Journal of hospital medicine最新文献

{"title":"Leadership & professional development: A TEAM sport: Dual-physician couples.","authors":"Christopher Wynkoop, Ann E Perrin","doi":"10.1002/jhm.70057","DOIUrl":"https://doi.org/10.1002/jhm.70057","url":null,"abstract":"","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061022","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":"A multi-institutional multi-methods analysis of jeopardy systems in academic hospital medicine.","authors":"Kirsten N Kangelaris, Angela Keniston, Andrew D Auerbach, Gregory Bowling, Marisha Burden, Shradha A Kulkarni, Luci K Leykum, Anne S Linker, Matthew Sakumoto, Jeffrey Schnipper, Gopi Astik","doi":"10.1002/jhm.70045","DOIUrl":"https://doi.org/10.1002/jhm.70045","url":null,"abstract":"<p><strong>Background: </strong>Hospital medicine programs use backup (\"jeopardy\") systems to cover unexpected staffing gaps, but little is known about their structures or optimal practices.</p><p><strong>Objectives: </strong>To describe jeopardy structures, assess clinician perceptions, and identify potential approaches across a broad sample of hospital medicine groups.</p><p><strong>Methods: </strong>This multi-methods study, conducted within a national hospitalist consortium, used virtual focus groups and an email survey to (1) describe the presence and structure of jeopardy systems and (2) explore features perceived as fair, equitable, and tolerable. Rapid qualitative analysis identified major themes, while descriptive methods analyzed survey data.</p><p><strong>Results: </strong>Twenty-five individuals participated in focus groups, and 26 completed the survey, representing 31 unique institutions. Participants were primarily physicians in academic hospital medicine groups. Three themes emerged: (1) jeopardy systems are widely used but vary in structure, activation criteria, and compensation, leading to inconsistencies in clinician experiences; (2) many clinicians report stress and dissatisfaction due to unpredictability, perceived inequities in assignment, and concerns about inappropriate use; and (3) strategies to improve fairness, equity and tolerability include structured scheduling, support for sick days, and compensation for the burden of jeopardy coverage. Survey data confirmed high variability in jeopardy systems across institutions. Common practices included jeopardy activation over redistributing patients and compensating clinicians for covered shifts.</p><p><strong>Conclusions: </strong>Jeopardy systems are essential for hospital medicine staffing but contribute to clinician dissatisfaction due to unpredictability and perceived inequities in coverage. Implementing deliberate scheduling, formalized support for absences, and equitable compensation models may reduce dissatisfaction and improve jeopardy system sustainability.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050594","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":"Clinical progress note: Secondary fracture prevention.","authors":"Emily E Waner, David Saxon, Heather E Nye","doi":"10.1002/jhm.70062","DOIUrl":"https://doi.org/10.1002/jhm.70062","url":null,"abstract":"<p><p>Osteoporosis is underdiagnosed and undertreated after fragility fractures. Hospitalists should be able to risk stratify osteoporosis severity to guide treatment decisions. Bisphosphonates remain the cornerstone of treatment. However, patients with the highest fracture risk may benefit from anabolic therapy before bisphosphonate use. Behavioral and environmental fall prevention measures also play a key role to prevent future fractures. Hospitalists are well-positioned to help address the gap in osteoporosis care-especially for patients who have already fractured and are at highest risk.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052597","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":"Gaps in care delivery for patients with heart failure: A qualitative study of patients with multiple readmissions.","authors":"Zara Latif, Tracy T Makuvire, Shelli L Feder, A Reshad Garan, Pablo Quintero Pinzon, Haider J Warraich","doi":"10.1002/jhm.70051","DOIUrl":"https://doi.org/10.1002/jhm.70051","url":null,"abstract":"<p><strong>Background: </strong>Despite significant advances in the management of patients with heart failure with preserved and reduced ejection fraction (HFpEF and HFrEF), readmission rates remain high.</p><p><strong>Objectives: </strong>In this study, we sought to understand the experiences and gaps in care delivery among heart failure (HF) patients with multiple readmissions.</p><p><strong>Methods: </strong>We conducted a qualitative study using semistructured interviews with patients admitted with HF exacerbation and who had a prior admission for HF exacerbation within 1 year of the interview. We analyzed the interview contents using thematic analysis. Additionally, we reviewed the medical charts and collected information regarding patients' disease course and treatments.