Journal of hospital medicine最新文献

{"title":"Real-time symptom monitoring using electronic patient-reported outcomes: A prospective study protocol to improve safety during care transitions for patients with multiple chronic conditions","authors":"Savanna Plombon BS, MPH,&nbsp;Robert S. Rudin PhD,&nbsp;Jorge Rodriguez MD, MPH,&nbsp;Pamela Garabedian MS,&nbsp;Stuart Lipsitz PhD,&nbsp;Maria Edelen PhD,&nbsp;Marie Leeson BS,&nbsp;Madeline Smith BS, MPH,&nbsp;Kaitlyn Konieczny BS,&nbsp;Anuj K. Dalal MD","doi":"10.1002/jhm.70013","DOIUrl":"10.1002/jhm.70013","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Adverse events (AEs) during transitions from hospitals to ambulatory settings occur in 19%–28% of cases, posing a significant threat to patient safety. Early screening for worrisome symptoms and deterioration in overall health is critical for older adult patients with multiple chronic conditions (MCCs). Clinically integrated apps that remotely monitor symptoms and collect patient-reported outcomes (PROs) can predict AEs when combined with electronic health record (EHR) data. This innovative intervention may enable more timely detection, escalation, and mitigation of harm from AEs for patients with MCCs during transitions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This remote monitoring intervention leverages evidence-based frameworks for care transitions and health technologies. We will develop and validate a prediction model of postdischarge AEs using validated symptoms, PRO questionnaires, and EHR data. Existing digital infrastructure will be adapted to facilitate remote monitoring. We will employ a user-centered approach to identify patient and clinician requirements to guide the design and development of our intervention. Interoperable data exchange standards and application programming interfaces will be utilized to integrate the intervention with vendor EHRs and patient portals. A randomized controlled trial will be conducted to compare the effect of our intervention versus usual care on postdischarge AEs in MCC patients transitioning from the hospital. A mixed-methods evaluation will be performed to generate best practices for disseminating this intervention at institutions with different EHRs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>A patient-centric, digitally enabled surveillance strategy that monitors symptoms and electronic PROs, educates patients about risks, and ensures communication with clinicians has the potential to transform care for patients with MCCs during transitions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 5","pages":"534-543"},"PeriodicalIF":2.3,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434749","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":"Reprioritizing and embracing change: Implications of the ACGME revised requirements on pediatric medical education and hospital medicine","authors":"Courtney A. Gilliam MD,&nbsp;Dominick DeBlasio MD, MEd,&nbsp;Sue E. Poynter MD, MEd,&nbsp;Adam A. Vukovic MD, MEd,&nbsp;Benjamin Kinnear MD, MEd","doi":"10.1002/jhm.70009","DOIUrl":"10.1002/jhm.70009","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":"20 9","pages":"1009-1011"},"PeriodicalIF":2.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412103","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":"Medical debt in America part I: High prices, few protections","authors":"Blake N. Shultz MD, JD,&nbsp;Ahmed M. Ahmed MD, MPP, MSc,&nbsp;Luke Messac MD, PhD","doi":"10.1002/jhm.70001","DOIUrl":"10.1002/jhm.70001","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":"20 5","pages":"521-523"},"PeriodicalIF":2.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412088","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":"Deciphering social disadvantage in diagnostic error rates","authors":"Susan Landon MD, MSc,&nbsp;Paula Chatterjee MD, MPH","doi":"10.1002/jhm.70004","DOIUrl":"10.1002/jhm.70004","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 7","pages":"793-794"},"PeriodicalIF":2.3,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412087","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":"Patients and families reading their discharge summaries: A cross-sectional analysis of benefits, concerns, and implications","authors":"Catherine M. DesRoches DrPH,&nbsp;Shoshana J. Herzig MD, MPH,&nbsp;Zhiyong Dong MSc,&nbsp;Fabienne Bourgeois MD, MPH,&nbsp;Isabel Hurwitz BS,&nbsp;Anna Garcia MD,&nbsp;Sigall Bell MD","doi":"10.1002/jhm.13594","DOIUrl":"10.1002/jhm.13594","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Transitioning from hospital to home is fraught with anxiety and risk, as patients and family members assume responsibility for caring for themselves.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We aimed to explore patients' experiences with reading their discharge summaries and the impact of having this information during the posthospitalization period. We focus on opportunities to address common concerns—such as medication changes, follow-up steps, and documentation errors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An email-based survey of hospitalized patients with portal accounts discharged to home was conducted between May 2022 and February 2023 at two academic health care centers in Boston, MA. We used qualitative and quantitative methods to analyze closed-ended and free-text survey responses. The primary outcomes were patient concerns about medications and the next steps.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three hundred and ninety-two patients responded (hospital 1 = 321, response rate [RR] = 19.5%; hospital 2 = 71, RR = 4.9%). Patients reported positive effects of reading their discharge summary, including understanding the reason for hospitalization (66.9%) and next steps in managing their care (72.1%), and knowing how to take their medications (74%). Five percent reported a concern about taking a medication and 9.4% had a concern about next steps. In qualitative analysis of patient-reported concerns, the most commonly noted were related to explanations and next steps.