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Rieger EY, Kushner JNS, Sriram V, Klein A, Wiklund LO, Meltzer DO, Tang JW. Primary care physician involvement during hospitalisation: a qualitative analysis of perspectives from frequently hospitalised patients. BMJ Open 2021; 11:e053784. [PMID: 34853107 PMCID: PMC8638455 DOI: 10.1136/bmjopen-2021-053784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To explore frequently hospitalised patients' experiences and preferences related to primary care physician (PCP) involvement during hospitalisation across two care models. DESIGN Qualitative study embedded within a randomised controlled trial. Semistructured interviews were conducted with patients. Transcripts were analysed using qualitative template analysis. SETTING In the Comprehensive Care Programme (CCP) Study, in Illinois, USA, Medicare patients at increased risk of hospitalisation are randomly assigned to: (1) care by a CCP physician who serves as a PCP across both inpatient and outpatient settings or (2) care by a PCP as outpatient and by hospitalists as inpatients (standard care). PARTICIPANTS Twelve standard care and 12 CCP patients were interviewed. RESULTS Themes included: (1) Positive attitude towards PCP; (2) Longitudinal continuity with PCP valued; (3) Patient preference for PCP involvement in hospital care; (4) Potential for in-depth involvement of PCP during hospitalisation often unrealised (involvement rare in standard care; in CCP, frequent interaction with PCP fostered patient involvement in decision making); and (5) PCP collaboration with hospital-based providers frequently absent (no interaction for standard care patients; CCP patients emphasising PCP's role in interdisciplinary coordination). CONCLUSION Frequently hospitalised patients value PCP involvement in the hospital setting. CCP patients highlighted how an established relationship with their PCP improved interdisciplinary coordination and engagement with decision making. Inpatient-outpatient relational continuity may be an important component of programmes for frequently hospitalised patients. Opportunities for enhancing PCP involvement during hospitalisation should be considered.
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Affiliation(s)
| | - Josef N S Kushner
- Department of Medicine, Lenox Hill Hospital, New York City, New York, USA
| | - Veena Sriram
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Abbie Klein
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Lauren O Wiklund
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - David O Meltzer
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Joyce W Tang
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
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2
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A Novel Approach to ICU Survivor Care: A Population Health Quality Improvement Project. Crit Care Med 2021; 48:e1164-e1170. [PMID: 33003081 DOI: 10.1097/ccm.0000000000004579] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Deliver a novel interdisciplinary care process for ICU survivor care and their primary family caregivers, and assess mortality, readmission rates, and economic impact compared with usual care. DESIGN Population health quality improvement comparative study with retrospective data analysis. SETTING A single tertiary care rural hospital with medical/surgical, neuroscience, trauma, and cardiac ICUs. PATIENTS ICU survivors. INTERVENTIONS Reorganization of existing post discharge health care delivery resources to form an ICU survivor clinic care process and compare this new process to post discharge usual care process. MEASUREMENTS AND MAIN RESULTS Demographic data, Acute Physiology and Chronic Health Evaluation IV scores, and Charlson Comorbidity Index scores were extracted from the electronic health record. Additional data was extracted from the care manager database. Economic data were extracted from the Geisinger Health Plan database and analyzed by a health economist. During 13-month period analyzed, patients in the ICU survivor care had reduced mortality compared with usual care, as determined by the Kaplan-Meier method (ICU survivor care 0.89 vs usual care 0.71; log-rank p = 0.0108) and risk-adjusted stabilized inverse probability of treatment weighting (hazard ratio, 0.157; 95% CI, 0.058-0.427). Readmission for ICU survivor care versus usual care: at 30 days (10.4% vs 26.3%; stabilized inverse probability of treatment weighting hazard ratio, 0.539; 95% CI, 0.224-1.297) and at 60 days (16.7% vs 34.7%; stabilized inverse probability of treatment weighting hazard ratio, 0.525; 95% CI, 0.240-1.145). Financial data analysis indicates estimated annual cost savings to Geisinger Health Plan ranges from $247,052 to $424,846 during the time period analyzed. CONCLUSIONS Our ICU survivor care process results in decreased mortality and a net annual cost savings to the insurer compared with usual care processes. There was no statistically significant difference in readmission rates.
