Journal of hospital medicine最新文献

{"title":"Things We Do for No Reason™: Discharge before noon","authors":"Aaron N. Dunn MD,&nbsp;Elise P. Lu MD, PhD","doi":"10.1002/jhm.13367","DOIUrl":"10.1002/jhm.13367","url":null,"abstract":"<p>\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 12","pages":"1174-1176"},"PeriodicalIF":2.4,"publicationDate":"2024-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13367","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140602623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gridlock: What hospitalists and health systems can do to help","authors":"Jennifer M. Zagursky MD, FHM,&nbsp;Robert E. Burke MD, MS,&nbsp;Andrew P. J. Olson MD, SFHM,&nbsp;Jennifer K. Readlynn MD, FHM","doi":"10.1002/jhm.13353","DOIUrl":"10.1002/jhm.13353","url":null,"abstract":"<p>\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 11","pages":"1066-1070"},"PeriodicalIF":2.4,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140578012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital-associated venous thromboembolism prophylaxis use by risk assessment at a large integrated health care network in Northern California","authors":"James Xu MD,&nbsp;Elad Neeman MD,&nbsp;Khanh K. Thai MS,&nbsp;Pranita Mishra MPP,&nbsp;David Schlessinger PhD,&nbsp;Heather Clancy MPH,&nbsp;Laura Myers MD, MPH,&nbsp;Nareg Roubinian MD, MPH,&nbsp;Vincent Liu MD, MS,&nbsp;Raymond Liu MD","doi":"10.1002/jhm.13350","DOIUrl":"10.1002/jhm.13350","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hospital-acquired venous thromboembolism (HA VTE) is a preventable complication in hospitalized patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We aimed to examine the use of pharmacologic prophylaxis (pPPX) and compare two risk assessment methods for HA VTE: a retrospective electronic Padua Score (ePaduaKP) and admitting clinician's choice of risk within the admission orderset (low, moderate, or high).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design, Settings and Participants</h3>\u0000 \u0000 <p>We retrospectively analyzed prophylaxis orders for adult medical admissions (2013–2019) at Kaiser Permanente Northern California, excluding surgical and ICU patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Intervention</h3>\u0000 \u0000 <p>ePaduaKP was calculated for all admissions. For a subset of these admissions, clinician-assigned HA VTE risk was extracted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome and Measures</h3>\u0000 \u0000 <p>Descriptive pPPX utilization rates between ePaduaKP and clinician-assigned risk as well as concordance between ePaduaKP and clinician-assigned risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 849,059 encounters, 82.2% were classified as low risk by ePaduaKP, with 42.3% receiving pPPX. In the subset with clinician-assigned risk (608,512 encounters), low and high ePaduaKP encounters were classified as moderate risk in 87.5% and 92.0% of encounters, respectively. Overall, 56.7% of encounters with moderate clinician-assigned risk received pPPX, compared to 7.2% of encounters with low clinician-assigned risk. pPPX use occurred in a large portion of low ePaduaKP risk encounters. Clinicians frequently assigned moderate risk to encounters at admission irrespective of their ePaduaKP risk when retrospectively examined. We hypothesize that the current orderset design may have negatively influenced clinician-assigned risk choice as well as pPPX utilization. Future work should explore optimizing pPPX for high-risk patients only.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 6","pages":"449-459"},"PeriodicalIF":2.6,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140578014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of billing reforms on academic hospitalist physician and advanced practice provider collaboration: A qualitative study","authors":"Sara Westergaard MD, MPH,&nbsp;Kasey Bowden MSN, FNP, AG-ACNP,&nbsp;Gopi J. Astik MD, MS,&nbsp;Greg Bowling MD,&nbsp;Angela Keniston PhD, MSPH,&nbsp;Anne Linker MD,&nbsp;Matthew Sakumoto MD,&nbsp;Natalie Schwatka PhD,&nbsp;Andrew Auerbach MD,&nbsp;Marisha Burden MD, MBA","doi":"10.1002/jhm.13356","DOIUrl":"10.1002/jhm.13356","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Medicare previously announced plans for new billing reforms for inpatient visits that are shared by physicians and advanced practice providers (APPs) whereby the clinician spending the most time on the patient visit would bill for the visit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To understand how inpatient hospital medicine teams utilize APPs in patient care and how the proposed billing policies might impact future APP utilization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design, Setting and Participants</h3>\u0000 \u0000 <p>We conducted focus groups with hospitalist physicians, APPs, and other leaders from 21 academic hospitals across the United States. Utilizing rapid qualitative methods, focus groups were analyzed using a mixed inductive and deductive method at the semantic level with templated summaries and matrix analysis. Thirty-three individuals (physicians [<i>n</i> = 21], APPs [<i>n</i> = 10], practice manager [<i>n</i> = 1], and patient representative [<i>n</i> = 1]) participated in six focus groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four themes emerged from the analysis of the focus groups, including: (1) staffing models with APPs are rapidly evolving, (2) these changes were felt to be driven by staffing shortages, financial models, and governance with minimal consideration to teamwork and relationships, (3) time-based billing was perceived to value tasks over cognitive workload, and (4) that the proposed billing changes may create unintended consequences impacting collaboration and professional satisfaction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Physician and APP collaborative care models are increasingly evolving to independent visits often driven by workloads, financial drivers, and local regulations such as medical staff rules and hospital bylaws. Understanding which staffing models produce optimal patient, clinician, and organizational outcomes should inform billing policies rather than the reverse.