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Eaton JL, Reed VR, Katsuki MY. Gynecologic Hospitalists: Expanding the "G" in the Obstetrics and Gynecologic Hospitalist Role. Obstet Gynecol Clin North Am 2024; 51:559-566. [PMID: 39098781 DOI: 10.1016/j.ogc.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
The obstetrics and gynecology (OB/GYN) hospitalist model designates obstetricians/gynecologists focused on hospitalized women's care. OB/GYN hospitalists engage in diverse activities, encompassing patient care, teaching, research, and inpatient leadership. Primarily, they manage obstetric and gynecologic patients in the hospital, handling emergencies and providing urgent care. Hospitalists oversee the entire continuum of patient care, from the emergency department to post-acute follow-up. This model emphasizes the traditional academic attending physician's role, particularly that of the gynecologic hospitalist, who excels in acute inpatient obstetric and gynecologic medicine, advancing skills in urgent care and medical education, and ensuring quality and safety metrics.
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Affiliation(s)
- Jennifer L Eaton
- Cleveland Clinic, Obstetrics and Gynecology Institute, A81, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Vicki R Reed
- Cleveland Clinic, Obstetrics and Gynecology Institute, A81, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Monique Yoder Katsuki
- Cleveland Clinic, Obstetrics and Gynecology Institute, A81, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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The Evaluation of Payment for Obstetric and Gynecology Services: From ACOG. Obstet Gynecol 2024; 143:e40-e53. [PMID: 38237166 DOI: 10.1097/aog.0000000000005487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/27/2023] [Indexed: 01/23/2024]
Abstract
PURPOSE To perform an environmental scan of the current status of reimbursement for obstetric and gynecology services and identify problematic issues and opportunities for change. The areas that were evaluated include the American Medical Association (AMA) relative value unit assignment process, payer rates (where available), and trends in employment and salary determination for obstetrician-gynecologists (ob-gyns). METHODS This report was developed by members of the American College of Obstetricians and Gynecologists' (ACOG) Committee on Health Economics and Coding using public-facing payment data from the Medicare Physician Fee Schedule and state Medicaid programs, as well as published research and commentary on payment for physicians, maternal health, and gynecologic surgery. Data from the Centers for Disease Control and Prevention were used to describe typical patient characteristics, and practice survey reports from the AMA were analyzed. Finally, an anonymous online survey was distributed to 27,854 members of ACOG in March 2022, with a response rate of 10.8% (3,018 members) and a CI of ±1.7%. FINDINGS The evaluation found that payment for ob-gyns is heavily influenced by the values and rates set by third-party payers, a patient case-mix that includes a higher-than-average number of patients with Medicaid insurance, and the increase of employed physicians reliant on salary contracts that include productivity requirements and bonuses. RECOMMENDATIONS The Committee identified action items, including payment reform for obstetric services; advocating for gynecologic surgery time as a priority for hospital administration; developing resources to assist employed physicians with payment, practice, and business management; developing a business and coding curriculum for students and early-career physicians; and continued advocacy with private and public policymakers who influence physician payment.
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Yim GW, Park SJ, Lee EJ, Lee M, Chung HH, Kim JW, Kim HS. Impact of gynecologic hospitalist on patient waiting time at the emergency department in Korea: A retrospective pre-post cohort study. Taiwan J Obstet Gynecol 2021; 60:851-856. [PMID: 34507660 DOI: 10.1016/j.tjog.2021.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study aimed to identify the impact of care and change in the consultation process given by a gynecologic hospitalist on patient waiting time in the emergency department (ED). MATERIALS AND METHODS This is a pre-post study that compared patients' length of stay at the ED ten months before and after intervention by the gynecologic hospitalist in 2018. The consultation process changed from ED staff contacting the gynecologic resident (pre-intervention group) to directly contacting the gynecologic hospitalist (post-intervention group). Times elapsed from gynecologic consultation to final disposition, from gynecologic consultation to discharge, and from arrival at ED to discharge were compared between the two groups. RESULTS Among 945 referrals at the ED during the study period, the number of daytime weekday gynecologic consultations were 68 and 187 cases in the pre-intervention and post-intervention groups, respectively. The time elapsed from gynecologic consultation to the final disposition, the time elapsed from gynecologic consultation to discharge and the time elapsed from arrival at ED to discharge were shorter in the post-intervention group than in the pre-intervention group (median values, 98 vs. 167.5 min, 205 vs. 311.5 min, and 419 vs. 497 min; P < 0.05), and extended length of stay more than 12 h at the ED was less common in the post-intervention group than in the pre-intervention group (9.6 vs. 19.1%; P < 0.01). CONCLUSION The waiting time of gynecologic patients upon admission and prolonged length of stay at ED significantly decreased after the establishment of the gynecologic hospitalist system.
