Journal of hospital medicine最新文献

{"title":"Posthospitalization telemedicine follow-up and 30-day readmission across the COVID-19 era: A multiphase analysis in a large integrated healthcare system.","authors":"Michael S Yoo, Lawrence S Block, Lue-Yen Tucker, Julia Wei, Kawai Cheung, Mary E Reed","doi":"10.1002/jhm.70109","DOIUrl":"https://doi.org/10.1002/jhm.70109","url":null,"abstract":"<p><strong>Background: </strong>Timely postdischarge visits reduce readmissions, but the impact of telemedicine follow-up remains unclear. The coronavirus disease 2019 (COVID-19) pandemic rapidly expanded telemedicine, offering a unique opportunity to assess its impact on outcomes.</p><p><strong>Objectives: </strong>Evaluate the association between telemedicine versus in-person follow-up and 30-day outcomes before, during, and after the COVID-19 pandemic.</p><p><strong>Methods: </strong>Retrospective cohort study of adults discharged from the Medicine Service across 21 hospitals (2017-2023). Telemedicine (video/telephone) versus in-person visits within 7 days of discharge were compared. The primary outcome was 30-day nonelective readmission. Secondary outcomes included 30-day all-cause readmission, emergency department (ED) visits, and mortality. Competing risk and Cox regression models were used, with inverse probability of treatment weighting to address differences.</p><p><strong>Results: </strong>Among 137,765 patients (mean age 67.5 years, 49.1% female), 59.2% received telemedicine follow-up. Pre-pandemic, 28.2% had telemedicine visits, associated with higher 30-day nonelective readmission risk (adjusted hazard ratio [aHR]: 1.23, 95% confidence interval [CI]: 1.19-1.28, p < .01) and mortality (aHR: 1.87, 95% CI: 1.71-2.05, p < .01). During COVID-19, telemedicine was associated with lower nonelective readmission risk (aHR: 0.92, 95% CI: 0.88-0.97, p < .01), fewer ED visits (aHR: 0.88, 95% CI: 0.84-0.92, p < .01), and no difference in mortality (aHR: 1.10, 95% CI: 0.98-1.24, p = .11). Post-COVID-19, readmission and ED visit risks were similar, though mortality was higher in the telemedicine group (aHR: 1.33, 95% CI: 1.20-1.49, p < .01).</p><p><strong>Conclusions: </strong>Telemedicine follow-up was associated with favorable outcomes during the pandemic, supporting its use as an alternative to in-person care. Pre- and postpandemic differences likely reflect patient selection. A hybrid follow-up model may optimize access and outcomes in postdischarge care.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caregiver experiences with deimplementation of continuous pulse oximetry monitoring for children hospitalized with bronchiolitis: A qualitative study.","authors":"Courtney Benjamin Wolk, Caroline S O'Brien, Christopher Bonafide, Rinad S Beidas, Enrique F Schisterman, Kimberly Albanowski, Canita Brent, Amanda C Schondelmeyer","doi":"10.1002/jhm.70123","DOIUrl":"10.1002/jhm.70123","url":null,"abstract":"<p><strong>Background: </strong>Continuous pulse oximetry monitoring in stable children with bronchiolitis not requiring supplemental oxygen has been identified as a low-value practice. However, little is known about how parents and other caregivers experience efforts to deimplement this practice.</p><p><strong>Objectives: </strong>This study investigated caregivers' experiences during their child's recent hospitalization for bronchiolitis on units involved in a deimplementation trial.</p><p><strong>Methods: </strong>We conducted semi-structured qualitative interviews with 15 caregivers of children hospitalized with bronchiolitis at 11 hospitals participating in deimplementation strategies to reduce unnecessary continuous pulse oximetry monitoring as part of the Eliminating Monitoring Overuse (EMO) trial. Interviews were recorded, transcribed, and coded using an integrative analytic approach.</p><p><strong>Results: </strong>Caregivers were a mean (SD) 31.1 (5.7) years old, predominantly female (93.3%), white (73.3%), and Non-Hispanic (86.7%). Previous hospitalization experiences and prior knowledge and training influenced caregiver perceptions of the value of monitoring. Participants did not discuss noticing changes in monitoring practices in interviews.</p><p><strong>Conclusions: </strong>Findings suggest that tailored education about monitoring may lessen caregiver concerns.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building vaccine confidence through empathy and evidence-based communication.","authors":"Paul G Mitchell, Elizabeth Adrianne Hammershaimb, Jessica R Cataldi","doi":"10.1002/jhm.70116","DOIUrl":"https://doi.org/10.1002/jhm.70116","url":null,"abstract":"<p><p>With a resurgence of vaccine-preventable diseases and increasing vaccine disinformation, vaccine hesitancy is a serious threat to public health around the world. Through an empathetic approach to vaccine conversations, sharing a strong recommendation, and using strategies like motivational interviewing, clinicians can partner with patients and families to improve vaccine confidence. Extending evidence-based approaches to vaccine communication and immunization delivery across patient populations can improve vaccination coverage from infancy through old age. Talking about and administering vaccines in hospital settings expands opportunities to address vaccine hesitancy and increase vaccination uptake.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Things We Do for No Reason™: Teach caregivers reflux precautions.","authors":"Abbye Degan, Jamee Walters","doi":"10.1002/jhm.70108","DOIUrl":"https://doi.org/10.1002/jhm.70108","url":null,"abstract":"<p><p>To decrease symptoms of physiological infant reflux, nonpharmacological techniques named \"reflux precautions\" are taught to families. Reflux precautions do not have a universal definition but can include burping, holding an infant upright pre- and postfeed, smaller and more frequent feedings, and elevating the head of the bed. Despite a lack of consensus on what constitutes reflux precautions, and a paucity of research, physicians and other providers continue to recommend them. In recommending reflux precautions, we pathologize normal physiology, sending mixed messages to families. Routine recommendation of reflux precautions for infant reflux is a Thing We Do for No Reason.