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Miyawaki A, Jena AB, Rotenstein LS, Tsugawa Y. Comparison of Hospital Mortality and Readmission Rates by Physician and Patient Sex. Ann Intern Med 2024; 177:598-608. [PMID: 38648639 DOI: 10.7326/m23-3163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Little is known as to whether the effects of physician sex on patients' clinical outcomes vary by patient sex. OBJECTIVE To examine whether the association between physician sex and hospital outcomes varied between female and male patients hospitalized with medical conditions. DESIGN Retrospective observational study. SETTING Medicare claims data. PATIENTS 20% random sample of Medicare fee-for-service beneficiaries hospitalized with medical conditions during 2016 to 2019 and treated by hospitalists. MEASUREMENTS The primary outcomes were patients' 30-day mortality and readmission rates, adjusted for patient and physician characteristics and hospital-level averages of exposures (effectively comparing physicians within the same hospital). RESULTS Of 458 108 female and 318 819 male patients, 142 465 (31.1%) and 97 500 (30.6%) were treated by female physicians, respectively. Both female and male patients had a lower patient mortality when treated by female physicians; however, the benefit of receiving care from female physicians was larger for female patients than for male patients (difference-in-differences, -0.16 percentage points [pp] [95% CI, -0.42 to 0.10 pp]). For female patients, the difference between female and male physicians was large and clinically meaningful (adjusted mortality rates, 8.15% vs. 8.38%; average marginal effect [AME], -0.24 pp [CI, -0.41 to -0.07 pp]). For male patients, an important difference between female and male physicians could be ruled out (10.15% vs. 10.23%; AME, -0.08 pp [CI, -0.29 to 0.14 pp]). The pattern was similar for patients' readmission rates. LIMITATION The findings may not be generalizable to younger populations. CONCLUSION The findings indicate that patients have lower mortality and readmission rates when treated by female physicians, and the benefit of receiving treatments from female physicians is larger for female patients than for male patients. PRIMARY FUNDING SOURCE Gregory Annenberg Weingarten, GRoW @ Annenberg.
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Affiliation(s)
- Atsushi Miyawaki
- Department of Health Services Research and Department of Public Health, Graduate School of Medicine, and Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan (A.M.)
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, Department of Medicine, Massachusetts General Hospital, Boston, and National Bureau of Economic Research, Cambridge, Massachusetts (A.B.J.)
| | - Lisa S Rotenstein
- Divisions of General Internal Medicine and Clinical Informatics, University of California at San Francisco, San Francisco, California, and Center for Physician Experience and Practice Excellence, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts (L.S.R.)
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, and Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California (Y.T.)
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Perez R, Yarrington ME, Deri CR, Smith MJ, Hayes J, Wrenn RH, Moehring RW. Teams in Transition: Increasing Role of Advanced Practice Providers in Antimicrobial Use and Infectious Diseases Consultation. Open Forum Infect Dis 2024; 11:ofae141. [PMID: 38577030 PMCID: PMC10993059 DOI: 10.1093/ofid/ofae141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/11/2024] [Indexed: 04/06/2024] Open
Abstract
Background Advanced practice providers (APPs) have taken on increasing responsibilities as primary team members in acute care hospitals, but the impact of this practice shift on antimicrobial prescribing and infectious diseases (ID) consultation requests is unknown. Here we describe longitudinal trends in antimicrobial days of therapy (DOT) and ID consultation by attributed provider type in 3 hospitals. Methods We performed a retrospective time series analysis of antimicrobial use and ID consultation from July 2015 to June 2022 at a major university hospital and 2 community hospitals. We evaluated antimicrobial DOT and ID consultation over time and assessed attribution to 3 groups of providers: attending physicians, trainees, and APPs. We used multinomial logistic regression to measure changes in percentage of DOT and ID consultation across the clinician groups over time using physicians as the referent. Results Baseline distribution of antimicrobial DOT and ID consultation varied by practice setting, but all subgroups showed increases in the proportion attributable to APPs. Large increases were seen in the rate of ID consultation, increasing by >30% during the study period. At our university hospital, by study end >40% of new ID consults and restricted antimicrobial days were attributed to APPs. Conclusions Hospitals had differing baseline patterns of DOT attributed to provider groups, but all experienced increases in DOT attributed to APPs. Similar increases were seen in changes to ID consultation. APPs have increasing involvement in antimicrobial use decisions in the inpatient setting and should be engaged in future antimicrobial stewardship initiatives.
