Journal of hospital medicine最新文献

{"title":"Unspoken worry.","authors":"Samir S Shah","doi":"10.1002/jhm.70480","DOIUrl":"https://doi.org/10.1002/jhm.70480","url":null,"abstract":"<p><p>A physician reflects on how an unspoken worry during a stressful overnight shift in internship became a lesson in communication among members of the medical team.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149221259","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":"White coat to Green vest.","authors":"Catherine Q Nguyen","doi":"10.1002/jhm.70518","DOIUrl":"https://doi.org/10.1002/jhm.70518","url":null,"abstract":"","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198480","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":"Cognition, oversight, and the safety case for documentation AI.","authors":"Fahad Wali Ahmed, Fauwad Ahmed","doi":"10.1002/jhm.70513","DOIUrl":"https://doi.org/10.1002/jhm.70513","url":null,"abstract":"<p><p>Large language models (LLMs) can now draft hospital discharge summaries. Reported hallucination rates vary by measurement context, from about 1%-2% in structured summarisation to over 60% under provocation testing. The common argument that LLMs outperform a tired resident treats a high-stakes clinical and legal document as a text-quality problem. We argue that a potentially underappreciated concern is the weakening of clinician oversight when reviewing fluent machine-generated text, and that the joint clinician-AI system is central to safety. We propose a Clinician-AI Oversight Model with four safeguards: bounded autonomy, structured verification, error-signal monitoring, and longitudinal evaluation of cognitive effects.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198482","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":"Medically ready for discharge: A multicenter Veterans Health Administration assessment of hospitalized patients.","authors":"Michelle M Guidry, Matthew Tuck, Joyce Akwe, Raj Sehgal, Elizabeth A Schackmann, Heather S Shaw, Ashley H Sweeney, Albertine S Beard, Dustin J Uhlenhopp, Nurit Harari, Jessica E Cyr, Andrea Smeraglio, LeeAnn M Cox, William Turbyfill, Daniel B Heppe, Megha Garg, Nathan Baskin, Amanda M Raines, Matthew V Ronan, Nazima Allaudeen, David Malinak, Samantha Spilman, Cherinne Arundel, Craig G Gunderson, Emily E Cantor, Casey Kaneshiro, James Darrell Laudate, Maralyssa Bann, Nicholas Meo, Paul Helgerson, Paul B Cornia","doi":"10.1002/jhm.70511","DOIUrl":"https://doi.org/10.1002/jhm.70511","url":null,"abstract":"<p><strong>Background: </strong>Patients may remain hospitalized despite being medically ready for discharge, some for prolonged periods. Delays in discharge may negatively impact patients and hospitals.</p><p><strong>Objective: </strong>To quantify the proportion of acute care general medicine patients in VHA hospitals who are medically ready for discharge but remain hospitalized due to major discharge barriers and to identify the major contributors.</p><p><strong>Methods: </strong>Cross-sectional study of 21 VHA hospitals using a structured tool to collect data from inpatient medicine attending physicians about their patients and the hospital on a single day. Primary outcomes were the percentage of patients medically ready for discharge and those with \"major discharge barriers\" (medically ready for discharge ≥1 week). Secondary outcomes explored support needs, resources awaited, and major contributing factors.</p><p><strong>Results: </strong>Of 1,348 sampled patients, 41.9% (n = 565, range 18.4%-64.7%) were medically ready for discharge, including 18.1% (n = 244, range 0%-32%) who had major discharge barriers. For more than half of these patients, the intended discharge location was a long-term care facility (41.9%, nursing home for custodial care; 9.7%, assisted living facility). The most identified support needs were assistance with ADLs and geriatric-psychiatric care. Payor source and selection of discharge location were the most common resources awaited.</p><p><strong>Conclusions: </strong>Nearly one in five hospitalized veterans had major discharge barriers leading to prolonged hospitalization after they were medically ready for discharge. More than half were awaiting long-term care placement. This was due to a lack of available post-discharge resources and support. Multidisciplinary engagement to streamline processes and increase resources for post-discharge facility placement is needed.