Cancer Screening Prevalence and Preference among Hospitalized Women With and Without Obesity.

OBJECTIVES: This study explored the prevalence of nonadherence and preferences for breast cancer (BRC) and colorectal cancer (CRC) screening among hospitalized women with and without obesity who were cancer-free at baseline. In addition, the study evaluated risk factors associated with nonadherence among hospitalized women with obesity. METHODS: A prospective interventional study evaluated nonadherence prevalence and preference for cancer screening among hospitalized women aged 50 to 75 years. The intervention consisted of one-to-one bedside education via handouts about cancer screening. In addition, multivariable logistic regression models assessed associations between sociodemographic and clinical comorbidity variables believed to influence screening adherence among hospitalized women. Six months after discharge from the hospital, study participants received a follow-up telephone survey to determine adherence to BRC/CRC screening guidelines. RESULTS: Of 510 enrolled women, 61% were obese (body mass index ≥30 kg/m2). Women with and without obesity were equally nonadherent to BRC (34% vs 32%, P = 0.56) and CRC (26% vs 28%, P = 0.71) screening guidelines. Almost half of the study population preferred undergoing indicated BRC/CRC screening in the hospital regardless of obesity status. After adjustment for sociodemographic and clinical risk factors, not having a primary care physician (odds ratio [OR] 5.88, 95% confidence interval [CI] 2.20-15.7) and nonadherence to CRC screening (OR 3.65, 95% CI 1.94-6.54) were associated with nonadherence to BRC screening among women with obesity. After similar adjustment, having an education less than high school level (OR 2.55, 95% CI 1.21-5.39) and nonadherence to BRC screening (OR 3.64, 95% CI 1.97-6.75) were associated with nonadherence to CRC among women with obesity. CONCLUSIONS: Women with obesity are at risk of being underscreened for obesity-related malignancies, and hospitalizations may offer screening opportunities for BRC and CRC.

Prevalence of Workplace Violence and Effects of De-escalation Training Among Hospitalists: A Pilot Study.

Introduction: Workplace violence (WPV) is increasing in healthcare and negatively impacts healthcare worker outcomes. De-escalation training for healthcare workers is recommended to reduce WPV from patients and visitors. Hospitalists may be at high risk for WPV, but the magnitude of WPV and the impact of de-escalation training among hospitalists is not known. Methods: We investigated the baseline prevalence of WPV experienced by 37 hospitalists at a single center. After an in-person de-escalation training, we measured hospitalists' self-reported "Confidence in Coping with Patient Aggression" using a validated scale (score range 10-110). Results: In the 12 months before de-escalation training, 86.5% of participants reported at least one form of WPV: 83.8% verbal abuse, 29.7% racial abuse, 18.9% physical violence, and 16.2% sexual abuse. The mean confidence score increased significantly from pre-training (43.2) to immediately after training (68.5) and remained significantly elevated at three months (57.2), six months (60.2), and after 12 months (59.9) (all P < 0.05; Ptrend <0.05). Conclusion: Hospitalists are at high risk for WPV. Structured in-person de-escalation training may provide the sustained ability for hospitalists to cope with WPV.

Discharge in the a.m.: A randomized controlled trial of physician rounding styles to improve hospital throughput and length of stay.

BACKGROUND: To relieve hospital capacity strain, hospitals often encourage clinicians to prioritize early morning discharges which may have unintended consequences. OBJECTIVE: We aimed to test the effects of hospitalist physicians prioritizing discharging patients first compared to usual rounding style. DESIGN, SETTING AND PARTICIPANTS: Prospective, multi-center randomized controlled trial. Three large academic hospitals. Participants were Hospital Medicine attending-level physicians and patients the physicians cared for during the study who were at least 18 years of age, admitted to a Medicine service, and assigned by standard practice to a hospitalist team. INTERVENTION: Physicians were randomized to: (1) prioritizing discharging patients first as care allowed or (2) usual practice. MAIN OUTCOME AND MEASURES: Main outcome measure was discharge order time. Secondary outcomes were actual discharge time, length of stay (LOS), and order times for procedures, consults, and imaging. RESULTS: From February 9, 2021, to July 31, 2021, 4437 patients were discharged by 59 physicians randomized to prioritize discharging patients first or round per usual practice. In primary adjusted analyses (intention-to-treat), findings showed no significant difference for discharge order time (13:03 ± 2 h:31 min vs. 13:11 ± 2 h:33 min, p = .11) or discharge time (15:22 ± 2 h:50 min vs. 15:21 ± 2 h:50 min, p = .45), for physicians randomized to prioritize discharging patients first compared to physicians using usual rounding style, respectively, and there was no significant change in LOS or on order times of other physician orders. CONCLUSIONS: Prioritizing discharging patients first did not result in significantly earlier discharges or reduced LOS.

Predictors of Nonadherence to Colorectal Cancer Screening among Hospitalized Women.

