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Mark V Williams - One of the best experts on this subject based on the ideXlab platform.
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the Hospital Medicine reengineering network homerun a learning organization focused on improving Hospital care
Academic Medicine, 2014Co-Authors: Andrew D. Auerbach, Sunil Kripalani, Mark V Williams, Joshua P Metlay, Mitesh S Patel, Jeffrey L Schnipper, Edmondo J Robinson, Peter K LindenauerAbstract:Converting the health care delivery system into a learning organization is a key strategy for improving health outcomes. Although the collaborative learning organization approach has been successful in neonatal intensive care units and disease-specific collaboratives, there are few examples in general Medicine and none in adult Medicine that have leveraged the role of Hospitalists nationally across multiple institutions to implement improvements. The authors describe the rationale for and early work of the Hospital Medicine Reengineering Network (HOMERuN), a collaborative of Hospitals, Hospitalists, and multidisciplinary care teams founded in 2011 that seeks to measure, benchmark, and improve the efficiency, quality, and outcomes of care in the Hospital and afterwards. Robust and timely evaluation, with learning and refinement of approaches across institutions, should accelerate improvement efforts. The authors review HOMERuN’s collaborative model, which focuses on a community-based participatory approach modified to include Hospitalbased staff as well as the larger community. HOMERuN’s initial project is described, focusing on care transition measurement using perspectives from the patient, caregiver, and providers. Next steps and sustainability of the organization are discussed, including benchmarking, collaboration, and effective dissemination of best practices to stakeholders.
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improving interunit transitions of care between emergency physicians and Hospital Medicine physicians a conceptual approach
Academic Emergency Medicine, 2012Co-Authors: Christopher Beach, Kevin J Oleary, Robert L Wears, Dickson S Cheung, Julie Apker, Leora I Horwitz, Eric E Howell, Emily S Patterson, Jeremiah D Schuur, Mark V WilliamsAbstract:Patient care transitions across specialties involve more complexity than those within the same specialty, yet the unique social and technical features remain underexplored. Further, little consensus exists among researchers and practitioners about strategies to improve interspecialty communication. This concept article addresses these gaps by focusing on the hand-off process between emergency and Hospital Medicine physicians. Sensitivity to cultural and operational differences and a common set of expectations pertaining to hand-off content will more effectively prepare the next provider to act safely and efficiently when caring for the patient. Through a consensus decision-making process of experienced and published authorities in health care transitions, including physicians in both specialties as well as in communication studies, the authors propose content and style principles clinicians may use to improve transition communication. With representation from both community and academic settings, similarities and differences between emergency Medicine and internal Medicine are highlighted to heighten appreciation of the values, attitudes, and goals of each specialty, particularly pertaining to communication. The authors also examine different communication media, social and cultural behaviors, and tools that practitioners use to share patient care information. Quality measures are proposed within the structure, process, and outcome framework for institutions seeking to evaluate and monitor improvement strategies in hand-off performance. Validation studies to determine if these suggested improvements in transition communication will result in improved patient outcomes will be necessary. By exploring the dynamics of transition communication between specialties and suggesting best practices, the authors hope to strengthen hand-off skills and contribute to improved continuity of care.
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Hospitalists lack of knowledge of the confusion assessment method a barrier to systematic validated delirium surveillance
Hospital Practice, 2012Co-Authors: Robert S Young, Keiki Hinami, Adnan Arseven, Bijal Jain, Mark V WilliamsAbstract:AbstractIntroduction: Delirium is frequently missed by inpatient health care providers despite the existence of a highly sensitive and specific assessment for delirium, the Confusion Assessment Method (CAM). The CAM, due to its test characteristics and ease of use, is an ideal physician instrument for systematic inpatient delirium screening; however, little is known about Hospitalists' knowledge of the CAM. Methods: A short survey with items assessing respondents' perceptions of delirium detection, familiarity and proficiency with the CAM, and knowledge of the CAM algorithm was administered at a regional Hospital Medicine conference. Participants included a group of Hospital Medicine providers comprised of physicians (79.9%), nurse practitioners (7.2%), and physician assistants (12.9%). Results in the form of counts, percentages, and distributions of Likert scale responses and multiple-choice questions were reported. Results: Of 157 surveys distributed, 94% (n = 147) were returned. Approximately 3 of 4 of...
