Journal of General Internal Medicine

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...

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...

BackgroundShort-video platforms have become increasingly important sources of health information for the general public. However, the informational quality and dissemination patterns of content related to specific therapeutic modalities, such as enhanced external counterpulsation (EECP), remain insufficiently characterized. This study aimed to evaluate the informational quality of EECP-related videos on a short-video platform and to examine the relationship between content quality and user engag...

ImportanceGlucagon-like peptide-1 receptor agonists (GLP-1RAs) are fast-growing treatments for type 2 diabetes, obesity, and sleep apnea and are under investigation as potential treatments for many other conditions. The National Institutes of Healths (NIHs) All of Us Research Program offers a robust observational data source for studying questions related to GLP-1RA use in real-world settings. ObjectiveThis article describes key characteristics of All of Us participants who have been prescribed...

ObjectiveTo evaluate the views of physicians in Trinidad and Tobago towards low value care MethodsPhysicians were surveyed using a cross sectional study design. An online questionnaire was disseminated through social media platforms using convenience sampling. A descriptive analysis was performed. ResultsData from 218 physicians were analysed. Most participants worked in internal medicine (n=59, 27.1%) and the majority of participants were junior doctors (n=147, 67.4%). Most participants (n=97...

BackgroundThe physician assistant (PA) workforce has expanded rapidly in the United States, increasing the importance of effective physician-PA collaboration. Although PAs improve patient outcomes and access to care, the determinants of effective collaboration has not been well studied. North Carolina provides a relevant context due to its growing PA workforce and supervisory regulatory structure, in which physicians retain administrative responsibility for PA supervision across practice setting...

IntroductionEighteenth-century medical texts document a formative period in the evolution of clinical reasoning, yet their integration into modern medical education is limited. The traditional approach to learning the history of medicine has naturally focused on passive reading, but new approaches using AI could enable learners to interrogate and simulate the historical diagnostic logic and therapeutic paradigms. More specifically, large language models (LLMs) offer an opportunity to create inte...

ObjectiveAlthough trauma-focused psychotherapies are effective for posttraumatic stress disorder (PTSD), recovery under routine outpatient conditions remains variable. We examined whether participation in a structured Specialty Care (SC) model integrating clinician specialization, flexible treatment density, and coordinated navigation was associated with accelerated PTSD recovery compared with standard outpatient care. MethodsWe conducted a retrospective matched cohort study (2024-2025) of U.S....

IntroductionHealthcare organizations have begun incorporating screening procedures for social determinants of health (SDOH) into care, recognizing the impact these factors can have on health outcomes. We aimed to present methods for evaluating redundancy in the risk information gained across SDOH questions and for evaluating whether demographic biases are present in whether patients were asked SDOH questions and whether they declined to answer them. MethodsSDOH question data were analyzed for 1...

ObjectiveTo analyze the impact of telemedicine on emergency department (ED) utilization among University of Virginia (UVA) Health System patients, examining which patient characteristics predict reduced ED usage and whether telemedicine reduces ED utilization. Materials and MethodsWe used UVA Electronic Health Records and public datasets to establish clinical and contextual features including demographics, comorbidities, insurance status, and community characteristics. UVA patient data were lin...

General-purpose large language models (LLMs) like ChatGPT are increasingly used for medical advice despite lacking medical training and frequently producing incorrect or unsafe output. Older adults health information-seeking behaviors using LLMs remain poorly characterized. We conducted a cross-sectional survey of 574 US adults aged 50+ recruited via Prolific, balanced by sex and race. Participants reported health information sources, ChatGPT and PubMed use, demographics, and health literacy. Mo...

RationalePatients receiving prolonged mechanical ventilation are often discharged to long-term acute care hospitals (LTACHs) with hopes of recovery and ultimately return to the community. Among those who survive and undergo tracheostomy, little is known about their quality of life and social outcomes after LTACH discharge. ObjectiveMeasure health related quality of life in a cohort of critical illness survivors who underwent tracheostomy and an LTACH stay MethodsSingle center, prospective obse...

Artificial intelligence (AI) is dramatically changing the healthcare landscape by providing patients, clinicians, administrators, and public health professionals with tools aiming to improve efficiency, outcomes, and experience in health. As elsewhere, New York State (NYS) experiences high demand for - and high investment in - transformation in healthcare with AI tools, though little is known about clinicians use and interest in adopting AI tools in their work. A large share of the nations futur...

BackgroundPalliative care improves quality of life and reduces healthcare utilization for people with heart failure, yet referrals remain inconsistent and delayed. Clinical decision support (CDS) offers a promising strategy to facilitate timely palliative care, but no CDS tool currently exists to specifically support palliative care decision-making in this population. MethodsGuided by the User-Centered Framework for Implementation of Technology (UFIT), we conducted a qualitative descriptive stu...

BackgroundSymptom diaries are widely used in acute respiratory infection trials to capture patient-reported symptom severity and recovery. Longer questionnaires may provide a more complete clinical picture but can increase participant burden and reduce adherence. Evidence directly comparing long and short formats within the same trial is limited. ObjectiveTo compare adherence, symptom trajectories, agreement between recovery measures, and predictive performance for recovery-related outcomes bet...

ObjectivesArtificial intelligence (AI)-enabled digital stethoscopes combine phonocardiography and electrocardiography to support detection of cardiac rhythm and structural abnormalities. This study evaluated the feasibility and exploratory diagnostic performance of AI-guided cardiac auscultation during routine general practice consultations and home visits. MethodsIn this prospective feasibility study, 50 consecutive patients aged [≥]65 years underwent AI-assisted auscultation using the Eko ...

BackgroundBRASH syndrome, characterized by bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalemia, is a recently described clinical entity that remains underrecognized. Current evidence is limited to case reports and small case series, and the pharmacological patterns underlying this syndrome have not been systematically evaluated. MethodsWe conducted a retrospective pharmacovigilance study using the U.S. Food and Drug Administration Adverse Event Reporting System ...

BackgroundMedication non-adherence is a critical problem among patients with heart failure (HF). Current evidence has shown its association with increased morbidity, mortality and healthcare costs. Prescription discrepancy is a significant risk factor that can increase non-adherence and subsequently increases the risk of HF-related hospitalization and mortality. Current literature has not provided a clear understanding of the non-adherence problem or contributing factors among Saudi HF patients....

BackgroundApproximately 33% of U.S. Veterans live in rural areas, often facing significant barriers to accessing healthcare due to staffing shortages at VA facilities. The Contract Buyout (CBO) program, authorized under the PACT Act of 2022, was designed to address rural healthcare staffing shortages by enabling Veterans Health Administration (VHA) facilities to buy out existing service contracts to work in rural VA facilities. Despite its potential, uptake of the program has been limited, with ...

AbstractAccurate health information is ineffective if patients cannot understand it. Large Language Model (LLM) health research values veridical precision; however, linguistic accessibility remains an under-examined component of output quality and usability. This study investigated two sources of variability in readability classification: differences across LLM systems and across readability metrics. The analysis tested 1,120 data points from seven systems in English and Portuguese, comparing ba...