Journal of hospital medicine最新文献

{"title":"What decades in medicine have taught me","authors":"Paul L. Fine MD","doi":"10.1002/jhm.70005","DOIUrl":"10.1002/jhm.70005","url":null,"abstract":"<p>The author declares no conflict of interest.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 8","pages":"890-892"},"PeriodicalIF":2.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.70005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123035","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":"Trends in resource utilization for new-onset psychosis hospitalizations at children's hospitals","authors":"Ankita Gupta MD,&nbsp;Matt Hall PhD,&nbsp;Benjamin Masserano MD,&nbsp;Averi Wilson MD,&nbsp;Katherine Johnson MD,&nbsp;Clifford Chen MD,&nbsp;Lasya Challa MD,&nbsp;Harita Katragadda MD,&nbsp;Vineeta Mittal MD, MBA","doi":"10.1002/jhm.13597","DOIUrl":"10.1002/jhm.13597","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Children with new-onset psychosis often require hospitalization for medical evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The goal of this study was to assess variations in the management of children with new-onset psychosis and characterize trends in resource utilization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study included index hospitalizations for children ages 7–18 admitted to children's hospitals with a primary diagnosis of psychosis from 2011 to 2022 using the Pediatric Health Information System (PHIS) database. Children with a complex chronic condition were excluded. Resource utilization categories included medication, imaging, laboratory, and other clinical resources. Variability in resource utilization was assessed using covariance tests for random intercepts with generalized linear modes after adjusting for age, sex, payor, and severity. Trends in resource utilization were examined using generalized estimating equations adjusting for the same factors and accounting for hospital clustering.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our data set included 7126 new-onset psychosis hospitalizations from 37 children's hospitals. Teenage males and non-Hispanic Whites were most likely to be hospitalized. There was a significant variation in resource utilization across hospitals in all categories (<i>p</i> &lt; .001). The most frequently utilized resources were antipsychotic medications (76%), serum chemistry (77%), toxicology labs (72%), and brain magnetic resonance imaging (22%). The most notable increases in utilization were in the performance of laboratory tests, brain imaging, anesthetic use, and intravenous immunoglobulin use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Study findings suggest that there has been a stable rate of hospitalization for children with new-onset psychosis, yet a significant variation in the medical evaluation exists. Significant increases and variations in resource utilization across all categories suggest an emerging need for robust evidence and consensus-based practice guidelines.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 7","pages":"710-726"},"PeriodicalIF":2.3,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13597","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076770","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":"Medical debt in America, Part II: Financial support for the most vulnerable","authors":"Blake N. Shultz MD, JD,&nbsp;Ahmed M. Ahmed MD, MPP, MSc,&nbsp;Luke Messac MD, PhD","doi":"10.1002/jhm.70002","DOIUrl":"10.1002/jhm.70002","url":null,"abstract":"<p>In this second part of a series on medical debt and the costs of care, we examine the past and present financial protections for low-income patients at nonprofit hospitals. Born of almshouses and religious orders, nonprofit hospitals were devoted at their founding to the care of the poor. However, over the course of the twentieth century, they became more focused on high-priced care for paying patients. Federal regulations surrounding tax exemption and charity care have been loosened to allow hospitals to spend relatively little on financial assistance, contributing to inequitable and inadequate financial protections for low-income patients.