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assessing patient perceptions of Hospitalist communication skills using the communication assessment tool cat
Journal of Hospital Medicine, 2010Co-Authors: Darlene Ferranti, Gregory Makoul, Victoria E Forth, Jennifer Rauworth, Jungwha Lee, Mark V WilliamsAbstract:BACKGROUND: Hospitalists care for an increasing percentage of Hospitalized patients, yet evaluations of patient perceptions of Hospitalists' communication skills are lacking. OBJECTIVE: Assess Hospitalist communication skills using the Communication Assessment Tool (CAT). METHODS: A cross-sectional study of patients, age 18 or older, admitted to the Hospital Medicine service at an urban, academic medical center with 873 beds. Thirty-five Hospitalists assigned to both direct care and teaching service were assessed. MEASUREMENTS: Hospitalist communication was measured with the CAT. The 14-item survey, written at a fourth grade level, measures responses along a 5-point scale (“poor” to “excellent”). Scores are reported as a percentage of “excellent” responses. RESULTS: We analyzed 700 patient surveys (20 for each of 35 Hospitalists). The proportion of excellent ratings for each Hospitalist ranged from 38.5% to 73.5%, with an average of 59.1% excellent (SD=9.5). Highest ratings on individual CAT items were for treating the patient with respect, letting the patient talk without interruptions, and talking in terms the patient can understand. Lowest ratings were for involving the patient in decisions as much as he or she wanted, encouraging the patient to ask questions, and greeting the patient in a way that made him or her feel comfortable. Overall scale reliability was high (Cronbach's alpha = 0.97). CONCLUSIONS: The CAT can be used to gauge patient perceptions of Hospitalist communication skills. Many Hospitalists may benefit from targeted training to improve communication skills, particularly in the areas of encouraging questions and involving patients in decision making. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.
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transitions of care consensus policy statement american college of physicians society of general internal Medicine society of Hospital Medicine american geriatrics society american college of emergency physicians and society for academic emergency Medicine
Journal of Hospital Medicine, 2009Co-Authors: Vincenza Snow, Tina Budnitz, Dennis Beck, Doriane Miller, Jane Potter, Robert L Wears, Kevin B Weiss, Mark V WilliamsAbstract:The American College of Physicians, Society of Hospital Medicine, and Society of General Internal Medicine convened a multi-stakeholder consensus conference in July 2007 to address the quality gaps in the transitions between inpatient and outpatient settings and to develop consensus standards for these transitions. Over 30 organizations sent representatives to the Transitions of Care Consensus Conference. Participating organizations included medical specialty societies from internal Medicine as well as family Medicine and pediatrics, governmental agencies such as the Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid Services, performance measure developers such as the National Committee for Quality Assurance and the American Medical Association Physician Consortium on Performance Improvement, nurse associations such as the Visiting Nurse Associations of America and Home Care and Hospice, pharmacist groups, and patient groups such as the Institute for Family-Centered Care. The Transitions of Care Consensus Conference made recommendations for standards concerning the transitions between inpatient and outpatient settings for future implementation. The American College of Physicians, Society of Hospital Medicine, Society of General Internal Medicine, American Geriatric Society, American College of Emergency Physicians, and Society for Academic Emergency Medicine all endorsed this document.
Tina Budnitz - One of the best experts on this subject based on the ideXlab platform.
