Journal of hospital medicine最新文献

Background and objectives: While children's hospitals (CH) tend to be the locus of specialized hospital care, they also care for common conditions. There is no system to understand the distribution of hospital days within CHs and non-CHs (NCH) based on how ubiquitous conditions are across hospitals. We develop a method to classify conditions based on their commonality and consolidation within hospitals.

Methods: We performed a retrospective study of the 2022 Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database, excluding normal newborns. For the 441 conditions, the volume of hospital days and the distribution of days across hospitals using the Hospital Days Consolidation Index (HDCI) were determined. Conditions were categorized into four groups based on k-means clustering of hospital days and HDCI.

Results: There were 1.5 million hospitalizations from 123 CH and 3366 NCH. There were 54 conditions representing 85.7% of hospital days classified as Very High Days & Very Low Consolidation (i.e., commodity conditions); 47.2% of these hospital days were at a CH. At the other extreme, there were 50 conditions classified as Very Low Days & Very High Consolidation (e.g., chronic lymphocytic leukemia) representing <1% of hospital days; 75.3% at CH. Among all hospital days for commodity conditions, 52.8% were at NCH and 47.2% were at a CH. However, for the remaining condition groups, 27.3% of days were at an NCH and 72.7% at a CH.

Conclusion: We identified commodity conditions but also conditions that are consolidated, typically within CH. Consolidation can be quantified, compared, and tracked using the HDCI.

Introduction: Low-value care refers to health services for which the potential harms or costs outweigh the benefits of use. Bronchiolitis is the most common and among the most costly causes of pediatric hospitalizations. Evidence consistently shows that many common tests and treatments used to manage bronchiolitis do not improve outcomes. Further, differential use of low-value care between patients may perpetuate care inequities. In Canada, rates of low-value care use in children hospitalized with bronchiolitis, and differences in care across hospitals, clinicians, and patient subgroups, remain poorly characterized.

Objective: To understand practice patterns for six low-value health services in the care of children aged 1-12 months hospitalized for bronchiolitis: respiratory virus testing; chest X-rays; continuous pulse oximetry; short-acting beta-agonists; systemic corticosteroids; and antibiotics.

Methods: We are conducting a multi-center prospective cohort study of children admitted with bronchiolitis in 15 Canadian hospitals. We will use chart reviews to compare low-value care use between hospitals and clinicians, and caregiver surveys to compare between sociodemographic groups. Questionnaires will also collect caregiver perspectives on their child's bronchiolitis care, including role in medical decision-making and understanding of treatment decisions.

Discussion: Our study will provide critical information on the usage and variation in delivery of low-value care for bronchiolitis in Canada, elucidating potential care inequities. Findings will inform the development of interventions to address such inequities, and improve opportunity costs for health systems. Enrollment began in October 2024 and is projected to be completed in May 2026, with analyses and reporting shortly following.

There is limited data on which hospitalist switch day is optimal for hospital operations and throughput. A quality improvement intervention was implemented, changing the hospitalist switch day from Monday to Tuesday. Retrospective observational analysis revealed an increase in Monday discharges (1.3%, p = .01), a decrease in Tuesday discharges (-1.6%, p < .005), and a significant reduction in 30-day unplanned readmission rates (-1.5%, p = .003), with no significant changes in the average length of stay. Additional studies are needed to further verify these findings in different hospital settings and to consider other switch day patterns.

Background: Achieving racial equity in sepsis care is a complex challenge that requires organizational readiness across multiple domains, such as culture and capacity.

Objectives: This study provides a validated tool to empirically measure health system readiness to address structural racism in sepsis care, essential for improving health equity and patient outcomes.

Methods: This study employed a mixed methods approach involving three key steps: adaptation, cognitive interviews, and psychometric analysis. The novel survey was first adapted based on a literature review and expert input. Cognitive interviews were conducted with healthcare professionals to refine the survey items. Finally, reliability testing was performed for psychometric analysis in measuring health system readiness to address structural racism in sepsis care. The survey was developed in the context of Champions Advancing Racial Equity in Sepsis (CARES), a coalition-based leadership intervention to equip health systems and their surrounding communities to identify and address racial inequities in sepsis care and outcomes. Senior and mid-level and front-line champions from across disciplines and departments that influence sepsis care (N = 30) participated in the survey.

Results: The survey consisted of five domains: learning and problem solving (10 items, Cronbach's α = 0.815), stress/pressure in the system (4 items, Cronbach's α = .779), psychological safety (7 items, Cronbach's α = .515), senior leadership support (4 items, Cronbach's α = .744), and strategic planning process (5 items, Cronbach's α = .918). Overall, the entire scale (30 items) was found to have excellent reliability (Cronbach's α = .908).

Conclusions: This study adapted and validated a novel survey to measure health system readiness to address structural racism in sepsis care, providing a reliable tool for identifying areas for improvement and guiding targeted interventions to enhance health equity.

Introduction: Unplanned hospital readmissions are associated with higher morbidity, mortality, and financial burden. This study evaluated the association between the use of remote biometric sensing devices (RBS) and all-cause readmission and mortality rates among adult patients discharged from the hospital.

Methods: We systematically searched MEDLINE, Embase, Scopus, and Global Health from inception to August 2023. Eligible studies assessed adult patients using RBS devices, defined as tools capable of automatically or manually measuring at least one biometric marker beyond physical activity, after hospital discharge. Studies required a comparison group and reported all-cause readmission rates. Risk ratios (RRs) with 95% confidence intervals (CIs) were summarized using random-effects models to account for variability. Subgroup analysis was conducted based on study design, follow-up period postdischarge, and index discharge diagnosis.

Results: Out of 9363 identified studies, 39 studies (23 RCTs, 14 cohort studies, and two nonrandomized trials) comprising 160,857 patients met the inclusion criteria. RBS use was associated with lower risk of all-cause readmission (RR = 0.75; 95% CI: 0.67-0.84, I² = 72.3%); especially within 30-day postdischarge (RR = 0.74; 95% CI: 0.64-0.87; I² = 35%). Among the subgroup of postsurgical patients, RBS use was associated with an 18% lower all-cause readmission risk (RR = 0.82; 95% CI: 0.69-0.98; I² = 0%). RBS use was associated with lower 30-day mortality risk (RR = 0.63; 95% CI: 0.46-0.85), with no significant associations thereafter.

Conclusion: Among patients recently discharged from the hospital, RBS use is associated with improved short-term outcomes. Future studies are needed to validate these findings.