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1.
BMC Health Serv Res ; 19(1): 659, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31511070

RESUMO

BACKGROUND: The first Multi-center Medication Reconciliation Quality Improvement Study (MARQUIS1) demonstrated that implementation of a medication reconciliation best practices toolkit decreased total unintentional medication discrepancies in five hospitals. We sought to implement the MARQUIS toolkit in more diverse hospitals, incorporating lessons learned from MARQUIS1. METHODS: MARQUIS2 is a pragmatic, mentored implementation QI study which collected clinical and implementation outcomes. Sites implemented a revised toolkit, which included interventions from these domains: 1) best possible medication history (BPMH)-taking; 2) discharge medication reconciliation and patient/caregiver counseling; 3) identifying and defining clinician roles and responsibilities; 4) risk stratification; 5) health information technology improvements; 6) improved access to medication sources; 7) identification and correction of real-time discrepancies; and, 8) stakeholder engagement. Eight hospitalists mentored the sites via one site visit and monthly phone calls over the 18-month intervention period. Each site's local QI team assessed opportunities to improve, implemented at least one of the 17 toolkit components, and accessed a variety of resources (e.g. implementation manual, webinars, and workshops). Outcomes to be assessed will include unintentional medication discrepancies per patient. DISCUSSION: A mentored multi-center medication reconciliation QI initiative using a best practices toolkit was successfully implemented across 18 medical centers. The 18 participating sites varied in size, teaching status, location, and electronic health record (EHR) platform. We introduce barriers to implementation and lessons learned from MARQUIS1, such as the importance of utilizing dedicated, trained medication history takers, simple EHR solutions, clarifying roles and responsibilities, and the input of patients and families when improving medication reconciliation.


Assuntos
Reconciliação de Medicamentos , Melhoria de Qualidade/organização & administração , Cuidado Transicional/organização & administração , Registros Eletrônicos de Saúde , Medicina Baseada em Evidências , Pesquisas sobre Serviços de Saúde , Humanos , Reconciliação de Medicamentos/métodos , Segurança do Paciente
2.
Artigo em Inglês | MEDLINE | ID: mdl-31044034

RESUMO

Background: Hospitalized patients with diabetes are at risk of complications and longer length of stay (LOS). Inpatient Diabetes Management Services (IDMS) are known to be beneficial; however, their impact on patient care measures in community, non-teaching hospitals, is unknown. Objectives: To evaluate whether co-managing patients with diabetes by the IDMS team reduces LOS and 30-day readmission rate (30DR). Methods: This retrospective quality improvement cohort study analyzed LOS and 30DR among patients with diabetes admitted to a community hospital. The IDMS medical team consisted of an endocrinologist, nurse practitioner, and diabetes educator. The comparison group consisted of hospitalized patients with diabetes under standard care of attending physicians (mostly internal medicine-trained hospitalists). The relationship between study groups and outcome variables was assessed using Generalized Estimating Equation models. Results: 4,654 patients with diabetes (70.8 ± 0.2 years old) were admitted between January 2016 and May 2017. The IDMS team co-managed 18.3% of patients, mostly with higher severity of illness scores (p < 0.0001). Mean LOS in patients co-managed by the IDMS team decreased by 27%. Median LOS decreased over time in the IDMS group (p = 0.046), while no significant decrease was seen in the comparison group. Mean 30DR in patients co-managed by the IDMS decreased by 10.71%. Median 30DR decreased among patients co-managed by the IDMS (p = 0.048). Conclusions: In a community hospital setting, LOS and 30DR significantly decreased in patients co-managed by a specialized diabetes team. These changes may be translated into considerable cost savings.