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding internal medicine board eligibility for international medical graduates in the United States.","authors":"Tarun Ramesh, Kushal Kadakia, Hao Yu","doi":"10.1002/jhm.70120","DOIUrl":"10.1002/jhm.70120","url":null,"abstract":"","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12247179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing (begrudgingly appropriate) interhospital transfers.","authors":"Mary S Vaughan Sarrazin, Michael E Ohl","doi":"10.1002/jhm.70119","DOIUrl":"https://doi.org/10.1002/jhm.70119","url":null,"abstract":"","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards resiliency in the US healthcare supply chain.","authors":"Kevin A Schulman, Wasan Kumar, Neera Ahuja","doi":"10.1002/jhm.70112","DOIUrl":"https://doi.org/10.1002/jhm.70112","url":null,"abstract":"","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Collaborative development of a rules-based electronic health record algorithm for Hospital-at-Home eligibility.","authors":"Tsai-Ling Liu, Timothy C Hetherington, Marc Kowalkowski, Marvin E Knight, Jamayla Culpepper, Andrew McWilliams, Shih-Hsiung Chou, McKenzie Isreal, Stephanie Murphy","doi":"10.1002/jhm.70107","DOIUrl":"https://doi.org/10.1002/jhm.70107","url":null,"abstract":"<p><p>Identifying appropriate patients for hospital at Home (HaH) is challenged by the extensive inpatient population, the dynamic nature of hospitalizations, and the eligibility window for entry into the care model. This study presents the development of a rules-based algorithm (RBA) leveraging electronic health record (EHR) data to improve HaH patient identification, which is crucial for efficient HaH operations. RBA adjustments incorporated clinician feedback to align analytics resources and enhance clinical workflows. Our study highlights the importance of interdisciplinary collaboration and the potential for analytics to optimize efficiency for emerging care models.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The speaker exchange program: Cooking up sponsorship strategies to raise the professional visibility of junior faculty.","authors":"Annie Massart, Mary Ann Kirkconnell Hall","doi":"10.1002/jhm.70118","DOIUrl":"https://doi.org/10.1002/jhm.70118","url":null,"abstract":"<p><p>Sponsorship-direct action (beyond mentorship) by professionals to promote the interests of junior colleagues-catalyzes career advancement but is not always available to junior faculty. This results from the relative youth of hospital medicine as a specialty (and its small pool of senior hospitalist sponsors) and heavy clinical loads, often without protected time for academic pursuits. Our reciprocal institutional Speaker Exchange Program (SEP) is a model for junior faculty to sponsor colleagues and mentees. The SEP combines creative promotion, including freshly baked cookie boxes for conference attendees with links to our list of junior faculty talks, to supplement traditional sponsorship and faculty development strategies.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interhospital variation in the management of Brief Resolved Unexplained Events (BRUE) in infants: A Canadian multicenter cohort study.","authors":"Nassr Nama, Kara Picco, Polina Kyrychenko, Jeffrey N Bone, Julie Quet, Jessica L Foulds, Josée Anne Gagnon, Chris Novak, Brigitte Parisien, Matthew Donlan, Ran D Goldman, Anupam Sehgal, Ronik Kanani, Joanna Holland, Sanjay Mahant, Eric Coon, Joel S Tieder, Peter J Gill","doi":"10.1002/jhm.70094","DOIUrl":"https://doi.org/10.1002/jhm.70094","url":null,"abstract":"<p><strong>Background: </strong>Guidelines on Brief Resolved Unexplained Event (BRUE) only provide recommendations for infants categorized at lower risk. However, most infants fall into the higher-risk category, leaving management decisions to individual clinicians and contributing to variation in care.</p><p><strong>Objectives: </strong>Describe interhospital variation in BRUE management and determine whether higher resource utilization improves detection of serious underlying diagnoses.</p><p><strong>Methods: </strong>This multicenter observational cohort (2017-2021) included infants (< 12 months) with BRUE at eight Canadian hospitals. We recorded admission, and use of electrocardiograms (ECG), electroencephalograms (EEG), antibiotic and anti-reflux medications, and subspecialty consultations. Multivariable median regression evaluated the association between tests/interventions and length of stay (LOS), and logistic regression assessed whether site-level resource use correlated with serious underlying diagnoses detection.</p><p><strong>Results: </strong>Of 758 infants (92% higher-risk), we noted variation in admission rates (32%-76%, p < .001), ICU admissions (0%-20%, p < .001), median LOS (0.8-2.0 days, p < .001), ECG (24%-78%, p < .001), EEG (8%-29%, p = .001), and anti-reflux medication (0%-21%, p < .001). Five percent had a serious underlying diagnosis, with no significant site differences (0%-8%, p = .49). Median regression showed EEG (19.9 h, 95% CI: 6.8-33.0, p = .03), empiric antibiotics (15.8 h, 95% CI: 4.7-26.9, p = .03), and subspecialty consultation (17.0 h, 95% CI: 10.8-23.2, p < .001) were associated with longer LOS. Higher resource use did not increase detection of serious underlying diagnoses.</p><p><strong>Conclusions: </strong>Substantial variation exists in BRUE management, associated with prolonged LOS. Higher admission and testing were not associated with increased detection of serious underlying diagnoses. These findings highlight the need for standardized care approaches.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}