Journal of hospital medicine最新文献

Background: Asthma, pneumonia, and bronchiolitis are the top causes of childhood hospitalization in the United States, leading to over 350,000 hospitalizations and ≈$2 billion in costs annually. The majority of these hospitalizations occur in general/community hospitals. Poor guideline adoption by clinicians contributes to poor health outcomes for children hospitalized with these illnesses, including longer recovery time/hospital stay, higher rates of intensive care unit transfer, and increased risk of hospital readmission. A prior single-center study at a children's hospital tested a multicondition clinical pathway intervention (simultaneous implementation of multiple pathways for multiple pediatric conditions) and demonstrated improved clinician guideline adherence and patient health outcomes. This intervention has not yet been studied in community hospitals, which face unique implementation barriers.

Objective: To study the implementation and effectiveness of a multicondition pathway intervention for children hospitalized with asthma, pneumonia, or bronchiolitis in community hospitals.

Methods: We will conduct a pragmatic, hybrid effectiveness-implementation, cluster-randomized trial in community hospitals around the United States (1:1 randomization to intervention vs. wait-list control). Our primary outcome will be the adoption of 2-3 evidence-based practices for each condition over a sustained period of 2 years. Secondary outcomes include hospital length of stay, ICU transfer, and readmission.

Discussion: This hybrid trial will lead to a comprehensive understanding of how to pragmatically and sustainably implement a multicondition pathway intervention in community hospitals and an assessment of its effects. Enrollment began in July 2022 and is projected to be completed in September 2024. Primary analysis completion is anticipated in March 2025, with reporting of results following.

Background: People with disability (PWD) face challenges accessing healthcare. Websites are a public-facing resource that can help PWD determine if a hospital can accommodate their needs, yet few studies have described whether hospital websites contain adequate accommodation information.

Objective: To characterize the extent to which information about disability accommodations is available on US hospital websites.

Methods: We manually reviewed hospital websites using a structured extraction form. We used the Centers for Medicare and Medicaid Services' Hospital General Information Data set to identify a stratified random sample of 600 nonspecialty hospitals in the United States. We excluded hospitals that shared a website with a previously reviewed hospital for a final sample of 445. We recorded (1) content about specific disability accommodations (in 11 predetermined categories); (2) descriptions of hospital policy mentioning disability; and (3) the point of contact to obtain more information about accommodations.

Results: About two-thirds (65.6%) of sampled hospitals were acute care hospitals (vs 34.4% critical access); 53.5% had 26-299 beds. Overall, 73.7% websites had information about accommodations; of these, 36.3% had information solely within hospital policies. Of the 47.0% websites with accommodation information beyond hospital policies, the mean number of accommodations listed (excluding policy statements) was 2.37 (of 11 possible). Hospitals with 300+ beds had higher odds of listing any nonpolicy accommodations than those with 1-26 beds (odds ratio = 2.768, p = .02). Less than half (40.5%) hospitals listed a contact person.

Conclusions: Information about disability accommodations is sparse on hospital websites. Comprehensive and actionable communication about accommodations is needed to better protect PWD's rights to accessible healthcare.

Background: Despite the central role of experiential learning in residency training, the actual clinical experiences residents participate in are not well characterized. A better understanding of the type, volume, and variation in residents' clinical experiences is essential to support precision medical education strategies.

Objective: We sought to characterize the entirety of the clinical experiences had by individual internal medicine residents throughout their time in training.

Method: We evaluated the clinical experiences of medicine residents (n = 51) who completed training at NYU Grossman School of Medicine's Brooklyn campus between 2020 and 2023. Residents' inpatient and outpatient experiences were identified using notes written, orders placed, and care team sign-ins; principal ICD-10 codes for each encounter were converted into medical content categories using a previously described crosswalk tool.

Results: Of 152,426 clinical encounters with available ICD-10 codes, 132,284 were mapped to medical content categories (94.5% capture). Residents' clinical experiences were particularly enriched in infectious and cardiovascular disease; most had very little exposure to allergy, dermatology, oncology, or rheumatology. Some trainees saw twice as many cases in a given content area as did others. There was little concordance between actual frequency of clinical experience and expected content frequency on the ABIM certification exam.

Conclusions: Individual residents' clinical experiences in training vary widely, both in number and in type. Characterizing these experiences paves the way for exploration of the relationships between clinical exposure and educational outcomes, and for the implementation of precision education strategies that could fill residents' experiential gaps and complement strengths with targeted educational interventions.