3.
J Health Organ Manag ; 32(5): 638-657, 2018 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-30175678

RESUMO

Purpose Academic healthcare systems face great challenges in coordinating services across a continuum of care that spans hospital, community providers, home and chronic care facilities. The Johns Hopkins Community Health Partnership (J-CHiP) was created to improve coordination of acute, sub-acute and ambulatory care for patients, and improve the health of high-risk patients in surrounding neighborhoods. The paper aims to discuss this issue. Design/methodology/approach J-CHiP targeted adults admitted to the Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center, patients discharged to participating skilled nursing facilities (SNFs), and high-risk Medicare and Medicaid patients receiving primary care in eight nearby outpatient sites. The primary drivers of the program were redesigned acute care delivery, seamless transitions of care and deployment of community care teams. Findings Acute care interventions included risk screening, multidisciplinary care planning, pharmacist-driven medication management, patient/family education, communication with next provider and care coordination protocols for common conditions. Transition interventions included post-discharge health plans, hand-offs and follow-up with primary care providers, Transition Guides, a patient access line and collaboration with SNFs. Community interventions involved forming multidisciplinary care coordination teams, integrated behavioral care and new partnerships with community-based organizations. Originality/value This paper offers a detailed description of the design and implementation of a complex program to improve care coordination for high-risk patients in an urban setting. The case studies feature findings from each intervention that promoted patient engagement, strengthened collaboration with community-based organizations and improved coordination of care.


Assuntos
Centros Médicos Acadêmicos , Continuidade da Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/normas , Assistência à Saúde/organização & administração , Eficiência Organizacional , Hospitais Urbanos , Melhoria de Qualidade , Atenção Primária à Saúde , Instituições de Cuidados Especializados de Enfermagem
5.
J Thorac Cardiovasc Surg ; 156(5): 1892-1893, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29934010
7.
J Thorac Cardiovasc Surg ; 156(2): 537-538, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29703410
8.
Int J Gen Med ; 11: 65-71, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29491714

RESUMO

Hospital medicine is the fastest growing specialty in the United States. An interesting aspect of the rapid expansion of hospital medicine is the expansion of the field beyond the United States. Although the health care systems, regulations, and cultural norms in these nations differ, there are striking similarities in the profession's development. We performed a literature review to better understand the factors contributing to the growth of hospital medicine internationally. In this article, we describe some of the drivers for expansion of hospital medicine outside the United States and the challenges faced by these groups. We also discuss the role the United States could play in the continued growth of hospital medicine internationally.

9.
Ann Emerg Med ; 71(4): 497-505.e4, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-28844764

RESUMO

STUDY OBJECTIVE: Emergency department (ED) crowding and patient boarding are associated with increased mortality and decreased patient satisfaction. This study uses a positive deviance methodology to identify strategies among high-performing, low-performing, and high-performance improving hospitals to reduce ED crowding. METHODS: In this mixed-methods comparative case study, we purposively selected and recruited hospitals that were within the top and bottom 5% of Centers for Medicare & Medicaid Services case-mix-adjusted ED length of stay and boarding times for admitted patients for 2012. We also recruited hospitals that showed the highest performance improvement in metrics between 2012 and 2013. Interviews were conducted with 60 key leaders (physicians, nurses, quality improvement specialists, and administrators). RESULTS: We engaged 4 high-performing, 4 low-performing, and 4 high-performing improving hospitals, matched on hospital characteristics including geographic designation (urban versus rural), region, hospital occupancy, and ED volume. Across all hospitals, ED crowding was recognized as a hospitalwide issue. The strategies for addressing ED crowding varied widely. No specific interventions were associated with performance in length-of-stay metrics. The presence of 4 organizational domains was associated with hospital performance: executive leadership involvement, hospitalwide coordinated strategies, data-driven management, and performance accountability. CONCLUSION: There are organizational characteristics associated with ED decreased length of stay. Specific interventions targeted to reduce ED crowding were more likely to be successfully executed at hospitals with these characteristics. These organizational domains represent identifiable and actionable changes that other hospitals may incorporate to build awareness of ED crowding.