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 6","pages":"645-648"},"PeriodicalIF":2.3,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.70002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082801","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":"Questions still unanswered: Future directions in exploring physician inpatient handoffs","authors":"Stephanie Thomas MD,&nbsp;Nicole D. Damari MD, MS,&nbsp;Jennifer K. O'Toole MD, MEd","doi":"10.1002/jhm.13596","DOIUrl":"10.1002/jhm.13596","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 6","pages":"653-654"},"PeriodicalIF":2.3,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048300","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":"Clinical progress note: Diagnostic approach to dizziness and vertigo","authors":"Susrutha Kotwal MD, MEHP,&nbsp;Daniel Gold DO,&nbsp;Jonathan A. Edlow MD","doi":"10.1002/jhm.13595","DOIUrl":"10.1002/jhm.13595","url":null,"abstract":"<p>Dizziness is a common clinical presentation that incurs huge financial costs. It is frequently misdiagnosed due to a wide differential involving both benign (inner ear disease) and serious (stroke) disorders. Traditional frameworks that emphasize symptom quality (dizziness/lightheadedness/vertigo) lack diagnostic utility. This Clinical Progress Note reviews the literature on acute dizziness evaluation in adult patients and presents an evidence-based framework for hospitalists to diagnose the majority of undifferentiated dizzy patients at the bedside. Future research should assess the validity of this approach with hospitalists' ability to accurately diagnose dizzy patients, and its impact on patient care and healthcare outcomes.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 6","pages":"597-602"},"PeriodicalIF":2.3,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143049369","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":"Improving healthcare value: Choosing Wisely Canada's hospital designation program","authors":"Daksh Datta MSc,&nbsp;Doreen Day MHSc,&nbsp;Christine Soong MD, MSc","doi":"10.1002/jhm.13593","DOIUrl":"10.1002/jhm.13593","url":null,"abstract":"&lt;p&gt;Choosing Wisely is a campaign led by clinicians to reduce unnecessary resource use in healthcare. It began with a focus on raising awareness about the harms of overuse of unnecessary tests and treatments. Choosing Wisely Canada (CWC) has since been actively leading and guiding organizations in system-level implementation through education, advocacy, the creation of a community of practice, and national collaborative implementation programs. Like all quality improvement work, implementation efforts are more likely to be successful when supported by system-level enablers. Some enablers that have been studied include mandatory accreditation programs, financial incentives, and intrinsic motivators. Choosing Wisely Canada chose to incorporate key elements of intrinsic motivators in a program tailored to recognize its resource stewardship goals.&lt;/p&gt;&lt;p&gt;In many jurisdictions, quality improvement enablers take the form of mandatory accreditation programs such as Accreditation Canada and the Joint Commission in the United States, designed for hospitals to meet quality indicators. However, accreditation bodies tend to be designed in partnership with regulatory bodies with frameworks which are neither specific nor all relevant to Choosing Wisely recommendations.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Financial incentives for the purposes of improved sustainability and stewardship are also found in healthcare systems worldwide&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; and have been shown to improve care in certain contexts.&lt;span&gt;&lt;sup&gt;2-4&lt;/sup&gt;&lt;/span&gt; However, there are criticisms levied towards stewardship programs structured around financial incentives and rewards,&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; including from physicians themselves.&lt;span&gt;&lt;sup&gt;6, 7&lt;/sup&gt;&lt;/span&gt; Many physicians may not feel that monetary incentives would motivate them to change practice patterns and feel they would increase discomfort or cause backlash from patients.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; They may prefer intrinsic motivation driven by peer perception, professional pride, and reputation. Intrinsic motivation is a well-studied behavioral factor related to the core human drive to feel competent and effective in order to maintain some control on causality in their surroundings.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; Whereas financial motivations and one-time payments diminish in effect over longer periods of time,&lt;span&gt;&lt;sup&gt;9-11&lt;/sup&gt;&lt;/span&gt; intrinsic motivators may sustain long-term and promote behavioral changes.