Implementation of a Hospital Medicine Rotation and Curriculum for Internal Medicine Residents.

Introduction: Hospital medicine is a growing field that focuses not only on expertise in inpatient medicine but also on knowledge of nonclinical health system topics. The traditional model for resident education does not lend itself to learning these topics. We developed a unique ward rotation with a dedicated curriculum called the Resident Inpatient Training Experience (RITE) to address this deficiency. Methods: The RITE rotation was initially implemented in the 2013-2014 academic year. The curriculum accompanying the rotation contained four case-based modules that included content on patient safety, quality improvement, cost-conscious care, hospital metrics/reimbursement, physician billing and coding, and transitions of care. Prior to RITE, residents received an email orientation to the service. To evaluate the rotation and curriculum, residents completed a pre- and postrotation online survey. Forty-six upper PGY 2 residents each rotated on the service for 1 month. An experienced hospitalist attended on the service and facilitated a weekly discussion on each module. This publication includes an updated version of the email orientation, the four modules, and the surveys. Results: There was a 72% response rate for completion of the pre- and postrotation survey. Confidence in managing hospitalized patients and knowledge of module content taught during the rotation improved. Discussion: We found that implementation of a hospital medicine rotation and curriculum improved resident independence and knowledge of the module topics and was a successful way to alleviate current deficiencies in resident education.

Continuity of care and cardiovascular risk factor management: does care by a single clinician add to informational continuity provided by electronic medical records?

BACKGROUND: Electronic medical records allow information sharing among multiple clinicians treating the same patient, enabling informational continuity between visits. OBJECTIVE: To assess the contribution of continuity of care (COC) with a single clinician to short-term outcomes in a setting in which electronic medical records are used. STUDY DESIGN: Retrospective cohort study. METHODS: Between January 1, 2003, and October 1, 2004, we identified 3718 patients assessed for lipid and blood pressure control and a subgroup of 1448 patients with diabetes mellitus assessed for glycemic control in the primary care clinics of a large Department of Veterans Affairs healthcare facility. Continuity of care was defined as having been seen by the same clinician (physician or nurse practitioner) in the year before testing. Analytic techniques accounting for clustering of patients by providers yielded robust estimators for the association between continuity with a single clinician and control of these cardiovascular disease risk factors. RESULTS: Patients with complete COC were more likely to be men with few medical problems and visits during the study period. Controlling for these differences, we detected no association between COC and patient attainment of recommended goals for cardiovascular disease risk factor control (P < .05 for all). CONCLUSION: Continuity of care with a single clinician contributes little to cardiovascular risk factor management in a setting in which electronic medical records provide enhanced informational continuity, although its value may be greater in the management and outcomes of established diseases that require coordination of care and ongoing collaboration between clinician and patient.

Effect of ABO blood group on the collagen-binding assay for von Willebrand factor.

von Willebrand disease (VWD) is the most common congenital bleeding disorder and is caused by a quantitative or qualitative abnormality of von Willebrand factor (VWF). Ristocetin cofactor (RCoF) assay is used to evaluate VWF activity, but it does not assess collagen-binding activity. Normal values of RCoF and VWF antigen vary with ABO blood group type. The collagen-binding assay (CBA) measures VWF activity; however, its relationship with ABO blood group has not been completely explored. We performed CBA on plasma samples from 131 healthy volunteers to determine if CBA values correlated with blood type. Individuals with blood group O had a mean CBA value of 94 +/- 28%, which was significantly different from the mean of 117 +/- 33% in persons with non-O blood groups (P = 0.0001). Thus, CBA values appear to correlate with ABO blood type in a manner similar to RCoF.