Assuntos
Aglomeração , Serviço Hospitalar de Emergência/normas , Admissão do Paciente/estatística & dados numéricos , Melhoria de Qualidade , Listas de Espera , Adulto , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Satisfação do Paciente , Fatores de Tempo , Estados Unidos
10.
JAMA Netw Open ; 1(7): e184273, 2018 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-30646347

RESUMO

Importance: The Johns Hopkins Community Health Partnership was created to improve care coordination across the continuum in East Baltimore, Maryland. Objective: To determine whether the Johns Hopkins Community Health Partnership (J-CHiP) was associated with improved outcomes and lower spending. Design, Setting, and Participants: Nonrandomized acute care intervention (ACI) and community intervention (CI) Medicare and Medicaid participants were analyzed in a quality improvement study using difference-in-differences designs with propensity score-weighted and matched comparison groups. The study spanned 2012 to 2016 and took place in acute care hospitals, primary care clinics, skilled nursing facilities, and community-based organizations. The ACI analysis compared outcomes of participants in Medicare and Medicaid during their 90-day postacute episode with those of a propensity score-weighted preintervention group at Johns Hopkins Community Health Partnership hospitals and a concurrent comparison group drawn from similar Maryland hospitals. The CI analysis compared changes in outcomes of Medicare and Medicaid participants with those of a propensity score-matched comparison group of local residents. Interventions: The ACI bundle aimed to improve transition planning following discharge. The CI included enhanced care coordination and integrated behavioral support from local primary care sites in collaboration with community-based organizations. Main Outcomes and Measures: Utilization measures of hospital admissions, 30-day readmissions, and emergency department visits; quality of care measures of potentially avoidable hospitalizations, practitioner follow-up visits; and total cost of care (TCOC) for Medicare and Medicaid participants. Results: The CI group had 2154 Medicare beneficiaries (1320 [61.3%] female; mean age, 69.3 years) and 2532 Medicaid beneficiaries (1483 [67.3%] female; mean age, 55.1 years). For the CI group's Medicaid participants, aggregate TCOC reduction was $24.4 million, and reductions of hospitalizations, emergency department visits, 30-day readmissions, and avoidable hospitalizations were 33, 51, 36, and 7 per 1000 beneficiaries, respectively. The ACI group had 26 144 beneficiary-episodes for Medicare (13 726 [52.5%] female patients; mean patient age, 68.4 years) and 13 921 beneficiary-episodes for Medicaid (7392 [53.1%] female patients; mean patient age, 52.2 years). For the ACI group's Medicare participants, there was a significant reduction in aggregate TCOC of $29.2 million with increases in 90-day hospitalizations and 30-day readmissions of 11 and 14 per 1000 beneficiary-episodes, respectively, and reduction in practitioner follow-up visits of 41 and 29 per 1000 beneficiary-episodes for 7-day and 30-day visits, respectively. For the ACI group's Medicaid participants, there was a significant reduction in aggregate TCOC of $59.8 million and the 90-day emergency department visit rate decreased by 133 per 1000 episodes, but hospitalizations increased by 49 per 1000 episodes and practitioner follow-up visits decreased by 70 and 182 per 1000 episodes for 7-day and 30-day visits, respectively. In total, the CI and ACI were associated with $113.3 million in cost savings. Conclusions and Relevance: A care coordination model consisting of complementary bundled interventions in an urban academic environment was associated with lower spending and improved health outcomes.


Assuntos
Instituições de Assistência Ambulatorial , Serviços de Saúde Comunitária , Análise Custo-Benefício , Custos de Cuidados de Saúde , Hospitais , Aceitação pelo Paciente de Cuidados de Saúde , Qualidade da Assistência à Saúde , Idoso , Baltimore , Serviços de Saúde Comunitária/economia , Serviços de Saúde Comunitária/normas , Redução de Custos , Serviço Hospitalar de Emergência , Feminino , Hospitalização , Humanos , Masculino , Medicaid , Medicare , Pessoa de Meia-Idade , Readmissão do Paciente , Atenção Primária à Saúde , Melhoria de Qualidade , Instituições de Cuidados Especializados de Enfermagem , Estados Unidos
11.
J Hosp Med ; 12(10): 811-817, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28991946

