Journal of General Internal Medicine

Elevated Risk of COVID-19 Infection for Hospital-Based Health Care Providers

Journal of General Internal Medicine

Olivia A Sacks, Amber E Barnato, Jonathan S Skinner, John D Birkmeyer, Annie Fowler, Nancy Birkmeyer

There have been numerous reports of SARS-CoV-2 infection among health care workers (HCWs) across the globe. However, data is lacking on risk of hospital vs. community COVID-19 exposure faced by US providers. We report COVID-19 infection rates for physicians (MDs) and advance practice providers (APPs) in hospital medicine and critical care at a national acute care medical practice between March and December 2020.

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The Association Between Neurohormonal Therapy and Mortality in Older Adults With Heart Failure With Reduced Ejection Fraction

Journal of General Internal Medicine

Lauren Gilstrap, Andrea M Austin, Barbara Gladders, Parag Goyal, A James O'Malley, Amber Barnato, Anna NA Tosteson, Jonathan S Skinner

Background/Objectives

Neurohormonal therapy, which includes beta‐blockers and angiotensin‐converting enzyme inhibitor/angiotensin receptor blockers (ACEi/ARBs), is the cornerstone of heart failure with reduced ejection fraction (HFrEF) treatment. While neurohormonal therapies have demonstrated efficacy in randomized clinical trials, older patients, which now comprise the majority of HFrEF patients, were underrepresented in those original trials. This study aimed to determine the association between short‐ (30 day) and long‐term (1 year) mortality and the use of neurohormonal therapy in HFrEF patients, across the age spectrum.

Design/Setting/Participants

This is a population‐based, retrospective, cohort study between January 2008 and December 2015. We used 100% Medicare Parts A and B and a random 40% sample of Part D to create a cohort of 295,494 fee‐for‐service beneficiaries with at least …

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Out-of-Pocket Spending in the Last Five Years of Life

Journal of General Internal Medicine
Kelley AS, McGarry K, Fahle S, Marshall SM, Du Q, Skinner JS

A key objective of the Medicare program is to reduce risk of financial catastrophe due to out-of-pocket healthcare expenditures. Yet little is known about cumulative financial risks arising from out-of-pocket healthcare expenditures faced by older adults, particularly near the end of life.

Decision-Making Process Reported by Medicare Patients Who Had Coronary Artery Stenting or Surgery for Prostate Cancer

Journal of General Internal Medicine
Fowler FJ, Gallagher PM, Bynum JP, Barry MJ, Lucas FL, Skinner JS

Patients facing decisions should be told about their options, have the opportunity to discuss the pros and cons, and have their preferences reflected in the final decision.

Racial and ethnic differences in preferences for end-of-life treatment

Journal of General Internal Medicine
Barnato AE, Anthony DL, Skinner, JS, Gallagher PM, Fisher ES

Studies using local samples suggest that racial minorities anticipate a greater preference for life-sustaining treatment when faced with a terminal illness. These studies are limited by size, representation, and insufficient exploration of sociocultural covariables.