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transitions of care consensus policy statement american college of physicians society of general internal Medicine society of Hospital Medicine american geriatrics society american college of emergency physicians and society for academic emergency Medicine
Journal of Hospital Medicine, 2009Co-Authors: Vincenza Snow, Tina Budnitz, Dennis Beck, Doriane Miller, Jane Potter, Robert L Wears, Kevin B Weiss, Mark V WilliamsAbstract:The American College of Physicians, Society of Hospital Medicine, and Society of General Internal Medicine convened a multi-stakeholder consensus conference in July 2007 to address the quality gaps in the transitions between inpatient and outpatient settings and to develop consensus standards for these transitions. Over 30 organizations sent representatives to the Transitions of Care Consensus Conference. Participating organizations included medical specialty societies from internal Medicine as well as family Medicine and pediatrics, governmental agencies such as the Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid Services, performance measure developers such as the National Committee for Quality Assurance and the American Medical Association Physician Consortium on Performance Improvement, nurse associations such as the Visiting Nurse Associations of America and Home Care and Hospice, pharmacist groups, and patient groups such as the Institute for Family-Centered Care. The Transitions of Care Consensus Conference made recommendations for standards concerning the transitions between inpatient and outpatient settings for future implementation. The American College of Physicians, Society of Hospital Medicine, Society of General Internal Medicine, American Geriatric Society, American College of Emergency Physicians, and Society for Academic Emergency Medicine all endorsed this document.
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transitions of care consensus policy statement american college of physicians society of general internal Medicine society of Hospital Medicine american geriatrics society american college of emergency physicians and society for academic emergency Medicine
Journal of Hospital Medicine, 2009Co-Authors: Vincenza Snow, Tina Budnitz, Dennis Beck, Robert L Wears, Kevin B Weiss, Doriane C Miller, Jane Frances Potter, Mark V WilliamsAbstract:The American College of Physicians (ACP), Society of Hospital Medicine (SHM), Society of General Internal Medicine (SGIM), American Geriatric Society (AGS), American College of Emergency Physicians (ACEP) and the Society for Academic Emergency Medicine (SAEM) developed consensus standards to address the quality gaps in the transitions between inpatient and outpatient settings. The following summarized principles were established: 1.) Accountability; 2) Communication; 3.) Timely interchange of information; 4.) Involvement of the patient and family member; 5.) Respect the hub of coordination of care; 6.) All patients and their family/caregivers should have a medical home or coordinating clinician; 7.) At every point of transitions the patient and/or their family/caregivers need to know who is responsible for their care at that point; 9.) National standards; and 10.) Standardized metrics related to these standards in order to lead to quality improvement and accountability. Based on these principles, standards describing necessary components for implementation were developed: coordinating clinicians, care plans/transition record, communication infrastructure, standard communication formats, transition responsibility, timeliness, community standards, and measurement.
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core competencies in Hospital Medicine development and methodology
Journal of Hospital Medicine, 2006Co-Authors: Daniel D Dressler, Michael J Pistoria, Tina Budnitz, Stephen Mckean, Alpesh AminAbstract:BACKGROUND: The Hospitalist model of inpatient care has been rapidly expanding over the last decade, with significant growth related to the quality and efficiency of care provision. This growth and development have stimulated a need to better define and characterize the field of Hospital Medicine. Training and developing curricula specific to Hospital Medicine are the next step in the evolution of the field. METHODS: The Core Competencies in Hospital Medicine: A Framework for Curriculum Development (the Core Competencies), by the Society of Hospital Medicine, introduces the expectations of Hospitalists and provides an initial structural framework to guide medical educators in developing curricula that incorporate these competencies into the training and evaluation of students, clinicians-in-training, and practicing Hospitalists. This article outlines the process that was undertaken to develop the Core Competencies, which included formation of a task force and editorial board, development of a topic list, the solicitation for and writing of chapters, and the execution of multiple reviews by the editorial board and both internal and external reviewers. RESULTS: This process culminated in the Core Competencies document, which is divided into three sections: Clinical Conditions, Procedures, and Healthcare Systems. The chapters in each section delineate the core knowledge, skills, and attitudes necessary for effective inpatient practice while also incorporating a systems organization and improvement approach to care coordination and optimization. CONCLUSIONS: These competencies should be a common reference and foundation for the creation of Hospital Medicine curricula and serve to standardize and improve inpatient training practices. Journal of Hospital Medicine 2006;1:48–56. © 2006 Society of Hospital Medicine.