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198521","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":"Variation in effectiveness of blood transfusion by hospital day: Threats to validity from survivorship bias, time-varying confounding, and endogenous hemoglobin.","authors":"Mellar P Davis","doi":"10.1002/jhm.70517","DOIUrl":"https://doi.org/10.1002/jhm.70517","url":null,"abstract":"","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198487","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":"Response to correspondence.","authors":"Nicholas A Bosch, Allan J Walkey","doi":"10.1002/jhm.70516","DOIUrl":"https://doi.org/10.1002/jhm.70516","url":null,"abstract":"","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187072","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":"\"Once they learn here…they can work pretty much anywhere\": Perspectives on clinical education in rural veterans affairs hospitals.","authors":"Colleen M Blue, Madeleine R Eldridge, Heather A King, Jennifer Zervakis, Julia Armendariz, Joel C Boggan, Lily Huang, Pranav Shah, Matthew Soltys, Laura Caputo","doi":"10.1002/jhm.70507","DOIUrl":"https://doi.org/10.1002/jhm.70507","url":null,"abstract":"<p><strong>Background: </strong>One of the Department of Veterans Affairs (VA)'s greatest contributions to US Healthcare is its commitment to education. Rural VAs are tasked with increasing the number of health professions trainees they teach, but little is known about the current experience of teaching in rural VA hospitals.</p><p><strong>Objectives: </strong>This evaluation explores the experiences of rural VA hospitalists and identifies and describes barriers and facilitators to engagement in clinical teaching.</p><p><strong>Methods: </strong>Using qualitative descriptive evaluation, we conducted six focus groups and one interview with hospitalists and others invested in the VA educational mission (n = 27) across six hospitalist divisions at rural VAs (VA systems caring for a population that is approximately 50% rural or greater). Focus group and interview questions were developed based on literature, a hospitalist needs assessment, and clinical experience. We used rapid qualitative analysis to report findings on the domains of VA Educational Mission-Rural Perspective, VA Rural Medicine, Rural VA Work/Life Balance, and Burnout among rural VA hospitalists.</p><p><strong>Results: </strong>VA educational mission contributed to rural hospitalists' decisions to work at VA, yet how teaching impacted burnout and work/life balance varied. Rurality impacted topics taught and trainee recruitment. Rural VA teaching barriers included administrative challenges, generational differences, and lack of specialty resources. Facilitators included professional growth, amplified personal and institutional impact, and serving rural Veterans.</p><p><strong>Conclusions: </strong>This evaluation identified several actionable areas to target in faculty development programs that can support rural hospitalists, including how to leverage the additive curriculum of rural medicine as an asset.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171630","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":"Real-time physical function assessment in hospitalized patients: Enhanced discharge disposition predictions with the PROMIS PF5 tool.","authors":"Michael S Yoo, Colleen Plimier, Patricia Kipnis, Gabriel J Escobar, Caitlin M Lydon, David Schlessinger, John D Greene, Brian L Lawson, Heather E Brown, Joeffrey R Hatton, Vincent X Liu","doi":"10.1002/jhm.70500","DOIUrl":"https://doi.org/10.1002/jhm.70500","url":null,"abstract":"<p><strong>Background: </strong>Physical function (PF) impairment is a key determinant of hospital discharge disposition, yet real-time PF assessments remain underutilized in inpatient care. The Patient-Reported Outcomes Measurement Information System Physical Function 5-item tool (PROMIS PF5, or PF5) was embedded into the electronic health record (EHR) across 21 Kaiser Permanente Northern California (KPNC) hospitals to standardize PF assessment and integrate it into care. Here, we evaluated its performance in predicting discharge disposition (to home, home with home health services [home health], or to a skilled nursing facility [SNF]).</p><p><strong>Methods: </strong>Our retrospective cohort study included inpatient and observation encounters from 21 KPNC hospitals (January 1, 2022, through March 31, 2024). PF5 data included patient-reported prior level of function (PLOF) and clinician-assessed current level of function (CLOF), updated daily. Gradient-boosted machine models predicted discharge disposition within the next 24 h using demographic, clinical, and functional covariates. Model performance was evaluated across the first 7 days of hospitalization using area under the receiver operating characteristic curve (AUC), precision-recall AUC (prAUC), and number needed to evaluate (NNE) and were compared with models using clinician-entered expected discharge dispositions (EDD).