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Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine

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https://www.readbyqxmd.com/read/28786438/reducing-readmissions-or-length-of-stay-which-is-more-important
#1
Michael Rothberg, Natalie Lee
BACKGROUND: HASH(0x4efe7b8) OBJECTIVE: HASH(0x4efade0) DESIGN, SETTING, PATIENTS: HASH(0x4eff058) INTERVENTION: HASH(0x4ef7d10) MEASUREMENTS: HASH(0x4e9b908) CONCLUSIONS: HASH(0x5924e88)
August 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28786437/continued-learning-in-supporting-value-based-decision-making
#2
Eric Hoefgen, Michael Tchou, Patrick Brady
BACKGROUND: HASH(0x4a3b890) OBJECTIVE: HASH(0x4a3aff0) DESIGN, SETTING, PATIENTS: HASH(0x4a3fed0) INTERVENTION: HASH(0x4a403e0) MEASUREMENTS: HASH(0x5929860) CONCLUSIONS: HASH(0x594ce10)
August 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28786436/the-impact-of-checklists-on-inpatient-safety-outcomes-a-systematic-review-of-randomized-controlled-trials
#3
Jamie Boyd, Guosong Wu, Henry Stelfox
BACKGROUND: Systematic reviews of non-randomized controlled trials (RCTs) suggest that using a checklist results in fewer medical errors and adverse events, but these evaluations are at risk of bias. OBJECTIVE: To conduct a systematic review of RCTs of checklists to determine their effectiveness in improving patient safety outcomes in hospitalized patients. METHODS: Ovid EMBASE, Ovid MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials were searched from inception until December 8, 2016...
August 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28786435/can-t-shake-this-feeling
#4
Yalda Shahram, Thomas Baudendistel, S Josephson
OBJECTIVE: HASH(0x594d6e0) DESIGN: HASH(0x58d3da0) SETTING: HASH(0x58d0d98) PATIENTS: HASH(0x587e238) MEASUREMENTS: HASH(0x58dc3d8) RESULTS: HASH(0x58e0450) CONCLUSIONS: HASH(0x58dc360)
August 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28786434/caring-wisely-a-program-to-support-frontline-clinicians-and-staff-in-improving-healthcare-delivery-and-reducing-costs
#5
Ralph Gonzales, Christopher Moriates, Catherine Lau, Victoria Valencia, Sarah Imershein, Alvin Rajkomar, Priya Prasad, Christy Boscardin, Deborah Grady, S Johnston
We describe a program called "Caring Wisely"®, developed by the University of California, San Francisco's (UCSF), Center for Healthcare Value, to increase the value of services provided at UCSF Health. The overarching goal of the Caring Wisely® program is to catalyze and advance delivery system redesign and innovations that reduce costs, enhance healthcare quality, and improve health outcomes. The program is designed to engage frontline clinicians and staff-aided by experienced implementation scientists-to develop and implement interventions specifically designed to address overuse, underuse, or misuse of services...
August 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28786433/ammonia-levels-and-hepatic-encephalopathy-in-patients-with-known-chronic-liver-disease
#6
Jacob Ninan, Leonard Feldman
Ammonia is predominantly generated in the gut by intestinal bacteria and enzymes and detoxified primarily in the liver. Since the 1930s, ammonia has been identified as the principal culprit in hepatic encephalopathy (HE). Many physicians utilize serum ammonia to diagnose, assess severity, and determine the resolution of HE in patients with chronic liver disease (CLD) despite research showing that ammonia levels are unhelpful in all of these clinical circumstances. HE in patients with CLD is a clinical diagnosis of exclusion that should not be based on ammonia levels...
August 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28786432/impact-of-a-safety-huddle-based-intervention-on-monitor-alarm-rates-in-low-acuity-pediatric-intensive-care-unit-patients
#7
Maya Dewan, Heather Wolfe, Richard Lin, Eileen Ware, Michelle Weiss, Lihai Song, Matthew MacMurchy, Daniela Davis, Christopher Bonafide
BACKGROUND: Physiologic monitors generate high rates of alarms in the pediatric intensive care unit (PICU), yet few are actionable. OBJECTIVE: To determine the association between a huddle-based intervention focused on reducing unnecessary alarms and the change in individual patients' alarm rates in the 24 hours after huddles. DESIGN: Quasi-experimental study with concurrent and historical controls. SETTING: A 55-bed PICU...