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how to use the core competencies in Hospital Medicine a framework for curriculum development
Journal of Hospital Medicine, 2006Co-Authors: Alpesh Amin, Daniel D Dressler, Tina Budnitz, Stephen Mckean, Michael J PistoriaAbstract:BACKGROUND The seminal article that coined the term Hospitalist, published in 1996, attributed the role of the Hospitalist to enhancing throughput and cost reduction, primarily through reduction in length of stay, accomplished by having a dedicated clinician on site in the Hospital. Since that time the role of the Hospitalist has evolved, and Hospitalists are being called upon to demonstrate that they actually improve quality of care and the education of the next generation of physicians. A companion article in this issue describes in detail the rationale for the development of the Core Competencies document and the methods by which it was created. METHODS Specific cases that Hospitalists may encounter in their daily practice are used to illustrate how the Core Competencies can be applied to curriculum development. The cases illustrate 1) a specific problem and the need for improvement; 2) a needs assessment of the targeted learners (Hospitalists and clinicians in training); 3) goals and specific measurable objectives; 4) educational strategies using the competencies to provide structure and guidance; 5) implementation (applying competencies to a variety of training opportunities and curricula); 6) evaluation and feedback; and 7) remaining questions and the need for additional research. RESULTS This article illustrates how to utilize The Core Competencies in Hospital Medicine to educate trainees and faculty, to prioritize educational scholarship and research strategies, and thus to improve the care of our patients. CONCLUSIONS Medical educators should compare their learning objectives to the Core Competencies to ensure that their trainees have achieved competency to practice Hospital Medicine and improve the Hospital setting. Journal of Hospital Medicine 2006;1:57–67. © 2006 Society of Hospital Medicine.
Vincenza Snow - One of the best experts on this subject based on the ideXlab platform.
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transitions of care consensus policy statement american college of physicians society of general internal Medicine society of Hospital Medicine american geriatrics society american college of emergency physicians and society for academic emergency Medicine
Journal of Hospital Medicine, 2009Co-Authors: Vincenza Snow, Tina Budnitz, Dennis Beck, Doriane Miller, Jane Potter, Robert L Wears, Kevin B Weiss, Mark V WilliamsAbstract:The American College of Physicians, Society of Hospital Medicine, and Society of General Internal Medicine convened a multi-stakeholder consensus conference in July 2007 to address the quality gaps in the transitions between inpatient and outpatient settings and to develop consensus standards for these transitions. Over 30 organizations sent representatives to the Transitions of Care Consensus Conference. Participating organizations included medical specialty societies from internal Medicine as well as family Medicine and pediatrics, governmental agencies such as the Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid Services, performance measure developers such as the National Committee for Quality Assurance and the American Medical Association Physician Consortium on Performance Improvement, nurse associations such as the Visiting Nurse Associations of America and Home Care and Hospice, pharmacist groups, and patient groups such as the Institute for Family-Centered Care. The Transitions of Care Consensus Conference made recommendations for standards concerning the transitions between inpatient and outpatient settings for future implementation. The American College of Physicians, Society of Hospital Medicine, Society of General Internal Medicine, American Geriatric Society, American College of Emergency Physicians, and Society for Academic Emergency Medicine all endorsed this document.
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transitions of care consensus policy statement american college of physicians society of general internal Medicine society of Hospital Medicine american geriatrics society american college of emergency physicians and society for academic emergency Medicine
Journal of Hospital Medicine, 2009Co-Authors: Vincenza Snow, Tina Budnitz, Dennis Beck, Robert L Wears, Kevin B Weiss, Doriane C Miller, Jane Frances Potter, Mark V WilliamsAbstract:The American College of Physicians (ACP), Society of Hospital Medicine (SHM), Society of General Internal Medicine (SGIM), American Geriatric Society (AGS), American College of Emergency Physicians (ACEP) and the Society for Academic Emergency Medicine (SAEM) developed consensus standards to address the quality gaps in the transitions between inpatient and outpatient settings. The following summarized principles were established: 1.) Accountability; 2) Communication; 3.) Timely interchange of information; 4.) Involvement of the patient and family member; 5.) Respect the hub of coordination of care; 6.) All patients and their family/caregivers should have a medical home or coordinating clinician; 7.) At every point of transitions the patient and/or their family/caregivers need to know who is responsible for their care at that point; 9.) National standards; and 10.) Standardized metrics related to these standards in order to lead to quality improvement and accountability. Based on these principles, standards describing necessary components for implementation were developed: coordinating clinicians, care plans/transition record, communication infrastructure, standard communication formats, transition responsibility, timeliness, community standards, and measurement.
