Scope of Practice Restrictions and Vulnerable Populations
Are There Enough Experienced Physicians to Treat Patients Hospitalized With COVID?
In this national study of 438,895 physicians, 45% provided care to hospitalized patients and 7% provided critical care. At the high estimate of patients requiring hospitalization at the projected peak of the pandemic, 18 states and Washington, DC would have patient to physician ratios greater than 15:1 (a level associated with poor outcomes among hospitalized patients). There was considerable geographic variation in the availability of physicians: 41% of hospital service areas did not have a physician with critical care experience.
How Machine Learning-Based Nudges Can Improve Cancer Care
For patients with cancer, serious illness conversations (SICs)—structured conversations about prognosis, goals, and wishes—can reduce depression and anxiety, improve quality of life, and avoid unnecessary acute care utilization.
Hospital and ICU Patient Volume per Physician at Peak of COVID Pandemic: State-Level Estimates
Anjali Bhatla, Kira L. Ryskina
Abstract [from journal]
Background: In anticipation of patient surge due to COVID-19, many states are working to increase the available healthcare workforce. To help inform state policies and initiatives aimed at physician deployment during COVID-19, we used predictions of peak patient volume for hospitals and intensive care units (ICU) and regional physician workforce estimates to measure patient to physician ratios at the peak of the pandemic for each state.
Methods: We
...Promotion Of Clinical Educators: A Critical Need In Academic Family Medicine
Christine K. Jacobs, Kelly M. Everard, Peter F. Cronholm
Abstract [from journal]
Background and objectives: Academic family medicine departments have traditionally promoted faculty using research and scholarship criteria augmented by teaching, clinical care, and service. Clinic-focused faculty who spend significant time in direct patient care may not have enough time to meet promotion criteria, although they are critical for training future family physicians and for rebalancing the system of academic promotion.
Methods: We surveyed family medicine department chairs on the
...COVID-19 Pandemic Significantly Decreases Acute Surgical Complaints
John S. Riley, Valerie L. Luks, Luis Filipe de Pina, Ziad Al Adas, Jordan B. Stoecker, Benjamin M. Jackson, Benjamin M. Braslow, Daniel N. Holena
Abstract [from journal]
Background: The coronavirus disease 2019 (COVID-19) pandemic significantly reduced elective surgery in the United States, but the impact of COVID-19 on acute surgical complaints and acute care surgery is unknown.
Study design: A retrospective review was performed of all surgical consults at the Hospital of the University of Pennsylvania in the 30 days prior to and 30 days following confirmation of the first COVID-19 patient at the institution. Consults to all divisions within general surgery
...Establishing An Orthopedic Excess Hospital Days In Acute Care Program
Michele Fang, Frances Mao, Eric Hume, S. Ryan Greysen
Abstract [from journal]
Background: Excess days in acute care (EDAC) after total joint arthroplasty (TJA) represent a large economic burden. We developed an Orthopedic EDAC program that triages TJA patients to the appropriate service line (orthopedic vs medicine) and level of care (observation vs inpatient) on re-presentation. We developed and used evidence-based protocols for the treatment of TJA patients who are rehospitalized.
Methods: We defined Orthopedic EDAC as the length of stay (LOS) during readmission and
...Assessing Contemporary Trends In Female Speakership Within Urologic Oncology
Ruchika Talwar, Adrien Bernstein, Amanda Jones, Juanita Crook, Andrea B. Apolo, Jennifer M. Taylor, Lauren M. Burke, Elizabeth R. Plimack, Sima P. Porten, Kirsten L. Greene, Sarah P. Psutka, Angela B. Smith
Abstract [from journal]
Objective: To evaluate multidisciplinary female representation at urologic oncology conferences, we reviewed speakership trends at contemporary Society of Urologic Oncology (SUO) and American Society of Clinical Oncology Genitourinary Symposium (GU-ASCO) annual meetings.
