Journal of hospital medicine最新文献

Background: Multiple workforce trends are reshaping the healthcare landscape including the growing influence of corporate ownership of healthcare systems and physician practices, including private equity (PE) and venture capital (VC) investments, and a rise of physician unionization.

Objective: Explore experiences and perceptions regarding these trends.

Methods: An exploratory embedded mixed methods design with a 15-question survey and semi-structured virtual focus groups held on May 14, 2024 and July 17, 2024 using rapid qualitative methods.

Results: Thirty-three individuals from 26 different organizations participated, with 28 participants completing the embedded survey. Most were physicians (93%) and leaders (36%) primarily from nonprofit or academic organizations. Participants (18%) stated that members in their hospitalist group were actively considering unionization. There were four themes: (1) the business of healthcare is perceived to create misalignment between clinicians and health systems, with corporatization, particularly PE, seen as adding to these challenges, (2) healthcare workers increasingly feel voiceless in a margin-focused environment, contributing to unionization efforts, (3) unionization was seen as an advocacy tool with benefits and drawbacks including conflicts with professional values, and (4) participants, primarily physicians, felt poorly informed about unionization and had a wide range of views on the topic. PE/VC was viewed as predominantly negative though varied by context.

Conclusions: In this exploratory study, participants perceived corporatization, including PE investment, as influencing clinician interest in unionization. While causal relationships cannot be inferred, findings suggest that unionization may be used as a mechanism for clinicians to regain voice with participants also noting potential uncertainties and drawbacks.

Background: Healthcare workers face workplace violence (WPV) at rates nearly five times higher than other industries. Traditional hospital responses to WPV, such as security involvement or zero-tolerance policies, may escalate patient distress and contribute to racialized harm. Behavioral Emergency Response Teams (BERTs) have emerged as an alternative, yet their implementation and outcomes in nonpsychiatric, inpatient settings remain poorly characterized.

Objective: This scoping review synthesizes the literature on BERT implementation in adult and pediatric nonpsychiatric inpatient and emergency department settings, with attention to team design, training, implementation, evaluation, and equity considerations.

Methods: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Five databases and gray literature were searched for studies on BERTs through May 2024. Data extraction and critical appraisal were conducted independently by multiple reviewers using validated tools.

Results: Ultimately, 28 studies were selected for inclusion. Most described BERTs in academic settings (n = 19) with diverse team compositions, often including security personnel (n = 22). Over half of the studies reported staff training in de-escalation (n = 16), though few detailed curricula. Overall, BERT implementation was associated with decreased WPV, restraint use, and security calls. Staff reported increased perceptions of safety and institutional support. However, reporting on equity metrics was limited; only eight studies tracked race, and some suggested disproportionate BERT interventions and restraint use among Black patients.

Conclusion: BERTs are a promising intervention to manage behavioral emergencies, reduce WPV, and reduce security calls. Standardized guidelines, training, and equity-focused evaluation will be essential to optimize BERT effectiveness and ensure equitable implementation.

Background: Academic hospital medicine faculty possess diverse interests and pursue a variety of career pathways. Faculty development programs are essential for career advancement; however, a lack of alignment between individual faculty needs and development activities can impede career development efforts. To our knowledge, there are no studies that have examined whether clusters of faculty exist with similar development needs, for which tailored faculty development "packages" can be offered.

Objective: To determine whether distinct clusters of faculty with shared development needs can be identified and to explore faculty-level factors associated with these clusters.

Method: We conducted a survey study among hospitalists at seven academic institutions from November 2023 to September 2024. We generated a comprehensive list of 33 potential faculty development topics and asked survey respondents to indicate whether each topic was important to them, choosing as many as applied. We used latent class analysis (LCA) to classify faculty into distinct clusters based on their selection of desired development topics.

Results: A total of 136 faculty (median age 38 years) participated in the study. LCA identified five distinct groups as the optimal solution: (1) Master clinician (29%), (2) medical education scholar (11%), (3) clinical investigator (24%), (4) educational leader (22%), and (5) operational leader (14%).

Conclusion: In a representative sample of academic hospitalists, we identified five distinct latent classes of faculty based on their preference for faculty development topics. These results can be leveraged to curate specific packages to optimally align faculty development offerings with diverse faculty interests and career trajectories.