Andrew D. Auerbach - One of the best experts on this subject based on the ideXlab platform.
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the Hospital Medicine reengineering network homerun a learning organization focused on improving Hospital care
Academic Medicine, 2014Co-Authors: Andrew D. Auerbach, Sunil Kripalani, Mark V Williams, Joshua P Metlay, Mitesh S Patel, Jeffrey L Schnipper, Edmondo J Robinson, Peter K LindenauerAbstract:Converting the health care delivery system into a learning organization is a key strategy for improving health outcomes. Although the collaborative learning organization approach has been successful in neonatal intensive care units and disease-specific collaboratives, there are few examples in general Medicine and none in adult Medicine that have leveraged the role of Hospitalists nationally across multiple institutions to implement improvements. The authors describe the rationale for and early work of the Hospital Medicine Reengineering Network (HOMERuN), a collaborative of Hospitals, Hospitalists, and multidisciplinary care teams founded in 2011 that seeks to measure, benchmark, and improve the efficiency, quality, and outcomes of care in the Hospital and afterwards. Robust and timely evaluation, with learning and refinement of approaches across institutions, should accelerate improvement efforts. The authors review HOMERuN’s collaborative model, which focuses on a community-based participatory approach modified to include Hospitalbased staff as well as the larger community. HOMERuN’s initial project is described, focusing on care transition measurement using perspectives from the patient, caregiver, and providers. Next steps and sustainability of the organization are discussed, including benchmarking, collaboration, and effective dissemination of best practices to stakeholders.
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redefining readmission risk factors for general Medicine patients
Journal of Hospital Medicine, 2011Co-Authors: Nazima Allaudeen, Arpana R Vidyarthi, Judith H Maselli, Andrew D. AuerbachAbstract:(odds ratio [OR], 1.43; 95% confidence interval [CI], 1.24‐1.65), inpatient use of narcotics (1.33; 1.16‐1.53) and corticosteroids (1.24; 1.09‐1.42), and the disease states of cancer (with metastasis 1.61; 1.33‐1.95; without metastasis 1.95; 1.54‐2.47), renal failure (1.19; 1.05‐1.36), congestive heart failure (1.30; 1.09‐1.56), and weight loss (1.26; 1.09‐1.47). Medicaid payer status (1.15; 0.97‐1.36) had a trend toward readmission. CONCLUSION: Readmission of general Medicine patients within 30 days is common and associated with several easily identifiable clinical and nonclinical factors. Identification of these risk factors can allow providers to target interventions to reduce potentially avoidable readmissions. Journal of Hospital Medicine 2011;6:54‐60. V C 2011 Society of Hospital Medicine
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influence of language barriers on outcomes of Hospital care for general Medicine inpatients
Journal of Hospital Medicine, 2010Co-Authors: Leah S Karliner, Sue E Kim, David O Meltzer, Andrew D. AuerbachAbstract:BACKGROUND: Few studies have examined whether patients with language barriers receive worse Hospital care in terms of quality or efficiency. OBJECTIVE: To examine whether patients' primary language influences Hospital outcomes. DESIGN AND SETTING: Observational cohort of urban university Hospital general medical admissions between July 1, 2001 to June 30, 2003. PATIENTS: Eighteen years old or older whose Hospital data included information on their primary language, specifically English, Russian, Spanish or Chinese. MEASUREMENTS: Hospital costs, length of stay (LOS), and odds for 30-day readmission or 30-day mortality. RESULTS: Of 7023 admitted patients, 84% spoke English, 8% spoke Chinese, 4% Russian and 4% Spanish. In multivariable models, non-English and English speakers had statistically similar total cost, LOS, and odds for mortality. However, non-English speakers had higher adjusted odds of readmission (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.0-1.7). Higher odds for readmission persisted for Chinese and Spanish speakers when compared to all English speakers (OR, 1.7; 95% CI, 1.2-2.3 and OR, 1.5; 95% CI, 1.0-2.3 respectively). CONCLUSIONS: After accounting for socioeconomic variables and comorbidities, non-English speaking Latino and Chinese patients have higher risk for readmission. Whether language barriers produce differences in readmission or are a marker for less access to post-Hospital care remains unclear. Journal of Hospital Medicine 2010;5:276–282. © 2010 Society of Hospital Medicine.