August 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28786431/a-contemporary-assessment-of-mechanical-complication-rates-and-trainee-perceptions-of-central-venous-catheter-insertion
#8
Lauren Heidemann, Niket Nathani, Rommel Sagana, Veneet Chopra, Michael Hueng
BACKGROUND: Limited data exist regarding rates of mechanical complications of ultrasound-guided, nontunneled central venous catheters (CVC). Similarly, trainee perceptions surrounding CVC complications are largely unknown. OBJECTIVES: To evaluate contemporary CVC mechanical complication rates, associated risk factors, and trainee perspectives. DESIGN: A single-center retrospective review of CVC procedures between June 1, 2014, and May 1, 2015...
August 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28786430/impact-of-displaying-inpatient-pharmaceutical-costs-at-the-time-of-order-entry-lessons-from-a-tertiary-care-center
#9
Sarah Conway, Daniel Brotman, Brian Pinto, David Merola, Leonard Feldman, Redonda Miller, Kenneth Shermock
BACKGROUND: A lack of cost-conscious medication use is a major contributor to excessive healthcare expenditures in the inpatient setting. Expensive medicines are often utilized when there are comparable alternatives available at a lower cost. Increasing prescriber awareness of medication cost at the time of ordering may help promote cost-conscious use of medications in the hospital. OBJECTIVE: To evaluate the impact of cost messaging on the ordering of 9 expensive medications...
August 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28786429/perspectives-of-clinicians-at-skilled-nursing-facilities-on-30-day-hospital-readmissions-a-qualitative-study
#10
Bennett Clark, Katelyn Baron, Kathleen Tynan-McKiernan, Meredith Britton, Karl Minges, Sarwat Chaudhry
BACKGROUND: Unplanned 30-day hospital readmissions are an important measure of hospital quality and a focus of national regulations. Skilled nursing facilities (SNFs) play an important role in the readmission process, but few studies have examined the factors that contribute to readmissions from SNFs, leaving hospitalists and other hospital-based clinicians with limited evidence on how to reduce SNF readmissions. OBJECTIVE: To understand the perspectives of clinicians working at SNFs regarding factors contributing to readmissions...
August 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28786428/use-of-post-acute-facility-care-in-children-hospitalized-with-acute-respiratory-illness
#11
Jay Berry, Karen Wilson, Helene Dumas, Edwin Simpser, Jane O'Brien, Kathleen Whitford, Rachna May, Vineeta Mittal, Nancy Murphy, David Steinhorn, Rishi Agrawal, Kris Rehm, Michelle Marks, Christine Traul, Michael Dribbon, Christopher Haines, Matt Hall
BACKGROUND: Recovery from respiratory illness (RI), a common reason for hospitalization, can be protracted for some children because of high illness severity or underlying medical complexity. OBJECTIVE: We assessed which children hospitalized with RI are the most likely to use post-acute facility care (PAC) for recovery. METHODS: Retrospective analysis of 609,800 hospitalizations for patients in 43 US children's hospitals between 2010- 2015 for RI, identified with the Agency for Healthcare Research and Quality Clinical Classification System...
August 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28786427/if-you-book-it-will-they-come-attendance-at-postdischarge-follow-up-visits-scheduled-by-inpatient-providers
#12
Rahul Banerjee, Alex Suarez, Melanie Kier, Steve Honeywell, Weiwei Feng, Nandita Mitra, David Grande, Jennifer Myers
BACKGROUND: Postdischarge follow-up visits (PDFVs) are widely recommended to improve inpatient-outpatient transitions of care. OBJECTIVE: To measure PDFV attendance rates. DESIGN: Observational cohort study. SETTING: Medical units at an academic quaternary-care hospital and its affiliated outpatient clinics. PATIENTS: Adult patients hospitalized between April 2014 and March 2015 for whom at least 1 PDFV with our health system was scheduled...
August 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28786426/excess-readmission-vs-excess-penalties-maximum-readmission-penalties-as-a-function-of-socioeconomics-and-geography
#13
Chris Caracciolo, Devin Parker, Emily Marshall, Jeremiah Brown
BACKGROUND: The Hospital Readmission Reduction Program (HRRP) penalizes hospitals with "excess" readmissions up to 3% of Medicare reimbursement. Approximately 75% of eligible hospitals received penalties, worth an estimated $428 million, in fiscal year 2015. OBJECTIVE: To identify demographic and socioeconomic disparities between matched and localized maximum-penalty and no-penalty hospitals. DESIGN: A case-control study in which cases included were hospitals to receive the maximum 3% penalty under the HRRP during the 2015 fiscal year...