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Affiliation(s)
- Ga Won Yim
- Department of Obstetrics and Gynecology, Dongguk University College of Medicine, Goyang, 10326, Republic of Korea
| | - Soo Jin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Eun Ji Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Maria Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea.
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Chae W, Kim J, Park EC, Jang SI. Comparison of Patient Satisfaction in Inpatient Care Provided by Hospitalists and Nonhospitalists in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158101. [PMID: 34360394 PMCID: PMC8345769 DOI: 10.3390/ijerph18158101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 12/02/2022]
Abstract
Background: A Korean hospitalist is a medical doctor in charge of inpatient care during hospital stays. The purpose of this study is to examine the patient satisfaction of hospitalist patients compared to non-hospitalist patients. Patient satisfaction is closely related to the outcome, quality, safety, and cost of care. Thus, seeking to achieve high patient satisfaction is essential in the inpatient care setting. Design, setting, and participants: This is a case-control study based on patient satisfaction survey by the Korean Health Insurance Review and Assessment Service. We measured patients’ satisfaction in physician accessibility, consultation and care service skills, and overall satisfaction through logistic regression analyses. A total of 3871 patients from 18 facilities responded to 18 questionnaires and had health insurance claim data. Results: Hospitalist patients presented higher satisfaction during the hospital stay compared to non-hospitalist patients. For example, as per accessibility, hospitalist patients could meet their attending physician more than twice a day (OR: 3.46, 95% CI: 2.82–4.24). Concerning consultation and care service skills, hospitalists’ explanations on the condition and care plans were easy to understand (OR: 2.33, 95% CI: 1.89–2.88). Moreover, overall satisfaction was significantly higher (β: 0.431, p < 0.0001). Subgroup analyses were conducted by medical division and region. Hospitalist patients in the surgical department and the rural area had greater patient satisfaction in all aspects of the survey than non-hospitalist patients. Conclusions: Hospitalists’ patients showed higher satisfaction during the hospital stay. Our study discovered that hospitalists could provide high-quality care as they provide onsite care continuously from admission to discharge.
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Affiliation(s)
- Wonjeong Chae
- BK21 FOUR R&E Center for Precision Public Health, College of Health Science, Korea University, Seoul 02841, Korea;
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea; (J.K.); (E.-C.P.)
| | - Juyeong Kim
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea; (J.K.); (E.-C.P.)
- Department of Health & Human Performance, Sahmyook University, Seoul 03722, Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea; (J.K.); (E.-C.P.)
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul 03722, Korea
| | - Sung-In Jang
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea; (J.K.); (E.-C.P.)
