Abstract:
BACKGROUND:Many academic hospitals have implemented overnight hospitalists to supervise house staff and improve outcomes, but few studies have described the impact of this role. OBJECTIVE:To investigate the effect of an overnight academic hospitalist program on patient-level outcomes. Secondary objectives were to describe the program's revenue generation and work tasks. DESIGN:Retrospective interrupted time-series analysis of patients admitted to the medicine service before and after implementation of the program. PARTICIPANTS:All patients aged 18 and older admitted to the acute or intermediate care units between 7:00 p.m. and 6:59 a.m. during the period before (April 2011-August 2012) and after (September 2012-April 2014) program implementation. INTERVENTION:An on-site attending-level physician directly supervising medicine house staff overnight, providing clinical care during high-volume periods, and ensuring safe handoffs to daytime providers. MAIN MEASURES:Primary outcomes included in-hospital mortality, 30-day hospital readmissions, length of stay, and upgrades in care on the night of admission and during hospitalization. Multivariable models estimated the effect on outcomes after adjusting for secular trends. Revenue generation and work tasks are reported descriptively. KEY RESULTS:During the study period, 6484 patients were admitted to the medicine service: 2722 (42 %) before and 3762 (58 %) after implementation. No differences were found in mortality (1.1 % vs. 0.9 %, p=0.38), 30-day readmissions (14.8 % vs. 15.6 %, p=0.39), mean length of stay (3.09 vs. 3.08 days, p=0.86), or upgrades to intensive care on the night of admission (0.4 % vs. 0.7 %, p=0.11) or during hospitalization (3.5 % vs. 4.2 %, p=0.20). During the first year, hospitalists billed 1209 patient encounters (3.3/shift) and 63 procedures (0.2/shift), and supervised 1939 patient admissions (6.12/shift) while supervising house staff 3-h/shifts. CONCLUSIONS:Implementation of an overnight academic hospitalist program showed no impact on several important clinical outcomes, and revenue generation was modest. As overnight hospitalist programs develop, investigations are needed to delineate the return on investment and focus on other outcomes that may be more sensitive to change, such as errors and provider/patient satisfaction.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Gonzalo JD,Kuperman EF,Chuang CH,Lehman E,Glasser F,Abendroth Tdoi
10.1007/s11606-015-3389-0subject
Has Abstractpub_date
2015-12-01 00:00:00pages
1795-802issue
12eissn
0884-8734issn
1525-1497pii
10.1007/s11606-015-3389-0journal_volume
30pub_type
杂志文章abstract:BACKGROUND:Little information exists regarding the impact of Medicare Part D on generic drug use. OBJECTIVE:To examine changes in the use of generic prescriptions attributable to Part D among a sample of Medicare beneficiaries. DESIGN, PARTICIPANTS, AND MEASUREMENTS:Difference-in-difference analysis of pharmacy claim...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-008-0742-6
更新日期:2008-10-01 00:00:00
abstract:BACKGROUND:Pregnancy and its impact on graduate medical training are not well understood. OBJECTIVE:To examine the effect of gender and pregnancy for Internal Medicine (IM) residents on evaluations by peers and faculty. DESIGN:This was a retrospective cohort study. SUBJECTS:All IM residents in training from July 1, ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-017-4010-5
更新日期:2017-06-01 00:00:00
abstract:BACKGROUND:Experts suggest an individualized approach to colon cancer screening to take into account variation in older adults' life expectancies and potential to benefit from screening. However, little is known about how physicians make decisions about colon cancer screening in adults age 75 and older. OBJECTIVE:To u...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-009-1006-9
更新日期:2009-07-01 00:00:00
abstract:BACKGROUND:The World Health Organization encourages the development of youth friendly services, yet little is known on how youth currently present in general practice. OBJECTIVE:To describe the perspectives, expectations, and service receipt of young people presenting to family doctors to inform the development of you...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0177-5
更新日期:2007-06-01 00:00:00
abstract::Decision analysis is a tool that clinicians can use to choose an option that maximizes the overall net benefit to a patient. It is an explicit, quantitative, and systematic approach to decision making under conditions of uncertainty. In this article, we present two teaching tips aimed at helping clinical learners unde...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-009-0918-8
更新日期:2009-05-01 00:00:00
abstract:OBJECTIVE:Heart failure (HF) is a leading cause of hospitalization. Clinical and socio-demographic factors have been associated with cardiac admissions, but little is known about the role of anxiety. We examined whether symptoms of anxiety were associated with cardiac hospitalizations at 12 months in HF patients. METH...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-011-1843-1
