Journal of hospital medicine最新文献

{"title":"On healing and humanity","authors":"Samir S. Shah MD, MSCE, MHM","doi":"10.1002/jhm.13549","DOIUrl":"10.1002/jhm.13549","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 12","pages":"1103"},"PeriodicalIF":2.4,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607838","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":"A sobering reminder and call to action: Preventing inpatient deaths from pulmonary emboli with a wraparound strategy","authors":"Anna L. Parks MD","doi":"10.1002/jhm.13547","DOIUrl":"10.1002/jhm.13547","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 4","pages":"422-423"},"PeriodicalIF":2.4,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607837","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":"Do outpatient visits prevent readmissions? Not a simple prescription","authors":"Daniel J. Brotman MD, FACP, MHM, Amy Deutschendorf RN","doi":"10.1002/jhm.13526","DOIUrl":"10.1002/jhm.13526","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 3","pages":"315-316"},"PeriodicalIF":2.4,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585358","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":"Association of physical function with hospital readmissions among older adults: A systematic review","authors":"Erin M. Thomas PT, DPT,&nbsp;James Smith PT, DPT, MA,&nbsp;Alisa Curry PT, DPT,&nbsp;Marka Salsberry PT, DPT,&nbsp;Kyle Ridgeway PT, DPT,&nbsp;Beth Hunt PT, DPT,&nbsp;Kristen Desanto MSLS, MS, RD, AHIP,&nbsp;Jason R. Falvey PT, DPT, PhD","doi":"10.1002/jhm.13538","DOIUrl":"10.1002/jhm.13538","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hospital readmissions pose significant burdens on healthcare systems, particularly among older adults. While efforts to reduce readmissions have historically focused on medical management, emerging evidence suggests physical function may also play a role in successful care transitions. However, there is a limited understanding of the relationship between functional measures and readmission risk. This systematic review aims to assess the association between physical function impairments and hospital readmissions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This systematic review aims to assess the association between physical function impairments and hospital readmissions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review was conducted following PRISMA guidelines, with studies identified through databases including PubMed, CINAHL, Embase, and others published January 1, 2010–December 31, 2022. Inclusion criteria encompassed observational studies of adults aged 50 and older in the United States, reporting readmissions within 90 days of discharge and assessing physical function across domains of the International Classification of Function model. Data extraction and risk of bias assessment were independently conducted by two authors using the Scottish Intercollegiate Guidelines Network (SIGN) tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventeen studies, representing 80,008 participants, were included in this systematic review. Patient populations included a wide array of medical populations, including general medical inpatients and those undergoing cardiac surgery. Across various functional measures assessed before or during admission, impairments were consistently associated with increased risk for hospital readmissions up to 90 days after admission. Measures of participation, including life-space mobility, were also associated with increased readmission risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Functional impairments are robust predictors of hospital readmissions in older adults. Routine assessment of physical function during hospitalization can improve risk stratification and may support successful care transitions, particularly in older adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 3","pages":"277-287"},"PeriodicalIF":2.4,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13538","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570869","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":"Point-counterpoint: Should hospitalists perform their own bedside procedures?","authors":"Joséphine A. Cool MD,&nbsp;Benjamin T. Galen MD,&nbsp;Ria Dancel MD","doi":"10.1002/jhm.13545","DOIUrl":"10.1002/jhm.13545","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 1","pages":"89-93"},"PeriodicalIF":2.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549764","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":"Characteristics, clinical care, and outcomes of sepsis among patients boarding in the emergency department","authors":"Jessica A. Blank MD,&nbsp;Jessie E. King MD, PhD,&nbsp;Julieann F. Grant MD, PhD,&nbsp;Shuo Tian PhD,&nbsp;Sachita Shrestha MPH,&nbsp;Peter England MD,&nbsp;David Paje MD, MPH,&nbsp;Stephanie P. Taylor MD, MS","doi":"10.1002/jhm.13536","DOIUrl":"10.1002/jhm.13536","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Patients who first meet clinical criteria for sepsis while boarding in the emergency department (ED) may not receive optimal sepsis care.