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Sakumoto M, Knees M, Rogers K, Segon A, Westergaard S, Yu A, Keniston A, Burden M. Virtual hospital care development and deployment: A rapid qualitative study of frontline clinicians and leaders. J Hosp Med 2024; 19:685-692. [PMID: 38664935 DOI: 10.1002/jhm.13380] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/04/2024] [Accepted: 04/10/2024] [Indexed: 08/03/2024]
Abstract
BACKGROUND Virtual hospitalist programs are rapidly growing in popularity due to worsening clinician shortages and increased pressure for flexible work options. These programs also have the potential to establish sustainable staffing models across multiple hospitals optimizing cost. We aimed to explore the current state of virtual hospitalist services at various health systems, challenges and opportunities that exist in providing virtual care, and future opportunities for these types of services. OBJECTIVES To identify perspectives on design and implementation of virtual hospitalist programs from academic hospitalist leaders. METHODS We conducted focus groups with United States academic hospitalist leaders. Semistructured interviews explored experiences with virtual hospitalist programs. Using rapid qualitative methods including templated summaries and matrix analysis, focus group recordings were analyzed to identify key themes. RESULTS We conducted four focus groups with 13 participants representing nine hospital systems across six geographic regions and range of experience with virtual hospital medicine care. Thematic analysis identified three themes: (1) a broad spectrum of virtual care delivery; (2) adoption and acceptance of virtual care models followed the stages of diffusion of innovation; and (3) sustainability and scalability of programs were affected by unclear finances. CONCLUSIONS Hospitalist leader perspectives revealed complex factors influencing virtual care adoption and implementation. Addressing concerns about care quality, financing, and training may accelerate adoption. Further research should clarify the best practices for sustainable models optimized for access, hospitalist experience, patient safety, and financial viability.
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Affiliation(s)
| | - Michelle Knees
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kendall Rogers
- Division of Hospital Medicine, University of New Mexico Health Sciences Center, Albuquerque, Mexico, USA
| | - Ankur Segon
- Division of Hospital Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Sara Westergaard
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Amy Yu
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Angela Keniston
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Judson TJ, Longhurst CA, Horman SF. Hospitalists outside the hospital: Preparing for new settings of care delivery. J Hosp Med 2024; 19:535-538. [PMID: 38439179 DOI: 10.1002/jhm.13323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/06/2024]
Affiliation(s)
- Timothy J Judson
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Christopher A Longhurst
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
- Division of Hospital Medicine, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Sarah F Horman
- Division of Hospital Medicine, Department of Medicine, University of California San Diego, La Jolla, California, USA
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Presley CJ, Dalal N, Davenport AP, Gounden A, Ramchandran K, Tonorezos E. Survivorship in Advanced Lung Cancer: Understanding a New Landscape and Opportunities. Am Soc Clin Oncol Educ Book 2024; 44:e433298. [PMID: 38768420 DOI: 10.1200/edbk_433298] [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: 05/22/2024]
Abstract
People with advanced lung cancer represent a distinct group whose needs remain understudied, especially compared with people diagnosed with limited-stage disease. Fortunately, novel treatments such as tyrosine kinase inhibitors and immune checkpoint inhibitors are leading to significant advances in prognosis and survival, even among those with advanced disease at the time of diagnosis. However, there are known gaps in symptom management, psychosocial and nutritional support, complex care coordination, health behavior coaching, and health care delivery efforts among patients living with advanced lung cancer. Many of these patients would benefit from survivorship and palliative care approaches. In particular, survivorship care may include health care maintenance, treatment of immune-related adverse events and late- or long-term effects, frailty assessment and rehabilitation, and care coordination. Palliative care may be best suited to discuss ongoing symptom management, advanced care planning, and end-of-life considerations, as well as psychosocial well-being. To this end, we share a review of the current status of the palliative and survivorship care infrastructure for patients with advanced lung cancer and provide suggestions across the care continuum for this diverse group of patients and families.
