Journal of hospital medicine最新文献

{"title":"Clinical guideline highlights for the hospitalist: GOLD COPD update 2024","authors":"Teresa Cornelius MD, MPH","doi":"10.1002/jhm.13416","DOIUrl":"10.1002/jhm.13416","url":null,"abstract":"<p><b>GUIDELINE TITLE</b>: Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2024 Report)</p><p><b>RELEASE DATE</b>: December 4, 2023</p><p><b>PRIOR VERSIONS</b>: Initial report was released in 2001 with major revisions in 2006, 2011, 2017, and 2023. This 2024 release is an update to the 2023 major revision</p><p><b>DEVELOPER</b>: Global Initiative for Chronic Obstructive Lung Disease (GOLD)</p><p><b>FUNDING SOURCE</b>: GOLD</p><p><b>TARGET POPULATION</b>: Adults with a diagnosis of or at risk for COPD</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13416","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155314","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":"Venous thromboembolism performance measurement in the United States: An evolving landscape with many stakeholders","authors":"Barbara I. Braun PhD,&nbsp;Karen M. Kolbusz MBA, BSN, RN,&nbsp;Michele R. Bozikis MPH,&nbsp;Stephen P. Schmaltz PhD,&nbsp;Karon Abe PhD, CAPT, USPHS,&nbsp;Nimia L. Reyes MD, MPH,&nbsp;Michelle N. Dardis MSN, MBA, RN","doi":"10.1002/jhm.13385","DOIUrl":"10.1002/jhm.13385","url":null,"abstract":"<p>Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is a life-threatening, costly, and common preventable complication associated with hospitalization. Although VTE prevention strategies such as risk assessment and prophylaxis are available, they are not applied uniformly or systematically across US hospitals and healthcare systems. Hospital-level performance measurement has been used nationally to promote standardized approaches for VTE prevention and incentivize the adoption of guideline-based care management. Though most measures reflect care processes rather than outcomes, certain domains including diagnosis, treatment, and continuity of care remain unmeasured. In this article, we describe the development of VTE prevention measures from various stakeholders, measure strengths and limitations, publicly reported rates, the impact of technology and health policy on measure use, and perspectives on future options for surveillance and performance monitoring.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141072480","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 health confidence with hospital length of stay and readmission","authors":"Ashley E. Brown MD, MS,&nbsp;Valerie G. Press MD, MPH,&nbsp;David O. Meltzer MD, PhD","doi":"10.1002/jhm.13405","DOIUrl":"10.1002/jhm.13405","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Length of stay (LOS) is an important measure of hospital quality and may be impacted by patient participation. However, concepts of patient participation, like health confidence, have received little examination in hospitalized patients' LOS, especially in diverse populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine if the Health Confidence Score (HCS) is associated with hospital LOS and readmission in a socioeconomically diverse population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Designs, Settings, and Participants</h3>\u0000 \u0000 <p>We conducted a prospective cohort study in 2022 of adult general medicine patients at an academic hospital in Chicago, Illinois.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Intervention</h3>\u0000 \u0000 <p>None.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome and Measures</h3>\u0000 \u0000 <p>Patient-reported responses to the HCS (scored 0 [<i>lowest health confidence</i>] to ‒12 [<i>highest health confidence</i>]), as well as demographic, socioeconomic, and clinical questions, were collected. Primary outcome was LOS and secondary outcomes were 30- and 90-day readmission.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 2797 socioeconomically diverse patients who completed the survey (response rate 28.5%), there was an average HCS of 9.19 (SD 2.68, range 0–12). Using linear regression, patients with high HCS (HCS ≥ 9) had a 1.53-day lower LOS (<i>p</i> &lt; .01, 95% confidence interval [CI] [–2.11, –0.95]) than patients with a low HCS (HCS &lt; 9). This association remained when examining individual HCS questions and controlling for covariates. In logistic regression, HCS was not significantly associated with readmission, but the question “I am involved in decisions about me” (adjusted model: odds ratio 0.83; 95% CI [0.71, 0.96]; <i>p</i> = .01) was associated with 90-day readmission.