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Mosquera RA, Avritscher EBC, Pedroza C, Bell CS, Samuels CL, Harris TS, Eapen JC, Yadav A, Poe M, Parlar-Chun RL, Berry J, Tyson JE. Hospital Consultation From Outpatient Clinicians for Medically Complex Children: A Randomized Clinical Trial. JAMA Pediatr 2021; 175:e205026. [PMID: 33252671 PMCID: PMC7783544 DOI: 10.1001/jamapediatrics.2020.5026] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Children with medical complexity (CMC) frequently experience fragmented care. We have demonstrated that outpatient comprehensive care (CC) reduces serious illnesses, hospitalizations, and costs for high-risk CMC. Yet continuity of care for CMC is often disrupted with emergency department (ED) visits and hospitalizations. OBJECTIVE To evaluate a hospital consultation (HC) service for CMC from their outpatient CC clinicians. DESIGN, SETTING, AND PARTICIPANTS Randomized quality improvement trial at the University of Texas Health Science Center at Houston with an outpatient CC clinic and tertiary pediatric hospital (Children's Memorial Hermann Hospital). Participants included high-risk CMC (≥2 hospitalizations or ≥1 pediatric intensive care unit [PICU] admission in the year before enrolling in our clinic) receiving CC. Data were analyzed between January 11, 2018, and December 20, 2019. INTERVENTIONS The HC included serial discussions between CC clinicians, ED physicians, and hospitalists addressing need for admission, inpatient treatment, and transition back to outpatient care. Usual hospital care (UHC) involved routine pediatric hospitalist care. MAIN OUTCOMES AND MEASURES Total hospital days (primary outcome), PICU days, hospitalizations, and health system costs in skeptical bayesian analyses (using a prior probability assuming no benefit). RESULTS From October 3, 2016, through October 2, 2017, 342 CMC were randomized to either HC (n = 167) or UHC (n = 175) before meeting the predefined bayesian stopping guideline (>80% probability of reduced hospital days). In intention-to-treat analyses, the probability that HC reduced total hospital days was 91% (2.72 vs 6.01 per child-year; bayesian rate ratio [RR], 0.61; 95% credible interval [CrI], 0.30-1.26). The probability of a reduction with HC vs UHC was 98% for hospitalizations (0.60 vs 0.93 per child-year; RR, 0.68; 95% CrI, 0.48-0.97), 89% for PICU days (0.77 vs 1.89 per child-year; RR, 0.59; 95% CrI, 0.26-1.38), and 94% for mean total health system costs ($24 928 vs $42 276 per child-year; cost ratio, 0.67; 95% CrI, 0.41-1.10). In secondary analysis using a bayesian prior centered at RR of 0.78, reflecting the opinion of 7 experts knowledgeable about CMC, the probability that HC reduced hospital days was 96%. CONCLUSIONS AND RELEVANCE Among CMC receiving comprehensive outpatient care, an HC service from outpatient clinicians likely reduced total hospital days, hospitalizations, PICU days, other outcomes, and health system costs. Additional trials of an HC service from outpatient CC clinicians are needed for CMC in other centers. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02870387.
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Affiliation(s)
- Ricardo A. Mosquera
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston,Center for Clinical Research and Evidence Based Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Elenir B. C. Avritscher
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston,Center for Clinical Research and Evidence Based Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Claudia Pedroza
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston,Center for Clinical Research and Evidence Based Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Cynthia S. Bell
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston,Center for Clinical Research and Evidence Based Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Cheryl L. Samuels
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Tomika S. Harris
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Julie C. Eapen
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Aravind Yadav
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Michelle Poe
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston,Center for Clinical Research and Evidence Based Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Raymond L. Parlar-Chun
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Jay Berry
- Complex Care Service, Division of General Pediatrics, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Jon E. Tyson
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston,Center for Clinical Research and Evidence Based Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston
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Reza JA, Steve Eubanks W, de la Fuente SG. Clinical and Financial Implications of Consulting Physicians in the Management of Surgical Patients. Am Surg 2020; 88:578-586. [PMID: 33291943 DOI: 10.1177/0003134820952439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The present study was designed to evaluate the immediate consequences that the number of consulting physicians has on length of stay (LOS), in-hospital mortality, 30-day readmission rates, direct health care costs, and contribution margins. METHODS A retrospective review of administrative databases for the years 2013 and 2014 was performed at the Florida Hospital Adventist Healthcare System. RESULTS 11 274 patients were included in the analysis. Total and variable costs increased by $1347 and $592, respectively, with each consulting physician service per patient. The contribution margin decreased by $354 per patient/consulting physician. Each consulting physician increased LOS by .72 days and increased odds ratio of mortality and 30-day readmission by 5% and 3%, respectively. CONCLUSIONS Our research suggests that each consulting physician added to the care of an individual surgical patient negatively affected LOS, readmission rates, in-hospital mortality, and costs.