RESUMO

BACKGROUND: To support hospital efforts to improve coordination of care, a tool is needed to evaluate care coordination from the perspective of inpatient healthcare professionals. OBJECTIVES: To develop a concise tool for assessing care coordination in hospital units from the perspective of healthcare professionals, and to assess the performance of the tool in measuring dimensions of care coordination in 2 hospitals after implementation of a care coordination initiative. METHODS: We developed a survey consisting of 12 specific items and 1 global item to measure provider perceptions of care coordination across a variety of domains, including teamwork and communication, handoffs, transitions, and patient engagement. The questionnaire was distributed online between October 2015 and January 2016 to nurses, physicians, social workers, case managers, and other professionals in 2 tertiary care hospitals. RESULTS: A total of 841 inpatient care professionals completed the survey (response rate = 56.6%). Among respondents, 590 (75%) were nurses and 37 (4.7%) were physicians. Exploratory factor analysis revealed 4 subscales: (1) Teamwork, (2) Patient Engagement, (3) Handoffs, and (4) Transitions (Cronbach's alpha 0.84-0.90). Scores were fairly consistent for 3 subscales but were lower for patient engagement. There were minor differences in scores by profession, department, and hospital. CONCLUSIONS: The new tool measures 4 important aspects of inpatient care coordination with evidence for internal consistency and construct validity, indicating that the tool can be used in monitoring, evaluating, and planning care coordination activities in hospital settings.


Assuntos
Continuidade da Assistência ao Paciente , Pessoal de Saúde/psicologia , Hospitais , Reprodutibilidade dos Testes , Inquéritos e Questionários , Comunicação , Feminino , Humanos , Masculino , Transferência da Responsabilidade pelo Paciente , Transferência de Pacientes
12.
J Contin Educ Health Prof ; 37(1): 3-8, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28252466

RESUMO

INTRODUCTION: There are now more than 50,000 hospitalists working in the United States. Limited empiric research has been performed to characterize clinical excellence in hospital medicine. We conducted a qualitative study to discover elements judged to be most pertinent to excellence in clinical care delivered by hospitalists. METHODS: The chiefs of hospital medicine at five hospitals were asked to identify their "clinically best" hospitalists. Data collection, in the form of one-on-one interviews, was directed by an interview guide. Interviews were transcribed verbatim, and the informants' perspectives were analyzed using editing analysis to identify themes. RESULTS: A total of 26 hospitalists were interviewed. The mean age of the physicians was 38 years, 13 (50%) were women, and 16 (62%) were non-white. Seven themes emerged that related to clinical excellence in hospital medicine: communicating effectively, appreciating partnerships and collaboration, having superior clinical judgment, being organized and efficient, connecting with patients, committing to continued growth and development, and being professional and humanistic. DISCUSSION: This qualitative study describes how respected hospitalists think about excellence in clinical care in hospital medicine. Their perspectives can be used to guide continuing medical education, so that offered programs can pay attention to enhancing the skills of learners so they can develop towards excellence, rather than using only competence as the desired target objective.


Assuntos
Competência Clínica/normas , Medicina Hospitalar/normas , Médicos Hospitalares/psicologia , Adulto , Baltimore , District of Columbia , Feminino , Médicos Hospitalares/normas , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Estados Unidos
13.
J Heart Lung Transplant ; 36(4): 443-450, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27863861

