Abstract：
BACKGROUND:Increased recognition of ionizing radiation risks has placed an emphasis on the appropriate use of myocardial perfusion imaging (MPI). Hospitalists frequently order MPI in the evaluation of chest pain and are thus at the forefront of its inpatient utilization. METHODS:We collected baseline figures for a group MPI rate (March 2010-February 2011) as well as individual MPI rates for hospitalists caring for cardiac floor patients at a community teaching hospital. We performed a 2-part intervention; we presented the individual MPI rate data back to the hospitalist division and carried out longitudinal educational efforts on MPI appropriateness criteria. We then calculated the group MPI utilization rate for 3 postintervention periods (March 2011-February 2012, March 2012-February 2013, and March 2013-February 2014) and the MPI rate for the subgroup of cardiac floor patients. Finally, we calculated the percentage of inappropriately performed stress tests before and after our intervention. RESULTS:Group MPI rate declined from 6.1% to 5.0% in the first year after our intervention (P = 0.009); a decrease was maintained a year later-MPI rate 4.9% (P = 0.004)-and became even more pronounced 2 years later-MPI rate 3.9% (P < 0.0001). The MPI rate for the subgroup of patients on the cardiac floor similarly decreased from 8.0% to 6.7% (P = 0.039). Finally, we report a particularly encouraging and significant trend of a 46% postintervention decrease (from 16.5% to 9%, P = 0.034) in the proportion of inappropriate stress tests ordered. CONCLUSIONS:Analyzing individual ordering rates and combining them with educational efforts was an effective strategy for impacting MPI utilization in the hospitalist group studied.
journal_name
J Hosp Medjournal_title
Journal of hospital medicineauthors
Bohossian HB,Park AW,Holcroft Cdoi
10.1002/jhm.2288subject
Has Abstractpub_date
2015-03-01 00:00:00pages
190-3issue
3eissn
1553-5592issn
1553-5606journal_volume
10pub_type
杂志文章abstract：:Increasing numbers of serious hospital/healthcare- or community-acquired infections are caused by resistant (often multi-drug resistant) bacterial pathogens. Because delayed or ineffective initial therapy can have severe negative consequences, patients at risk for these types of infections typically receive initial em...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,评审
doi：10.1002/jhm.983
更新日期：2012-01-01 00:00:00
abstract：OBJECTIVES:Guidelines recommend pharmacologic prophylaxis for hospitalized medical patients at increased risk of thromboembolism. Despite recommendations, multiple studies demonstrate underutilization. Factors contributing to underutilization include uncertainty that prophylaxis reduces clinically relevant events, as w...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,meta分析
doi：10.1002/jhm.450
更新日期：2009-05-01 00:00:00
abstract：:Interstitial lung disease (ILD) is a diverse group of disorders typically with insidious onset. Diagnosis and management largely occur in the outpatient setting; however, ILD can present acutely necessitating hospitalization. Effective inpatient management requires the clinician to establish an accurate diagnosis and ...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,评审
doi：10.12788/jhm.2774
更新日期：2017-07-01 00:00:00
abstract：IMPORTANCE:There is an increasing trend toward designing hospitals with patient-centered features like reduced noise, improved natural light, visitor friendly facilities, well-decorated rooms, and hotel-like amenities. It has also been suggested that because patients cannot reliably distinguish positive experiences wit...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.2297
更新日期：2015-03-01 00:00:00
abstract：:Hyponatremia is relatively common in patients admitted with pneumonia, and it is associated with higher disease severity. The precise mechanism is incompletely understood, but the syndrome of inappropriate antidiuretic hormone secretion is felt to play a significant role. Traditional options to manage hyponatremia in ...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,评审
doi：10.1002/jhm.1933
更新日期：2012-04-01 00:00:00
abstract：BACKGROUND:A lack of cost-conscious medication use is a major contributor to excessive healthcare expenditures in the inpatient setting. Expensive medicines are often utilized when there are comparable alternatives available at a lower cost. Increasing prescriber awareness of medication cost at the time of ordering may...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.2779
更新日期：2017-08-01 00:00:00
