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Trost MJ, Allen AH, Naifeh M, Tseng A, McDermott A, Shah S, Winer JC, Hoefgen E, Thomson J, Dudas RA. Characteristics of Pediatric Hospital Medicine Fellowship Program Directors. Hosp Pediatr 2024; 14:e144-e149. [PMID: 38347822 DOI: 10.1542/hpeds.2023-007196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND AND OBJECTIVES Rapid growth in pediatric hospital medicine (PHM) fellowships has occurred, yielding many new program directors (PDs). Characteristics of PDs have potential implications on the field. To describe characteristics (demographic, educational) and scholarly interests of PHM fellowship PDs. METHODS We developed and distributed a 15-question, cross-sectional national survey to the PHM PDs listserv. Questions were pilot tested. The survey was open for 4 weeks with weekly reminders. Responses were summarized using descriptive statistics. RESULTS Fifty-six current fellowship leaders (40 PDs, 16 associate PDs [APDs]) responded, including at least 1 from 43 of 59 active PHM fellowship programs (73%). Most respondents identified as female (71%) and ≤50 years old (80%). Four (7%, n = 2 PD, 2 APD) leaders identified as underrepresented in medicine. About half (n = 31, 55.4%) completed a fellowship themselves (APDs > PDs; 87.5% vs 42.5%), and 53.5% (n = 30) had advanced nonmedical degrees (eg, Master of Science, Doctor of Philosophy; APDs > PDs; 62% vs 45%). Most leaders (59%, n = 33) chose multiple domains when asked to select a "primary domain of personal scholarship." Education was the most frequently selected (n = 37), followed by quality improvement (n = 29) and then clinical research (n = 19). CONCLUSIONS This survey confirms a high percentage of women as PHM fellowship leaders and highlights the need to increase diversity. Less than half of senior PDs completed a fellowship in any specialty. Leaders report interest in multiple domains of scholarship; few focus solely on clinical research.
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Affiliation(s)
- Margaret J Trost
- Division of Hospital Medicine, University of Southern California, Los Angeles, California
- Children's Hospital Los Angeles, Los Angeles, California
| | - Ann H Allen
- Department of Pediatrics, University of Wisconsin, Madison, Wisconsin
| | - Monique Naifeh
- Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Ashlie Tseng
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | | | - Snehal Shah
- Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
| | | | - Erik Hoefgen
- Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
| | | | - Robert A Dudas
- Johns Hopkins All Children's Hospital, St Petersburg, Florida
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Roberts KB, Fisher ERS, Rauch DA. The History of Pediatric Hospital Medicine in the United States, 1996-2019. J Hosp Med 2020; 15:424-427. [PMID: 32195659 DOI: 10.12788/jhm.3381] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Kenneth B Roberts
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Erin Ragan-Stucky Fisher
- Department of Pediatrics, University of California San Diego School of Medicine/Rady Children's Hospital, San Diego, California
- Rady Children's Hospital, San Diego, California
| | - Daniel A Rauch
- Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts
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3
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Bennett TD, Callahan TJ, Feinstein JA, Ghosh D, Lakhani SA, Spaeder MC, Szefler SJ, Kahn MG. Data Science for Child Health. J Pediatr 2019; 208:12-22. [PMID: 30686480 PMCID: PMC6486872 DOI: 10.1016/j.jpeds.2018.12.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/11/2018] [Accepted: 12/18/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Tellen D Bennett
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; CU Data Science to Patient Value (D2V), University of Colorado School of Medicine, Aurora, CO; Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO; Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Computational Bioscience Program, University of Colorado Denver Anschutz Medical Campus, Aurora, CO.
