Journal of General Internal Medicine

ObjectiveThis study compared primary care physicians self-reported experiences with Electronic Health Records (EHR) interoperability, as reported across three surveys: the 2022 Continuous Certification Questionnaire (CCQ) from the American Board of Family Medicine, the 2022 University of California San Franciscos (UCSF) Physician Health IT Survey, and the 2021 National Electronic Health Records Survey (NEHRS). Materials and MethodsWe used descriptive analyses to identify differences between sur...

ObjectiveTo determine the extent to which family physicians closed their doors altogether or for in-person visits during the pandemic, their future practice intentions, and related factors. MethodsBetween March and June 2021, we conducted a cross-sectional survey using email, fax, and phone of 1,186 family doctors practicing comprehensive family medicine in Toronto, Ontario. We asked about practice patterns in January 2021, use of virtual care, and practice intentions. ResultsOf the 1,016 (86%...

ImportanceLLMs have encoded a vast array of medical knowledge and are being integrated into clinical settings as decision-support tools to improve physician performance across various aspects of care. However, evidence of the impact of LLMs on the clinical reasoning of physicians remains limited. ObjectiveTo evaluate the impact of LLM on core aspects of physicians clinical reasoning: diagnostic reasoning, information gathering, and management reasoning in primary care scenarios. Design, Settin...

IntroductionThe population in need of primary care is rapidly growing and increasingly complex with respect to chronic disease burden. We must develop alternative and more efficient approaches to managing patients if we are to increase access to care without sacrificing continuity; however, there is little guidance for innovation strategies at the practice level. MethodsThe Mayo Clinic Department of Family Medicine engaged in a 2-year multistage planning process to develop plans for a Model Uni...

BackgroundPalliative care teams generally lack prospective tools to identify individuals who could benefit from specialty palliative care, which hinders their ability to find and treat patients early in their illness trajectories. Health systems are also limited in their ability to assess how well their palliative care services reach the population in need, which in turn makes it much more difficult to determine the quality, value, and effectiveness of those services. This study describes the cr...

BackgroundLittle is known about long-term recovery from severe COVID-19 disease. Here, we characterize overall health, physical health and mental health of patients one month after discharge for severe COVID-19. MethodsThis was a prospective single health system observational cohort study of patients [≥]18 years hospitalized with laboratory-confirmed COVID-19 disease who required at least 6 liters of oxygen during admission, had intact baseline cognitive and functional status and were discha...

ObjectiveTo determine the capabilities of ChatGPT for rapidly generating, rewriting, and evaluating (via diagnostic and triage accuracy) sets of clinical vignettes. DesignWe explored the capabilities of ChatGPT for generating and rewriting vignettes. First, we gave it natural language prompts to generate 10 new sets of 10 vignettes, each set for a different common childhood illness. Next, we had it generate 10 sets of 10 vignettes given a set of symptoms from which to draw. We then had it rewri...

BackgroundData on patients with coronavirus disease 2019 (COVID-19) who return to hospital after discharge are scarce. Characterization of these patients may inform post-hospitalization care. Methods and FindingsRetrospective cohort study of patients with confirmed SARS-CoV-2 discharged alive from five hospitals in New York City with index hospitalization between February 27th-April 12th, 2020, with follow-up of [&ge;]14 days. Significance was defined as P<0.05 after multiplying P by 125 study-...

IntroductionPatients with comorbidities have been shown to experience increased vulnerability during the COVID-19 pandemic, and to suffer disruption in their care coordination; having a multidisciplinary team is a care coordination strategy that can improve outcomes. The aim of this study was to describe the perspectives of team leads on coordination practices at their multidisciplinary health team (MHT) prior to, and during the COVID-19 pandemic. MethodsUsing a cross-sectional survey design, t...

BackgroundThere have been rapid shifts in outpatient care models during the COVID-19 pandemic but the impact of these changes on patient outcomes are uncertain. We designed this study to examine ambulatory outpatient visit patterns and outcomes between March 1, 2019 to February 29, 2020 (pre-pandemic) and from March 1, 2020 to February 28, 2021 (pandemic). MethodsWe conducted a population-based retrospective cohort study of all 3.8 million adults in the Canadian province of Alberta, which has a...