abstract：:Only 1 of 8 stroke patients is managed exclusively by a neurologist. Furthermore, many stroke patients harbor other vascular comorbidities and are also at risk for developing general medical complications that can lead to death following stroke. With the growing hospitalist system, it is quite clear that hospitalists ...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,评审
doi：10.1002/jhm.147
更新日期：2007-01-01 00:00:00
abstract：BACKGROUND:In the hospitalized patient, nephrotoxin exposure is one potentially modifiable risk factor for acute kidney injury (AKI). Clinical decision support based on nephrotoxin ordering was developed at our hospital to assist inpatient providers with the prevention or mitigation of nephrotoxin-related AKI. The init...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.3196
更新日期：2019-08-01 00:00:00
abstract：BACKGROUND AND OBJECTIVE:Previous local quality improvement focused on discharging patients with inhaled corticosteroids (ICS) "in-hand" decreased healthcare reutilization after hospitalization for an asthma exacerbation. However, as a result of these new processes, some patients admitted for an asthma exacerbation rec...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.3275
更新日期：2020-01-01 00:00:00
abstract：BACKGROUND:No national policy requires health care providers to discuss with hospitalized patients whether the latter would want cardiopulmonary resuscitation (CPR) or mechanical ventilation (MV) in the event of cardiopulmonary failure. OBJECTIVE:To determine whether hospitalized patients are willing to discuss end-of...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,随机对照试验
doi：10.1002/jhm.78
更新日期：2006-05-01 00:00:00
abstract：:Many children's hospitals are actively working to reduce readmissions to improve care and avoid financial penalties. We sought to determine if pediatric readmission rates have changed over time. We used data from 66 hospitals in the Inpatient Essentials Database including index hospitalizations from January, 2010 thro...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.3210
更新日期：2019-10-01 00:00:00
abstract：:The accountable care organization (ACO) concept is advocated as a promising value-based payment model that could successfully realign the current payment system to financially reward improvements in quality and efficiency. Focusing on the care of hospitalized patients and controlling a substantive portion of variable ...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.2965
更新日期：2018-04-01 00:00:00
abstract：BACKGROUND:Patient-centered care has been identified as 1 of the 6 aims for the 21st century healthcare system. The notepad is a simple tool for reminders and personal interactions. We introduced Dear Doctor (DD) notes, a bedside notepad designed to prompt patient questions and improve patient satisfaction. OBJECTIVE:...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.2073
更新日期：2013-10-01 00:00:00
abstract：:The objective of this study was to measure internal medicine resident engagement with an electronic medical record-based dashboard providing feedback on their use of routine laboratory tests relative to service averages. From January 2016 to June 2016, residents were e-mailed a snapshot of their personalized dashboard...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.2811
更新日期：2017-09-01 00:00:00
abstract：OBJECTIVE:We examined the impact of an aspart insulin protocol for treatment of hyperglycemia in the emergency department (ED) coupled with rapid initiation of a detemir-aspart insulin protocol for patients admitted to the hospital. RESEARCH DESIGN AND METHODS:ED patients with type 2 diabetes mellitus and a blood gluc...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,随机对照试验
doi：10.1002/jhm.866
更新日期：2011-05-01 00:00:00
abstract：BACKGROUND:Hospital leaders have had mixed success reducing readmissions Little is known about the readmitted patient's perspective. METHODS:A cross-sectional 36-item survey was administered to 1084 readmitted inpatients of The Hospital of the University of Pennsylvania (an urban academic medical center) and Penn Pres...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.1966
更新日期：2012-11-01 00:00:00
abstract：OBJECTIVE:To explore why it is permissible for surgeons to "unilaterally withhold" surgery, whereas it is not commonplace (in the United States) to unilaterally withhold cardiopulmonary resuscitation (CPR) for clinical situations with similar degrees of uncertainty and prognosis. DATA SOURCES:The medical literature wa...