| | - Tiffany J Callahan
- Computational Bioscience Program, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
| | - James A Feinstein
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Debashis Ghosh
- CU Data Science to Patient Value (D2V), University of Colorado School of Medicine, Aurora, CO; Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO; Computational Bioscience Program, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
| | - Saquib A Lakhani
- Pediatric Genomics Discovery Program, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Michael C Spaeder
- Pediatric Critical Care, University of Virginia School of Medicine, Charlottesville, VA
| | - Stanley J Szefler
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Michael G Kahn
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Computational Bioscience Program, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
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4
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Stockwell DC, Landrigan CP, Toomey SL, Loren SS, Jang J, Quinn JA, Ashrafzadeh S, Wang MJ, Wu M, Sharek PJ, Classen DC, Srivastava R, Parry G, Schuster MA. Adverse Events in Hospitalized Pediatric Patients. Pediatrics 2018; 142:peds.2017-3360. [PMID: 30006445 PMCID: PMC6317760 DOI: 10.1542/peds.2017-3360] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2018] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5789657761001PEDS-VA_2017-3360Video Abstract BACKGROUND: Patient safety concerns over the past 2 decades have prompted widespread efforts to reduce adverse events (AEs). It is unclear whether these efforts have resulted in reductions in hospital-wide AE rates. We used a validated safety surveillance tool, the Global Assessment of Pediatric Patient Safety, to measure temporal trends (2007-2012) in AE rates among hospitalized children. METHODS We conducted a retrospective surveillance study of randomly selected pediatric inpatient records from 16 teaching and nonteaching hospitals. We constructed Poisson regression models with hospital random intercepts, controlling for patient age, sex, insurance, and chronic conditions, to estimate changes in AE rates over time. RESULTS Examining 3790 records, reviewers identified 414 AEs (19.1 AEs per 1000 patient days; 95% confidence interval [CI] 17.2-20.9) and 210 preventable AEs (9.5 AEs per 1000 patient days; 95% CI 8.2-10.8). On average, teaching hospitals had higher AE rates than nonteaching hospitals (26.2 [95% CI 23.7-29.0] vs 5.1 [95% CI 3.7-7.1] AEs per 1000 patient days, P < .001). Chronically ill children had higher AE rates than patients without chronic conditions (33.9 [95% CI 24.5-47.0] vs 14.0 [95% CI 11.8-16.5] AEs per 1000 patient days, P < .001). Multivariate analyses revealed no significant changes in AE rates over time. When stratified by hospital type, neither teaching nor nonteaching hospitals experienced significant temporal AE rate variations. CONCLUSIONS AE rates in pediatric inpatients are high and did not improve from 2007 to 2012. Pediatric AE rates were substantially higher in teaching hospitals as well as in patients with more chronic conditions.
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Affiliation(s)
- David C. Stockwell
- Children’s National Medical Center,
Washington, District of Columbia;,Division of Critical Care Medicine, Department of
Pediatrics, School of Medicine and Health Sciences, George Washington
University, Washington, District of Columbia
| | - Christopher P. Landrigan
- Division of General Pediatrics, Department of
Medicine, Boston Children’s Hospital, Boston, Massachusetts;,Harvard Medical School, Harvard University, Boston,
Massachusetts;,Division of Sleep Medicine, Department of Medicine,
Brigham and Women’s Hospital, Boston, Massachusetts
| | - Sara L. Toomey
- Division of General Pediatrics, Department of
Medicine, Boston Children’s Hospital, Boston, Massachusetts;,Harvard Medical School, Harvard University, Boston,
Massachusetts
| | - Samuel S. Loren
- Division of General Pediatrics, Department of
Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Jisun Jang
- Division of General Pediatrics, Department of
Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Jessica A. Quinn
- Division of General Pediatrics, Department of
Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Sepideh Ashrafzadeh
- Division of General Pediatrics, Department of
Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Michelle J. Wang
- Division of General Pediatrics, Department of
Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Melody Wu
- Division of General Pediatrics, Department of
Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Paul J. Sharek
- Division of Pediatric Hospitalist Medicine,
Department of Pediatrics, School of Medicine, Stanford University, Stanford,
California
| | - David C. Classen
- Division of Clinical Epidemiology, Department of
Internal Medicine and
| | - Rajendu Srivastava
- Division of Inpatient Medicine, Department of
Pediatrics, University of Utah, Salt Lake City, Utah;,Primary Children’s Hospital and,Institute for Healthcare Delivery Research,
Intermountain Healthcare, Salt Lake City, Utah; and
| | - Gareth Parry
- Harvard Medical School, Harvard University, Boston,
Massachusetts;,Institute for Healthcare Improvement, Cambridge,
Massachusetts
| | - Mark A. Schuster
- Division of General Pediatrics, Department of