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influence of language barriers on outcomes of Hospital care for general Medicine inpatients
Journal of Hospital Medicine, 2010Co-Authors: Leah S Karliner, Sue E Kim, David O Meltzer, Andrew D. AuerbachAbstract:BACKGROUND: Few studies have examined whether patients with language barriers receive worse Hospital care in terms of quality or efficiency. OBJECTIVE: To examine whether patients' primary language influences Hospital outcomes. DESIGN AND SETTING: Observational cohort of urban university Hospital general medical admissions between July 1, 2001 to June 30, 2003. PATIENTS: Eighteen years old or older whose Hospital data included information on their primary language, specifically English, Russian, Spanish or Chinese. MEASUREMENTS: Hospital costs, length of stay (LOS), and odds for 30-day readmission or 30-day mortality. RESULTS: Of 7023 admitted patients, 84% spoke English, 8% spoke Chinese, 4% Russian and 4% Spanish. In multivariable models, non-English and English speakers had statistically similar total cost, LOS, and odds for mortality. However, non-English speakers had higher adjusted odds of readmission (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.0-1.7). Higher odds for readmission persisted for Chinese and Spanish speakers when compared to all English speakers (OR, 1.7; 95% CI, 1.2-2.3 and OR, 1.5; 95% CI, 1.0-2.3 respectively). CONCLUSIONS: After accounting for socioeconomic variables and comorbidities, non-English speaking Latino and Chinese patients have higher risk for readmission. Whether language barriers produce differences in readmission or are a marker for less access to post-Hospital care remains unclear. Journal of Hospital Medicine 2010;5:276–282. © 2010 Society of Hospital Medicine.
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challenges and opportunities in academic Hospital Medicine report from the academic Hospital Medicine summit
Journal of Hospital Medicine, 2009Co-Authors: Scott A Flanders, Bob Centor, Valerie Weber, Thomas Mcginn, Karen B Desalvo, Andrew D. AuerbachAbstract:BACKGROUND: The field of Hospital Medicine is growing rapidly in academic medical centers. However, few organizations have explicitly considered the opportunities for and barriers to Hospital Medicine's development as an academic field in internal Medicine. OBJECTIVE: The objective was to develop consensus around key areas limiting or facilitating Hospital Medicine's development as an academic discipline. DESIGN: The design was a consensus format conference of key stakeholders in academic Hospital Medicine. RESULTS: The consensus group identified several issues impeding the development of academic Hospital Medicine as a recognized entity in academic settings, including extraordinarily rapid growth, increasingly preponderant nonteaching roles, and demands to perform nonclinical duties (such as quality improvement) not generally viewed as academic pursuits. The consensus group developed recommendations for addressing these concerns, specifically: 1) characterizing the optimal job description for an academic Hospitalist, 2) developing better local and at-a-distance opportunities for training academic Hospitalists in key aspects of early career success, and 3) advocating for the development of fellows and junior faculty researchers in Hospital Medicine. SUMMARY: Fostering academic Hospital Medicine will help address these issues more effectively and will help the field while also attracting the next generation of generalists needed to care for an increasingly complex inpatient population. Journal of Hospital Medicine 2009;4:240–246. © 2009 Society of Hospital Medicine.
Robert L Wears - One of the best experts on this subject based on the ideXlab platform.