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Affiliation(s)
- Joseph A Reza
- Department of Surgery, AdventHealth Orlando, FL, USA
| | - W Steve Eubanks
- Department of Surgery, AdventHealth Orlando, FL, USA.,University of Central Florida, Orlando, FL, USA
| | - Sebastian G de la Fuente
- Department of Surgery, AdventHealth Orlando, FL, USA.,University of Central Florida, Orlando, FL, USA
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Zackoff MW, Graham C, Warrick D, Pulda K, Gosdin C, Simpson B, Marischen J, Bunch P, Vossmeyer M, Mussman GM. Increasing PCP and Hospital Medicine Physician Verbal Communication During Hospital Admissions. Hosp Pediatr 2019; 8:220-226. [PMID: 29559504 DOI: 10.1542/hpeds.2017-0119] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES During hospital admission, communication between primary care physicians (PCPs) and hospital medicine (HM) physicians provides an opportunity for collaboration. Two-way communication facilitates collaboration by allowing the receiver to ask and respond to questions. At our institution, most HM-to-PCP communication occurred by telephone call after discharge. Our specific aim was to increase the percentage of patients for whom a telephone conversation occurred between HM and PCPs during hospital admission from 40% to >80%. METHODS An improvement team that included PCPs and HM physicians redesigned the process for communication with PCPs to emphasize collaboration during hospitalization. Interventions were used to target key drivers of information transparency, PCP and HM provider buy-in, the value of early call initiation, process standardization, accommodating provider availability, and preoccupation with failure. We used improvement-science methods and run charts to measure our progress and attain our goal. RESULTS The median weekly percentage of patients with a phone call completed during hospitalization increased from 40% to 85% at the satellite campus and 40% to 80% at the main campus. In addition to the standardized use of a telephone operator system to route calls and follow-up on unplaced calls, critical interventions included feedback on PCP call preferences to providers and the provider script for calls. CONCLUSIONS PCPs and HM physicians applied quality-improvement methodology to ensure reliable HM-PCP communication during hospital admission. Interventions to facilitate communication between providers and learners (who may otherwise have limited interaction), such as the scripting of phone calls and feedback from PCPs to HM physicians, were important for success.
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Affiliation(s)
| | - Camille Graham
- Divisions of General and Community Pediatrics.,Mid-City Pediatrics Inc, Cincinnati, Ohio; and
| | | | - Kathleen Pulda
- Physician Priority Link, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | - Paul Bunch
- Divisions of General and Community Pediatrics.,Springdale-Mason Pediatric Associates Inc, Cincinnati, Ohio
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Wingate KS, Woods S, Whitaker-Brown C, Kelly WS. Preventing Rehospitalization by Bringing Primary Care to the Bedside. J Nurse Pract 2019. [DOI: 10.1016/j.nurpra.2018.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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8
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Shamaskin-Garroway AM, Knobf MT, Adams LJ, Haskell SG. "I Think It's Pretty Much the Same, as It Should Be": Perspectives of Inpatient Care Among Women Veterans. QUALITATIVE HEALTH RESEARCH 2018; 28:600-609. [PMID: 29231129 DOI: 10.1177/1049732317746380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of this study was to gain a deeper understanding of the inpatient hospitalization experience for women veterans through in-depth interviews. Women veterans who were admitted for inpatient care on medical units within a university-affiliated VA hospital were invited to participate in a semistructured interview that inquired about their hospital experience, interactions with medical providers, and how being a woman veteran might affect this experience. Interviews were transcribed verbatim and analyzed using constant comparative method until thematic saturation was achieved ( n = 25). Three themes, (a) Being a woman and a veteran: Intersecting identities, (b) Expecting equality and equity, and (c) Defining woman-centered inpatient care described the unique perspective and context for Veterans Health Administration (VHA) health care of women veterans. These findings provide insight and guidance to clinical practice and care delivery for women veterans, including training and interpersonal approaches medical providers can take to improve the hospital experience for women.