</p><p><strong>Results: </strong>Our study included 24 patients, 54% had HFrEF, and 46% had HFpEF. Two major themes emerged; the first theme was centered on hospital readmissions, which often uncovered gaps in communication and deficiencies in discharge education. Patients expressed frustration with recurrent admissions, identified communication challenges while inpatient, and highlighted the shortcomings of the current discharge education models. The second theme explored the ways in which fragmented understanding of HF as a result of gaps in effective care delivery impacted multiple domains of care spanning the spectrum from initial diagnosis to prognosis. The interviews highlighted important differences between patients with HFrEF and HFpEF.</p><p><strong>Conclusions: </strong>Patients with HF and recurrent admissions shared multiple gaps in care delivery with important differences noted between HFpEF and HFrEF patients. These findings can inform the design of future targeted interventions to ensure effective care delivery to a high-risk population.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059341","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":"Impact of an electronically-integrated clinical pathway on hospital initiation of medications for alcohol use disorder and subsequent hospital utilization.","authors":"Kelsey O Cole, Melissa B Weimer, Kaicheng Wang, David A Fiellin, Anisha J Advani, Nidhi Shah, Christopher T Zemaitis, Deborah J Rhodes","doi":"10.1002/jhm.70049","DOIUrl":"https://doi.org/10.1002/jhm.70049","url":null,"abstract":"<p><strong>Background: </strong>Medications for alcohol use disorder (MAUD) are underutilized and multiple barriers and disparities in treatment initiation have been identified. Effective hospital-based strategies to promote MAUD use are not well-defined.</p><p><strong>Objective: </strong>To determine whether an electronic health record (EHR)-integrated clinical pathway increases MAUD initiation.</p><p><strong>Methods: </strong>We conducted a prospective observational cohort study with consecutive adult inpatients diagnosed with alcohol use disorder (AUD) and withdrawal requiring treatment who were admitted to a health system comprising a mix of community and tertiary academic medical centers. The impact of voluntary use of an AUD EHR-integrated clinical pathway on MAUD initiation (main outcome) and ED return or readmission for any cause within 30 days of discharge (secondary outcomes) was evaluated.</p><p><strong>Results: </strong>Among 2630 inpatient medicine encounters, the pathway was utilized in 17.8%. Pathway utilization was associated with 4.31 (confidence interval [CI]: 3.10-5.99, p < .001) increased odds of MAUD initiation as compared with encounters without pathway utilization (31% vs. 15.4%). There were no differences in rates of 30-day ED returns (odds ratio [OR]: 0.76; 95% confidence interval [CI]: 0.35-1.62; p = .47) or 30-day readmissions (OR: 1.19; 95% CI: 0.80-1.76; p = .40) and no differences in MAUD initiation by race or ethnicity when the pathway was utilized versus not utilized.</p><p><strong>Conclusions and relevance: </strong>Utilization of an EHR-integrated clinical pathway for individuals with AUD significantly increased MAUD initiation at hospital discharge. These findings support the use of an EHR-integrated clinical pathway as an implementation tool for overcoming barriers to MAUD initiation and may be a generalizable strategy for increasing low rates of MAUD prescribing for patients with AUD.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015889","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":"Increasing timely code status discussions in hospitalized children with medical complexity.","authors":"James Bowen, Laura Brower, Daniel Kadden, Jasmine Parker, Alexandra Delvalle, Andrew Krueger, Kristin Todd, Rachel Peterson","doi":"10.1002/jhm.70058","DOIUrl":"https://doi.org/10.1002/jhm.70058","url":null,"abstract":"<p><strong>Background and objectives: </strong>Children with medical complexity (CMC) have an increased risk of hospitalization and clinical deterioration. Documentation of code statuses concordant with family goals is rare, increasing the risk of serious unintended consequences. We aimed to increase the percentage of patients with documentation of timely code status orders (CSOs) from 5% to 80% over 6 months.</p><p><strong>Methods: </strong>This quality improvement project took place at one freestanding children's hospital and included patients admitted to the complex care team (CCT). Multiple plan-do-study-act cycles were performed focusing on interventions aimed at key drivers, including increasing knowledge in performing code status discussions (CSDs) and improving understanding of institutional policies. A P-chart was used to track the effect of the interventions over time by using established rules for determining special cause. Clinical deterioration events occurring with active CSOs were evaluated by using a Fisher's exact test. Pediatric palliative care (PPC) consultation rates were tracked as a balancing measure.