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul 03722, Korea
- Correspondence: ; Tel.: +82-2-2228-1862; Fax: +82-2-392-8133
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Gutierrez J, Moeckli J, Holcombe A, O’Shea AMJ, Bailey G, Rewerts K, Hagiwara M, Sullivan S, Simon M, Kaboli P. Implementing a Telehospitalist Program Between Veterans Health Administration Hospitals: Outcomes, Acceptance, and Barriers to Implementation. J Hosp Med 2021; 16:156-163. [PMID: 33617436 PMCID: PMC7929612 DOI: 10.12788/jhm.3570] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/12/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Telehospitalist services are an innovative alternative approach to address staffing issues in rural and small hospitals. OBJECTIVE To determine clinical outcomes and staff and patient satisfaction with a novel telehospitalist program among Veterans Health Administration (VHA) hospitals. DESIGN, SETTING, AND PARTICIPANTS We conducted a mixed-methods evaluation of a quality improvement program with pre- and postimplementation measures. The hub site was a tertiary (high-complexity) VHA hospital, and the spoke site was a 10-bed inpatient medical unit at a rural (low-complexity) VHA hospital. All patients admitted during the study period were assigned to the spoke site. INTERVENTION Real-time videoconferencing was used to connect a remote hospitalist physician with an on-site advanced practice provider and patients. Encounters were documented in the electronic health record. MAIN OUTCOMES Process measures included workload, patient encounters, and daily census. Outcome measures included length of stay (LOS), readmission rate, mortality, and satisfaction of providers, staff, and patients. Surveys measured satisfaction. Qualitative analysis included unstructured and semi-structured interviews with spoke-site staff. RESULTS Telehospitalist program implementation led to a significant reduction in LOS (3.0 [SD, 0.7] days vs 2.3 [SD, 0.3] days). The readmission rate was slightly higher in the telehospitalist group, with no change in mortality rate. Satisfaction among teleproviders was very high. Hub staff perceived the service as valuable, though satisfaction with the program was mixed. Technology and communication challenges were identified, but patient satisfaction remained mostly unchanged. CONCLUSION Telehospitalist programs are a feasible and safe way to provide inpatient coverage and address rural hospital staffing needs. Ensuring adequate technological quality and addressing staff concerns in a timely manner can enhance program performance.
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Affiliation(s)
- Jeydith Gutierrez
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center – Iowa City, Iowa City VA Healthcare System, Iowa City, Iowa
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- Corresponding Author: Jeydith Gutierrez, MD; ; Telephone: (319) 356-4019. Twitter: @JeydithMd
| | - Jane Moeckli
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center – Iowa City, Iowa City VA Healthcare System, Iowa City, Iowa
- The Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, Iowa
| | - Andrea Holcombe
- The Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, Iowa
| | - Amy MJ O’Shea
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center – Iowa City, Iowa City VA Healthcare System, Iowa City, Iowa
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- The Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, Iowa
| | - George Bailey
- The Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, Iowa
| | - Kelby Rewerts
- The Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, Iowa
| | - Mariko Hagiwara
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Steven Sullivan
- Acute Care Services, Tomah VA Medical Center, Tomah, Wisconsin
| | - Melissa Simon
- Acute Care Services, Tomah VA Medical Center, Tomah, Wisconsin
| | - Peter Kaboli
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center – Iowa City, Iowa City VA Healthcare System, Iowa City, Iowa
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- The Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, Iowa
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Harrington JW. Integrated pediatric urgent care: A perfect fit into patient-centered medical home and meeting the needs of population health and our profession. Curr Probl Pediatr Adolesc Health Care 2021; 51:100969. [PMID: 33676841 DOI: 10.1016/j.cppeds.2021.100969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
General Pediatricians have been constrained into a narrower band of primary care practice with the advent of hospitalists, advanced practice professionals and pediatric specific urgent cares. This new patient care structure will require electronic medical records and institutional systems to decrease interfaces and increase integration, thereby allowing a free flow of information that will provide more efficient and safe care. Pediatric specific urgent cares that are integrated will be able to utilize both efficient system level 1 thinking and deeper more thoughtful system level 2 thinking, which will benefit the pediatric patient by decreasing diagnostic errors. If done appropriately, everywhere a pediatric patient contacts the healthcare system, including pediatric specific urgent cares, the patient should be provided a longitudinal, seamless and specific high quality of care that fits the venue they contact.
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Affiliation(s)
- John W Harrington
- Children's Hospital of The King's Daughters, Norfolk, Virginia, United States.