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improving interunit transitions of care between emergency physicians and Hospital Medicine physicians a conceptual approach
Academic Emergency Medicine, 2012Co-Authors: Christopher Beach, Kevin J Oleary, Robert L Wears, Dickson S Cheung, Julie Apker, Leora I Horwitz, Eric E Howell, Emily S Patterson, Jeremiah D Schuur, Mark V WilliamsAbstract:Patient care transitions across specialties involve more complexity than those within the same specialty, yet the unique social and technical features remain underexplored. Further, little consensus exists among researchers and practitioners about strategies to improve interspecialty communication. This concept article addresses these gaps by focusing on the hand-off process between emergency and Hospital Medicine physicians. Sensitivity to cultural and operational differences and a common set of expectations pertaining to hand-off content will more effectively prepare the next provider to act safely and efficiently when caring for the patient. Through a consensus decision-making process of experienced and published authorities in health care transitions, including physicians in both specialties as well as in communication studies, the authors propose content and style principles clinicians may use to improve transition communication. With representation from both community and academic settings, similarities and differences between emergency Medicine and internal Medicine are highlighted to heighten appreciation of the values, attitudes, and goals of each specialty, particularly pertaining to communication. The authors also examine different communication media, social and cultural behaviors, and tools that practitioners use to share patient care information. Quality measures are proposed within the structure, process, and outcome framework for institutions seeking to evaluate and monitor improvement strategies in hand-off performance. Validation studies to determine if these suggested improvements in transition communication will result in improved patient outcomes will be necessary. By exploring the dynamics of transition communication between specialties and suggesting best practices, the authors hope to strengthen hand-off skills and contribute to improved continuity of care.
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transitions of care consensus policy statement american college of physicians society of general internal Medicine society of Hospital Medicine american geriatrics society american college of emergency physicians and society for academic emergency Medicine
Journal of Hospital Medicine, 2009Co-Authors: Vincenza Snow, Tina Budnitz, Dennis Beck, Doriane Miller, Jane Potter, Robert L Wears, Kevin B Weiss, Mark V WilliamsAbstract:The American College of Physicians, Society of Hospital Medicine, and Society of General Internal Medicine convened a multi-stakeholder consensus conference in July 2007 to address the quality gaps in the transitions between inpatient and outpatient settings and to develop consensus standards for these transitions. Over 30 organizations sent representatives to the Transitions of Care Consensus Conference. Participating organizations included medical specialty societies from internal Medicine as well as family Medicine and pediatrics, governmental agencies such as the Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid Services, performance measure developers such as the National Committee for Quality Assurance and the American Medical Association Physician Consortium on Performance Improvement, nurse associations such as the Visiting Nurse Associations of America and Home Care and Hospice, pharmacist groups, and patient groups such as the Institute for Family-Centered Care. The Transitions of Care Consensus Conference made recommendations for standards concerning the transitions between inpatient and outpatient settings for future implementation. The American College of Physicians, Society of Hospital Medicine, Society of General Internal Medicine, American Geriatric Society, American College of Emergency Physicians, and Society for Academic Emergency Medicine all endorsed this document.
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transitions of care consensus policy statement american college of physicians society of general internal Medicine society of Hospital Medicine american geriatrics society american college of emergency physicians and society for academic emergency Medicine
Journal of Hospital Medicine, 2009Co-Authors: Vincenza Snow, Tina Budnitz, Dennis Beck, Robert L Wears, Kevin B Weiss, Doriane C Miller, Jane Frances Potter, Mark V WilliamsAbstract:The American College of Physicians (ACP), Society of Hospital Medicine (SHM), Society of General Internal Medicine (SGIM), American Geriatric Society (AGS), American College of Emergency Physicians (ACEP) and the Society for Academic Emergency Medicine (SAEM) developed consensus standards to address the quality gaps in the transitions between inpatient and outpatient settings. The following summarized principles were established: 1.) Accountability; 2) Communication; 3.) Timely interchange of information; 4.) Involvement of the patient and family member; 5.) Respect the hub of coordination of care; 6.) All patients and their family/caregivers should have a medical home or coordinating clinician; 7.) At every point of transitions the patient and/or their family/caregivers need to know who is responsible for their care at that point; 9.) National standards; and 10.) Standardized metrics related to these standards in order to lead to quality improvement and accountability. Based on these principles, standards describing necessary components for implementation were developed: coordinating clinicians, care plans/transition record, communication infrastructure, standard communication formats, transition responsibility, timeliness, community standards, and measurement.