Background: Subspecialty consultation among hospitalists varies significantly across and within hospitals. While in many cases consultation is clinically necessary, in other cases it may represent overuse. Recent studies have explored predictors of consultation using observational administrative and EHR data. Qualitative methods may generate knowledge about additional factors and complex processes influencing consultation behavior not ascertainable […]

Background: Subspecialty consultation among hospitalists varies significantly across and within hospitals. While in many cases consultation is clinically necessary, in other cases it may represent overuse. Recent studies have explored predictors of consultation using observational administrative and EHR data. Qualitative methods may generate knowledge about additional factors and complex processes influencing consultation behavior not ascertainable […]

Background: “Hospital at Home” (HaH) models of care have existed for over 20 years in the U.S. Demand for healthcare value, advances in relevant technologies, and the ongoing global pandemic have driven renewed attention to HaH models, by way of policy-based and academic pilot programs – and even commercialization attempts. Where studied, these models have […]

Background: Equity is an essential domain of healthcare quality [1] but is rarely addressed within quality measurement programs. Quality initiatives, without explicit equity focus, may exacerbate underlying disparities.[2]To address this historic lack of focus on equity, the Centers for Medicare & Medicaid (CMS) now provides confidential reports to hospitals on two disparity metrics for Medicare […]

Background: Healthcare in the U.S. is increasingly delivered by large health systems that include one or more hospitals and associated outpatient practices. It is unclear what role health systems play in driving or preventing overutilization of healthcare services in the U.S. We sought to learn what characteristics allow certain health systems to avoid low-value care […]

Background: Panel-based Nucleic acid amplification tests (NAATs) are laboratory tools that are used to detect small quantities of RNA or DNA to rapidly identify a multitude of infectious organisms. A systematic review and meta-analysis looking at the diagnostic accuracy of the BioFire® FilmArray® meningitis-encephalitis (ME) panel which is used at our institution showed that it […]

Background: CMS launched the Hospital Value-Based Purchasing (VBP) Program in 2010 as part of their initiatives to incorporate healthcare quality into Medicare payment structures. Participating hospitals are assessed according to four domains: Clinical Care, Person and Community Engagement, Safety, and Efficiency and Cost Reduction. Interventions to improve patient safety such as hand hygiene, contact precautions, […]

Background: It has been well demonstrated that improving patient health literacy positively impacts patient adherence to their treatment plan as well as patient satisfaction. The time just before hospital discharge is particularly important because the provider can summarize the admission including what the possible etiologies were that prompted admission, in-hospital therapies utilized, and what the […]

Background: Over-testing leads to inflated direct and indirect costs of care. Re-ordering tests prior to a given recommended interval, whether secondary to a lack of awareness of information in the patient’s chart or a lack of knowledge of the given recommended interval, most often increases costs without benefiting patients. Best Practice Advisory (BPA) pop-ups and […]

Background: Lack of mobilization of hospitalized non-ICU medical patients has known negative consequences, including worse health and psychological outcomes, functional decline and increased hospital length of stay (1). Known challenges to increasing mobilization amongst inpatients include patient- and institutional-related limitations such as patient symptoms and lack of available assistance (2). At our urban, quaternary care, […]