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Gutierrez J, Kuperman E, Kaboli PJ. Using Telehealth as a Tool for Rural Hospitals in the COVID-19 Pandemic Response. J Rural Health 2020; 37:161-164. [PMID: 32277777 PMCID: PMC7262306 DOI: 10.1111/jrh.12443] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jeydith Gutierrez
- VA Office of Rural Health, Veterans Rural Health Resource Center - Iowa City (VRHRC-IC), Iowa City VA Healthcare System, Iowa City, Iowa.,The Center for Access and Delivery Research and Evaluation (CADRE), at the Iowa City VA Healthcare System, Iowa City, Iowa.,The Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Ethan Kuperman
- The Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Peter J Kaboli
- VA Office of Rural Health, Veterans Rural Health Resource Center - Iowa City (VRHRC-IC), Iowa City VA Healthcare System, Iowa City, Iowa.,The Center for Access and Delivery Research and Evaluation (CADRE), at the Iowa City VA Healthcare System, Iowa City, Iowa.,The Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Velásquez ST, Wang ES, White AA, Chadha J, Mader M, Leykum LK, Pugh J. Hospitalists as Triagists: Description of the Triagist Role across Academic Medical Centers. J Hosp Med 2020; 12:87-90. [PMID: 31634098 DOI: 10.12788/jhm.3327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
From the hospitalist perspective, triaging involves the evaluation of a patient for potential admission to an inpatient service. Although traditionally done by residents, many academic hospitalist groups have assumed the responsibility for triaging. We conducted a cross-sectional survey of 235 adult hospitalists at 10 academic medical centers (AMCs) to describe the similarities and differences in the triagist role and assess the activities and skills associated with the role. Eight AMCs have a defined triagist role; at the others, hospitalists supervise residents/advanced practice providers. The triagist role is generally filled by a faculty physician and shared by all hospitalists.We found significant variability in verbal communication practices (P = .02) and electronic communication practices (P < .0001) between the triagist and the current provider (eg, emergency department, clinic provider), and in the percentage of patients evaluated in person (P < .0001). Communication skills, personal efficiency, and systems knowledge are dominant themes of attributes of an effective triagist.
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Affiliation(s)
- Sadie Trammell Velásquez
- Department of Medicine, Division of General and Hospital Medicine, University of Texas Health San Antonio, San Antonio, Texas
- South Texas Veterans Health Care System, Medicine Service, San Antonio, Texas
| | - Emily S Wang
- Department of Medicine, Division of General and Hospital Medicine, University of Texas Health San Antonio, San Antonio, Texas
- South Texas Veterans Health Care System, Medicine Service, San Antonio, Texas
| | - Andrew A White
- University of Washington School of Medicine, Department of Medicine, Seattle, Washington
| | - Jagriti Chadha
- University of Kentucky, Division of Hospital Medicine, Lexington, Kentucky
| | - Michael Mader
- Department of Medicine, Division of General and Hospital Medicine, University of Texas Health San Antonio, San Antonio, Texas
- South Texas Veterans Health Care System, Medicine Service, San Antonio, Texas
| | - Luci K Leykum
- Department of Medicine, Division of General and Hospital Medicine, University of Texas Health San Antonio, San Antonio, Texas
- South Texas Veterans Health Care System, Medicine Service, San Antonio, Texas
| | - Jacqueline Pugh
- Department of Medicine, Division of General and Hospital Medicine, University of Texas Health San Antonio, San Antonio, Texas
- South Texas Veterans Health Care System, Medicine Service, San Antonio, Texas
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Crawford D, Paranji S, Chandra S, Wright S, Kisuule F. The effect of racial and gender concordance between physicians and patients on the assessment of hospitalist performance: a pilot study. BMC Health Serv Res 2019; 19:247. [PMID: 31018841 PMCID: PMC6480874 DOI: 10.1186/s12913-019-4090-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 04/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lack of racial concordance between physicians and patients has been linked to health disparities and inequities. Studies show that patients prefer physicians who look like them; however, there are too few underrepresented minority physicians in the workforce. Hospitalists are Internal Medicine physicians who specialize in inpatient medicine. At our hospital, hospitalists care for 60% of hospitalized medical patients. We utilized the validated Tool to Assess Inpatient Satisfaction with Care from Hospitalists (TAISCH) to assess the effect of patient-provider race and gender concordance on patients' assessment of their physician's performance. METHODS Four hundred thirty-seven inpatients admitted to the non-teaching hospitalist service, cared for by a unique hospitalist physician for two or more consecutive days, were surveyed using the validated TAISCH instrument. The influence of gender and racial concordance on TAISCH scores for patient - hospitalist pairs were assessed by comparing the specific dyads with the overall mean scores. T-tests were used to compare the means. Generalized estimating equations were used to account for clustering. RESULTS Of the 34 hospitalist physicians in the analysis, 20% were African American (AA-non-Hispanic), 15% were Caucasians (non-Hispanic) and 65% were in the "other" category. The "other" category consisted of predominantly physicians of South East Asian decent (i.e. Indian subcontinent) and Hispanic. Of the 437 patients, 66% were Caucasians, and 32% were AA. The overall mean TAISCH score, as these 437 patients assessed their hospitalist provider was 3.8 (se = 0.60). The highest mean TAISCH score was for the Caucasian provider-AA patient dyads at 4.2 (se = 0.21, p = 0.05 compared to overall mean). The lowest mean TAISCH score was 3.5 (se = 0.14) seen in the AA provider/AA patient dyads, significantly lower than the overall mean (p = 0.013). There were no statistically significant differences noted between mean TAISCH scores of gender and racially concordant versus discordant doctor-patient dyads (all p's > 0.05). CONCLUSIONS In the inpatient setting, it appears as if neither race nor gender concordance with the provider affects a patient's assessment of a hospitalist's performance.