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13405","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140945968","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":"The sepsis coding intensity measure: Is this the scalpel that will dissect out illness severity or is it still too blunt for the task?","authors":"Harris L. Carmichael MD, MSHP,&nbsp;Ajay Bhasin MD, MS,&nbsp;Gregory W. Ruhnke MD, MS, MPH","doi":"10.1002/jhm.13410","DOIUrl":"10.1002/jhm.13410","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946068","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":"Breaking barriers, building faculty: A qualitative analysis to exploring faculty development in academic hospital medicine","authors":"Jack Badawy MD,&nbsp;Matthew Sakumoto MD,&nbsp;Elizabeth Murphy MD,&nbsp;David Schmit MD,&nbsp;Christine Davis MS,&nbsp;Ankur Segon MD, MPH,&nbsp;Andrew Auerbach MD,&nbsp;Marisha Burden MD, MBA","doi":"10.1002/jhm.13406","DOIUrl":"10.1002/jhm.13406","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hospital medicine (HM) continues to be primarily composed of junior hospitalists and research has highlighted a paucity of mentors and academic output. Faculty advancement programs have been identified as a means to support junior hospitalists in their career trajectories and to advance the field. The optimal approach to supporting faculty development (FD) efforts is not known.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To understand hospitalist groups' approaches to FD, including efforts that were perceived to be effective, and to identify barriers as well as potential future directions for FD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Rapid qualitative methods were utilized including templated summaries and matrix analysis to identify major themes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting and Participants</h3>\u0000 \u0000 <p>Virtual focus groups with hospitalists in the Hospital Medicine Reengineering Network (HOMERuN).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome and Measures</h3>\u0000 \u0000 <p>Qualitative themes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nineteen individuals from 17 unique institutions from across the United States in May 2022 participated in seven focus groups. Four key themes emerged from the study and included (1) academic hospitalist programs face multifaceted challenges and barriers to FD in HM, (2) groups have embraced a diversity of structures and frameworks, (3) due to clinical volumes, FD programs have had to adapt and evolve to meet FD needs, and (4) participants identified multiple areas for improvement, including defining tangible outcomes of FD programs and creating a repository of FD material which can be shared widely.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140945969","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":"What do patients and families observe about pediatric safety?: A thematic analysis of real-time narratives","authors":"Christine Studenmund MD,&nbsp;Audrey Lyndon PhD, RNC,&nbsp;James R. Stotts PhD, RN,&nbsp;Caroline Peralta-Neel MPS,&nbsp;Anjana E. Sharma MD, MAS,&nbsp;Naomi S. Bardach MD, MAS","doi":"10.1002/jhm.13388","DOIUrl":"10.1002/jhm.13388","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Data on inpatient safety are documented by hospital staff through incident reporting (IR) systems. Safety observations from families or patients are rarely captured. The Family Input for Quality and Safety (FIQS) study created a mobile health tool for pediatric patients and their families to anonymously report safety observations in real time during hospitalization. The study objectives were to describe these observations and identify domains salient to safety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this observational study, we analyzed pediatric patient safety reports from June 2017 to April 2018. Participants were: English-speaking family members and hospitalized patients ≥13 years old. The analysis had two stages: (1) assessment of whether narratives met established safety event criteria and whether there were companion IRs; (2) thematic analysis to identify domains.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 248 enrolled participants, 58 submitted 120 narrative reports. Of the narratives, 68 (57%) met safety event criteria, while only 1 (0.8%) corresponded to a staff-reported IR. Twenty-five percent of narratives shared positive feedback about patient safety efforts; 75% shared constructive feedback. We identified domains particularly salient to safety: (1) patients and families as safety actors; (2) emotional safety; (3) system-centered care; and (4) shared safety domains, including medication, communication, and environment of care. Some domains capture data that is otherwise difficult to obtain (#1–3), while others fit within standard healthcare safety domains (#4).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients and families observe and report salient safety events that can fill gaps in IR data. Healthcare leaders should consider incorporating patient and family observations—collected with an option for anonymity and eliciting both positive and constructive comments.