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 6","pages":"486-494"},"PeriodicalIF":2.6,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13356","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140578086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Things We Do for No Reason™: Routine respiratory pathogen panels for emergency department and hospitalized patients","authors":"Samara Levin MD,&nbsp;David Mayer MD,&nbsp;Yoram A. Puius PhD,&nbsp;Shitij Arora MD,&nbsp;Alex Gileles-Hillel MD","doi":"10.1002/jhm.13365","DOIUrl":"10.1002/jhm.13365","url":null,"abstract":"<p>\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 12","pages":"1170-1173"},"PeriodicalIF":2.4,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140578085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and evaluation of a writing retreat program to build community and promote productivity in academic hospital medicine","authors":"Christopher P. Bonafide MD, MSCE,&nbsp;Kristin D. Maletsky MD, MSEd,&nbsp;Chén Kenyon MD, MSHP,&nbsp;Stephanie K. Doupnik MD, MSHP,&nbsp;Aditi Vasan MD, MSHP,&nbsp;Irit R. Rasooly MD, MSCE,&nbsp;Laura Goldstein MD, MSEd,&nbsp;Meghan Galligan MD, MSHP,&nbsp;Jessica Hart MD, MHQS,&nbsp;Halley Ruppel PhD, RN,&nbsp;Chris Feudtner MD, PhD, MPH,&nbsp;Rebecca Tenney-Soeiro MD, MSEd","doi":"10.1002/jhm.13352","DOIUrl":"10.1002/jhm.13352","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Scientific writing is a core component of academic hospital medicine, and yet finding time to engage in deeply focused writing is difficult in part due to the highly clinical, 24/7 nature of the specialty that can limit opportunities for writing-focused collaboration and mentorship.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Our objective was to develop and evaluate an academic writing retreat program.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We drafted a set of key retreat features to guide implementation of a 3-day, 2-night retreat program held within a 2 h radius of our hospital. Agendas included writing blocks ranging from 45 to 90 min interspersed with breaks and opportunities for feedback, exercise, and preparing meals together. After each retreat, we distributed an evaluation with multiple choice and free text response options to characterize retreat helpfulness and later gathered data on the status of each paper and grant worked on.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We held 4 retreats between September 2022 and October 2023, engaging 18 faculty and fellows at a cost of $296 per attendee per retreat. In evaluations, nearly 80% reported that the retreat was extremely helpful, and comments praised the highly mentored environment, enriching community of colleagues, and release from commitments that get in the way of writing. Of the 24 papers attendees worked on, 12 have been accepted and 6 are under review. Of the 4 grant proposals, 2 are under review.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We implemented a low-cost, productive writing retreat program that attendees reported was helpful in supporting deep work and represented a meaningful step toward building a community centered around academic writing.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 7","pages":"559-564"},"PeriodicalIF":2.4,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140578010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting stroke risk after sepsis hospitalization with new-onset atrial fibrillation","authors":"Laura C. Myers MD, MPH,&nbsp;Ithan D. Peltan MD, MSc,&nbsp;Khanh K. Thai MS,&nbsp;Patricia Kipnis PhD,&nbsp;Manisha Desai PhD,&nbsp;Ycar Devis BS,&nbsp;Heather Clancy MPH,&nbsp;Yun W. Lu MPH,&nbsp;Samuel M. Brown MD, MS,&nbsp;Alan S. Go MD,&nbsp;Romain S. Neugebauer PhD,&nbsp;Vincent X. Liu MD, MS,&nbsp;Allan J. Walkey MD, MSc","doi":"10.1002/jhm.13343","DOIUrl":"10.1002/jhm.13343","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>New-onset atrial fibrillation (AF) during sepsis is common, but models designed to stratify stroke risk excluded patients with secondary AF. We assessed the predictive validity of CHA₂DS₂VASc scores among patients with new-onset AF during sepsis and developed a novel stroke prediction model incorporating presepsis and intrasepsis characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included patients ≥40 years old who survived hospitalizations with sepsis and new-onset AF across 21 Kaiser Permanente Northern California hospitals from January 1, 2011 to September 30, 2017. We calculated the area under the receiver operating curve (AUC) for CHA₂DS₂VASc scores to predict stroke or transient ischemic attack (TIA) within 1 year after a hospitalization with new-onset AF during sepsis using Fine-Gray models with death as competing risk. We similarly derived and validated a novel model using presepsis and intrasepsis characteristics associated with 1-year stroke/TIA risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 82,748 adults hospitalized with sepsis, 3992 with new-onset AF (median age: 80 years, median CHA₂DS₂VASc of 4) survived to discharge, among whom 70 (2.1%) experienced stroke or TIA outcome and 1393 (41.0%) died within 1 year of sepsis. The CHA₂DS₂VASc score was not predictive of stroke risk after sepsis (AUC: 0.50, 95% confidence interval [CI]: 0.48–0.52). A newly derived model among 2555 (64%) patients in the derivation set and 1437 (36%) in the validation set included 13 variables and produced an AUC of 0.61 (0.49–0.73) in derivation and 0.54 (0.43–0.65) in validation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Current models do not accurately stratify risk of stroke following new-onset AF secondary to sepsis. New tools are required to guide anticoagulation decisions following new-onset AF in sepsis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 7","pages":"565-571"},"PeriodicalIF":2.4,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140578096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The generative artificial intelligence revolution: How hospitalists can lead the transformation of medical education","authors":"Verity Schaye MD, MHPE,&nbsp;Marc M. Triola MD","doi":"10.1002/jhm.13360","DOIUrl":"10.1002/jhm.13360","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 12","pages":"1181-1184"},"PeriodicalIF":2.4,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140578013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reckoning with uncertainty to repair trust","authors":"Lekshmi Santhosh MD, MAEd","doi":"10.1002/jhm.13362","DOIUrl":"10.1002/jhm.13362","url":null,"abstract":"&lt;p&gt;&lt;i&gt;An eager MS1 drinks from the fountain of knowledge, filling her brain with medical facts, answering multiple-choice questions dutifully, choosing the “single best right answer.” An industrious MS3 proposes thoughtful courses of action in her oral presentation and gets feedback to “be more confident” and “put your nickel down.” As she transitions to residency, the shades of grey multiply before her eyes, and she realizes quickly how patients “do not read the textbook.” Lying awake in bed, unable to sleep, after a long day in the hospital as an attending, her brain runs through all aspects of the day where she had to navigate the stormy ship of uncertainty—how do I communicate this evolving picture to the family? How do I even begin to hand this patient off to the next provider? How do I know what I'll be walking into in the morning?&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Diagnostic and prognostic uncertainty are ubiquitous throughout patients' care journeys,&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; yet the dominant culture within medical education does little to acknowledge it, and even actively discourages communicating uncertainty. But falsely expressing certainty can have dire consequences, for both patients, clinicians, and the public alike. Although we can never truly take the uncertainty out of medical care, effectively reckoning with uncertainty, conveying it on rounds, and expressing it to patients and families can ultimately deepen our relationships with patients and improve trust in health care.&lt;/p&gt;&lt;p&gt;Do patients even trust physicians who express uncertainty? Although some might worry that acknowledging uncertainty might worsen mistrust, research has demonstrated that explicitly acknowledging and discussing uncertainty with patients and families can actually improve patient and physician trust.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; When it comes to diagnostic uncertainty, examples abound—I have seen patients in my outpatient clinic who have been told with certainty that they have long COVID, yet I have made new diagnoses of metastatic cancers, autoimmune conditions, and pregnancy-associated conditions. In the ICU, I have witnessed examples of septic shock hiding in plain sight from what clinicians had previously attributed to alcohol withdrawal. Instead of holding onto diagnostic hubris—which increases the risk of diagnostic errors—we must do a better job of pausing and building in cognitive tools to explicitly acknowledge uncertainty, grapple with it, and ultimately reach the correct diagnosis sooner.&lt;/p&gt;&lt;p&gt;In addition to being comfortable with diagnostic uncertainty, how do we best communicate with patients and families and set expectations about prognostic certainty? On the medicine wards, we often see patients who have multiple chronic illnesses that are “peri-stable,” and the true prognosis can be uncertain. How can we communicate that although we know that the mortality benefit behind guideline-directed medical therapy for heart failure is immense, we cannot predict how long a parti","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 12","pages":"1185-1187"},"PeriodicalIF":2.4,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13362","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140588109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical progress note: Glucagon-like peptide-1 receptor agonists and hospitalized patients","authors":"Anjali Ravee BS,&nbsp;Desiree Burroughs-Ray MD, MPH,&nbsp;Christopher D. Jackson MD,&nbsp;Susan E. Spratt MD,&nbsp;Suchita Shah Sata MD","doi":"10.1002/jhm.13357","DOIUrl":"10.1002/jhm.13357","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 8","pages":"716-719"},"PeriodicalIF":2.4,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140588016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}