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Affiliation(s)
- Damian Crawford
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 5200 Eastern Avenue, MFL Building West Tower 6th Floor CIMS Suite, Baltimore, MD, 21224, USA.
| | - Suchitra Paranji
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shalini Chandra
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Scott Wright
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Flora Kisuule
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Bergmann S, Tran M, Robison K, Fanning C, Sedani S, Ready J, Conklin K, Tamondong-Lachica D, Paculdo D, Peabody J. Standardising hospitalist practice in sepsis and COPD care. BMJ Qual Saf 2019; 28:800-808. [DOI: 10.1136/bmjqs-2018-008829] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 02/15/2019] [Accepted: 03/01/2019] [Indexed: 12/22/2022]
Abstract
BackgroundHospitalist medicine was predicated on the belief that providers dedicated to inpatient care would deliver higher quality and more cost-effective care to acutely hospitalised patients. The literature shows mixed results and has identified care variation as a culprit for suboptimal quality and cost outcomes. Using a scientifically validated engagement and measurement approach such as Clinical Performance and Value (CPV), simulated patient vignettes may provide the impetus to change provider behaviour, improve system cohesion, and improve quality and cost efficiency for hospitalists.MethodsWe engaged 33 hospitalists from four disparate hospitalist groups practising at Penn Medicine Princeton Health. Over 16 months and four engagement rounds, participants cared for two patients per round (with a diagnosis of chronic obstructive pulmonary disease [COPD] and sepsis), then received feedback, followed by a group discussion. At project end, we evaluated both simulated and real-world data to measure changes in clinical practice and patient outcomes.ResultsParticipants significantly improved their evidence-based practice (+13.7% points, p<0.001) while simultaneously reducing their variation (−1.4% points, p=0.018), as measured by the overall CPV score. Correct primary diagnosis increased significantly for both sepsis (+19.1% points, p=0.004) and COPD (+22.7% points, p=0.001), as did adherence to the sepsis 3-hour bundle (+33.7% points, p=0.010) and correct admission levels for COPD (+26.0% points, p=0.042). These CPV changes coincided with real-world improvements in length of stay and mortality, along with a calculated $5 million in system-wide savings for both disease conditions.ConclusionThis study shows that an engagement system—using simulated patients, benchmarking and feedback to drive provider behavioural change and group cohesion, using parallel tracking of hospital data—can lead to significant improvements in patient outcomes and health system savings for hospitalists.
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Bhandari S, Jha P, Thakur A, Gooley BT, Lange JJ, Paudel H, Frank M. Perceptions of Third-year Medical Students of a Non-resident Hospitalist Rotation. Cureus 2019; 11:e4214. [PMID: 31114733 PMCID: PMC6505734 DOI: 10.7759/cureus.4214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Although medical students in the United States frequently rotate on a non-resident hospitalist team, there is a paucity of literature on their perceptions regarding such rotation. We sought to assess the perceptions of third-year medical students (M3s) regarding a non-resident hospitalist rotation. Methods We conducted a web-based survey of M3s who had previously rotated on a non-resident hospitalist service. We assessed their perceptions regarding patient assignments and complexities, rounding preferences, barriers to learning, and the benefits of the rotation. A descriptive analysis was performed on the responses. Results Out of 49 respondents, 47% preferred carrying a maximum of three patients during rounds and 57% preferred patients with fewer comorbidities. Fifty-one percent preferred rounding on all patients covered by the team as opposed to rounding on their assigned patients only. Despite several perceived benefits of the rotation, students also identified various barriers to learning while rotating in a non-resident hospitalist rotation. Conclusions Our study evaluated the perceptions of M3s regarding the ideal patient load, patient complexities, barriers to learning and various benefits of a non-resident hospitalist rotation. The students' perceptions can potentially be addressed and incorporated to make the non-resident hospitalist rotation more educational for the students.