BackgroundCurrent literature on direct primary care (DPC) is largely composed of opinion-based arguments that the model may exacerbate healthcare inequity. Objective data are needed to assess how DPC practices are distributed and whether they contribute to disparities in access to care. Methods1. Visited DPC Frontier website (https://mapper.dpcfrontier.com). 2. Extracted clinic information from the website using a custom web-socket script (ws.py) that requested each entry using its practice-key...

During Covid-19, the Defense Health Agencys TRICARE insurance plan expanded its coverage to include 30.1% additional civilian healthcare providers. The DHAs Annual Report, however, states that TRICAREs provider directories are only 80% accurate. Although the DHAs 9.6 million beneficiaries need expanded access to care, they also require protection from misleading information, medical fraud, patient abuse, and identity theft. Since 2013, the Department of Health and Human Services Office of the In...

BackgroundThe International Organization for Standardization (ISO) and US Food and Drug Administration (FDA) are updating regulations for pulse oximeters to reduce performance disparities linked to skin pigment. We tested common oximeters with current and anticipated regulatory frameworks. We hypothesized that not all oximeters show more positive bias in darkly vs lightly pigmented participants and that few oximeters would pass the anticipated FDA regulations. MethodsWe used a controlled desat...

ObjectiveTo assess the use of remote care by patients with long-term conditions (LTC) in France to interact with their referring physician (RP), and their preferences for in-person versus remote care with their RP or another physician. Methods and AnalysisVignette-based survey among adults with at least one LTC recruited from the ComPaRe cohort, a nationwide cohort of patients with LTC in France. Data were weighted to represent French patients with LTC. The survey assessed 1) the availability a...

IntroductionOne of the noted features of COVID-19 is the spectrum of expressivity in symptoms among those with the disease, ranging from no or mild symptoms that may last a small number of days, to severe and/or longer lasting symptoms. It is emerging that many patients have long lasting symptoms, several months after initial infection with COVID-19. The aim of this research was to characterize post-acute COVID-19 syndrome (PACS). MethodsThis was a retrospective cross-sectional observational st...

ObjectiveTo evaluate the impact of a comprehensive behavioral health (BH) program on healthcare utilization and total medical spending across 17 employer health plans. Study Setting and DesignA retrospective evaluation of benefit implementation across 17 employer-sponsored health plans between November 1, 2019, and January 1, 2025. Interrupted time series analysis models were used to estimate shifts in utilization patterns and medical spending across the entire health plan population before and...

IntroductionThe COVID-19 pandemic exacerbated long-standing healthcare disparities, disproportionately affecting racial, ethnic, sexual, and gender minoritized populations. Structural inequities fuel medical mistrust and hinder equitable vaccine access. Culturally responsive communication (CRC) is a critical strategy in primary care that has the potential to improve patient-provider interactions and vaccine acceptance. ObjectivesThis scoping review examines how CRC is conceptualized and impleme...

IntroductionEmergency Department (ED) Observation Units (OUs) are increasingly-common. Centers for Medicare and Medicaid Services (CMS) reimbursement policies incentivize documenting longer times spent on the disposition/discharge process ([&ge;]31 minutes). In addition, there is a well-recognized phenomenon of "terminal digit preference (ending times in 0 or 5). The Long Island Jewish Medical Center (LIJ) EDs OU disposition process is performed by physician assistants (PAs). This study investig...

Quality Improvement (QI) tools abound to help clinicians improve the quality of their care. Such tools, however, assume one knows the process that needs attention. A systematic approach is thus needed for selecting the QI activities that have the greatest impact on quality. This study applies Functional Job Analysis (FJA) to systematically identify areas in preventive care most suitable for high-impact QI efforts. Seven internal medicine practice personnel served as subject matter experts (SMEs)...

Communication with patients in language they understand leads to greater comprehension of treatment and diagnoses but can be time consuming for clinicians. Here we sought to investigate the utility of ChatGPT to translate clinic letters into language patients understood, without loss of clinical information. Twenty-three letters from a range of specialities were translated, resulting in no loss of clinical information. Subjective analysis from patient representatives revealed significantly incre...