Devices

Recently, several pharmaceutical companies have been shown to have withheld negative clinical trial results from the public. These incidents have resulted in a concerted global effort to register all trials at inception, so that all subsequent results can be tracked regardless of whether they are positive or negative. These trial registration policies have been driven in large...

“That’s Like an Act of Suicide” Patients’ Attitudes Toward Deactivation of Implantable Defibrillators

ObjectiveTo understand potential patient barriers to discussions about implantable cardioverter defibrillator (ICD) deactivation in patients with advanced illness.DesignQualitative focus groups.ParticipantsFifteen community-dwelling, ambulatory patients with ICDs assigned to focus groups based on duration of time since implantation and whether they had ever received a shock from...

Patient Complexity: More Than Comorbidity. The Vector Model of Complexity

BACKGROUND The conceptualization of patient complexity is just beginning in clinical medicine. OBJECTIVES This study aims (1) to propose a conceptual approach to complex patients; (2) to demonstrate how this approach promotes achieving congruence between patient and provider, a critical step in the development of maximally effective treatment plans; and (3) to examine...

Patients with Complex Chronic Diseases: Perspectives on Supporting Self-Management

A Complex Chronic Disease (CCD) is a condition involving multiple morbidities that requires the attention of multiple health care providers or facilities and possibly community (home)-based care. A patient with CCD presents to the health care system with unique needs, disabilities, or functional limitations. The literature on how to best support self-management efforts in those...

Chronic Illness with Complexity: Implications for Performance Measurement of Optimal Glycemic Control

OBJECTIVE To evaluate the association between chronic illness with complexity (CIC) and optimal glycemic control. PARTICIPANTS Cross-sectional and longitudinal analyses of Diabetes Epidemiologic Cohort database of Veterans Health Administration (VHA) users with diabetes, less than 75 years old, with HbA1c tests in fiscal year (FY) 1999 and 2000, alive at FY2000 end (N = 95,423...

Applying Systems Engineering Principles in Improving Health Care Delivery

Background In a highly publicized joint report, the National Academy of Engineering and the Institute of Medicine recently recommended the systematic application of systems engineering approaches for reforming our health care delivery system. For this to happen, medical professionals and managers need to understand and appreciate the power that systems engineering concepts and...

Managing Complexity in Chronic Care: An overview of the VA State-of-the-Art (SOTA) Conference

Introduction The aging of the population and the increasing prevalence of multiple chronic illnesses, along with multiplying options for clinical management, pose great challenges to both the Veterans Health Administration (VHA) and the broader US health care system. Developing effective and efficient health care for persons with complex and multiple medical conditions is a...

Mortality Rate in Veterans with Multiple Chronic Conditions

Background Among patients with multiple chronic conditions, there is increasing appreciation of the complex interrelatedness of diseases. Previous studies have focused on the prevalence and economic burden associated with multiple chronic conditions, much less is known about the mortality rate associated with specific combinations of multiple diseases. Objective Measure the...

What is the Business Case for Improving Care for Patients with Complex Conditions?

INTRODUCTION Patients with complex conditions account for a disproportionate share of health care spending. Although evidence indicates that care for these patients could be provided more efficiently, the financial impact of mechanisms to improve the care they receive is unclear. DESIGN/METHODS Numerous mechanisms—emphasizing patient self-management, care coordination, and...

The Challenges of Multimorbidity from the Patient Perspective

BackgroundAlthough multiple co-occurring chronic illnesses within the same individual are increasingly common, few studies have examined the challenges of multimorbidity from the patient perspective.ObjectiveThe aim of this study is to examine the self-management learning needs and willingness to see non-physician providers of patients with multimorbidity compared to patients...

Multiple Chronic Conditions: Prevalence, Health Consequences, and Implications for Quality, Care Management, and Costs

Persons with multiple chronic conditions are a large and growing segment of the US population. However, little is known about how chronic conditions cluster, and the ramifications of having specific combinations of chronic conditions. Clinical guidelines and disease management programs focus on single conditions, and clinical research often excludes persons with multiple chronic...

Information Technology to Support Improved Care For Chronic Illness

BackgroundIn populations with chronic illness, outcomes improve with the use of care models that integrate clinical information, evidence-based treatments, and proactive management of care. Health information technology is believed to be critical for efficient implementation of these chronic care models. Health care organizations have implemented information technologies, such as...

Assessing Dual-Role Staff-Interpreter Linguistic Competency in an Integrated Healthcare System

Background Interpreter services for medical care increase physician–patient communication and safety, yet a “formal certification” process to demonstrate interpreter competence does not exist. Testing and training is left to individual health care facilities nationwide. Bilingual staff are often used to interpret, without any assessment of their skills. Assessing interpreters...

Patient Satisfaction with Different Interpreting Methods: A Randomized Controlled Trial

Background Growth of the foreign-born population in the U.S. has led to increasing numbers of limited-English-proficient (LEP) patients. Innovative medical interpreting strategies, including remote simultaneous medical interpreting (RSMI), have arisen to address the language barrier. This study evaluates the impact of interpreting method on patient satisfaction. Methods 1,276...