Background: Compared with health care systems globally, the U.S. health care system expends more resources yet achieves worse patient outcomes. Growing recognition that such low-value care is a system-level problem has spurred efforts to optimize system-level processes. Low-value hospital admissions are a major contributor to overall low-value care, but limited descriptions of specific processes for [...]

Background: Patient-reported measures including health confidence correlate with health outcomes, such as hospital utilization and post-acute care (PAC) needs within research settings. A more recent approach has been to develop learning health systems (LHS) with these measures to incorporate research findings into clinical care at a rapid rate. We have found that a measure of [...]

Background: Effective discharge communication is critical to ensuring safe patient transitions from the hospital and can improve outcomes. We have observed declining HCAHPS communication performance across our Section of Hospital Medicine and the transition out of the hospital was identified as a significant contributor. HCAHPS data was too slow to inform real-time improvement, so we [...]