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  • JAMA Internal Medicine April 1, 2017

    Figure: Maximum Allowable Copy Fees for Hypothetical Medical Records

    Maximum allowable copy fees for hypothetical 15-, 150-, and 500-page medical records requested from hospitals in 2015, not including postage or images. Each data point represents a state's maximum allowed cost for a medical record. The first and third quartiles of the distribution of possible costs across states are indicated by bars, with the median at the interface of the 2 shaded areas. The maximum allowable copy fees are calculated based on statutes in the 42 states that set specific limits on fees. The states with the highest maximum allowable fees are Texas ($53.60 for 15 pages) and Minnesota ($218.70 for 150 pages and $687.70 for 500 pages).
  • Copy Fees and Limitation of Patients’ Access to Their Own Medical Records

    Abstract Full Text
    JAMA Intern Med. 2017; 177(4):457-458. doi: 10.1001/jamainternmed.2016.8560

    This Viewpoint addresses fees that patients must pay for copies of their personal medical records and how the availability of digital medical records can improve this situation.

  • JAMA Internal Medicine February 1, 2017

    Figure: Penicillin Allergy Pathway for Antibiotic Prescription in Patients With Penicillin Allergy

    Patient reactions are categorized as type II to IV hypersensitivity reaction (HSR) (serum sickness, Stevens-Johnson syndrome or toxic epidermal necrolysis, acute interstitial nephritis, drug rash eosinophilia and systemic symptoms, hemolytic anemia) for which cross-reactivity data are limited; type I IgE-mediated allergy (anaphylaxis, angioedema, wheezing, bronchospasm, hypotension, urticaria) or unknown reaction; mild reaction (delayed morbilliform or maculopapular eruption or electronic medical record [EMR] or medical record discrepancy with patient interview). When the pathway advises consultation by the allergy and immunology service, penicillin skin testing is recommended before using the specified antibiotics. Reprinted from Blumenthal et al with permission from Elsevier.
  • The Diagnostic and Healing Qualities of Story: Goals of Care

    Abstract Full Text
    JAMA Intern Med. 2014; 174(7):1037-1037. doi: 10.1001/jamainternmed.2014.1800
  • Known Unknowns and Unknown Unknowns at the Point of Care

    Abstract Full Text
    JAMA Intern Med. 2013; 173(21):1959-1961. doi: 10.1001/jamainternmed.2013.7494
  • The Challenge to the Medical Record

    Abstract Full Text
    JAMA Intern Med. 2013; 173(13):1171-1172. doi: 10.1001/jamainternmed.2013.976
  • Failure to Engage Hospitalized Elderly Patients and Their Families in Advance Care Planning

    Abstract Full Text
    free access
    JAMA Intern Med. 2013; 173(9):778-787. doi: 10.1001/jamainternmed.2013.180
    Heyland et al inquired about patients’ advance care planning activities before hospitalization and preferences for care from the perspectives of patients and family members, measuring real-time concordance between expressed preferences for care and documentation of those preferences in the medical record.
  • JAMA Internal Medicine May 13, 2013

    Figure: Failure to Engage Hospitalized Elderly Patients and Their Families in Advance Care Planning

    Figure 2. Relationship between expressed preferences for use (or nonuse) of life-sustaining treatments and documented goals of care in the medical record. A, Patients' preferences for care and documented goals of care. Two patients with missing preference data and 77 with missing documentation were excluded; 199 of 278 enrolled patients (71.6%) were included in the analysis. The preferences were described and categorized as follows: (1) aggressive use of heroic measures and artificial life-sustaining treatments, including CPR (cardiopulmonary resuscitation), to keep me alive at all costs; (2) full medical care, but in the event my heart or breathing stops, no CPR; (3) physicians will be focused on my comfort by alleviating suffering and not on keeping me alive by artificial means or heroic measures, such as trying to prolong my life with CPR and other life-sustaining technologies; (4) a mix of the above options (eg, try to fix problems, but if I am not getting better, switch to focusing only on my comfort, even if it hastens death); (5) unsure; and (6) other. B , Family members' preferences for patient care and documented goals of care, with categories as listed for panel A. One family member with missing data and 71 with missing documentation were excluded; 153 of 225 enrolled family members (68.0%) were included in this analysis.
  • JAMA Internal Medicine August 8, 2011

    Figure: Long-term Outcomes Following Positive Fecal Occult Blood Test Results in Older Adults: Benefits and Burdens