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Affiliation(s)
- Reinaldo Perez
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Department of Medicine, Duke Center for Antimicrobial Stewardship and Infection Prevention, Department of Medicine, Durham, North Carolina, USA
| | - Michael E Yarrington
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Department of Medicine, Duke Center for Antimicrobial Stewardship and Infection Prevention, Department of Medicine, Durham, North Carolina, USA
| | - Connor R Deri
- Department of Pharmacy, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael J Smith
- Department of Medicine, Duke Center for Antimicrobial Stewardship and Infection Prevention, Department of Medicine, Durham, North Carolina, USA
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Jillian Hayes
- Department of Pharmacy, Duke University Medical Center, Durham, North Carolina, USA
| | - Rebekah H Wrenn
- Department of Pharmacy, Duke University Medical Center, Durham, North Carolina, USA
| | - Rebekah W Moehring
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Department of Medicine, Duke Center for Antimicrobial Stewardship and Infection Prevention, Department of Medicine, Durham, North Carolina, USA
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Khoo JEJ, Lim CW, Lai YF. Performance management of generalist care for hospitalised multimorbid patients-a scoping review for value-based care. FRONTIERS IN HEALTH SERVICES 2024; 3:1147565. [PMID: 38469170 PMCID: PMC10925702 DOI: 10.3389/frhs.2023.1147565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 12/29/2023] [Indexed: 03/13/2024]
Abstract
Objectives Given the shift towards value-based healthcare and the increasing recognition of generalist care, enacting value-based healthcare for generalist care is critical. This work aims to shed light on how to conduct performance management of generalist care to facilitate value-based care, with a focus on medical care of hospitalised patients. Design and setting A scoping review of published literature was conducted. 30 publications which were relevant to performance management of generalist medical inpatient care were included in the review. Outcome measures The performance measures used across the studies were analysed and other qualitative findings were also obtained. Results We report an overall lack of research on performance management methods for generalist inpatient care. Relevant performance measures found include both outcome and process of care measures and both clinical and reported measures, with clinical outcome measures the most frequently reported. Length of stay, readmission rates and mortality were the most frequently reported. The insights from the papers emphasise the relevance of process of care measures for performance management, the advantages and disadvantages of types of measures and provide suggestions relevant for performance management of generalist inpatient care. Conclusion The findings of this scoping review outline a variety of performance measures valuable for generalist inpatient care including clinical outcome measures, reported outcome measures and process of care measures. The findings also suggest directions for implementation of such performance management, including emphasis on physician level performance management and the importance of documentation training. Further research for selecting and operationalising the measures for specific contexts and developing a comprehensive performance management system involving these measures will be important for achieving value-based healthcare for generalist inpatient care.
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Affiliation(s)
- Jia En Joy Khoo
- Ministry of Health (MOH) Office for Healthcare Transformation, Singapore, Singapore
- Department of Life Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Cher Wee Lim
- Ministry of Health (MOH) Office for Healthcare Transformation, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Yi Feng Lai
- Ministry of Health (MOH) Office for Healthcare Transformation, Singapore, Singapore
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
- School of Public Health, University of Illinois at Chicago, Chicago, IL, United States
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Millwee S, Hall MAK. An Effective Model for Unit-Based Advanced Practice Provider/Physician Collaboration on a Complex Medicine Hospital Unit. J Nurs Adm 2022; 52:449-451. [PMID: 35994600 DOI: 10.1097/nna.0000000000001181] [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: 11/25/2022]
Abstract
Advanced practice provider care effectively improves outcomes and reduces costs. During COVID-19 challenges and staffing shortages, a team developed and piloted a collaborative advanced practice provider/physician hospital medicine model that resulted in improved outcomes, costs, and quality metrics, including increased productivity and revenue, decreased length of stay, and decreased medical emergency team/rapid response calls.
