Sonieya Nagarajah and Peter E. Wu conceptualized the manuscript and contributed to the collection of data and figures, as well as the writing of the first draft of the manuscript. All authors reviewed and revised the manuscript and approved of its final version. All authors participated in the care of this patient.
The authors declare no conflict of interest.
The authors have obtained informed, written consent.
Hepatitis C (HCV) is a chronic, prevalent disease that disproportionately affects people who use drugs in the United States. One strategy to decrease HCV prevalence is the initiation of treatment during hospitalization. Factors affecting the success of this approach are not well-characterized in the literature. Subspecialty providers in fields that treat substantial numbers of patients with HCV are well-positioned to describe factors affecting treatment provision.
To understand barriers and facilitators of inpatient hepatitis C treatment from the perspectives of subspecialty physicians in the United States.
In this qualitative research study, we interviewed 20 infectious diseases, hepatology, and addiction medicine physicians at 12 medical institutions across the United States. We analyzed interviews using a rapid matrix technique.
Four major themes emerged: (1) hospitalization can be a gateway to care for patients who otherwise might not receive HCV treatment; (2) patients are vulnerable to being lost to follow-up in the transition from inpatient to outpatient care; (3) the inpatient payment model is a barrier to widespread implementation of programs to treat HCV during hospitalization; and (4) treatment protocols and project “champions” can support inpatient HCV treatment initiatives.
Physicians view hospitalization as an opportunity for patients to start HCV treatment. However, they have concerns about patients becoming lost to follow-up after hospital discharge. Interviewees perceived that these concerns could be mitigated by implementing standardized protocols for HCV treatment with clear process ownership, as well as by dedicated funding for care navigators and systems champions. Lastly, physicians report that insurance coverage and reimbursement present major barriers to inpatient HCV treatment initiation.
Hospitalist workflows have evolved significantly, yet optimal workflows and workloads remain ill-defined. Time and motion studies (TMSs) offer insights into hospitalist activities but face methodological challenges, including variability and lack of standardization.
We aimed to systematically review TMSs of hospitalist workflows, assess trends in direct and indirect patient care, and develop a novel quality assessment tool for evaluating TMS studies.
We conducted a comprehensive search of Ovid MEDLINE (1946–October 2024), Embase (1947–October 2024), and Web of Science (1974–October 2024) in August 2023 and updated October 7, 2024. We included studies that employed observational or quantitative TMS methods focused on attending hospitalists in US general adult inpatient settings and reported the proportion of time spent in direct and indirect patient care. We assessed study quality using a quality assessment tool adapted from the Newcastle-Ottawa scale.
Seven studies met the inclusion criteria. Direct patient care accounted for a mean of 18% (range: 13%–25%) of observed time. We identified high variability in study quality, with scores ranging from 2 to 5 out of eight stars. Significant study variability precluded statistical analysis of trends, though a narrative synthesis was possible. Few studies represented diverse settings or shifts.
This review utilizes a novel quality assessment tool and highlights the need for standardized TMS methodologies to enable longitudinal comparisons and more accurate assessments of hospitalist workflows. Future studies should integrate validated tools, consider multitasking, and explore emerging metrics beyond productivity.
Geographic cohorting (GCh) is a popular model of care that localizes physician teams to a single hospital unit.
We conducted a scoping review identifying the aims, implementation strategies, study methods, and measured outcomes of GCh.
We searched the medical literature analysis and retrieval system online, Embase, and Scopus databases. Eligible citations included English language reports of interventions including GCh in adult patients. Included studies were screened for their aim, GCh implementation strategy, study method, and outcomes measured.
Of 1863 identified citations, 30 met inclusion criteria, representing 27 interventions. Implementation aims varied from specific goals measured by a single metric to multiple outcomes intended to capture wide-ranging effects of GCh. A majority of studies (n = 13, 48.1%) used a pre-post cohort design. GCh was implemented in one of four ways: (1) as a stand-alone intervention, (2) bundled with accountable care unit elements, (3) bundled with care components that did not include all ACU elements, (4) GCh bundled with ACU elements and additional components (“enhanced” ACU). The measured outcomes sorted to eight different categories: patient outcomes, patient safety, patient experience, work flow, workload, clinician experience, communication/team work, and cost.
The current literature on GCh describes implementation as both a stand-alone intervention and bundled with other care elements. Current research has not delineated whether the degree to which GCh is implemented matters, nor what impact it has as part of a bundled care intervention. Future work would benefit from a prospective design that clarifies these questions, facilitating care models tailored to the needs of the practice ecosystem.
The 21st Century Cures Act Information Blocking Rule mandates patient access to all information in their electronic medical record (EMR) without delay, cost, or special effort. Prior research into patient portal use in hospitalized adults is limited.
To better understand the characteristics of hospitalized adults who have an existing patient portal account and identify demographic factors associated with accessing information via the patient portal while hospitalized.
This single-center, cross-sectional observational study analyzed adult hospitalizations from April 5, 2021, to March 31, 2023, at Beth Israel Deaconess Medical Center (BIDMC). The primary outcome was the proportion of hospitalized patients who had an active BIDMC EMR account (“PatientSite”).
Of the 43,588 patients included in our analytic cohort, 13,517 (31.0%) had an active PatientSite account during their hospitalization and of those, 7311 (54.0%) accessed their account while hospitalized. A total of 62% of patients who logged into their portal also accessed clinician notes. After multivariable adjustment, patients who were older, Black, male, non-English speaking, covered by Medicaid, or from out-of-state were less likely to have an active PatientSite account. Similar disparities were found in PatientSite login and accessing clinician notes, albeit smaller in magnitude than the observed disparities in having an active account.
This study highlights low patient portal utilization among hospitalized patients and disparities in access based on race/ethnicity, gender, age, and insurance status.
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