August 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28786425/we-want-to-know-eliciting-hospitalized-patients-perspectives-on-breakdowns-in-care
#14
Kimberly Fisher, Kelly Smith, Thomas Gallagher, Laura Burns, Crystal Morales, Kathleen Mazor
BACKGROUND: There is increasing recognition that patients have critical insights into care experiences, including breakdowns in care. Harnessing patient perspectives for hospital improvement requires an in-depth understanding of the types of breakdowns patients identify and the impact of these events. METHODS: We interviewed a broad sample of patients during hospitalization and postdischarge to elicit patient perspectives on breakdowns in care. Through an iterative process, we developed a categorization of patient-perceived breakdowns called the Patient Experience Coding Tool...
August 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28786424/comparison-of-methods-to-define-high-use-of-inpatient-services-using-population-based-data
#15
James Wick, Brenda Hemmelgarn, Braeden Manns, Marcello Tonelli, Hude Quan, Richard Lewanczuk, Paul Ronksley
BACKGROUND: A variety of methods have been proposed to define "high users" of inpatient services, which may have implications for targeting subgroups for intervention. OBJECTIVE: To compare 3 common definitions of high inpatient service use and their influence on patient capture, outcomes, and inpatient burden. DESIGN, SETTING, PATIENTS: We defined "high use" based on the upper 5th percentile of the population by 3 definitions: (1) number of inpatient episodes (≥3 hospitalizations/year), (2) cumulative length of stay (≥56 days in hospital/year), and (3) cumulative cost based on hospitalization resource intensity weights (≥ $63,597 Canadian dollars/year)...
August 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28699950/the-hospitalized-patient-with-interstitial-lung-disease-a-hospitalist-primer
#16
Erica Farrand, Rupal Shah, Harold Collard
Interstitial lung disease (ILD) is a diverse group of disorders typically with insidious onset. Diagnosis and management largely occur in the outpatient setting; however, ILD can present acutely necessitating hospitalization. Effective inpatient management requires the clinician to establish an accurate diagnosis and understand the natural history and treatment responsiveness of each ILD subtype. We propose a general framework for approaching the evaluation of hospitalized patients with ILD, and provide focused guidance on key inpatient diagnostic and management decisions...
July 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28699949/the-plot-thickens
#17
Ryan Fleming, Laura Sena, Reza Manesh, Carol Huff, Paul Aronowitz
OBJECTIVE: HASH(0x4fdb768) DESIGN: HASH(0x584a8a0) SETTING: HASH(0x495e090) PATIENTS: HASH(0x5863140) MEASUREMENTS: HASH(0x585f2c8) RESULTS: HASH(0x5866dd8) CONCLUSIONS: HASH(0x586b188)
July 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28699948/academyhealth-s-delivery-system-science-fellowship-training-embedded-researchers-to-design-implement-and-evaluate-new-models-of-care
#18
Nisha Kanani, Erin Hahn, Michael Gould, Kimberly Brunisholz, Lucy Savitz, Erin Holve
AcademyHealth's Delivery System Science Fellowship (DSSF) provides a paid postdoctoral pragmatic learning experience to build capacity within learning healthcare systems to conduct research in applied settings. The fellowship provides hands-on training and professional leadership opportunities for researchers. Since its inception in 2012, the program has grown rapidly, with 16 health systems participating in the DSSF to date. In addition to specific projects conducted within health systems (and numerous publications associated with those initiatives), the DSSF has made several broader contributions to the field, including defining delivery system science, identifying a set of training objectives for researchers working in delivery systems, and developing a national collaborative network of care delivery organizations, operational leaders, and trainees...
July 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28699947/fecal-occult-blood-testing-in-hospitalized-patients-with-upper-gastrointestinal-bleeding
#19
Benji Mathews, Temple Ratcliffe, Raj Sehgal, James Abraham, Bradley Monash
A 47-year-old man with a history of alcohol abuse, cirrhosis, and grade II esophageal varices is admitted for treatment of alcohol withdrawal. He reports having some dark-colored stools a week prior to admission, but his stools since then have been normal in color. A repeat hemoglobin is stable, but a fecal occult blood test is positive. What should be done next?
July 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28699946/using-standardized-patients-to-assess-hospitalist-communication-skills
#20
Dennis Chang, Micah Mann, Terry Sommer, Robert Fallar, Alan Weinberg, Erica Friedman
Standardized patients (SPs) have been used to assess communication skills in undergraduate medical education, but no published studies describe the use of SPs in assessing practicing physicians on their communication skills. In this study, done with 23 hospitalists at a large urban academic hospital, 3 SP scenarios, daily rounding, discharge, and interacting with a difficult patient, were created. After each encounter, each hospitalist reviewed their videotape and received feedback from their SP based on a checklist that had 3 core domains: Listen, Courtesy and Respect, and Explain...
July 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
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