OBJECTIVES: Despite proven mortality benefit, disparities in colorectal cancer (CRC) screening utilization persist, especially among younger women, minorities, and low-income women, even those who are insured. The purpose of the present study is to evaluate and estimate the effects of sociodemographic and clinical variables associated with nonadherence to CRC screening among hospitalized women. METHODS: A cross-sectional bedside survey was conducted to collect sociodemographic and clinical comorbidity data believed to affect CRC screening adherence of hospitalized women aged 50 to 75 years who were cancer free (except skin cancer) at enrollment. Logistic regression models were used to assess the association between these factors and nonadherence CRC screening. RESULTS: In total, 510 women were enrolled for participation in the study. After adjustment for sociodemographic and clinical predictors, only two variables were found to be independently associated with nonadherence to CRC screening: age younger than 60 years (odds ratio [OR] 2.62, 95% confidence interval [CI] 1.58-4.33) and nonadherence to breast cancer screening (OR 3.72, 95% CI 2.29-6.04). By contrast, hospitalized women at high risk for CRC were more likely to be compliant with CRC screening (OR 0.14, 95% CI 0.04-0.50). CONCLUSIONS: Both younger age and behavior toward screening remain barriers to CRC screening. Hospitalization creates an environment where patients are in close proximity to healthcare resources, and strategies could be used to capitalize on this opportunity to counsel, educate, and motivate patients toward this screening that is necessary for health maintenance. Seizing on this opportunity may help improve CRC screening adherence.

Colorectal Cancer Screening Prevalence, Perceived Barriers, and Preference for Screening Colonoscopy Among Hospitalized Women.

Barriers to colorectal cancer screening persist despite screening campaigns, especially among women. This study explores the prevalence, preferences, and barriers associated with colorectal cancer screening and evaluates the effect of an inpatient intervention (one-on-one bedside education and handout about colorectal cancer) on screening adherence among hospitalized women. METHODS: A prospective intervention study among 510 hospitalized women, who are cancer-free (except for skin cancer) at enrollment, aged between 50 and 75 years was conducted at an academic center. Socio-demographic, family history, and medical comorbidities data were collected for all patients. A post-hospitalization follow-up survey determined the effect of inpatient intervention on colorectal cancer screening adherence. Unpaired t-test and chi-square tests were used to compare characteristics, perspectives, and preferences for screening among adherent and non-adherent groups. RESULTS: Mean age was 60.5 years, 45% reported an annual household income of <$20 000, 36% of women were African American, 27% of women were overdue for colorectal cancer screening, and 33% never had a screening colonoscopy. The most frequently reported barriers to colorectal cancer screening were "I have other problems more important than getting a colonoscopy," "No transportation to get to the test," and "Not counseled by primary care provider." Sixty-six percent of the non-adherent women would agree to have an inpatient screening colonoscopy if offered. CONCLUSION: A significant number of hospitalized women are non-adherent to colorectal cancer screening, while the educational intervention was partially successful in enhancing colorectal cancer screening, most hospitalized women remained non-adherent after hospitalization. A majority of these women were amenable to inpatient screening colonoscopy if offered during a hospital stay.

Elements Influencing Recruitment and Retention of Millennial Hospitalists Born in or after 1982: a Survey-Based Study.

BACKGROUND: Hospitalist turnover is exceedingly high, placing financial burdens on hospital medicine groups (HMGs). Following training, many begin their employment in medicine as early-career hospitalists, the majority being millennials. OBJECTIVE: To understand what elements influence millennial hospitalists' recruitment and retention. DESIGN: We developed a survey that asked participants to rate the level of importance of 18 elements (4-point Likert scale) in their decision to choose or remain at an HMG. PARTICIPANTS: The survey was electronically distributed to hospitalists born in or after 1982 across 7 HMGs in the USA. MAIN MEASURES: Elements were grouped into four major categories: culture of practice, work-life balance, financial considerations, and career advancement. We calculated the means for all 18 elements reported as important across the sample. We then calculated means by averaging elements within each category. We used unpaired t-tests to compare differences in means for categories for choosing vs. remaining at an HMG. KEY RESULTS: One hundred forty-four of 235 hospitalists (61%) responded to the survey. 49.6% were females. Culture of practice category was the most frequently rated as important for choosing (mean 96%, SD 12%) and remaining (mean 96%, SD 13%) at an HMG. The category least frequently rated as important for both choosing (mean 69%, SD 35%) and remaining (mean 76%, SD 32%) at an HMG was career advancement. There were no significant differences between respondent gender, race, or parental status and ratings of elements for choosing or remaining with HMGs. CONCLUSION: Culture of practice at an HMG may be highly important in influencing millennial hospitalists' decision to choose and stay at an HMG. HMGs can implement strategies to create a millennial-friendly culture which may help improve recruitment and retention.

