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 help promote cost-conscious use of medications in the hospital. OBJECTIVE:To evaluate the impact of cost messaging on the ordering of 9 expensive medications. DESIGN:Retrospective analysis of an institutional cost-transparency initiative. SETTING:A 1145-bed, tertiary care, academic medical center. PARTICIPANTS:Prescribers who ordered medications through the computerized provider order entry system at the Johns Hopkins Hospital. METHODS:Interrupted time series and segmented regression models were used to examine prescriber ordering before and after implementation of cost messaging for 9 highcost medications. RESULTS:Following the implementation of cost messaging, no significant changes were observed in the number of orders or ordering trends for intravenous (IV) formulations of eculizumab, calcitonin, levetiracetam, linezolid, mycophenolate, ribavirin, and levothyroxine. An immediate and sustained reduction in medication utilization was seen in 2 drugs that underwent a policy change during our study, IV pantoprazole and oral voriconazole. IV pantoprazole became restricted at our facility due to a national shortage (-985 orders per 10,000 patient days;
journal_name
J Hosp Medjournal_title
Journal of hospital medicineauthors
Conway S,Brotman D,Pinto B,Merola D,Feldman L,Miller R,Shermock Kdoi
10.12788/jhm.2779subject
Has Abstractpub_date
2017-08-01 00:00:00pages
639-645issue
8eissn
1553-5592issn
1553-5606journal_volume
12pub_type
杂志文章abstract：:Clozapine was approved by the US Food and Drug Administration in 1989 for the management of treatment-resistant schizophrenia, and has since proven to reduce symptom burden and suicide risk, increase quality of life, and reduce substance use in individuals with psychotic disorders. Nevertheless, clozapine's psychiatri...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,评审
doi：10.1002/jhm.2345
更新日期：2015-08-01 00:00:00
abstract：BACKGROUND:Gender earnings disparities among physicians exist even after considering differences in specialty, part-time status, and practice type. Little is known about the role of job satisfaction priorities on earnings differences. OBJECTIVE:To examine gender differences in work characteristics and job satisfaction...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.2400
更新日期：2015-08-01 00:00:00
abstract：:Physical examination (PE) is a core clinical competency, and the internal medicine clerkship is a premiere venue for students to develop PE skills. However, clinical rotations often lack opportunities for real-time instruction. We sought to measure the frequency, content, and factors affecting PE instruction during th...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.2972
更新日期：2018-06-01 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:Initiation of enteral feeding is an important part of the best practice model for critically ill patients. Although nasogastric feeding is appropriate for the majority of patients requiring short-term nutrition support, certain patients benefit greatly from postpyloric feeding. OBJECTIVE:To determine which ...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.2122
更新日期：2014-01-01 00:00:00
abstract：:For generations, American hospitals have been considered recession-proof, but there is reason to believe the current economic crisis is an exception. Hospitals have shown declining financial margins and decreased admissions. The severe recession has adversely affected many hospitals' finances, creating a risk of closu...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,评审
doi：10.1002/jhm.654
更新日期：2010-05-01 00:00:00
abstract：BACKGROUND:Despite safe and cost-effective venous thromboembolism (VTE) prevention measures, VTE prophylaxis rates are often suboptimal. Healthcare reform efforts emphasize transparency through programs to report performance and payment incentives through pay-for-performance programs. OBJECTIVE:To sequentially examine...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.2303
更新日期：2015-03-01 00:00:00
abstract：BACKGROUND:Best practice alerts (BPAs) provide clinical decision support (CDS) at the point of care to reduce unnecessary blood product transfusions, yet substantial transfusions continue outside of recommended guidelines. OBJECTIVE:To understand why providers order blood transfusions outside of recommended guidelines...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.2236
更新日期：2015-01-01 00:00:00
abstract：BACKGROUND:Although severity of illness indices such as pneumonia severity index (PSI) are good predictors of short-term mortality for community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP), other patient factors may have added prognostic value. OBJECTIVE:To identify patient factors beyond the P...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.985
更新日期：2012-03-01 00:00:00
abstract：:Physicians are notorious for poor hand hygiene (HH) compliance. We wondered if lower performance by physicians compared with other health professionals might reflect differences in the Hawthorne effect. We introduced covert HH observers to see if performance differences between physicians and nurses decreased and to g...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.2632
更新日期：2016-12-01 00:00:00
abstract：BACKGROUND:Obtaining blood cultures (BCs) for patients hospitalized with community-acquired-pneumonia (CAP) has been recommended by experts and used as a measure of quality of care. However, BCs are infrequently positive in these patients and their effect on clinical management has been questioned. PURPOSE:We performe...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,评审