Background: Clinical growth is outpacing educational growth at academic medical centers (AMCs) reducing traditional teaching opportunities, especially in rapidly expanding fields like hospital medicine. Despite these pressures, little guidance exists on how leadership should allocate limited teaching time.

Objectives: To explore academic hospitalists' preferences for allocating traditional teaching time (i.e., time on services with interns and residents) amid clinical expansion.

Methods: A cross-sectional survey of academic adult hospitalists at six large AMCs across the United States with survey responses and free-response questions analyzed qualitatively.

Results: Of 572 hospitalists surveyed, 156 academic hospitalists responded (27%). Respondents averaged 8.9 years' experience and spent 25% of their clinical time on traditional teaching services. Teaching was a strong professional priority: 74% rated it very or extremely important when considering new job positions, and 66% preferred it as their primary service role. Most respondents (81%) preferred a merit-based model that rewards teaching skill development and learner engagement beyond clinical care. An external recognition-based model (i.e., teaching evaluations) was also supported (64%), although respondents raised concerns about bias. Equal distribution, seniority-based, and split-group models were less favored. Only 6% of respondents preferred working exclusively on direct care services (i.e., a service without learners).

Conclusions: In this exploratory sample, academic hospitalists highly value teaching but most spend little time on it. Hospitalists preferred a merit-based model, where faculty demonstrate their interest in and commitment to education by improving their teaching skills.

Background: High recruitment, intervention fidelity, and retention rates in clinical trials are necessary to ensure generalizable conclusions; quality improvement (QI) methods can be used to track and improve these rates. The Garnering Effective Telehealth to Help Optimize Multidisciplinary Team Engagement (GET2HOME) study is a randomized controlled trial comparing a discharge intervention bundle to standard care for patients with medical complexity.

Objective: We sought to achieve a mean enrollment rate of 55% and intervention fidelity rate of 90% for each intervention. Additionally, we aimed to achieve survey completion rates (retention) of 90% for the 7- and 30-day surveys, and 75% for the 60- and 90-day surveys.

Methods and interventions: Using the Model for Improvement, we frequently reviewed data with the multidisciplinary study team and implemented tests of change. Tests of change sought to improve the research team's roles and responsibilities, enhance study visibility, and ensure consistent communication among clinical care teams and research staff.

Results: During the study period, we improved the mean enrollment rate (53%-72%). Fidelity rates also improved across the three interventions: predischarge huddle (69%-85%), postdischarge huddle (65%-90%), and discharge task tracker completion (64%-100%). Survey retention at the end of the study was 90% at 7- and 60-days, 88% at 30-days, and 92% at 90-days.

Conclusions: We increased enrollment and intervention fidelity rates while maintaining high retention rates in a randomized trial by improving enrollment processes and survey completion methods. QI methods can facilitate optimized trial enrollment and intervention fidelity.

Background and objectives: Vaccination rates have declined in recent years, resulting in outbreaks of vaccine-preventable diseases (VPDs) among children. We aimed to evaluate VPD hospitalization rates from 2014 to 2024 and to report associated trends in outcomes including intensive care utilization, mortality, readmissions, and costs.

Methods: Trends in hospitalizations due to VPDs were examined from July 1, 2014, to June 30, 2024, among patients aged 0-18 at US children's hospitals within the Pediatric Health Information System database using seasonal autoregressive integrated moving average models. Subanalyses were conducted to examine trends in hospitalization rates and outcomes for children with medical complexity and immune-compromising conditions.

Results: We identified 160,435 hospitalizations for VPDs, most commonly due to influenza (112,074 [70%]), pneumococcus (16,592 [10%]), Haemophilus influenzae (14,086 [9%]), and rotavirus (10,917 [7%]). Rates of hospitalizations due to all VPDs for the total cohort exhibited seasonal variation and increased over time, with a break in expected trends during the COVID-19 pandemic. Mean total adjusted cost for VPD hospitalizations per year was $610 million and increased over time. Nearly 25% (n = 39,223) of children required intensive care and 0.8% (n = 1345) died. Children with medical complexity and immune-compromising conditions experienced higher rates of hospitalization due to VPDs as well as higher cost, readmission rates, and mortality.

Conclusions: Pediatric VPD hospitalization rates have increased over time. Children with medical complexity and immune-compromising conditions are disproportionately impacted by VPD hospitalizations. Addressing vaccination hesitancy and barriers to vaccination has the potential to impact healthcare costs and outcomes for children.