Effect of inpatient breast cancer education and risk assessment on mammography utilization among hospitalized women post discharge.

OBJECTIVE: To evaluate prevalence of nonadherence to breast cancer screening guidelines after bedside educational intervention and informed individualized risk assessment score during an inpatient stay. METHODS: A prospective intervention study was conducted among 507 cancer-free (except skin cancer) women aged 50-75 years hospitalized to a general medicine service. Study intervention included one-on-one bedside education via handout and videos about breast cancer screening and informed individualized risk assessment using the Gail risk model to predict 5-year risk for breast cancer development. Study outcomes were measured using posthospitalization follow-up survey to determine if intervention resulted in improved adherence to breast cancer screening. Chi-square and unpaired t-tests were utilized to compare population characteristics. RESULTS: The mean age for the study population was 60.5 years (SD = 6.9), the mean 5-year Gail risk score was 1.77 (SD = 1), and 36% of women were African American. One hundred sixty nine (33%) hospitalized women were nonadherent to breast cancer screening recommendations. Only 15% of the nonadherent women were reachable for follow-up survey, and 42% of these women self-reported adherence to screening mammography after a mean follow-up period of 27 months. CONCLUSION: This study provides evidence that most women who are nonadherent to breast cancer screening remain nonadherent after hospital discharge despite educational interventions. Our study intervention was only partially successful in enhancing breast cancer screening among hospitalized women who were overdue and at high risk. Further studies need to evaluate strategies to overcome the barriers and improve adherence whenever patients encounter health care system regardless of clinical locale.

Healthcare distrust among hospitalised black patients during the COVID-19 pandemic.

STUDY PURPOSE: Distrust of the healthcare system is longstanding in the black community. This may especially threaten the health of the population when a highly contagious infection strikes. This study aims to compare COVID-19-related perspectives and behaviours between hospitalised black patients who trust versus distrust doctors and healthcare systems. STUDY DESIGN: Cross-sectional study at a tertiary care academic hospital in Baltimore, Maryland. Hospitalised adult black patients without a history of COVID-19 infection were surveyed between November 2020 and March 2021 using an instrument that assessed COVID-19-related matters. Analyses compared those who trusted versus mistrusted doctors and healthcare systems. RESULTS: 37 distrusting hospitalised black patients were compared with 103 black patients who trusted doctors and healthcare systems. Groups had similar sociodemographics (all p>0.05). Distrustful patients were less likely to think that they were at high risk of contracting COVID-19 (54.0% vs 75.7%; p=0.05), less likely to believe that people with underlying medical conditions were at higher risk of dying from the virus (86.4% vs 98.0%; p=0.01) and less likely to be willing to accept COVID-19 vaccination (when available) (51.3% vs 77.6%; p<0.01) compared with those who were trusting. CONCLUSION: Healthcare distrustful hospitalised black patients were doubtful of COVID-19 risk and hesitant about vaccination. Hospitalisations are concentrated exposures to the people and processes within healthcare systems; at these times, seizing the opportunity to establish meaningful relationships with patients may serve to gain their trust.

Documentation of Clinical Reasoning in Admission Notes of Hospitalists: Validation of the CRANAPL Assessment Rubric.

BACKGROUND: High-quality documentation of clinical reasoning is a professional responsibility and is essential for patient safety. Accepted standards for assessing the documentation of clinical reasoning do not exist. OBJECTIVE: To establish a metric for evaluating hospitalists' documentation of clinical reasoning in admission notes. STUDY DESIGN: Retrospective study. SETTING: Admissions from 2014 to 2017 at three hospitals in Maryland. PARTICIPANTS: Hospitalist physicians. MEASUREMENTS: A subset of patients admitted with fever, syncope/dizziness, or abdominal pain were randomly selected. The nine-item Clinical Reasoning in Admission Note Assessment & Plan (CRANAPL) tool was developed to assess the comprehensiveness of clinical reasoning documented in the assessment and plans (A&Ps) of admission notes. Two authors scored all A&Ps by using this tool. A&Ps with global clinical reasoning and global readability/clarity measures were also scored. All data were deidentified prior to scoring. RESULTS: The 285 admission notes that were evaluated were authored by 120 hospitalists. The mean total CRANAPL score given by both raters was 6.4 (SD 2.2). The intraclass correlation measuring interrater reliability for the total CRANAPL score was 0.83 (95% CI, 0.76-0.87). Associations between the CRANAPL total score and global clinical reasoning score and global readability/clarity measures were statistically significant (P < .001). Notes from academic hospitals had higher CRANAPL scores (7.4 [SD 2.0] and 6.6 [SD 2.1]) than those from the community hospital (5.2 [SD 1.9]), P < .001. CONCLUSIONS: This study represents the first step to characterizing clinical reasoning documentation in hospital medicine. With some validity evidence established for the CRANAPL tool, it may be possible to assess the documentation of clinical reasoning by hospitalists.