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Assess the association between ED boarding status and sepsis quality of care and outcomes.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We conducted a retrospective cohort study of adult patients admitted to a large academic hospital from July 2021 to October 2023 who had clinical features consistent with sepsis present while physically in the ED. We compared outcomes for patients who experienced time zero (T-0; the time clinical features of sepsis were first present) while boarding in the ED (physically in the ED but admitted to a different service) to those experiencing T-0 while still under the care of the ED provider team. We used logistic regression to estimate the association between ED boarding status at T-0 and compliance with the US Centers for Medicare &amp; Medicaid Services (CMS) Severe Sepsis and Septic Shock: Management Bundle (SEP-1) core measure, individual bundle element compliance, and hospital mortality adjusting for prespecified covariates. In a subgroup analysis among patients who had not already received antibiotics before T-0, we conducted a Cox proportional hazards model to estimate the association between boarding status on time-to-antibiotics.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Among 4795 patients meeting a clinical definition of sepsis in the ED, 422 (8.8%) experienced T-0 as ED boarders. These patients were similar in age, sex, and comorbidities compared with patients experiencing T-0 while still under ED care. Fewer patients with T-0 as an ED boarder received SEP-1 compliant care (25% vs. 38%, &lt;i&gt;p&lt;/i&gt; &lt; .001), including a lower proportion of fluid resuscitation (15% vs. 26%, &lt;i&gt;p&lt;/i&gt; = .004) and lactate assessment (62% vs. 94%, &lt;i&gt;p&lt;/i&gt; &lt; .001). Overall, more patients in the ED boarder group received antibiotics within 3 hours, but one-third of patients had already received antibiotics prior to T-0. Among patients who had not already received antibiotics prior to T-0, experiencing T-0 as an ED boarder was associated with a decreased likelihood of receiving antibiotics (hazard ratio [HR]: 0.67 [95% confidence interval [CI], 0.54–0.84]) and longer time to antibiotics from T-0 (142 min vs. 100 min, &lt;i&gt;p&lt;/i&gt; = .007).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Sepsis patients e","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 4","pages":"368-373"},"PeriodicalIF":2.4,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13536","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515393","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":"Including the excluded: Hospitalists' role in offloading crowded emergency departments","authors":"Tara B. Spector MD,&nbsp;Suchita Shah Sata MD","doi":"10.1002/jhm.13541","DOIUrl":"10.1002/jhm.13541","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 4","pages":"418-419"},"PeriodicalIF":2.4,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515395","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":"Respiratory hospitalizations and ICU admissions among children with and without medical complexity at the end of the COVID-19 pandemic","authors":"Christina Belza PhD, MN,&nbsp;Christina Diong MSc,&nbsp;Eleanor Pullenayegum PhD,&nbsp;Katherine E. Nelson MD, PhD,&nbsp;Kazuyoshi Aoyama MD, PhD,&nbsp;Longdi Fu MSc,&nbsp;Francine Buchanan BA, MLIS, PhD,&nbsp;Sanober Diaz MSc,&nbsp;Ori Goldberg MD, MPH,&nbsp;Astrid Guttmann MDCM, MSc,&nbsp;Charlotte Moore Hepburn MD,&nbsp;Sanjay Mahant MD, MSc,&nbsp;Rachel Martens,&nbsp;Natasha R. Saunders MD, MSc,&nbsp;Eyal Cohen MD, MSc","doi":"10.1002/jhm.13505","DOIUrl":"10.1002/jhm.13505","url":null,"abstract":"<p>Decreased severe respiratory illness was observed during the first 2 years of the COVID-19 pandemic, with a relatively smaller decrease among children with medical complexity (CMC) compared to non-CMC. We extended this analysis to the third pandemic year (April 1, 2022, to March 31, 2023) when pandemic public health measures were loosened. A population-based repeated cross-sectional study evaluated respiratory hospitalizations among CMC and non-CMC (&lt;18 years) in Ontario, Canada. Among the 67,517 CMC and 3,006,504 non-CMC in Ontario, there were more CMC respiratory hospitalizations compared with the expected prepandemic levels (<i>n</i> = 3145 hospitalizations, corresponding to rate ratio [RR], 1.20; 95% confidence interval [CI], 1.16–1.25) with an even larger relative increase among non-CMC (<i>n</i> = 6653, RR, 1.36; 95% CI, 1.34–1.38). Increased intensive care unit admissions for respiratory illness were also observed (CMC: RR, 1.44; 95% CI, 1.31–1.59; non-CMC: RR, 2.02; 95% CI, 1.89–2.16). Understanding respiratory surge drivers may provide insights to protect at-risk children from respiratory morbidity.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 3","pages":"266-270"},"PeriodicalIF":2.