更新日期:2012-03-01 00:00:00
abstract::The quality of diabetes care delivered to patients falls below the expectations of practice guidelines and clinical trial evidence. Studies in many jurisdictions with varying health care systems have shown that recommended processes of care occur less often than they should; hence, outcomes of care are inadequate. Man...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-006-0027-x
更新日期:2007-02-01 00:00:00
abstract:BACKGROUND:Health-related quality of life (HRQoL) has become an important facet of HIV/AIDS research. Typically, the unit of analysis is either the total instrument score or subscale score. Developing a typology of responses across various HRQoL measures, however, may advance understating of patients' perspectives. ME...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2006.00645.x
更新日期:2006-12-01 00:00:00
abstract:BACKGROUND:Early in medical education, physicians must develop competencies needed for tobacco dependence treatment. OBJECTIVE:To assess the effect of a multi-modal tobacco dependence treatment curriculum on medical students' counseling skills. DESIGN:A group-randomized controlled trial (2010-2014) included ten U.S. ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1007/s11606-015-3508-y
更新日期:2016-02-01 00:00:00
abstract:PURPOSE:Studies show that measures of physician and medical students' empathy decline with clinical training. Presently, there are limited data relating self-reported measures to observed behavior. This study explores a self-reported measure and observed empathy in medical students. METHOD:Students in the Class of 200...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-009-1193-4
更新日期:2010-03-01 00:00:00
abstract::Starfield and colleagues have suggested four overarching attributes of good primary care: "first-contact access for each need; long-term person- (not disease) focused care; comprehensive care for most health needs; and coordinated care when it must be sought elsewhere." As this series on reinventing primary care highl...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-016-3945-2
更新日期:2017-04-01 00:00:00
abstract:BACKGROUND:Little is known about the quality of the patient-physician relationship for terminally ill African Americans. OBJECTIVE:To compare the quality of the patient-physician relationship between African-American and white patients and examine the extent to which relationship quality contributes to differences in ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0370-6
更新日期:2007-11-01 00:00:00
abstract:BACKGROUND:Despite evidence of inadequate physical examination skills among medical students, teaching these skills has declined. One method of enhancing inspection skills is teaching "visual literacy," the ability to reason physiology and pathophysiology from careful and unbiased observation. OBJECTIVE:To improve stu...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-008-0667-0
更新日期:2008-07-01 00:00:00
abstract:OBJECTIVE:To develop a patient-based classification system to describe the clinical content of ambulatory medicine practices. DESIGN:A system of 100 diagnosis clusters was developed based on retrospective review of computerized problem lists of patients from a university practice, and then applied to the problem lists...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599394
更新日期:1991-01-01 00:00:00
abstract:OBJECTIVE:Translating lessons from clinical trials on the prevention or delay of type 2 diabetes to populations in nonstudy settings remains a challenge. The purpose of this paper is to review, from the perspective of practicing clinicians, available evidence on lifestyle interventions or medication to prevent or delay...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1111/j.1525-1497.2005.0277.x
更新日期:2006-01-01 00:00:00
abstract:OBJECTIVE:To determine whether physicians at a general internal medicine clinic spend more time with non-English-speaking patients. DESIGN:A time-motion study comparing physician time spent with non-English-speaking patients and time spent with English-speaking patients during 5 months of observation. We also tested p...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1999.00338.x
更新日期:1999-05-01 00:00:00
abstract:BACKGROUND:Although hip fractures in older adults are associated with a high degree of mortality and disability, the use of advance care planning (ACP) in this population is unknown. OBJECTIVE:To determine the prevalence of ACP and need for surrogate decision-making prior to death in older adults with hip fracture and...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-05644-1
更新日期:2020-07-01 00:00:00
abstract:BACKGROUND:Medical weblogs ("blogs") have emerged as a new connection between health professionals and the public. OBJECTIVE:To examine the scope and content of medical blogs and approximate how often blog authors commented about patients, violated patient privacy, or displayed a lack of professionalism. DESIGN:We de...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-008-0726-6