&lt;span&gt;&lt;sup&gt;7, 12&lt;/sup&gt;&lt;/span&gt; Unlike financial incentives, these motivators also address the issue of dual agency: the perception that physicians place financial factors above their patients' interests. This approach builds trust by having conversations and discussions with experts rather than decreeing absolute policy changes, and produces learning networks to disseminate information, engage partners, and implement new approaches to healthcare, all of which are indicators of a reliable, competent, and sustainable program.","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 8","pages":"886-889"},"PeriodicalIF":2.3,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13593","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019050","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":"Patient physical violence toward healthcare workers at a US children's hospital","authors":"Adrienne G. DePorre MD,&nbsp;Troy Richardson PhD,&nbsp;Henry T. Puls MD,&nbsp;Alec M. Bernstein PhD, BCBA-D, LBA,&nbsp;Rebecca Ebbers MS, BCBA,&nbsp;Cy Nadler PhD","doi":"10.1002/jhm.13592","DOIUrl":"10.1002/jhm.13592","url":null,"abstract":"<p>An improved understanding of patient-related violent events toward healthcare workers (HCWs) is a critical step in mitigating patient violence in the pediatric medical hospital setting. Therefore, we sought to describe the timing/setting, potential antecedents to, and management of pediatric patient-related violence toward HCW. Using our electronic health record (EHR), we performed a retrospective study of patient-related physical violent events from 2017 to 2022 among youth hospitalized at our free-standing children's hospital. We identified 144 violent events associated with 75 patients. Most (66.7%) events occurred after a youth was medically cleared for discharge, and most (55%) events were preceded by an aversive experience the youth was trying to avoid. Most (77.1%) youth received medications for de-escalation, and nearly one-half (47.9%) experienced mechanical restraints. Our results highlight the challenges hospitals face while caring for youth at risk for behavioral escalations and support the need for both comprehensive in-patient behavioral health teams.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 9","pages":"971-975"},"PeriodicalIF":2.3,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019054","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":"Introducing Visual Vignettes","authors":"Samir S. Shah MD, MSCE, MHM,&nbsp;Manpreet Malik MD, SFHM","doi":"10.1002/jhm.13591","DOIUrl":"10.1002/jhm.13591","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 6","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13591","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019051","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":"Dying in the hospital: Spiritual-based care at the end of life","authors":"Hafsa Bhatty BA,&nbsp;Ashima Lal MD,&nbsp;Emily Pinto Taylor MD","doi":"10.1002/jhm.13588","DOIUrl":"10.1002/jhm.13588","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 8","pages":"882-885"},"PeriodicalIF":2.3,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973255","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":"Accuracy of pathogen diagnostic codes for acute hematogenous musculoskeletal infections in children","authors":"Justin B. Searns MD,&nbsp;Matt Hall PhD,&nbsp;Meghan Birkholz MSPH,&nbsp;Kevin J. Downes MD,&nbsp;Brittany B. Hubbell MD,&nbsp;Andrew S. Kern-Goldberger MD, MSCE,&nbsp;Jessica L. Markham MD, MSc,&nbsp;Jason G. Newland MD, MEd,&nbsp;Stephanie L. Rolsma MD, PhD,&nbsp;Marie E. Wang MD, MPH,&nbsp;Sean T. O'Leary MD,&nbsp;Samuel R. Dominguez MD, PhD,&nbsp;Sarah K. Parker MD,&nbsp;Matthew P. Kronman MD, MSCE","doi":"10.1002/jhm.13584","DOIUrl":"10.1002/jhm.13584","url":null,"abstract":"<p>Administrative databases are powerful tools for pediatric research but lack patient-level microbiology results. This study aimed to determine the accuracy of pathogen discharge diagnosis codes for children hospitalized with acute hematogenous musculoskeletal infections (MSKIs). Medical records for 244 children hospitalized with acute hematogenous MSKIs were manually reviewed to determine which bacterial pathogen, if any, was identified for each MSKI based on microbiology results obtained during the hospitalization. Microbiology results for each patient were then compared to their discharge diagnoses in the Pediatric Health Information System (PHIS) database to determine the accuracy of pathogen discharge codes. Discharge diagnostic codes correctly matched the microbiology results in 89.3% of encounters. Sensitivity and specificity for <i>Staphylococcus aureus</i> discharge diagnostic codes were 88.6% and 96.4% respectively for methicillin-susceptible <i>S. aureus</i> and 92.9% and 99.5% for methicillin-resistant <i>S. aureus</i>. Pathogen discharge codes are reliable surrogates that accurately reflect the microbiology results for children with MSKIs.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 8","pages":"853-857"},"PeriodicalIF":2.3,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142981087","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}