</p><p><strong>Results: </strong>The average percentage of patients who received a CSO placed in their chart within 72 h of admission to the CCT increased from 5% to 61% over 6 months. Rates of CSO placement before clinical deterioration events improved from 9% to 44% (p = 0.04) and rates of patients who received PPC consultation remained stable (1% of patients to 5%, p = 0.16).</p><p><strong>Conclusions: </strong>Interventions targeting knowledge in performing CSDs and multidisciplinary stakeholder engagement improved rates of code status discussions on the CCT. Further study is needed to evaluate these interventions in other practice settings.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065512","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":"Leadership & professional development: Time poverty: The plague of 21st century medicine.","authors":"Sherine Salib","doi":"10.1002/jhm.70060","DOIUrl":"https://doi.org/10.1002/jhm.70060","url":null,"abstract":"","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016039","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":"Pediatric hospital medicine fellow expectations for postgraduate employment.","authors":"Daniel Herchline, Jennifer A Hoefert, Deanna Chieco, Adam Cohen, Martha J Elster, Eleanor Sharp, Jennifer Maniscalco","doi":"10.1002/jhm.70054","DOIUrl":"https://doi.org/10.1002/jhm.70054","url":null,"abstract":"<p><strong>Background: </strong>Pediatric Hospital Medicine (PHM) has a rapidly changing landscape following subspecialty certification in 2016. As the field continues to evolve, so does the role of fellowship training.</p><p><strong>Objectives: </strong>The goal of this study was to characterize postgraduate expectations of current PHM fellows to contribute to the understanding of PHM workforce dynamics.</p><p><strong>Methods: </strong>Using a constructivist approach, we employed a cross-sectional survey method with both multiple-choice and free-text questions to study PHM fellows' perspectives regarding posttraining employment and motivations for pursuing fellowship. We used multiple listservs to recruit current PHM fellows for participation. We analyzed survey data using descriptive statistics and free-text responses using conventional inductive content analysis.</p><p><strong>Results: </strong>A total of 119 PHM fellows (response rate 61%) completed the survey. Most participants anticipated higher starting salaries, more protected time and leadership opportunities, and more efficient career advancement because of PHM fellowship training. Additionally, participants noted several modifiable factors influencing their postgraduate employment considerations which included workplace culture and lifestyle considerations. Participants reported various motivations for pursuing PHM fellowship training, including future job security and career flexibility.</p><p><strong>Conclusions: </strong>Despite different reasons for pursuing additional training, the majority of PHM fellows in our study believe that fellowship training should result in increased compensation, resources, and career opportunities than if they had not completed fellowship training. These findings have implications for counseling trainees interested in PHM and for the PHM workforce.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061026","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":"Data to decisions: Enhancing mortality predictions as a step toward precision medicine.","authors":"Michael Osnard, Gregory W Ruhnke","doi":"10.1002/jhm.70038","DOIUrl":"https://doi.org/10.1002/jhm.70038","url":null,"abstract":"","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813006","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":"Trends in hospital encounters for child physical abuse through the COVID-19 pandemic.","authors":"Henry T Puls, Jay G Berry, Matthew Hall","doi":"10.1002/jhm.70056","DOIUrl":"https://doi.org/10.1002/jhm.70056","url":null,"abstract":"<p><p>Child physical abuse did not increase early in the coronavirus disease 2019 (COVID-19) pandemic as anticipated. However, abuse epidemiology has not been evaluated during later periods of the pandemic. This study's objective was to compare the volume of hospital encounters (i.e., emergency department visits and hospitalizations) for abuse and injuries concerning for abuse at 42 US children's hospitals across three pandemic periods compared with prepandemic, during January 1, 2018 through June 30, 2023. Median monthly volumes of encounters as well as child- and encounter-level characteristics for each pandemic period were compared with pre-pandemic. Hospital encounters for abuse and injuries concerning for abuse remained relatively unchanged throughout the pandemic, including during the late-pandemic period when many pandemic-related economic and relief policies had been discontinued. Hispanic children, however, accounted for an increasing proportion of cases throughout the pandemic, indicating potential emerging demographic changes in child abuse epidemiology.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813115","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}