Journal of hospital medicine最新文献

The recent Acute Hospital Care at Home (AHCaH) initiative has increased Hospital-at-Home (HaH) access and utilization, but it is unknown how care delivery differs between AHCaH-compliant HaH programs and brick-and-mortar (BaM) inpatient care-specifically for common, costly hospital conditions like chronic obstructive pulmonary disease (COPD). In this retrospective cohort study, we compared management and outcomes for adults hospitalized with COPD treated in HaH and BaM settings in 2022. We analyzed EHR data from 297 adults who were eligible for HaH, including 119 who remained in BaM and 178 in HaH. HaH patients had higher likelihood of orders for supplemental oxygen (risk ratio [RR]: 1.04, 95% confidence interval [CI]: 1.01-1.09) and bronchodilators (RR: 1.12, 95% CI: 1.04-1.20), compared to BaM. HaH patients also had higher mean 30-day acute care-free days alive (mean ratio [MR]: 1.04, 1.01-1.08). Our findings suggest similar or improved guideline-directed therapy and outcomes for COPD patients treated in HaH.

Background: Sleep deprivation significantly impacts millions of hospitalized patients and is a critical factor in their recovery process. One major contributor to sleep disturbances is early morning blood draws.

Objective: This study investigated the effect of delaying early morning blood draws by 2 h on both sleep quality and quantity.

Methods: In this quasi-experimental study, we recruited adult medical patients admitted to two similar acute medical units. Patients in one unit were assigned to have their routing morning blood draws at the usual time of 4:00 a.m., while those in the other unit had their blood draws delayed until 6:00 a.m. Primary outcomes of sleep quality and quantity were evaluated using two primary measures: the Richards-Campbell Sleep Questionnaire (RCSQ) and self-reported sleep duration.

Results: A total of 128 patients were included (64 in the 4:00 a.m. group and 64 in the 6:00 a.m. group). The timing of blood draws was significantly associated with sleep quality, with a higher mean sleep quality score in the 6:00 a.m. group of 63.7 (standard deviation [SD] = 21.8) compared with a mean of 53.2 (SD = 22.1) (p = .006) in the 4:00 a.m. group. Additionally, the 6:00 a.m. group averaged 7.0 h of sleep (SD = 2.6), while the 4:00 a.m. group averaged 5.9 h (SD = 2.5) (p = 0.02).

Conclusions and relevance: This study found that among hospitalized adult patients, later morning blood draw times were associated with better sleep quality and longer sleep duration compared with earlier morning blood draw times.

Background: Prior work has identified disparities in antibiotic use for children in the ambulatory setting, but few studies have explored antibiotic disparities in the inpatient setting.

Objectives: We evaluated the association of both race and ethnicity and Childhood Opportunity Index (COI) with antibiotic utilization for children hospitalized with pneumonia.

Methods: This cross-sectional study included children hospitalized with pneumonia at one of 43 hospitals in the Pediatric Health Information System (2022-2024). We evaluated the association between race and ethnicity and COI quintiles (very low quintile representing the lowest opportunity neighborhoods) and antibiotic utilization using generalized estimating equations adjusted for confounders. Antibiotic utilization included any antibiotics and among children with antibiotics, use of broad- versus narrow-spectrum and intravenous versus oral antibiotics.

Results: Among 49,332 children, compared with non-Hispanic White children, we found higher odds of receiving antibiotics among Asian (86% vs. 80%; odds ratio [OR]: 1.45 (95% confidence interval [CI]: 1.14, 1.84]) and non-Hispanic Black children (83% vs. 80%; OR: 1.59 [1.17, 2.15]). Hispanic children had greater odds receiving broad- rather than narrow-spectrum antibiotics (52% vs. 46%; OR: 1.30 [1.03, 1.63]). Compared with non-Hispanic White children, all other groups had greater odds of intravenous rather than oral antibiotics. Compared with children in the very high COI quintile, children in the very low COI quintile had greater odds of receiving antibiotics (86% vs. 79%; OR: 1.69 [1.12, 2.55]) and broad-spectrum antibiotics.

Conclusion: Children of some minoritized backgrounds and those residing in the lowest opportunity neighborhoods had greater odds of receiving antibiotics, broad-spectrum antibiotics, and intravenous antibiotics for pneumonia.

