Background: Co-management across service lines has become increasingly common in hospital medicine. SHM’s Co-Management Task Force has outlined several components of a successful co-management program. Recent studies have shown that cross-disciplinary service arrangements, which are more collaborative, enhance provider satisfaction and may improve patient care. These benefits have encouraged institutions to roll out multiple co-management [...]

Background: Reducing readmission rates may only be successfully realized if all factors that influence readmissions are thoughtfully considered. Beyond medical elements, nontraditional risk factors such as social and environmental variables may be associated with a higher likelihood of being readmitted.  In this study we evaluated the effect of distance between home and ‘key resources’ on [...]

Background: The Centers for Medicare & Medicaid Services (CMS) have sought to reduce readmissions through penalties applied to hospitals with readmission rates that are higher than expected, as calculated from models that use patient-level administrative data to account for case mix. Similar approaches are used to determine expected morality rates. Currently, CMS disseminates hospital-level adjusted [...]

Background: Unplanned readmissions among cancer patients are common and gastrointestinal (GI) cancer has some of the highest readmission volumes. Under the Affordable Care Act, hospitals have been getting penalized for excessive readmission rates. For now, the medical treatment of cancer is exempt from this measure. This is because the readmission profile of the cancer patient [...]

Background: In shared decision making models, decisional conflict is a measure of uncertainty and readiness and comfort level in making a decision. The literature examining decisional conflict is currently relatively immature. The act of a patient being readmitted is, in part, an effect of multiple small decisions a patient makes in the time between index [...]

Background: Defined approaches to reducing rates of hospital readmissions rates assume that patients are invested in their healthcare and in preventing readmissions. However, the extent to which patients believe that readmission is a “bad” outcome and feel that it is inevitable have not been defined. Further, the ability of patients to anticipate their own readmissions [...]

Background: Patients who are at risk for readmissions and emergency department visits following hospital discharge frequently have multiple medical comorbidities and a history of multiple prior hospitalizations. Over the past five years, reducing hospital readmissions has increasingly become a priority for hospitals, and effective interventions to reduce readmissions have included multiple components and multiple disciplines. [...]

Background: Hydroxyurea is an FDA approved medication for use in adults with sickle cell disease. Clinical guidelines, based on high quality evidence, recommend its use in all adults with sickle cell anemia and 3 or more moderate to severe pain crises within one year.  Studies suggest its use to be inappropriately low. We assessed local [...]

Background: Hospital medical groups use various staffing models which systematically affect care continuity during the admission process. Our service changed models of care from a “general model”, where hospitalists who perform hospital rounds and discharges also perform admissions on the same service day, to an “admitter-rounder model”, where service work is divided each day between [...]

Background: Patients discharged to post-acute care facilities are at higher risk for re-admissions compared to those discharged home. Mount Sinai Hospital (MSH) discharges a significant number of patients to Terence Cardinal Cooke Health Care Center (TCC), a post-acute care nursing facility in Manhattan. In 2013, MSH discharges by the hospitalist service to TCC had an average [...]