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515397","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":"Inclusion of Veterans Health Administration hospitals in Centers for Medicare & Medicaid Services Overall Hospital Quality Star Ratings","authors":"Kyle Bagshaw MPH,&nbsp;Cameron J. Gettel MD, MHS,&nbsp;Li Qin PhD,&nbsp;Zhenqiu Lin PhD,&nbsp;Lisa G. Suter MD,&nbsp;Eve Rothenberg BA,&nbsp;Prince Omotosho BS,&nbsp;Reena Duseja MD, MS,&nbsp;James Krabacher BS,&nbsp;Michelle Schreiber MD,&nbsp;Tyson Nakashima BS,&nbsp;Raquel Myers PhD, JD, MPH,&nbsp;Arjun K. Venkatesh MD, MBA, MHS","doi":"10.1002/jhm.13523","DOIUrl":"10.1002/jhm.13523","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background/Objective</h3>\u0000 \u0000 <p>The Centers for Medicare &amp; Medicaid Services (CMS) Overall Hospital Quality Star Rating, established in 2016, is a summary of publicly available quality information for acute care hospitals. In July 2023, Veterans Health Administration (VHA) hospitals became eligible to receive a CMS Overall Hospital Quality Star Rating for the first time. Our objective was to compare performance in quality ratings among VHA and non-VHA hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used the hospital quality measure scores posted to Care Compare on Medicare.gov as of January 2023 as our primary data set. We conducted a pair of analyses to characterize the performance of VHA hospitals compared to non-VHA hospitals: an overall analysis including all rated hospitals, and a matched analysis in which only a single nearby hospital was included for each VHA hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 4518 non-VHA hospitals, 2962 (65.6%) received a Star Rating, compared to 114 (84%) of 136 VHA hospitals. VHA hospitals tended to receive higher ratings overall (one-star: 8%; two-star: 11%; three-star: 14%; four-star: 35%; five-star: 32%) than non-VHA (one-star: 8%; two-star: 22%; three-star: 29%; four-star: 26%; five-star: 15%). A similar pattern was observed in the matched analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>VHA hospitals tended to perform better on the Overall Star Rating compared to non-VHA hospitals, as evidenced by being more likely to receive a four- or five-star rating. The eligibility of VHA hospitals to receive an Overall Star Rating signifies an important addition to the program that will allow Veterans to make more informed healthcare decisions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 3","pages":"258-265"},"PeriodicalIF":2.4,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13523","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484219","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 features of suspected and unsuspected fatal pulmonary emboli in hospitalized patients","authors":"Scott L. Hagan MD,&nbsp;Tyler J. Albert MD,&nbsp;Helene Starks PhD, MPH,&nbsp;Paul B. Cornia MD","doi":"10.1002/jhm.13533","DOIUrl":"10.1002/jhm.13533","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pulmonary embolism (PE) is often unsuspected by treating clinicians. Since the adoption of clinical prediction scores for PE and the widespread availability of computed tomography (CT)-pulmonary angiogram, there are few reports of clinical presentations of hospitalized patients who died of PE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To compare the clinical signs, symptoms, and comorbidities of hospitalized patients who died of PE for whom PE was suspected versus not suspected antemortem.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design and Methods</h3>\u0000 \u0000 <p>Case–control study from January 1999 to December 2018 in one Veterans Affairs (VA) hospital. We compared groups to examine differences in clinical presentations of fatal PE over the two decades.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 1345 autopsies performed during the study period, 52 patients (4%) with fatal PE were included in the final analyses. PE was unsuspected before death in 29/52 patients (56%). Comparing groups, there were significant differences for: dyspnea (suspected 91%; unsuspected: 59%, <i>p</i> = 0.01); active malignancy (suspected 74%; unsuspected: 28%, <i>p</i> = 0.002); and atrioventricular (AV) nodal blocking treatment (suspected: 62%; unsuspected 30%,<i>p</i>= 0.03). A greater proportion of patients with unsuspected PE lacked symptoms of PE (suspected 0%; unsuspected: 31%, <i>p</i> = 0.003).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Fatal PE remains a common, unsuspected cause of inpatient death in the modern era. Symptoms of PE, active malignancy, and potentially confounding AV nodal blocking treatment were less frequent in patients with unsuspected PE. These data highlight the variation in presentation and the challenge of making the diagnosis in many hospitalized patients, particularly those without typical symptoms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 4","pages":"360-367"},"PeriodicalIF":2.4,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484214","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}