RESUMO

BACKGROUND: Hospital readmissions are costly and have become a focus for quality improvement. We aimed to determine risk factors, rate, and outcomes of readmissions within the first year after lung transplantation and the potential impact on patient survival. METHODS: A retrospective cohort study of all lung transplant recipients ≥18 years old who had undergone initial transplantation (2004-2013) at a single center was conducted. Logistic regression was used to identify independent predictors of readmission for patients who survived hospitalization. Cox regression was used to explore the relationship between readmission and long-term risk of death, while adjusting for potential confounders for patients who survived the first year. RESULTS: During the study period, 412 patients met inclusion criteria for the readmission analysis. There were 276 patients (67%) readmitted within 1 year after lung transplantation for a total of 609 readmissions (average ± SD, 1.5 ± 2). Average length of readmission stay was 6 days ± 7, with 44% of readmissions lasting ≤3 days. Airway complications were found to be a significant risk factor for readmission (odds ratio, 4.18; 95% confidence interval, 1.78-9.54; p = 0.001). After adjustment, the overall risk of death was significantly higher with each readmission during the first year (hazard ratio, 1.22; 95% confidence interval, 1.13-1.31, p < 0.0001). CONCLUSIONS: Most patients who survive the first post-operative year experience at least 1 readmission, with patients who experience airway complications at particular risk. Patients discharged to inpatient rehabilitation were less likely to be readmitted. The cumulative burden of multiple readmissions is associated with worse long-term survival.


Assuntos
Pneumopatias/cirurgia , Transplante de Pulmão/efeitos adversos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Pneumopatias/complicações , Pneumopatias/mortalidade , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo
14.
Healthc (Amst) ; 4(4): 264-270, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27693204

RESUMO

To address the challenging health care needs of the population served by an urban academic medical center, we developed the Johns Hopkins Community Health Partnership (J-CHiP), a novel care coordination program that provides services in homes, community clinics, acute care hospitals, emergency departments, and skilled nursing facilities. This case study describes a comprehensive program that includes: a community-based intervention using multidisciplinary care teams that work closely with the patient's primary care provider; an acute care intervention bundle with collaborative team-based care; and a skilled nursing facility intervention emphasizing standardized transitions and targeted use of care pathways. The program seeks to improve clinical care within and across settings, to address the non-clinical determinants of health, and to ultimately improve healthcare utilization and costs. The case study introduces: a) main program features including rationale, goals, intervention design, and partnership development; b) illness burden and social barriers of the population contributing to care challenges and opportunities; and c) lessons learned with steps that have been taken to engage both patients and providers more actively in the care model. Urban health systems, including academic medical centers, must continue to innovate in care delivery through programs like J-CHiP to meet the needs of their patients and communities.


Assuntos
Centros Médicos Acadêmicos , Planejamento em Saúde Comunitária , Comportamento Cooperativo , Assistência à Saúde/organização & administração , Estudos de Casos Organizacionais , Adulto , Idoso , Baltimore , Serviços de Saúde Comunitária , Assistência à Saúde/economia , Feminino , Hospitais Urbanos , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Centrada no Paciente , Atenção Primária à Saúde , Serviços Urbanos de Saúde
15.
J Card Surg ; 31(7): 456-60, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27183897

RESUMO

Proximal aortic pathology provides a technical challenge for endovascular repair. We present a case of successful transapical endovascular aortic repair in a patient with a proximal suture line pseudoaneurysm who was not a candidate for open surgical repair. doi: 10.1111/jocs.12766 (J Card Surg 2016;31:456-460).


Assuntos
Falso Aneurisma/cirurgia , Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Procedimentos Endovasculares/métodos , Idoso , Aneurisma Dissecante , Feminino , Humanos , Stents , Resultado do Tratamento
16.
J Hosp Med ; 11(7): 467-72, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26970217