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13388","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140917588","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":"Outcomes associated with initial narrow-spectrum versus broad-spectrum antibiotics in children hospitalized with urinary tract infections","authors":"Jessica L. Markham MD, MSc,&nbsp;Alaina Burns PharmD, BCPPS,&nbsp;Matthew Hall PhD,&nbsp;Matthew J. Molloy MD, MPH,&nbsp;John R. Stephens MD,&nbsp;Elisha McCoy MD,&nbsp;Irma T. Ugalde MD, MBE,&nbsp;Michael J. Steiner MD, MPH,&nbsp;Jillian M. Cotter MD, MSCS,&nbsp;Samantha A. House DO, MPH,&nbsp;Megan E. Collins MD,&nbsp;Andrew G. Yu MD,&nbsp;Michael J. Tchou MD, MSc,&nbsp;Samir S. Shah MD, MSCE","doi":"10.1002/jhm.13390","DOIUrl":"10.1002/jhm.13390","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The aim of this study is to describe the proportion of children hospitalized with urinary tract infections (UTIs) who receive initial narrow- versus broad-spectrum antibiotics across children's hospitals and explore whether the use of initial narrow-spectrum antibiotics is associated with different outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design, Setting and Participants</h3>\u0000 \u0000 <p>We performed a retrospective cohort analysis of children aged 2 months to 17 years hospitalized with UTI (inclusive of pyelonephritis) using the Pediatric Health Information System (PHIS) database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome and Measures</h3>\u0000 \u0000 <p>We analyzed the proportions of children initially receiving narrow- versus broad-spectrum antibiotics; additionally, we compiled antibiogram data for common uropathogenic organisms from participating hospitals to compare with the observed antibiotic susceptibility patterns. We examined the association of antibiotic type with adjusted outcomes including length of stay (LOS), costs, and 7- and 30-day emergency department (ED) revisits and hospital readmissions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 10,740 hospitalizations for UTI across 39 hospitals. Approximately 5% of encounters demonstrated initial narrow-spectrum antibiotics, with hospital-level narrow-spectrum use ranging from &lt;1% to 25%. Approximately 80% of hospital antibiograms demonstrated &gt;80% <i>Escherichia coli</i> susceptibility to cefazolin. In adjusted models, those who received initial narrow-spectrum antibiotics had shorter LOS (narrow-spectrum: 33.1 [95% confidence interval; CI]: 30.8–35.4] h vs. broad-spectrum: 46.1 [95% CI: 44.1–48.2] h) and reduced costs (narrow-spectrum: $4570 [$3751–5568] versus broad-spectrum: $5699 [$5005–$6491]). There were no differences in ED revisits or hospital readmissions. In summary, children's hospitals have low rates of narrow-spectrum antibiotic use for UTIs despite many reporting high rates of cefazolin-susceptible <i>E. coli</i>. These findings, coupled with the observed decreased LOS and costs among those receiving narrow-spectrum antibiotics, highlight potential antibiotic stewardship opportunities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140909604","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":"Maintaining public trust in organ donation while expanding the organ pool","authors":"Brendan Parent JD","doi":"10.1002/jhm.13409","DOIUrl":"10.1002/jhm.13409","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140909600","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":"Sex concordance between physicians and patients and discharge opioid prescribing","authors":"Aksharananda Rambachan MD, MPH,&nbsp;Mihir Joshi MD,&nbsp;Andrew D. Auerbach MD,&nbsp;Margaret C. Fang MD, MPH","doi":"10.1002/jhm.13389","DOIUrl":"10.1002/jhm.13389","url":null,"abstract":"<p>Inpatient pain management is challenging for clinicians and inequities are prevalent. We examined sex concordance between physicians and patients to determine if discordance was associated with disparate opioid prescribing on hospital discharge. We examined 15,339 hospitalizations from 2013 to 2021. Adjusting for patient, clinical, and hospitalization-level characteristics, we calculated the odds of a patient receiving an opioid on discharge and the days of opioids prescribed across all hospitalizations and for patients admitted with a common pain diagnosis. We did not find an overall association between physician–patient sex concordance and discharge opioid prescriptions. Compared to concordant sex pairs, patients in discordant pairs were not significantly less likely to receive an opioid prescription (odds ratio: 1.04; 95% confidence interval [CI]: 0.95, 1.15) and did not receive significantly fewer days of opioids (2.1 fewer days of opioids; 95% CI: −4.4, 0.4). Better understanding relationships between physician and patient characteristics is essential to achieve more equitable prescribing.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11222022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900486","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":"Handle with care: Preventing harm during critical care unit relocation","authors":"Maitreya Coffey MD, FAAP, FRCP(C),&nbsp;Monica E. Kleinman MD, FAAP","doi":"10.1002/jhm.13361","DOIUrl":"10.1002/jhm.13361","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140878235","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}