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Affiliation(s)
- Sara Millwee
- Author Affiliations: Chief of Advanced Practice Providers for Hospital Medicine (Dr Millwee), Emory Healthcare; Adjunct Faculty (Dr Millwee), Nell Hodgson Woodruff School of Nursing; and Senior Medical Writer (Ms Hall), Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia
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Singh A, Klimpl D, Kisuule F, Cardin T, Tackett S, Gupta I, Blum K, Wimmer K, Wright S, Colbert‐Getz J. Development of a novel hospitalist advanced practice provider assessment instrument: A pilot study. J Hosp Med 2022; 17:176-180. [PMID: 35504586 PMCID: PMC9305217 DOI: 10.1002/jhm.12790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/11/2022] [Accepted: 01/20/2022] [Indexed: 11/24/2022]
Abstract
Advanced practice providers (APPs) graduate from school with variable hospitalist experience. While hospitalist-specific onboarding is recommended for hospitalist APPs, no standard method currently exists to assess their readiness for practice. We created a 17-item instrument called the Cardin Hospitalist Advanced Practice Provider-Readiness Assessment (CHAPP-RA) to assess APPs'; readiness for practice using a milestones-based scale. We piloted CHAPP-RA at a single site where 11 APPs with varied experience were rated by 30 supervising physicians. Supervisors also provided global ratings for overall performance. We investigated the feasibility of CHAPP-RA and collected validity evidence for the interpretation of scores. The mean time to complete one CHAPP-RA was 10.5 min. Supervisors rated novice APPs lower than more experienced APPs, p ≤ .001. CHAPP-RA ratings also correlated strongly with global ratings. CHAPP-RA is feasible to implement and has initial validity evidence.
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Affiliation(s)
- Amteshwar Singh
- Department of Medicine, Johns Hopkins Bayview Medical Center, Division of Hospital MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - David Klimpl
- Division of Hospital MedicineUniversity of Colorado School of MedicineDenverColoradoUSA
| | - Flora Kisuule
- Department of Medicine, Johns Hopkins Bayview Medical Center, Division of Hospital MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | | | - Sean Tackett
- Department of Medicine, Johns Hopkins Bayview Medical Center, Division of General Internal MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Biostatistics, Epidemiology, and Data Management CoreJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Ishaan Gupta
- Department of Medicine, Johns Hopkins Bayview Medical Center, Division of Hospital MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Kimberly Blum
- Department of Medicine, Johns Hopkins Bayview Medical Center, Division of Hospital MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Kinsey Wimmer
- Division of Hospital MedicineUniversity of Colorado School of MedicineDenverColoradoUSA
| | - Scott Wright
- Department of Medicine, Johns Hopkins Bayview Medical Center, Division of General Internal MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Jorie Colbert‐Getz
- Department of Internal Medicine, Division of General Internal MedicineUniversity of Utah School of MedicineSalt Lake CityUtahUSA
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Shannon EM, Cauley M, Vitale M, Wines L, Chopra V, Greysen SR, Herzig SJ, Kripalani S, O'Leary KJ, Vasilevskis EE, Williams MV, Auerbach AD, Mueller SK, Schnipper JL. Patterns of utilization and evaluation of advanced practice providers on academic hospital medicine teams: A national survey. J Hosp Med 2022; 17:186-191. [PMID: 35504577 DOI: 10.1002/jhm.12788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 11/09/2022]
Abstract
This survey study aimed to provide a contemporary appraisal of advanced practice provider (APP) practice and to summarize perceptions of the benefits and challenges of integrating APPs into adult academic hospital medicine (HM) groups. We surveyed leaders of academic HM groups. We received responses from 43 of 86 groups (50%) surveyed. Thirty-four (79%) reported that they employed APPs. In most groups (85%), APPs were reported to perform daily tasks of patient care, including rounding and documentation. Less than half of the groups reported that APPs had completed HM-specific postgraduate training. The reported benefits of APPs included improved perceived quality of care and greater volume of patients that could be seen. Reported challenges included training requirements and support for new hires. Further investigation is needed to determine which APP team structures deliver the highest quality care. There may be a role for expanding standardized competency-based postgraduate training for APPs planning to practice HM.