Background: Hospitalized patients are typically inactive, though evidence highlights the effectiveness of mobility-enhancing interventions in improving health outcomes. Technology-assisted approaches are increasingly used to encourage patient movement.

Objectives: This scoping review examines technology-assisted initiatives designed to promote physical activity in hospitalized adults and explores implementation strategies used to facilitate these initiatives.

Methods: The Arksey and O'Malley's 2005 framework was used. Studies were identified through searches of MEDLINE, EMBASE, CINAHL, Scopus, and Cochrane trials. Bibliographies of included studies were searched. Characteristics of technology-assisted interventions and implementation strategies used were extracted, categorized, and analyzed for frequency.

Results: Thirty papers representing 28 unique initiatives were identified from 6049 articles. The technology used were wearable step or activity counters (20), exergames (6), mobile ambulation reminders (3), and applications for in-bed exercises (1). Five implementation strategies reported from three studies were coded using the Expert Recommendations for Implementing Change: identifying and preparing champions, facilitating relay of clinical data, conducting educational meetings, developing and distributing educational materials. Eight behavior change techniques were reported: encouragement, collaborative goal setting, increasing daily goals, progress tracking, visual data display, patient education, environmental modification and physical therapist support.

Conclusion: The implementation of technology-assisted mobility interventions in hospitals to enhance patient mobility is emerging. Applying implementation and behavioral science frameworks may enhance effectiveness. Future studies are required to evaluate implementation strategy outcomes and to examine patient and clinician experiences to inform intervention adaptation and to facilitate integration into routine clinical hospital ward/unit practice.

Peer review of research products suffers from poor inter-rater reliability. Few studies examine whether this limitation generalizes to case reports. We conducted a cross-sectional analysis of peer reviews of clinical vignette abstracts submitted to a national hospitalist meeting in 2024 and 2025. Three randomly assigned reviewers scored each vignette on a 1-10 scale. We analyzed variation in scores across abstracts and reviewers and estimated inter-rater reliability via intraclass correlation coefficient (ICC). Two hundred twenty-one reviewers evaluated 1630 abstracts in 2024-2025. Abstract scores varied substantially: 384/1630 (23.6%) abstracts had a difference of 4 or more points (>2 standard deviations) between highest and lowest reviewer scores. Scores varied by reviewer: 2024 reviewer-level mean scores ranged 4.27-8.47 (standard deviation (SD): 0.70-2.80); 2025 scores ranged 4.06-8.59 (SD: 0.62-2.69). Inter-rater reliability was poor (ICC: 0.37). Adjusting final scores based on reviewer scoring tendencies changed the accept/reject category for 183 (11.2%) abstracts, suggesting opportunities for quality improvement.

Background: Medical training often omits systematic approaches to prognostication and goals of care (GOC) communication, leading to end-of-life (EOL) hospital care misaligned with patients' values, lower clinician self-efficacy, and greater clinician distress.

Objective: This communication training intervention aimed to improve clinician knowledge and self-efficacy and to reduce distress in conducting GOC discussions.

Methods: We developed and implemented GOComm, a 4-h serious illness communication training program across eight campuses of a large health system. Utilizing a train-the-trainer model, facilitators taught GOComm to inpatient clinicians, primarily hospitalists, intensivists, physician assistants (PAs), and trainees. Topics included prognosticating, conveying serious news, managing emotions, creating values-informed medical recommendations, and discussing hospice. Simulations included a clinician and simulated patient (SP) role play and a family meeting, in which a clinical dyad encountered an SP dyad. Mixed methods evaluation included pre- and postsurveys.

Results: Three hundred and ninety-three clinicians participated: 322 provided demographics, with a mean of 5.57 years in practice; 71.7% were women, 50% were White, and 29.5% were Asian. Of 315 listing roles: 41% were physicians, 41% were PAs. Two hundred and forty-two completed both pre- and postsurveys. Clinicians had statistically significant gains in GOC knowledge, self-efficacy, and distress tolerance. GOComm had high clinician acceptability: 96.2% indicated they would recommend GOComm to a colleague, and 83.2% credited it with changing how they will manage patients.

Conclusions: GOComm is an effective train-the-trainer curriculum for hospital-based clinicians to gain knowledge and confidence in empathic communication skills. Clinician distress tolerance can be mitigated by enhancing skills training and social support through team simulations.