RESUMO

BACKGROUND: Sleep is a vital part to healing and recovery, hence poor sleep during hospitalizations is highly undesirable. Few studies have assessed interventions to optimize sleep among hospitalized patients. OBJECTIVE: To assess the effect of sleep-promoting interventions on sleep quality and duration among hospitalized patients. DESIGN: Quasi-experimental prospective study. SETTING: Academic medical center. PARTICIPANTS: Adult patients on the general medicine ward. INTERVENTION: Nurse-delivered sleep-promoting interventions augmented by sleep hygiene education and environmental control to minimize sleep disruption. MEASUREMENTS: Objective and subjective measurement of sleep parameters using validated sleep questionnaires, daily sleep diary, and actigraphy monitor. RESULTS: Of the 112 patients studied, the mean age was 58 years, 55% were female, the mean body mass index was 32, and 43% were in the intervention group. Linear mixed models tested mean differences in 7 sleep measures and group differences in slopes representing nightly changes in sleep outcomes over the course of hospitalization between intervention and control groups. Only total sleep time, computed from sleep diaries, demonstrated significant overall mean difference of 49.6 minutes (standard error [SE] = 21.1, P < 0.05). However, significant differences in average slopes of subjective ratings of sleep quality (0.46, SE = 0.18, P < 0.05), refreshing sleep (0.54, SE = 0.19, P < 0.05), and sleep interruptions (-1.6, SE = 0.6, P < 0.05) indicated improvements during hospitalization within intervention patients compared to controls. CONCLUSION: This study demonstrated that there is an opportunity to identify patients not sleeping well in the hospital. Sleep-promoting initiatives, both at the unit level as well as individualized offerings, may improve sleep during hospitalizations, particularly over the course of the hospitalization. Journal of Hospital Medicine 2016;11:467-472. © 2016 Society of Hospital Medicine.


Assuntos
Hospitalização/tendências , Educação de Pacientes como Assunto/métodos , Sono/fisiologia , Actigrafia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Inquéritos e Questionários
17.
J Contin Educ Health Prof ; 36(1): 61-8, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26954247

RESUMO

INTRODUCTION: Physicians have been shown to possess limited ability for accurate self-assessment; thus, effective feedback is crucial for their professional development. This study describes providers' reflections on their data and evaluates the hospitalist physicians' impressions about receiving this feedback derived from a new survey metric specifically designed to obtain patient assessment of their treating hospitalist provider coupled with reflective sessions. METHODS: Participants were 26 hospitalists from one institution. These physicians' data were used for the development and validation of a new metric, Tool to Assess Inpatient Satisfaction with Care from Hospitalists (TAISCH). Participants received a summary of ratings from patients for whom they were the primary provider. This was followed by a 15-minute semistructured telephone interview to discuss the data. Participants then completed an online survey to assess their perceptions about the data and the efficacy of the feedback. Both quantitative and qualitative results were analyzed. RESULTS: All 26 providers reviewed their evaluation data, participated in the discussion of results by phone, and completed the online survey. Most (54%) agreed that TAISCH was superior to Hospital Consumer Assessment of Healthcare Providers and Systems in providing hints on how to improve the quality of the care and in providing detailed information about the performance in specific areas (62%). After stratifying hospitalists according to their performance, it was observed that those who scored better responded more favorably to the data. The two main themes that emerged from the qualitative analysis were "reflection on one's performance" and "feedback using TAISCH." DISCUSSION: Most hospitalists in our study felt that TAISCH provided meaningful feedback.


Assuntos
Competência Clínica/normas , Retroalimentação , Médicos Hospitalares/normas , Adulto , Feminino , Médicos Hospitalares/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Inquéritos e Questionários
18.
J Hosp Med ; 11(6): 425-31, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26969890

RESUMO

OBJECTIVE: To develop a valid instrument to assess morale and explore the relationship between morale and intent to leave employment due to unhappiness. PATIENTS AND METHODS: An expert panel identified 46 drivers of hospitalist morale. In May 2009, responders of our single-site pilot survey rated each driver in terms of current contentment and importance to their morale. With exploratory factor analysis, a 28-item/7-factor instrument emerged. In May 2011, the refined scale was distributed to 108 hospitalists from 2 academic and 3 community hospitals. Confirmatory factor analysis (CFA) was used for internal validation and refinement of the Hospitalist Morale Index. Importance ratings and contentment assessments were used to generate item scores, which were then combined to generate factor scores and personal morale scores. Results were used to validate the instrument and evaluate the relationship between hospitalist morale and intent to leave due to unhappiness. RESULTS: The 2011 response rate was 86%. The final CFA resulted in a 5-factor and 5-stand-alone-item model. Personal morale scores were normally distributed (mean = 2.79, standard deviation = 0.58). For every categorical increase on a global question that assessed overall morale, personal morale scores rose 0.23 points (P < 0.001). Each 1-point increase in personal morale score was associated with an 85% decrease (odds ratio: 0.15, 95% confidence interval: 0.05-0.41, P < 0.001) in the odds of intending to leave because of unhappiness. CONCLUSION: The Hospitalist Morale Index is a validated instrument that evaluates hospitalist morale across multiple dimensions of morale. The Hospitalist Morale Index may help program leaders monitor morale and develop customized and effective retention strategies. Journal of Hospital Medicine 2016;11:425-431. © 2016 Society of Hospital Medicine.


