Re-envisioning interhospital transfer: A qualitative study exploring alternatives to transfer.

Background: Interhospital transfer (IHT, the transfer of patients between acute care hospitals) is often undertaken to provide patients with specialized care. However, mounting hospital capacity pressures suggest a need for re-envisioning IHT with consideration of alternatives to transfer in select patients.

Methods: We conducted a qualitative focus group study with key informants involved in IHT, including patient/family representatives, accepting and transferring clinicians, and hospital leadership.

Community Health Centers' Response to COVID-19 and Serving the Community: This Feeling of Never Being Enough and Never Doing Enough.

Objective: Community health centers (CHCs) are a vital safety net for under-resourced and medically underserved patients. As few studies have explored how they implemented broad-based organizational changes throughout the COVID-19 pandemic, we aimed to qualitatively examine CHCs' longitudinal, comprehensive pandemic response through the perspectives of staff, administrators, and researchers working in CHCs.

Methods: 25 clinic leaders, staff, and researchers from three CHC networks and two academic medical centers in Northern California and the Central Valley of California participated in 18 focus groups and interviews between April and October 2022.

'They Were Talking to Each Other but Not to Me': Examining the Drivers of Patients' Poor Experiences During the Transition From the Hospital to Skilled Nursing Facility.

Introduction: Hospital-to-skilled nursing facility (SNF) transitions have been characterised as fragmented and having poor quality. The drivers, or the factors and actions, that directly lead to these poor experiences are not well described. It is essential to understand the drivers of these experiences so that specific improvement targets can be identified.

Research priorities for adult hospital medicine: A survey of US hospital medicine leaders.

Hospital medicine (HM), a well-established clinical specialty, requires clarity of research priorities to identify target areas for investment in HM research infrastructure and activities. The Society of Hospital Medicine's Research Committee developed a 20-item survey and used purposeful sampling of US hospitalist leaders to prioritize primary research topic domains and subdomains. Respondents were asked to rank their HM research priorities using a scale (1 [highest] to 8 [lowest]).

Outcomes Evidence Must Keep Up with the Implementation of the 4Ms Framework to Ensure Age-Friendly Health System Transformation.

The Age-Friendly Health System (AFHS) movement was conceptualized as a transformative solution to reliably deliver evidence-based care to older adults. Guided by the 4Ms framework: What Matters, Mobility, Mentation, and Medication, AFHS healthcare systems have been given the flexibility to tailor 4Ms interventions and care processes to their context, preferences and populations. This flexibility has facilitated the widespread adoption of 4Ms care.

Development of a Tool to Measure Potentially Inappropriate Inter-Hospital Transfer (IHT): The POINT Study.

Background: Although inter-hospital transfer (IHT, the transfer of patients between acute care hospitals) aims at matching patients' care needs to appropriate sites of care, IHT practices are variable leaving some patients vulnerable to risks of discontinuity of care without clear benefit. Identifying which patients may not need IHT can help to prevent inappropriate care and improve patient outcomes.

Study Overview: The POINT Study, "Identification and Prevention of Potentially Inappropriate Inter-Hospital Transfers," is a 5-year study (AHRQ-R01HS028621) that aims to define potentially inappropriate IHT using key stakeholder input, evaluate the incidence and patient safety impact of potentially inappropriate IHT across a nationally representative sample of 18 hospitals, and develop an intervention toolkit to reduce potentially inappropriate IHT.

"Nobody Can Be Equipped for This": Advice From New Residents of Long-Term Care Facilities.

Background: The transition into a long-term care facility (LTCF) is difficult for older adults, prompting calls for clinicians to help guide and plan. Yet we know little about how those with lived experience of moving into an LTCF would advise others.

Methods: We conducted in-person semi-structured interviews with nursing home (NH) and assisted living (AL) residents within 6 months of moving into an urban non-profit continuing care retirement community in California between 2023 and 2024.

Mobility Loss in Hospitalized Adults Predicts Poor Clinical Outcomes.

Background:: The Johns Hopkins Activity and Mobility Program is a systematic approach to measure and improve patient mobility.

Purpose:: The purpose of this study was to evaluate the relationship between mobility loss and quality outcomes.

Methods:: A retrospective cohort study design was used.

Trainee Autonomy and Supervision in the Inpatient Clinical Learning Environment.

Background: Balancing autonomy and supervision during medical residency is important for trainee development while ensuring patient safety. In the increasingly complex inpatient clinical learning environment, tension exists when this balance is skewed. In this study, we aimed to understand current and ideal states of autonomy and supervision and then describe factors that contribute to imbalance from both trainee and attending perspectives.

Developing a Life Story Intervention for Older Adults With Dementia or at Risk of Delirium Who Were Hospitalized: Multistage, Stakeholder-Engaged Co-Design Study.

Background: Older adults with chronic or acute cognitive impairment, such as dementia or delirium, who are hospitalized face unique barriers to person-centered care and a higher risk for negative outcomes stemming from hospitalizations. There is a need for co-designed interventions adapted for these patients to the hospital setting to improve care and outcomes. Patient life storytelling interventions have demonstrated promise in enhancing person-centered care by improving patient-care team relationships and providing information to enable care tailored to individual needs and values.