Methods: Meeting programs from SUO and GU-ASCO from 2015 to 2019 were analyzed. Biographical information was determined by querying institutional websites and social/professional media platforms. Statistical analyses were
..."I Don't Have Time To Sit And Talk With Them": Hospitalists' Perspectives on Palliative Care Consultation for Patients With Dementia
Katherine R. Courtright, Trishya L. Srinivasan, Vanessa L. Madden, Jason Karlawish, Stephanie Szymanski, Sarah H. Hill, Scott D. Halpern, Mary Ersek
Abstract [from journal]
Background/objectives: Specialty palliative care for hospitalized patients with dementia is widely recommended and may improve outcomes, yet rates of consultation remain low. We sought to describe hospitalists' decision-making regarding palliative care consultation for patients with dementia.
Design: Descriptive qualitative study.
Setting: Seven hospitals within a national nonprofit health system.
Participants: Hospitalist physicians.
...Do Physician Incentives Increase Patient Medication Adherence?
Edward Kong, John Beshears, David Laibson, Brigitte Madrian, Kevin Volpp, George Loewenstein, Jonathan Kolstad, James J. Choi
Abstract [from journal]
Objective: To test the effectiveness of physician incentives for increasing patient medication adherence in three drug classes: diabetes medication, antihypertensives, and statins.
Data sources: Pharmacy and medical claims from a large Medicare Advantage Prescription Drug Plan from January 2011 to December 2012.
Study design: We conducted a randomized experiment (911 primary care practices and 8,935 nonadherent patients) to test the effect of paying physicians for
...Three LDI Senior Fellows Win Top AcademyHealth Awards
Development Of Persistent Opioid Use After Cardiac Surgery
Chase R. Brown, Zehang Chen, Fabliha Khurshan, Peter W. Groeneveld, Nimesh D. Desai
Abstract [from journal]
Importance The overuse of opioids for acute pain management has led to an epidemic of persistent opioid use.
Objective To determine the proportion of opioid-naive patients who develop persistent opioid use after cardiac surgery and investigate the association between the initial amount of opioids prescribed at discharge and the likelihood of developing new persistent opioid use.
Design, Setting, and Participants This retrospective cohort study used data from a national...
A Targeted Program In An Academic Rheumatology Practice To Improve Compliance With Opioid Prescribing Guidelines For The Treatment Of Chronic Pain
Eric J. Wang, Rebecca Helgesen, Chadwick R. Johr, Hannah S. Lacko, Michael A. Ashburn, Peter A. Merkel
Abstract [from journal]
Objective: The Centers for Disease Control and Prevention (CDC) and many state governments have issued guidelines for opioid prescribing for the treatment of chronic non-cancer-associated pain. We sought to decrease practice variation and increase adherence to these guidelines in a tertiary academic Rheumatology practice by developing an interdisciplinary Opioid Working Group and using Electronic Health Record (EHR)-integrated data feedback.
Methods: Division leadership and providers
...Physicians And Students Take To The Streets To Ask: What Do People Want From Their Health Care?
Kimberly DiGioia, Mohit Nair, Morgan Shields, Vikas Saini
Abstract [from journal]
With the aim of better understanding what the public (as opposed to "patients") wants from health care, this study asked people on the street, "What does the right health care mean to you?" Responses ranged from "Caring about me more than just in the appointment" to "That everyone should see exactly what medical treatment costs." A qualitative analysis revealed that all responses fell into 2 overarching categories: health care at the interpersonal level and health care at the system level. Approximately 66.7% of responses included
...Phenotyping Physician Practice Patterns And Associations With Response To A Nudge In The Electronic Health Record For Influenza Vaccination: A Quasi-Experimental Study
Sujatha Changolkar, Jeffrey Rewley, Mohan Balachandran, Charles A L Rareshide, Christopher K Snider, Susan C Day, Mitesh S Patel
Abstract [from journal]
Background: Health systems routinely implement changes to the design of electronic health records (EHRs). Physician behavior may vary in response and methods to identify this variation could help to inform future interventions. The objective of this study was to phenotype primary care physician practice patterns and evaluate associations with response to an EHR nudge for influenza vaccination.
Methods and findings: During the 2016-2017 influenza season, 3 primary care practices at Penn Medicine...