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Affiliation(s)
- Carolyn J Presley
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Ashley P Davenport
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
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Kulkarni SA, Wachter RM. The Hospitalist Movement 25 Years Later. Annu Rev Med 2024; 75:381-390. [PMID: 37802086 DOI: 10.1146/annurev-med-051022-043301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
Hospitalists are generalists who specialize in the care of hospitalized patients. In the 25 years since the term hospitalist was coined, the field of hospital medicine has grown exponentially and established a substantial footprint in the medical community. There are now more hospitalists than practicing physicians in any other internal medicine subspecialty. Several key forces catalyzed the growth in the field of hospital medicine, including the quality, safety, and value movements; residency duty hour restrictions; the emergence of electronic health records; and the COVID-19 pandemic. Looking ahead, we see new opportunities in the realms of technology and telemedicine, and challenges persist in regard to balancing financial considerations with increasing workload and burnout. Hospitalists must remain nimble and seize emerging opportunities to continue supporting the field's prominence and growth.
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Affiliation(s)
- Shradha A Kulkarni
- Department of Medicine, University of California, San Francisco, California, USA; ,
| | - Robert M Wachter
- Department of Medicine, University of California, San Francisco, California, USA; ,
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Keniston A, Sakumoto M, Astik GJ, Auerbach A, Eid SM, Kangelaris KN, Kulkarni SA, Lee T, Leykum LK, Linker AS, Worster DT, Burden M. Adaptability on Shifting Ground: a Rapid Qualitative Assessment of Multi-institutional Inpatient Surge Planning and Workforce Deployment During the COVID-19 Pandemic. J Gen Intern Med 2022; 37:3956-3964. [PMID: 35319085 PMCID: PMC8939495 DOI: 10.1007/s11606-022-07480-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/03/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND During the initial wave of COVID-19 hospitalizations, care delivery and workforce adaptations were rapidly implemented. In response to subsequent surges of patients, institutions have deployed, modified, and/or discontinued their workforce plans. OBJECTIVE Using rapid qualitative methods, we sought to explore hospitalists' experiences with workforce deployment, types of clinicians deployed, and challenges encountered with subsequent iterations of surge planning during the COVID-19 pandemic across a collaborative of hospital medicine groups. APPROACH Using rapid qualitative methods, focus groups were conducted in partnership with the Hospital Medicine Reengineering Network (HOMERuN). We interviewed physicians, advanced practice providers (APP), and physician researchers about (1) ongoing adaptations to the workforce as a result of the COVID-19 pandemic, (2) current struggles with workforce planning, and (3) evolution of workforce planning. KEY RESULTS We conducted five focus groups with 33 individuals from 24 institutions, representing 52% of HOMERuN sites. A variety of adaptations was described by participants, some common across institutions and others specific to the institution's location and context. Adaptations implemented shifted from the first waves of COVID patients to subsequent waves. Three global themes also emerged: (1) adaptability and comfort with dynamic change, (2) the importance of the unique hospitalist skillset for effective surge planning and redeployment, and (3) the lack of universal solutions. CONCLUSIONS Hospital workforce adaptations to the COVID pandemic continued to evolve. While few approaches were universally effective in managing surges of patients, and successful adaptations were highly context dependent, the ability to navigate a complex system, adaptability, and comfort in a chaotic, dynamic environment were themes considered most critical to successful surge management. However, resource constraints and sustained high workload levels raised issues of burnout.
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Affiliation(s)
- Angela Keniston
- Division of Hospital Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, Mail Stop F782, Aurora, CO, 80045, USA.
| | - Matthew Sakumoto
- Division of General Internal Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Gopi J Astik
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrew Auerbach
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Shaker M Eid
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Kirsten N Kangelaris
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Shradha A Kulkarni
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Tiffany Lee
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Luci K Leykum
- The University of Texas at Austin, Dell Medical School, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Anne S Linker
- Division of Hospital Medicine, Mount Sinai Hospital/Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Devin T Worster
- Section of Hospital Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Application of Virtual Reality Technology in Clinical Practice, Teaching, and Research in Complementary and Alternative Medicine. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1373170. [PMID: 35990836 PMCID: PMC9388243 DOI: 10.1155/2022/1373170] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022]
Abstract
Background The application of virtual reality (VR) in clinical settings is growing rapidly, with encouraging results. As VR has been introduced into complementary and alternative medicine (CAM), a systematic review must be undertaken to understand its current status. Aim This review aims to evaluate and summarize the current applications of VR in CAM, as well as to explore potential directions for future research and development. Methods After a brief description of VR technology, we discuss the past 20 years of clinical VR applications in the medical field. Then, we discuss the theoretical basis of the combination of VR technology and CAM, the research thus far, and practical factors regarding usability, etc., from the following three main aspects: clinical application, teaching, and scientific research. Finally, we summarize and propose hypotheses on the application of VR in CAM and its limitations. Results Our review of the theoretical underpinnings and research findings to date leads to the prediction that VR and CAM will have a significant impact on future research and practice. Conclusion Although there is still much research needed to advance the science in this area, we strongly believe that VR applications will become indispensable tools in the toolbox of CAM researchers and practitioners and will only grow in relevance and popularity in the era of digital health.