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Affiliation(s)
- Evan M Shannon
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, California, USA
| | - Marissa Cauley
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Matthew Vitale
- Harvard Medical School, Boston, Massachusetts, USA
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Leanne Wines
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Vineet Chopra
- Department of Medicine, Division of Hospital Medicine, University of Denver, Denver, Colorado, USA
| | - S Ryan Greysen
- Section of Hospital Medicine, Perelman School of Medicine at the University of Pennsylvania, Division of General Internal Medicine, Philadelphia, Pennsylvania, USA
- The Wharton School at the University of Pennsylvania, Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, USA
| | - Shoshana J Herzig
- Harvard Medical School, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Division of General Medicine, Boston, Massachusetts, USA
| | - Sunil Kripalani
- Section of Hospital Medicine, Vanderbilt University Medical Center, Division of General Internal Medicine and Public Health, Nashville, Tennessee, USA
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin J O'Leary
- Department of Medicine, Northwestern University Feinberg School of Medicine, Division of Hospital Medicine, Chicago, Illinois, USA
| | - Eduard E Vasilevskis
- Section of Hospital Medicine, Vanderbilt University Medical Center, Division of General Internal Medicine and Public Health, Nashville, Tennessee, USA
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research Education and Clinical Center, VA Tennessee Valley, Nashville, Tennessee, USA
| | - Mark V Williams
- Washington University School of Medicine, Division of Hospital Medicine, St. Louis, Missouri, USA
| | - Andrew D Auerbach
- Division of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
| | - Stephanie K Mueller
- Harvard Medical School, Boston, Massachusetts, USA
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jeffrey L Schnipper
- Harvard Medical School, Boston, Massachusetts, USA
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Atlas KR, Forbes M, Riches J, Maina E, Lim R, Johnson T, Niessen T, Desai N. The scope of hospital medicine practice at night: a national survey of night shift hospitalists. Hosp Pract (1995) 2021; 49:292-297. [PMID: 34030568 DOI: 10.1080/21548331.2021.1932507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Although in-person hospitalist presence, increasingly staffed by dedicated nocturnists, has become the norm overnight in the hospital, the scope of nocturnist practice and typical workload has not been defined. This study examines the clinical responsibilities and patient safety perceptions of hospitalists who work night shifts in the United States.Methods: In the fall of 2019, a cross-sectional, web-based survey was administered to physician and nurse practitioner/physician assistant (NP/PA) hospitalists who work night shifts. The questionnaire assessed night staffing structure, typical responsibilities, patient volume, perceptions of safety overnight, as well as demographic information. The survey was posted on the Society of Hospital Medicine (SHM) Hospital Medicine Exchange (HMX) Online Discussion Forum. Additionally, the survey was distributed by 'snowball method' by respondents to other night hospitalists. Responses were collected anonymously.Results: Of the 167 respondents, 157 reported working night shifts. There was at least one respondent from 32 different states. In addition to performing admissions to medicine services and covering inpatients, night hospitalists cover ICU patients, participate in RRT/Code teams and procedure teams, perform consults, participate in medical education, and take outpatient calls. Across institutions, there was a large distribution in numbers of patients covered in a night shift; however, patient volume fell into typical ranges: 5-10 admissions for physicians, 0-6 admissions for NP/PAs, and 25-75 patient cross-coverage census. When physicians perform more than five admissions per night, hospitalists were less likely to agree that they could provide safe care (88% vs. 63%, p = 0.0006).Conclusions: This is the first national study to examine the clinical responsibilities of hospitalists working overnight. Overnight responsibilities are heterogeneous across institutions. As hospitals are increasingly employing nocturnists, more research is needed to guide night staffing and optimize patient safety.
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Affiliation(s)
- Kathleen R Atlas
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meggan Forbes
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Jamie Riches
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elizabeth Maina
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard Lim
- Department of Medicine, Our Lady of Fatima Hospital, North Providence, RI, USA
| | | | - Timothy Niessen
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Neil Desai
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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