    Figure 1. Flowchart of the long-term outcomes following a positive fecal occult blood test (FOBT) result. *Among the 94 patients who did not have a follow-up colonoscopy related to their positive FOBT result, 10 ultimately underwent colonoscopy for symptoms that developed over the 7-year study period (eg, hematochezia, unexplained weight loss, anemia), and 2 patients underwent screening colonoscopy many years later without any mention of their positive FOBT result from 2001. The 3 patients in the no–follow-up colonoscopy group who died of colorectal cancer within 5 years of their FOBT all had refused follow-up colonoscopy. †Eight patients did not have a pathology report available from their colonoscopy performed outside of the Veterans Affairs (VA) health system to determine size or type of polyps detected. Therefore, we were unable to definitively classify them as “significant adenoma” vs “nonsignificant or normal findings.” None of these 8 patients had any evidence in their medical records that they ever were diagnosed as having colorectal cancer. Overall, 17% of patients received follow-up colonoscopy outside the VA health care system (35 of 212). ‡ Significant adenoma was defined as an adenoma of 1 cm or larger, 3 or more adenomas, and/or any adenoma with villous features. §One patient was diagnosed as having an incidental colorectal cancer and survived more than 5 years. ∥Twelve patients had complications from colonoscopy: 3 of the 34 patients with significant adenomas had notable bleeding following polypectomy; of these, the first required hospital admission; the second had a vasovagal episode following epinephrine treatment for bleeding; and the third had the procedure aborted and required another colonoscopy. Two patients had complications from other testing after their colonoscopy; of these, the first had a fall after a barium enema and required transfer to the emergency department but was otherwise unharmed; the second had a sigmoidectomy to treat a large adenoma complicated by a hypoxic event and a 3-week hospitalization. Three of the 45 patients with normal colonoscopy findings had discomfort with the colonoscopy. Finally, colonoscopy may have contributed to the death of 1 patient who died within 3 days of his colonoscopy, although the exact cause of death was unknown, per the medical records. Gray shading indicates patients who potentially benefited from screening.
  • Patient Record Review of the Incidence, Consequences, and Causes of Diagnostic Adverse Events

    Abstract Full Text
    free access
    Arch Intern Med. 2010; 170(12):1015-1021. doi: 10.1001/archinternmed.2010.146
  • Diagnostic Adverse Events: On to Chapter 2: Comment on “Patient Record Review of the Incidence, Consequences, and Causes of Diagnostic Adverse Events”

    Abstract Full Text
    Arch Intern Med. 2010; 170(12):1021-1022. doi: 10.1001/archinternmed.2010.156
  • The Quality of Care Provided to Hospitalized Patients at the End of Life

    Abstract Full Text
    free access
    Arch Intern Med. 2010; 170(12):1057-1063. doi: 10.1001/archinternmed.2010.175
  • JAMA Internal Medicine June 22, 2009

    Figure: Frequency of Failure to Inform Patients of Clinically Significant Outpatient Test Results

    Flowchart of medical records reviewed. PNFs indicates physician notification forms.
  • JAMA Internal Medicine August 11, 2008

    Figure 1: Medical Records and Quality of Care in Acute Coronary Syndromes: Results From CRUSADE

    Medical records quality scores (maximum score, 20) were calculated for each eligible patient (n = 607); score distribution is shown.
  • JAMA Internal Medicine August 11, 2008

    Figure 2: Medical Records and Quality of Care in Acute Coronary Syndromes: Results From CRUSADE

    Association between medical records quality score and use of evidence-based medicine (EBM) treatments. Medical records quality scores were stratified into tertiles and examined for correlation with short-term EBM therapy use. Results revealed that higher medical records quality scores were associated with increased use of EBM therapies in the cohort population (n = 607) and in the overall CRUSADE population (n = 44 204). CRUSADE indicates the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines National Quality Improvement Initiative; ACC, American College of Cardiology; and AHA, American Heart Association.*After adjustment for in-hospital clustering of EBM use, associations were attenuated in the CRUSADE population.
  • JAMA Internal Medicine August 11, 2008

    Figure 3: Medical Records and Quality of Care in Acute Coronary Syndromes: Results From CRUSADE

    Association between medical records quality score and mortality. Medical records quality scores were stratified into tertiles and examined for correlation with in-hospital mortality in the overall CRUSADE population (n = 44 204) but not in the cohort population. (Overall deaths were too few in the cohort population [n = 19] for analysis to be performed.) Results revealed that higher medical records quality scores were associated with decreased in-hospital mortality. CRUSADE indicates the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines National Quality Improvement Initiative; ACC, American College of Cardiology; and AHA, American Heart Association.
  • Medical Records and Quality of Care in Acute Coronary Syndromes: Results From CRUSADE

    Abstract Full Text
    free access
    Arch Intern Med. 2008; 168(15):1692-1698. doi: 10.1001/archinte.168.15.1692
  • Supervision: A 2-Way Street

    Abstract Full Text
    Arch Intern Med. 2008; 168(10):1117-1117. doi: 10.1001/archinte.168.10.1117-a
  • JAMA Internal Medicine November 13, 2006

    Figure 4: The Use of Screening Colonoscopy for Patients Cared for by the Department of Veterans Affairs

    The annual frequency and indications of colonoscopy performed at Department of Veterans Affairs facilities between October 1, 1997, and September 30, 2003. The indications for the procedures were defined according to the algorithm in Figure 1, adjusted for the accuracy of this algorithm estimated from the medical record validation study.
  • The Computerized Medical Record: The Next Frontier

    Abstract Full Text
    Arch Intern Med. 2006; 166(11):1234-1235. doi: 10.1001/archinte.166.11.1234-b