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Witkowska-Zimny M, Nieradko-Iwanicka B. Telemedicine in Emergency Medicine in the COVID-19 Pandemic-Experiences and Prospects-A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8216. [PMID: 35805873 PMCID: PMC9266315 DOI: 10.3390/ijerph19138216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 02/06/2023]
Abstract
Even before the year 2020, telemedicine has been proven to contribute to the efficacy of healthcare systems, for example in remote locations or in primary care. However, with the outbreak of the COVID-19 pandemic, telehealth solutions have emerged as a key component in patient healthcare delivery and they have been widely used in emergency medicine ever since. The pandemic has led to a growth in the number of telehealth applications and improved quality of already available telemedicine solutions. The implementation of telemedicine, especially in emergency departments (EDs), has helped to prevent the spread of COVID-19 and protect healthcare workers. This narrative review focuses on the most important innovative solutions in emergency care delivery during the COVID-19 pandemic. It outlines main categories of active telehealth use in daily practice of dealing with COVID-19 patients currently, and in the future. Furthermore, it discusses benefits as well as limitations of telemedicine.
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Affiliation(s)
| | - Barbara Nieradko-Iwanicka
- Chair and Department of Hygiene and Epidemiology, Medical University of Lublin, 7 Chodzki Str., 20-093 Lublin, Poland;
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Gutierrez J, Rewerts K, CarlLee S, Kuperman E, Anderson ML, Kaboli PJ. A systematic review of telehealth applications in hospital medicine. J Hosp Med 2022; 17:291-302. [PMID: 35535926 DOI: 10.1002/jhm.12801] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/12/2022] [Accepted: 01/28/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Despite the proliferation of telehealth, uptake for acute inpatient services has been slower. Hospitalist shortages in rural and critical access hospitals as well as the COVID-19 pandemic have led to a renewed interest in telehealth to deliver acute inpatient services. Understanding current evidence is crucial for promoting uptake and developing evidence-based practices. OBJECTIVE To conduct a systematic review of telehealth applications in acute inpatient general medicine and pediatric hospital wards and synthesize available evidence. DATA SOURCES A search of five databases (PubMed, CINAHL, Embase, Scopus, and ProQuest Theses, and Dissertations) using a combination of search terms including telemedicine and hospital medicine/inpatient care keywords yielded 17,015 citations. STUDY SELECTION AND DATA EXTRACTION Two independent coders determined eligibility based on inclusion and exclusion criteria. Data were extracted and organized into main categories based on findings: (1) feasibility and planning, (2) implementation and technology, and (3) telehealth application process and outcome measures. RESULTS Of the 20 publications included, three were feasibility and planning studies describing the creation of the program, services provided, and potential cost implications. Five studies described implementation and technology used, including training, education, and evaluation methods. Finally, twelve discussed process and outcome measures, including patient and provider satisfaction and costs. CONCLUSION Telehealth services for hospital medicine were found to be effective, well received, and initial cost estimates appear favorable. A variety of services were described across programs with considerable benefit appreciated by rural and smaller hospitals. Additional work is needed to evaluate clinical outcomes and overall program costs.
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Affiliation(s)
- Jeydith Gutierrez
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, Iowa, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Kelby Rewerts
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, Iowa, USA
- The Comprehensive Access and Delivery Research and Evaluation (CADRE) Center at the Iowa City VA Healthcare System, Iowa City, Iowa, USA
| | - Sheena CarlLee
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Fayetteville, Arkansas, USA
| | - Ethan Kuperman
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Melver L Anderson
- Department of Internal Medicine, University of Colorado Anschutz School of Medicine, Denver, Colorado, USA
| | - Peter J Kaboli
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, Iowa, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- The Comprehensive Access and Delivery Research and Evaluation (CADRE) Center at the Iowa City VA Healthcare System, Iowa City, Iowa, USA
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