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Affiliation(s)
- Andrea M Shamaskin-Garroway
- 1 School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
- 2 VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - M Tish Knobf
- 3 Yale School of Nursing, Orange, Connecticut, USA
| | - Lynette J Adams
- 2 VA Connecticut Healthcare System, West Haven, Connecticut, USA
- 4 Yale School of Medicine, New Haven, Connecticut, USA
| | - Sally G Haskell
- 2 VA Connecticut Healthcare System, West Haven, Connecticut, USA
- 4 Yale School of Medicine, New Haven, Connecticut, USA
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Atinga RA, Agyepong IA, Esena RK. Ghana's community-based primary health care: Why women and children are 'disadvantaged' by its implementation. Soc Sci Med 2018; 201:27-34. [PMID: 29427893 DOI: 10.1016/j.socscimed.2018.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/25/2018] [Accepted: 02/02/2018] [Indexed: 01/14/2023]
Abstract
Policy analysis on why women and children in low- and middle-income settings are still disadvantaged by access to appropriate care despite Primary Health Care (PHC) programmes implementation is limited. Drawing on the street-level bureaucracy theory, we explored how and why frontline providers (FLP) actions on their own and in interaction with health system factors shape Ghana's community-based PHC implementation to the disadvantage of women and children accessing and using health services. This was a qualitative study conducted in 4 communities drawn from rural and urban districts of the Upper West region. Data were collected from 8 focus group discussions with community informants, 73 in-depth interviews with clients, 13 in-depth interviews with district health managers and FLP, and observations. Data were recorded, transcribed and coded deductively and inductively for themes with the aid of Nvivo 11 software. Findings showed that apart from FLP frequent lateness to, and absenteeism from work, that affected care seeking for children, their exercise of discretionary power in determining children who deserve care over others had ripple effects: families experienced financial hardships in seeking alternative care for children, and avoided that by managing symptoms with care provided in non-traditional spaces. FLP adverse behaviours were driven by weak implementation structures embedded in the district health systems. Basic obstetric facilities such as labour room, infusion stand, and beds for deliveries, detention and palpation were lacking prompting FLP to cope by conducting deliveries using a patchwork of improvised delivery methods which worked out to encourage unassisted home deliveries. Perceived poor conditions of service weakened FLP commitment to quality maternal and child care delivery. Findings suggest the need for strategies to induce behaviour change in FLP, strengthen district administrative structures, and improve on the supply chain and logistics system to address gaps in CHPS maternal and child care delivery.
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Affiliation(s)
- Roger A Atinga
- Department of Public Administration and Health Services Management, University of Ghana Business School, Box LG 78, Legon, Accra, Ghana.
| | - Irene Akua Agyepong
- Ghana Health Service, Research and Development Division, P.O. Box MB-190, Greater Accra Region, Ghana.
| | - Reuben K Esena
- Department of Health Policy, Planning and Management, University of Ghana School of Public Health, P.O. Box LG 13, Legon, Accra, Ghana.
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Doohan N, DeVoe J. The Chief Primary Care Medical Officer: Restoring Continuity. Ann Fam Med 2017; 15:366-371. [PMID: 28694275 PMCID: PMC5505458 DOI: 10.1370/afm.2078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/17/2017] [Accepted: 02/08/2017] [Indexed: 11/09/2022] Open
Abstract
The year 2016 marked the 20th anniversary of the hospitalist profession, with more than 50,000 physicians identifying as hospitalists. The Achilles heel of hospitalist medicine, however, is discontinuity. Despite many current payment and delivery systems rewarding this discontinuity and severing long-term relationships between patient and primary care teams at the hospital door, primary care does not stop being important when a person is admitted to the hospital. The notion of a broken primary care continuum is not an academic construct, it causes real harm to patients. As a step toward fixing the discontinuity in our health care systems, we propose that every hospital needs a Chief Primary Care Medical Officer (CPCMO), an expert in practice across the spectrum of care. The CPCMO can lead hospital efforts to create systems that ensure primary care's continuum is complete, while strengthening physician collaboration across specialties, and moving toward achieving the Quadruple Aim of enhancing patient experience, improving population health, reducing costs, and improving the work life of health care providers. For hospitals operating on value-based payment structures, anticipated improvement in measurable outcomes such as decreased length of stay, decreased readmission rates, improved transitions of care, improved patient satisfaction, improved access to primary care, and improved patient health, will enhance the rate of return on the hospital's investment. The speciality of family medicine should reevaluate our purpose, and reembrace our mission as personal physicians by championing the creation of Chief Primary Care Medical Officers.
