1
|
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
| |
Collapse
|
2
|
Bryant AD, Robinson TJ, Gutierrez-Perez JT, Manning BL, Glenn K, Imborek KL, Kuperman EF. Outcomes of a home telemonitoring program for SARS-CoV-2 viral infection at a large academic medical center. J Telemed Telecare 2024; 30:675-680. [PMID: 35275502 PMCID: PMC8919094 DOI: 10.1177/1357633x221086067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/21/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Telemedicine serves as a viable option during the COVID-19 pandemic to provide in-home care, maintain home isolation precautions, reduce unnecessary healthcare exposures, and de-burden hospitals. METHODS We created a novel telemedicine program to closely monitor patients infected with SARS-CoV-2 (COVID-19) at home. Adult patients with COVID-19 were enrolled in the program at the time of documented infection. Patients were followed by a team of providers via telephone or video visits at frequent intervals until resolution of their acute illness. Additionally, patients were stratified into high-risk and low-risk categories based on demographics and underlying comorbidities. The primary outcome was hospitalization after enrollment in the home monitoring program, including 30 days after discharge from the program. RESULTS Over a 3.5-month period, 1128 patients met criteria for enrollment in the home monitoring program. 30.7% were risk stratified as high risk for poor outcomes based on their comorbidities and age. Of the 1128 patients, 6.2% required hospitalization and 1.2% required ICU admission during the outcome period. Hospitalization was more frequent in patients identified as high risk (14.2% vs 2.7%, P < 0.001). DISCUSSION Enrollment in a home monitoring program appears to be an effective and sustainable modality for the ambulatory management of COVID-19.
Collapse
Affiliation(s)
- Andrew D Bryant
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Tommy J Robinson
- Internal Medicine Residency, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Bradley L Manning
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Kevin Glenn
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Katherine L Imborek
- Department of Family Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Ethan F Kuperman
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| |
Collapse
|
3
|
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.
Collapse
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; ,
| |
Collapse
|
4
|
Maxey J, Gupta A, Houchens N. Quality and safety in the literature: April 2023. BMJ Qual Saf 2023; 32:235-240. [PMID: 36931631 DOI: 10.1136/bmjqs-2023-015977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 01/27/2023] [Indexed: 03/19/2023]
Affiliation(s)
- Jordan Maxey
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Ashwin Gupta
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Nathan Houchens
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| |
Collapse
|
5
|
Subramaniam S, Chen J, Wilkerson TL, Stevenson L, Kincaid C, Firestone C, Ball SL. Refining the Implementation of a Hub-and-Spoke Model for TelePain Through Qualitative Inquiry. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2022; 8:1-11. [PMID: 36530381 PMCID: PMC9734451 DOI: 10.1007/s41347-022-00288-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/07/2022] [Accepted: 10/27/2022] [Indexed: 06/17/2023]
Abstract
The hub-and-spoke telehealth model leverages centrally located providers who utilize telehealth technology to bring specialized care to medically underserved areas. This model has the potential to promote equitable access to healthcare. However, few studies address how to facilitate the adoption and implementation of hub-and-spoke telehealth. We examined spoke site providers' experiences with TelePain, a national hub-and-spoke model of interdisciplinary chronic pain care, with a focus on improving future implementation. We conducted semi-structured individual interviews (20-45 min) with 27 VA spoke site providers via teleconferencing between August 2020 and February 2021. Interview transcripts were coded in Atlas.ti 8.0 using deductive (identified a priori and used to build the interview guide) and inductive (emerging) codes. Our analysis identified the following themes stressed by the spoke sites: (1) spoke sites needed to envision how TelePain services would work at their site before deciding to adopt; (2) TelePain implementation needed to fit into local existing care processes; (3) hub sites needed to understand spoke sites' context (e.g., via needs assessment) to tailor the services accordingly, and (4) hub-and-spoke sites needed to establish bidirectional communication. Our findings provide a practical guide to improve future rollout of hub-and-spoke telehealth models. Recommendations focus on the role of the hub site in promoting program adoption by (1) developing a clear and detailed marketing plan and (2) considering how the program can be adapted to fit the local spoke site context. To improve implementation, hub-and-spoke sites must establish ongoing and consistent bidirectional communication; this is particularly critical in the everchanging post-peak pandemic healthcare system. An important next step is the development of recommendations and guidelines for implementing hub-and-spoke telehealth, as well as examining pain outcomes for patients touched by this program.
Collapse
Affiliation(s)
- Soumya Subramaniam
- VA Northeast Ohio Healthcare System, 10701 East Blvd, Cleveland, OH 44106 USA
| | - Jessica Chen
- Puget Sound VA Healthcare System, 1660 S, Columbian Way, Seattle, WA 98108 USA
| | - Tai-Lyn Wilkerson
- VA Northeast Ohio Healthcare System, 10701 East Blvd, Cleveland, OH 44106 USA
| | - Lauren Stevenson
- VA Northeast Ohio Healthcare System, 10701 East Blvd, Cleveland, OH 44106 USA
| | - Carrie Kincaid
- Puget Sound VA Healthcare System, 1660 S, Columbian Way, Seattle, WA 98108 USA
| | - Christine Firestone
- VA Northeast Ohio Healthcare System, 10701 East Blvd, Cleveland, OH 44106 USA
| | - Sherry L. Ball
- VA Northeast Ohio Healthcare System, 10701 East Blvd, Cleveland, OH 44106 USA
| |
Collapse
|
6
|
Albright K, Jones CD. Methodological progress note: The case for mixed methods in quality improvement and research projects. J Hosp Med 2022; 17:468-471. [PMID: 35535915 DOI: 10.1002/jhm.12806] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/02/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Karen Albright
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Veterans Health Affairs Eastern Colorado Healthcare System, Aurora, Colorado, USA
- Division of General Internal Medicine, Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
| | - Christine D Jones
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Veterans Health Affairs Eastern Colorado Healthcare System, Aurora, Colorado, USA
- Division of Hospital Medicine, Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|