Assuntos
Médicos Hospitalares/psicologia , Moral , Reorganização de Recursos Humanos , Inquéritos e Questionários , Centros Médicos Acadêmicos , Feminino , Hospitais Comunitários , Humanos , Satisfação no Emprego , Liderança , Masculino
19.
Obstet Gynecol Clin North Am ; 42(3): 433-46, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26333633

RESUMO

The forces promoting the hospitalist model arose from the need for high-value care; therefore, improving quality and cost has been part of the hospitalist formula for success. The factors driving the rapid growth of generalist and subspecialty hospitalists include nationally mandated quality and safety measures, increasing age and complexity of the hospitalized patient, reduced residency duty hours, increased economic pressures to contain costs and reduce length of stay, and also primary care physicians, and specialists, relinquishing hospital privileges to focus on outpatient practices. Hospitalists are playing key roles in patient safety and quality as either leaders or practitioners in the field.


Assuntos
Cateterismo/métodos , Competência Clínica/normas , Ginecologia , Médicos Hospitalares , Obstetrícia , Qualidade da Assistência à Saúde/normas , Cateterismo/efeitos adversos , Feminino , Ginecologia/normas , Humanos , Obstetrícia/normas , Satisfação do Paciente , Papel do Médico , Qualidade da Assistência à Saúde/organização & administração , Estados Unidos
20.
South Med J ; 108(8): 496-501, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26280779

RESUMO

OBJECTIVES: By 2014, there were more than 40,000 hospitalists delivering the majority of inpatient care in US hospitals. No empiric research has characterized hospitalist comportment and communication patterns as they care for patients. METHODS: The chiefs of hospital medicine at five different hospitals were asked to identify their best hospitalists. These hospitalists were watched during their routine clinical care of patients. An observation tool was developed that focused on elements believed to be associated with excellent comportment and communication. One observer watched the physicians, taking detailed quantitative and qualitative field notes. RESULTS: A total of 26 hospitalists were shadowed. The mean age of the physicians was 38 years, and their average experience in hospital medicine was 6 years. The hospitalists were observed for a mean of 5 hours, during which time they saw an average of 7 patients (patient encounters observed N = 181). Physicians spent an average of 11 minutes with each patient. There was large variation in the extent to which desirable behaviors were performed. For example, most physicians (76%) started encounters with an open-ended question, and relatively few (30%) attempted to integrate nonmedical content into conversation with patients. CONCLUSIONS: This study represents a first step in trying to characterize comportment and communication in hospital medicine. Because hospitalists spend only a small proportion of their clinical time in direct patient care, it is imperative that excellent comportment and communication are clearly defined and established as a goal for every encounter.


Assuntos
Comunicação , Médicos Hospitalares/normas , Assistência ao Paciente/métodos , Papel Profissional , Adulto , Feminino , Médicos Hospitalares/psicologia , Médicos Hospitalares/tendências , Hospitais , Humanos , Masculino , Assistência ao Paciente/normas , Relações Médico-Paciente , Padrões de Prática Médica , Papel Profissional/psicologia , Qualidade da Assistência à Saúde , Inquéritos e Questionários , Estados Unidos
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