doi：10.1002/jhm.382
更新日期：2009-02-01 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：: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:There are 250,000 cases of central line-associated blood stream infections in the United States annually, some of which may be prevented by the removal of lines that are no longer needed. OBJECTIVE:To test the performance of criteria to identify an idle line as a guideline to facilitate its removal. METHOD...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.2573
更新日期：2016-07-01 00:00:00
abstract：:Efforts to improve the patient experience are increasingly focusing on engaging patients and their "care partners" by using patient portals. The Acute Care Patient Portal Task Force was supported by the Gordon and Betty Moore Foundation to convene a national meeting of an interdisciplinary group of stakeholders, inclu...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.2860
更新日期：2017-12-01 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：:Improving early discharges may improve patient flow and increase hospital capacity. We conducted a national survey of academic medical centers addressing the prevalence, importance, and effectiveness of early-discharge initiatives. We assembled a list of hospitalist and general internal medicine leaders at 115 US-base...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.2885
更新日期：2018-06-01 00:00:00
abstract：:Many hospitalists are routinely granted hospital privileges to perform invasive bedside procedures, but criteria for privileging are not well described. We conducted a survey of 21 hospitalist procedure experts from the Society of Hospital Medicine Point-of-Care Ultrasound Task Force to better understand current privi...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.2837
更新日期：2017-10-01 00:00:00
abstract：BACKGROUND:High-flow nasal cannula (HFNC) is increasingly used to treat children hospitalized with bronchiolitis; however, the best practices for feeding during HFNC and the impact of feeding on time to discharge and adverse events are unknown. The study objective was to assess whether feeding exposure during HFNC was ...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.3306
更新日期：2019-09-18 00:00:00
abstract：BACKGROUND:Academic medical centers (AMCs) have a constrained resident work force. Many AMCs have increased the use of nonresident service hospitalists to manage continued growth in clinical volume. To optimize their time in the hospital, it is important to understand hospitalists' work flow. DESIGN:We performed a tim...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.613
更新日期：2010-07-01 00:00:00
abstract：: ...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.3114
更新日期：2019-01-01 00:00:00
abstract：BACKGROUND:Increasing use of testing among hospitalized patients has resulted in an increase in radiologic incidental findings (IFs), which challenge the provision of high-value care in the hospital setting. OBJECTIVE:To understand impact of radiologic incidental findings on resource utilization in patients hospitaliz...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.2722
更新日期：2017-05-01 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
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：:Every year, nearly 5 million adults with cancer are hospitalized. Limited evidence suggests that hospitalization of the cancer patient is associated with adverse morbidity and mortality. Hospitalization of the patient with advanced cancer allows for an intense examination of health status in the face of terminal illne...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,评审
doi：10.1002/jhm.2511
更新日期：2016-04-01 00:00:00
abstract：BACKGROUND:Readmission to a different hospital than the original discharge hospital may result in breakdowns in continuity of care. In different-hospital readmissions (DHRs), continuity can be maintained when hospitals are connected through health information exchange (HIE) systems. OBJECTIVE:To examine whether length...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.2535
更新日期：2016-06-01 00:00:00
abstract：:Depression among hospitalized patients is often unrecognized, undiagnosed, and therefore untreated. Little is known about the feasibility of screening for depression during hospitalization, or whether depression is associated with poorer outcomes, longer hospital stays, and higher readmission rates. We searched PubMed...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,评审
doi：10.12788/jhm.2693
更新日期：2017-02-01 00:00:00
abstract：:Registry data indicate a gap between evidence-based guidelines and current management of patients with acute decompensated heart failure (ADHF). Bridging this gap is crucial given the frequency and cost of hospitalization for this disorder. Patients with ADHF require rapid assessment to determine appropriate treatment...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,评审
doi：10.1002/jhm.395
更新日期：2008-11-01 00:00:00
abstract：BACKGROUND:Unplanned (unexpected) transfers to the intensive care unit (ICU) are typically preceded by physiologic instability. However, trends toward instability may be subtle and not accurately reflected by changes in vital signs. The shock index (SI) (heart rate/systolic blood pressure as an indicator of left ventri...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.779
更新日期：2010-10-01 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