</p><p><strong>Results: </strong>PF5-based models outperformed clinician-entered EDD, especially early during hospitalization when EDD was often missing. Across 493,035 hospital encounters, PF5-particularly CLOF-strongly predicted discharge disposition. For example, on Day 3 of hospitalization, SNF discharge predictions using models with PF5 achieved an AUC of 0.89 (vs. 0.75 using EDD alone). CLOF was the most influential predictor across models. The NNE for SNF discharge improved from 4.0 (Day 1) to 1.4 (Day 7) at a sensitivity threshold of 60%. Models for home and home health disposition similarly showed improved accuracy with PF5.</p><p><strong>Conclusions: </strong>Models incorporating physical function enhanced prediction of discharge disposition, significantly outperforming models using expected discharge disposition alone. Our findings suggest that EHR-integrated functional assessment tools may provide earlier, more objective insight into discharge disposition compared with clinician-entered estimates. Further studies should evaluate whether incorporating such tools into clinical workflows improves discharge processes or patient outcomes.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170470","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":"Medicaid utilization in children: Condition-specific incidence and spending.","authors":"Madelyn Hall, Jay G Berry, Samir S Shah, Vineeta Mittal, Matt Hall, Henry T Puls, Jessica L Markham","doi":"10.1002/jhm.70498","DOIUrl":"https://doi.org/10.1002/jhm.70498","url":null,"abstract":"<p><p>Medicaid insures over half of US children, yet gaps remain in understanding how funds are allocated across the care of nonchronic conditions, the care of chronic conditions, and preventative services. We conducted a retrospective analysis of 7.2 million Medicaid-enrolled children from 12 states in the 2022 Medicaid Marketscan database. Only 78.5% of enrolled children had a Medicaid healthcare claim. Among those with at least one Medicaid claim, half received preventative care, accounting for just 8.5% of total Medicaid spending. Care of nonchronic conditions accounted for the highest proportion (50.4%) of spending, while the care of chronic conditions affected 27.7% of children and represented 41.1% of spending. These findings highlight opportunities for preventive care and the need for strategies to increase access and optimize Medicaid's impact on children's health.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120908","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":"What makes or breaks a rotation? An analysis of rotation evaluations from pediatric residents.","authors":"Mollie G Wasserman, Laura E Chiel, Carolyn H Marcus","doi":"10.1002/jhm.70503","DOIUrl":"https://doi.org/10.1002/jhm.70503","url":null,"abstract":"<p><strong>Purpose: </strong>Inpatient clinical rotations are central to residency training. Studies have examined aspects of the inpatient learning environment, but few have characterized factors that differentiate exemplary from problematic rotations from the resident perspective. This study aimed to understand what distinguishes rotations through analysis of resident-generated evaluations across inpatient and acute-care specialties in a residency program.</p><p><strong>Methods: </strong>Residents in a large pediatric residency program complete anonymous end-of-rotation evaluations, rating rotations on a 5-point scale with optional free-text commentary. This study analyzed inpatient and acute-care rotation evaluations submitted July 2019-June 2024 with a \"very highly\" or \"very poorly\" rating and an associated free-text response. Two investigators inductively coded a subset of evaluations to develop a codebook, which was applied to the remaining evaluations. Codes were organized into subthemes and themes, which aligned with self-determination theory (SDT). SDT was used as a guiding framework, and thematic saturation was confirmed.</p><p><strong>Results: </strong>A total of 712 \"very highly\" rated and 106 \"very poorly\" rated rotation evaluations met the inclusion criteria. Subthemes impacted one or more domains of SDT: autonomy, competence, and relatedness. Autonomy was shaped by ownership of patient care, supervisor oversight, and leadership. Competence was fostered by high-quality teaching, educational context, and patient-based learning. Relatedness was enhanced by communication, team culture, and role clarity. Psychological safety and trainee team inclusion impacted all SDT domains.</p><p><strong>Conclusions: </strong>Autonomy, competence, and relatedness, promoted by psychological safety and trainee integration, are central to the resident experience. Educators should consider these factors when designing inpatient rotations.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120820","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}