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Affiliation(s)
- Sanjay Bhandari
- Internal Medicine, Medical College of Wisconsin, Milwaukee, USA
| | - Pinky Jha
- Internal Medicine, Brookfield Heart and Vascular Clinic and Medical College of Wisconsin, Brookfield, USA
| | - Abhishek Thakur
- Internal Medicine, Frank H. Netter MD School of Medicine, North Haven, USA
| | - Brian T Gooley
- Internal Medicine, Medical College of Wisconsin, Milwaukee, USA
| | - Joel J Lange
- Emergency Medicine, Medical College of Wisconsin, Milwaukee, USA
| | - Hari Paudel
- Internal Medicine, Medical College of Wisconsin, Milwaukee, USA
| | - Michael Frank
- Internal Medicine, Medical College of Wisconsin, Milwaukee, USA
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Abstract
Hospital medicine is the fastest growing specialty in the United States. An interesting aspect of the rapid expansion of hospital medicine is the expansion of the field beyond the United States. Although the health care systems, regulations, and cultural norms in these nations differ, there are striking similarities in the profession’s development. We performed a literature review to better understand the factors contributing to the growth of hospital medicine internationally. In this article, we describe some of the drivers for expansion of hospital medicine outside the United States and the challenges faced by these groups. We also discuss the role the United States could play in the continued growth of hospital medicine internationally.
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Affiliation(s)
- Flora Kisuule
- Johns Hopkins School of Medicine, Division of Hospital Medicine, Johns Bayview Medical Center, Baltimore, MD, USA
| | - Eric Howell
- Johns Hopkins School of Medicine, Division of Hospital Medicine, Johns Bayview Medical Center, Baltimore, MD, USA
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13
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Hudali T, Papireddy M, Bhattarai M, Deckard A, Hingle S. Evaluating YouTube as a Source of Patient Education on the Role of the Hospitalist: A Cross-Sectional Study. Interact J Med Res 2017; 6:e1. [PMID: 28073738 PMCID: PMC5263860 DOI: 10.2196/ijmr.6393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 12/05/2016] [Accepted: 12/13/2016] [Indexed: 11/21/2022] Open
Abstract
Background Hospital medicine is a relatively new specialty field, dedicated to the delivery of comprehensive medical care to hospitalized patients. YouTube is one of the most frequently used websites, offering access to a gamut of videos from self-produced to professionally made. Objective The aim of our study was to determine the adequacy of YouTube as an effective means to define and depict the role of hospitalists. Methods YouTube was searched on November 17, 2014, using the following search words: “hospitalist,” “hospitalist definition,” “what is the role of a hospitalist,” “define hospitalist,” and “who is a hospitalist.” Videos found only in the first 10 pages of each search were included. Non-English, noneducational, and nonrelevant videos were excluded. A novel 7-point scoring tool was created by the authors based on the definition of a hospitalist adopted by the Society of Hospital Medicine. Three independent reviewers evaluated, scored, and classified the videos into high, intermediate, and low quality based on the average score. Results A total of 102 videos out of 855 were identified as relevant and included in the analysis. Videos uploaded by academic institutions had the highest mean score. Only 6 videos were classified as high quality, 53 as intermediate quality, and 42 as low quality, with 82.4% (84/102) of the videos scoring an average of 4 or less. Conclusions Most videos found in the search of a hospitalist definition are inadequate. Leading medical organizations and academic institutions should consider producing and uploading quality videos to YouTube to help patients and their families better understand the roles and definition of the hospitalist.
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Affiliation(s)
- Tamer Hudali
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States
| | - Muralidhar Papireddy
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States
| | - Mukul Bhattarai
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States
| | - Alan Deckard
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States
| | - Susan Hingle
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States
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