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Affiliation(s)
- Noemi Doohan
- Department of Family and Community Medicine, University of California Davis, Sacramento, California
| | - Jennifer DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
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Barrett DJ, McGuinness GA, Cunha CA, Emans SJ, Gerson WT, Hazinski MF, Lister G, Murray KF, St Geme JW, Whitley-Williams PN. Pediatric Hospital Medicine: A Proposed New Subspecialty. Pediatrics 2017; 139:peds.2016-1823. [PMID: 28246349 DOI: 10.1542/peds.2016-1823] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2016] [Indexed: 11/24/2022] Open
Abstract
Over the past 20 years, hospitalists have emerged as a distinct group of pediatric practitioners. In August of 2014, the American Board of Pediatrics (ABP) received a petition to consider recommending that pediatric hospital medicine (PHM) be recognized as a distinct new subspecialty. PHM as a formal subspecialty raises important considerations related to: (1) quality, cost, and access to pediatric health care; (2) current pediatric residency training; (3) the evolving body of knowledge in pediatrics; and (4) the impact on both primary care generalists and existing subspecialists. After a comprehensive and iterative review process, the ABP recommended that the American Board of Medical Specialties approve PHM as a new subspecialty. This article describes the broad array of challenges and certain unique opportunities that were considered by the ABP in supporting PHM as a new pediatric subspecialty.
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Affiliation(s)
- Douglas J Barrett
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida;
| | | | | | - S Jean Emans
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | - Mary F Hazinski
- School of Nursing, Vanderbilt University, Nashville, Tennessee
| | - George Lister
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Karen F Murray
- Division of Gastroenterology and Hepatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Joseph W St Geme
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
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Abstract
I had intended to spend our spring break week in Montana with my kids and my dad, going to parks and museums together. Instead, I spent the week in the hospital, helping my dad make end-of-life choices and learning more about the importance of communication in health care settings and the preciousness of close relationships in life. I am a better person and a better physician because my dad trusted me to be there while he was dying. During his last week, I was grateful to have spent years studying medicine and years getting to know my dad. This combination of professional and personal knowledge enabled me to help him choose his own end-of-life path. As someone who does not like hospitals, I have always wondered why I became a doctor; now I know.
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Affiliation(s)
- Sanjay Mahant
- Division of Paediatric Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Michael Weinstein
- Division of Paediatric Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
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Greysen SR, Detsky AS. Solving the puzzle of posthospital recovery: What is the role of the individual physician? J Hosp Med 2015; 10:697-700. [PMID: 26316366 DOI: 10.1002/jhm.2421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/09/2015] [Accepted: 06/21/2015] [Indexed: 11/08/2022]
Abstract
Improving transitions of care from the acute care setting has been an important focus of health policy in the United States and Canada. Over the past decade, hospital performance metrics related to successful recovery have been used in the United States to implement incentives for reform. This focus has led to a laudable number of interventions to reduce readmissions--a proxy for failed recovery--but most of these have focused on the hospital or system level rather than the individual physician level. Individual physicians in both the inpatient and outpatient setting have important roles to play, but little guidance or structured support is available to them to enable successful engagement in postdischarge management of patient transitions. We describe several tensions of physician engagement in this process from the perspective of front-line providers and highlight several possible approaches to improve physician engagement in transitions.
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Affiliation(s)
- S Ryan Greysen
- Division of Hospital Medicine, University of California San Francisco, San Francisco, California
| | - Allan S Detsky
- Institute of Health Policy, Management and Evaluation and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
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