Medicine, Boston Children’s Hospital, Boston, Massachusetts;,Harvard Medical School, Harvard University, Boston,
Massachusetts
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Hester G, Nelson K, Mahant S, Eresuma E, Keren R, Srivastava R. Methodological quality of national guidelines for pediatric inpatient conditions. J Hosp Med 2014; 9:384-90. [PMID: 24677729 PMCID: PMC4043870 DOI: 10.1002/jhm.2187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 02/11/2014] [Accepted: 02/28/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Guidelines help inform standardization of care for quality improvement (QI). The Pediatric Research in Inpatient Settings network published a prioritization list of inpatient conditions with high prevalence, cost, and variation in resource utilization across children's hospitals. The methodological quality of guidelines for priority conditions is unknown. OBJECTIVE To rate the methodological quality of national guidelines for 20 priority pediatric inpatient conditions. DESIGN We searched sources including PubMed for national guidelines published from 2002 to 2012. Guidelines specific to 1 organism, test or treatment, or institution were excluded. Guidelines were rated by 2 raters using a validated tool (Appraisal of Guidelines for Research and Evaluation) with an overall rating on a 7-point scale (7 = the highest). Inter-rater reliability was measured with a weighted kappa coefficient. RESULTS Seventeen guidelines met inclusion criteria for 13 conditions; 7 conditions yielded no relevant national guidelines. The highest methodological-quality guidelines were for asthma, tonsillectomy, and bronchiolitis (mean overall rating 7, 6.5, and 6.5, respectively); the lowest were for sickle cell disease (2 guidelines) and dental caries (mean overall rating 4, 3.5, and 3, respectively). The overall weighted kappa was 0.83 (95% confidence interval 0.78-0.87). CONCLUSIONS We identified a group of moderate to high methodological-quality national guidelines for priority pediatric inpatient conditions. Hospitals should consider these guidelines to inform QI initiatives.
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Affiliation(s)
| | | | - Sanjay Mahant
- Department of Pediatrics, SickKids, University of Toronto
- For the Pediatric Research in Inpatient Settings (PRIS) Network
| | | | - Ron Keren
- Department of Pediatrics, Children's Hospital of Philadelphia
- For the Pediatric Research in Inpatient Settings (PRIS) Network
| | - Rajendu Srivastava
- Department of Pediatrics, University of Utah
- For the Pediatric Research in Inpatient Settings (PRIS) Network
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6
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Quality improvement research in pediatric hospital medicine and the role of the Pediatric Research in Inpatient Settings (PRIS) network. Acad Pediatr 2013; 13:S54-60. [PMID: 24268086 DOI: 10.1016/j.acap.2013.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 04/03/2013] [Accepted: 04/12/2013] [Indexed: 11/20/2022]
Abstract
Pediatric hospitalists care for many hospitalized children in community and academic settings, and they must partner with administrators, other inpatient care providers, and researchers to assure the reliable delivery of high-quality, safe, evidence-based, and cost-effective care within the complex inpatient setting. Paralleling the growth of the field of pediatric hospital medicine is the realization that innovations are needed to address some of the most common clinical questions. Some of the unique challenges facing pediatric hospitalists include the lack of evidence for treating common conditions, children with chronic complex conditions, compressed time frame for admissions, and the variety of settings in which hospitalists practice. Most pediatric hospitalists are engaged in some kind of quality improvement (QI) work as hospitals provide many opportunities for QI activity and innovation. There are multiple national efforts in the pediatric hospital medicine community to improve quality, including the Children's Hospital Association (CHA) collaboratives and the Value in Pediatrics Network (VIP). Pediatric hospitalists are also challenged by the differences between QI and QI research; understanding that while improving local care is important, to provide consistent quality care to children we must study single-center and multicenter QI efforts by designing, developing, and evaluating interventions in a rigorous manner, and examine how systems variations impact implementation. The Pediatric Research in Inpatient Setting (PRIS) network is a leader in QI research and has several ongoing projects. The Prioritization project and Pediatric Health Information System Plus (PHIS+) have used administrative data to study variations in care, and the IIPE-PRIS Accelerating Safe Sign-outs (I-PASS) study highlights the potential for innovative QI research methods to improve care and clinical training. We address the importance, current state, accomplishments, and challenges of QI and QI research in pediatric hospital medicine; define the role of the PRIS Network in QI research; describe an exemplary QI research project, the I-PASS Study; address challenges for funding, training and mentorship, and publication; and identify future directions for QI research in pediatric hospital medicine.
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