journal_title：Journal of hospital medicine
pub_type： 社论
doi：10.1002/jhm.986
更新日期：2012-03-01 00:00:00
abstract：BACKGROUND:High hospital occupancy is a challenge for quality of care and access, while low levels of occupancy may be inefficient in terms of resource utilization. Variability from scheduling decisions may affect occupancy and be amenable to alteration. OBJECTIVE:Describe variability in admission, discharge, and occu...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.819
更新日期：2011-02-01 00:00:00
abstract：BACKGROUND:Hospitalized patients with diabetes have experienced a disproportionate reduction in mortality over the past decade. OBJECTIVE:To examine whether this differential decrease affected all patients with diabetes, and to identify explanatory factors. DESIGN:Serial, cross-sectional observational study. SETTING...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.2321
更新日期：2015-04-01 00:00:00
abstract：BACKGROUND:Peripheral intravenous catheter (PIVC) use in health care is common worldwide. Failure of PIVCs is also common, resulting in premature removal and replacement. OBJECTIVE:To investigate the characteristics, management practices, and outcomes of PIVCs internationally. DESIGN: SETTING/PATIENTS:Cross-sectiona...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.3039
更新日期：2018-05-30 00:00:00
abstract：:Over the past 10 years, postdischarge clinics have been introduced in response to various health system pressures, including the focus on rehospitalizations and the challenges of primary care access. Often ignored in the discussion are questions of the effect of postdischarge physician visits on readmissions. In addit...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,评审
doi：10.12788/jhm.2750
更新日期：2017-06-01 00:00:00
abstract：BACKGROUND:Access to hand-carried ultrasound technology for noncardiologists has increased significantly, yet development and evaluation of training programs are limited. OBJECTIVE:We studied a focused program to teach hospitalists image acquisition of inferior vena cava (IVC) diameter and IVC collapsibility index wit...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.2103
更新日期：2013-12-01 00:00:00
abstract：:Esophageal variceal bleeding (EVB) is a frequent complication in cirrhotic patients resulting in considerable mortality and morbidity. The aim of this study was to investigate the occurrence, impact, and trends of EVB in hospitalized cirrhotic patients on a nationwide level in the United States. We interrogated data f...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.2360
更新日期：2015-07-01 00:00:00
abstract：BACKGROUND:Patients and their relatives exposed to mental stress caused by hospitalization or illness might use violence against healthcare staff and interfere with quality healthcare. OBJECTIVE:The aim of this study was to investigate incidences of workplace violence and the attributes of healthcare staff who are at ...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.976
更新日期：2012-02-01 00:00:00
abstract：:Women continue to be underrepresented as speakers at national conferences, and research has shown similar trends in hospital medicine. The Society of Hospital Medicine (SHM) Annual Meeting has historically had an open call peer review process for workshop speakers and, in 2019, expanded the process for didactic speake...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.3401
更新日期：2020-04-01 00:00:00
abstract：:Posttraumatic stress disorder (PTSD) is common in the United States, with a prevalence of nearly 8% in the general population and between 10% and 30% in veterans. Despite how common PTSD is, inpatient providers may not be familiar with its manifestations or feel comfortable taking care of patients who may exhibit symp...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,评审
doi：10.12788/jhm.3409
更新日期：2021-01-01 00:00:00
abstract：BACKGROUND:Experts and national regulatory bodies have deemed femoral vein catheterization (FVC) unsafe, and recommend avoiding it whenever possible. OBJECTIVE:To assess rates of catheter-related bloodstream infections (CRBI) and deep venous thrombosis (DVT) complicating FVC. DESIGN:Prospective observational cohort s...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.696
更新日期：2011-01-01 00:00:00
abstract：BACKGROUND:Asymptomatic blood pressure elevation is common in the inpatient setting. National guidelines recommend treating with oral agents to slowly decrease blood pressure; however, many clinicians use intravenous antihypertensive medications, which can lead to unpredictable changes in blood pressure. OBJECTIVE:To ...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.3190
更新日期：2019-03-01 00:00:00
abstract：BACKGROUND:Specialty hospitals are a subset of acute-care hospitals that provide a narrower set of services than general medical hospitals (GMHs), predominantly in areas such as cardiac disease and surgery. Although specialty hospitals also advertise high patient satisfaction, this has not been examined using national ...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.2225
更新日期：2014-09-01 00:00:00
abstract：BACKGROUND:Efforts to curb healthcare spending have included interventions that target frequently hospitalized individuals. It is unclear the extent to which the most frequently hospitalized individuals also represent the costliest individuals. OBJECTIVE:To examine the relationship between 2 types of "high users" comm...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.2096
更新日期：2013-12-01 00:00:00