Barriers and facilitators to screening for intimate partner violence at a level 1 trauma center.

Background: Intimate partner violence (IPV) is a significant public health problem that is associated with substantial health sequelae, including traumatic injury. Surgical professional societies recommend universal intimate partner violence screening in patients presenting after trauma, but this recommendation is not uniformly implemented. We designed and implemented a quality improvement project at our institution in July 2020 to enhance intimate partner violence screening.

Use of Muscle Relaxants After Surgery in Traditional Medicare Part D Enrollees.

Background: Surgeons have come under increased scrutiny for postoperative pain management, particularly for opioid prescribing. To decrease opioid use but still provide pain control, nonopioid medications such as muscle relaxants are being used, which can be harmful in older adults. However, the prevalence of muscle relaxant prescribing, trends in use over time, and risk of prolonged use are unknown.

Association of Race and Ethnicity With Postoperative Gabapentinoid and Opioid Prescribing Trends for Older Adults.

Background: Disparities in opioid prescribing by race/ethnicity have been described in many healthcare settings, with White patients being more likely to receive an opioid prescription than other races studied. As surgeons increase prescribing of nonopioid medications in response to the opioid epidemic, it is unknown whether postoperative prescribing disparities also exist for these medications, specifically gabapentinoids.

Methods: We conducted a retrospective cohort study using a 20% Medicare sample for 2013-2018.

Development and evaluation of a concise nurse-driven non-pharmacological delirium reduction workflow for hospitalized patients: An interrupted time series study.

We created a concise nurse-driven delirium reduction workflow with the aim of reducing delirium rates and length of stay for hospitalized adults. Our nurse-driven workflow included five evidence-based daytime "sunrise" interventions (patient room lights on, blinds up, mobilization/out-of-bed, water within patient's reach and patient awake) and five nighttime "turndown" interventions (patient room lights off, blinds down, television off, noise reduction and pre-set bedtime). Interventions were also chosen because fidelity could be quickly monitored twice daily without patient interruption from outside the room.

Achieving diagnostic excellence through prevention and teamwork (ADEPT) study protocol: A multicenter, prospective quality and safety program to improve diagnostic processes in medical inpatients.

Background: Few hospitals have built surveillance for diagnostic errors into usual care or used comparative quantitative and qualitative data to understand their diagnostic processes and implement interventions designed to reduce these errors.

Objectives: To build surveillance for diagnostic errors into usual care, benchmark diagnostic performance across sites, pilot test interventions, and evaluate the program's impact on diagnostic error rates.

Methods And Analysis: Achieving diagnostic excellence through prevention and teamwork (ADEPT) is a multicenter, real-world quality and safety program utilizing interrupted time-series techniques to evaluate outcomes.

Impact of standardized, language-concordant hospital discharge instructions on postdischarge medication questions.

Written instructions improve patient comprehension of discharge instructions but are often provided only in English even for patients with a non-English language preference (NELP). We implemented standardized written discharge instructions in English, Spanish, and Chinese for hospital medicine patients at an urban academic medical center. Using an interrupted time series analysis, we assessed the impact on medication-related postdischarge questions for patients with English, Spanish, or Chinese language preferences.

Trainee Autonomy and Supervision in the Modern Clinical Learning Environment: A Mixed-Methods Study of Faculty and Trainee Perspectives.

Background: Balancing autonomy and supervision during medical residency is important for trainee development while ensuring patient safety. In the modern clinical learning environment, tension exists when this balance is skewed. This study aimed to understand the current and ideal states of autonomy and supervision, then describe the factors that contribute to imbalance from both trainee and attending perspectives.

Trends in the Use of Gabapentinoids and Opioids in the Postoperative Period Among Older Adults.

Importance: In response to the opioid epidemic, recommendations from some pain societies have encouraged surgeons to embrace multimodal pain regimens with the intent of reducing opioid use in the postoperative period, including by prescribing gabapentinoids.

Objective: To describe trends in postoperative prescribing of both gabapentinoids and opioids after a variety of surgical procedures by examining nationally representative Medicare data and further understand variation by procedure.

Design, Setting, And Participants: This serial cross-sectional study of gabapentinoid prescribing from January 1, 2013, through December 31, 2018, used a 20% US Medicare sample.

Patient Perceptions of e-Visits: Qualitative Study of Older Adults to Inform Health System Implementation.

Background: Electronic visits (e-visits) are billable, asynchronous patient-initiated messages that require at least five minutes of medical decision-making by a provider. Unequal use of patient portal tools like e-visits by certain patient populations may worsen health disparities. To date, no study has attempted to qualitatively assess perceptions of e-visits in older adults.

Long-term outcomes and life-impacts of necrotizing enterocolitis: A survey of survivors and parents.

Necrotizing enterocolitis (NEC) is a devastating intestinal disease that primarily affects premature infants. Necrotizing enterocolitis is associated with adverse two-year outcomes, yet limited research has evaluated the impact of NEC on long-term complications and quality of life in children older than two years. We conducted a survey to characterize the long-term impact of NEC on physical and mental health, social experiences, and quality of life as self-reported by adult NEC survivors and parents of children who survived NEC.