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Rapidly spreading information transparency could transform how patients engage in care and communicate with clinicians. Patients and families report benefits from reading discharge summaries; however, over a quarter reported a concern. More work is needed in the inpatient arena to understand how to capitalize on data transparency in a way that benefits patients, families, clinicians, and organizations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 7","pages":"701-709"},"PeriodicalIF":2.3,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412102","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 magnificent seven: An assembly of educational opportunities within an academic hospital medicine program","authors":"Dustin T. Smith MD,&nbsp;Khaalisha Ajala MD,&nbsp;Monee Amin MD,&nbsp;Mary Ann Kirkconnell Hall MPH,&nbsp;Erin Kim MD,&nbsp;Ketino Kobaidze MD,&nbsp;Mohamad Moussa MD,&nbsp;Daniel P. Hunt MD,&nbsp;Annie Massart MD","doi":"10.1002/jhm.70006","DOIUrl":"10.1002/jhm.70006","url":null,"abstract":"<p>Increasing clinical demands and a reduction in traditional teaching opportunities at academic medical centers threaten the ability of hospitalists to participate in their institution's educational mission. Hospitalists with teaching as part of their career focus benefit from faculty development or the creation of teaching activities to stimulate interest in academic medicine and overcome pre-existing barriers to education. Our large, multi-site hospital medicine division sought to engage hospitalists from various practice settings in educational opportunities to expand their skill sets as teachers. An Education Council introduced seven initiatives embedded with educator roles for faculty: clinicopathological conference, clinical vignette competition, Grand Rounds, peer observation of teaching, teaching competition, visiting professorship, and ward teacher workshop. Program opportunities generated directorships, faculty, and peer development roles. Multimodal assessment demonstrated increased attendance, evaluations, recognition, scholarship, and events over time. This innovative heptad of faculty educational opportunities within an academic hospital medicine program is feasible, effective, and scalable.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 9","pages":"976-980"},"PeriodicalIF":2.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400998","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":"Elevation in white blood cell count after corticosteroid use in noninfected hospitalized patients","authors":"Erin Sullivan BS,&nbsp;Rebecca Schulte MPH,&nbsp;Michael B. Rothberg MD, MPH","doi":"10.1002/jhm.70008","DOIUrl":"10.1002/jhm.70008","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>It is widely accepted that corticosteroids cause leukocytosis. Clinicians must decide whether a rise in white blood cell (WBC) count is due to steroids versus other processes like developing infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of this study is to measure the increase in white blood cell count after corticosteroid administration in hospitalized patients without malignancy, infection, or immune dysfunction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a retrospective cohort study from 2017 to 2018 in a single large healthcare system. We analyzed the trajectory of WBC count stratified by steroid dose. The study included nonsurgical patients admitted with at least two complete blood count measurements. Patients were excluded if they had immunosuppression, infection, malignancy, or steroid use within 2 weeks before admission. The main outcome was mean WBC count by day following corticosteroid administration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our sample included 28,425 patients with at least two WBC measurements, 1608 (5.7%) of which received steroids. WBC response peaked at 48 h after steroid administration with a mean increase of 2.4 × 10⁹/L WBCs. In all patients on steroids, across doses, the mean increase was 0.3 × 10⁹/L WBCs, 1.7 × 10⁹/L WBCs, and 4.84 × 10⁹/L WBCs in low, medium, and high dose groups, respectively. For patients not on steroids, the mean WBC count decreased during hospitalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>When interpreting WBC counts after initiating steroids, increases of up to 4.84 × 10⁹/L cells may be seen within 48 h after high-dose steroids. Larger increases, and any increase after low-dose steroids, suggest other causes of leukocytosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 8","pages":"824-828"},"PeriodicalIF":2.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.70008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392824","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":"Our moral imperative to rethink leadership: A call for modern leaders","authors":"Neha H. Shah MD, MPH,&nbsp;Jennifer O'Toole MD, MEd,&nbsp;Vineeta Mittal MD, MBA,&nbsp;Barbara Overholser MA,&nbsp;Nancy D. Spector MD","doi":"10.1002/jhm.70010","DOIUrl":"10.1002/jhm.70010","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 9","pages":"1012-1014"},"PeriodicalIF":2.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400994","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":"Methodological progress note: Longitudinal qualitative research and applications to hospital medicine","authors":"Andrew R. Orr MD, MSEd,&nbsp;Dorene F. Balmer PhD","doi":"10.1002/jhm.70000","DOIUrl":"10.1002/jhm.70000","url":null,"abstract":"<p>Longitudinal qualitative research (LQR) is an emerging methodology in healthcare and health professions education research that focuses on change in complex, dynamic transitions, and processes as that change unfolds. This approach allows for in-depth exploration of personal and professional transitions, developmental processes, and evolution in how individuals make sense of experiences and events. In this Methodological Progress Note, we define the key features of LQR, distinguish LQR from other qualitative methodologies, and present a case for longitudinal qualitative work to offer a lens of time that might illuminate gaps in the field of hospital medicine.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 7","pages":"736-739"},"PeriodicalIF":2.3,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.70000","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375068","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 use of antibiotics for acute uncomplicated diverticulitis","authors":"Nikolas Evan Marino MD, MBA,&nbsp;Sidra Lenore Speaker MD, MS,&nbsp;John Rossettie MD,&nbsp;Brian Kwan MD","doi":"10.1002/jhm.70003","DOIUrl":"10.1002/jhm.70003","url":null,"abstract":"<p>The treatment of acute uncomplicated diverticulitis (UD) with antibiotics remains common despite substantial evidence supporting the non-inferiority of nonantibiotic outpatient management. In the past 15 years, there have been two landmark randomized-controlled clinical trials, follow-up studies, and numerous retrospective studies that have supported the non-inferiority of nonantibiotic management of UD. Multiple medical societies including the American Gastroenterological Association and the American College of Physicians recommend using antibiotics selectively rather than routinely in UD. We aim to raise physician awareness of the latest guideline recommendations through our article, potentially improving antibiotic stewardship and reducing related healthcare costs.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 8","pages":"874-877"},"PeriodicalIF":2.3,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257675","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}