更新日期:2008-10-01 00:00:00
abstract:BACKGROUND:For more than a decade, the presence of diabetes has been considered a coronary heart disease (CHD) "risk equivalent". OBJECTIVE:The objective of this study was to revisit the concept of risk equivalence by comparing the risk of subsequent CHD events among individuals with or without history of diabetes or ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-015-3556-3
更新日期:2016-04-01 00:00:00
abstract:BACKGROUND:This study assesses the rate and predictors of treatment retention for primary care patients with opioid dependence-prescribed buprenorphine, a long-acting partial opioid agonist. METHODS:Observational cohort study of patients prescribed buprenorphine/naloxone and followed for 6 months in the period after t...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2005.0228.x
更新日期:2005-11-01 00:00:00
abstract:BACKGROUND:Hemophilia A is a rare, sex-linked genetic disorder treated with intravenous administration of factor VIII (FVIII) to prevent bleeding; however, approaches vary across and within countries. Value-of-information (VOI) methods identify situations in which the cost-benefit evidence is sufficient to adopt one tr...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-014-2880-3
更新日期:2014-08-01 00:00:00
abstract:BACKGROUND:Fewer than half of the US population has an advance healthcare directive. Hospitalizations offer a key opportunity for clinicians to engage patients in advance care planning (ACP) conversations. Guidelines suggest screening for the presence of "serious illness" but do not further specify how to prioritize th...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-06150-0
更新日期:2020-08-20 00:00:00
abstract::The community of health services researchers in general internal medicine has played an important role in affecting health policy at the national and state levels. Community-based participatory research (CBPR) offers health services researchers an opportunity to identify and address health policy questions at the loca...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-011-1878-3
更新日期:2011-12-01 00:00:00
abstract:BACKGROUND:Inadequate pain assessment is a barrier to appropriate pain management, but single-item "pain screening" provides limited information about chronic pain. Multidimensional pain measures such as the Brief Pain Inventory (BPI) are widely used in pain specialty and research settings, but are impractical for prim...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-009-0981-1
更新日期:2009-06-01 00:00:00
abstract:OBJECTIVE:To determine whether a Bayesian method of lung scan (LS) reporting could influence the management of patients with suspected pulmonary embolism (PE). DESIGN:1) A descriptive study of the diagnostic process for suspected PE using the new reporting method; 2) a non-experimental evaluation of the reporting meth...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02600392
更新日期:1990-07-01 00:00:00
abstract:BACKGROUND:Type 2 diabetes patients often initiate treatment with a sulfonylurea and subsequently intensify their therapy with insulin. However, information on optimal treatment regimens for these patients is limited. OBJECTIVE:To compare risk of cardiovascular disease (CVD) and hypoglycemia between sulfonylurea initi...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-016-3633-2
更新日期:2016-06-01 00:00:00
abstract:CASE REPORT:A 32-year-old African male presented with 10 hours of severe back pain. Initial computed tomography scan of the back showed no abnormality, and initial laboratory investigations were consistent with rhabdomyolysis. Despite stopping potential causative medications, aggressive intravenous hydration, and urine...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-008-0569-1
更新日期:2008-06-01 00:00:00
abstract:BACKGROUND:Obesity and its related co-morbidities place a huge burden on the health care system. Patients who know they are obese may better control their weight or seek medical attention. Self-recognition may be affected by race/ethnicity, but little is known about racial/ethnic differences in knowledge of obesity's h...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-010-1623-3
更新日期:2011-06-01 00:00:00
abstract::This report examines alternative methods of paying for clinical preventive care services. First, the extent of coverage of preventive health care services in public and private health insurance plans is reviewed. Included in this review are Medicare, Medicaid, health maintenance organizations, and private health insur...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02600851
更新日期:1990-09-01 00:00:00
abstract:BACKGROUND:Studies examining the effectiveness of pay-for-performance programs to improve quality of care primarily have been confined to bonus-type arrangements that reward providers for performance above a predetermined threshold. No studies to date have evaluated programs placing providers at financial risk for perf...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0185-5
更新日期:2007-06-01 00:00:00