Background: CDC guidelines recommend and promote public awareness for Hepatitis C virus (HCV) screening for baby boomers (1945-1965) and individuals who report risk factors such as IDU. These strict guidelines and targeted educated are hindering positive patients who are non- baby boomers without risk factors from entering care due to the lack of education for [...]

Background: Healthcare expenditures in the United States have grown from 5% of the gross domestic product in 1960 to nearly 18% in 2015. Despite spending more for healthcare than any other industrialized country, healthcare outcomes are inferior. There are many factors identified for rising costs without an equivalent improvement in outcomes. This includes an estimated [...]

Background: Previous work suggests that hospitals’ teaching status is correlated with readmission rates, cost of care, and mortality. This research has focused on conditions closely tracked by the Centers for Medicare and Medicaid Services (CMS). The extent to which hospitals’ teaching status impacts care processes for syncope has not been extensively studied. Methods: We merged [...]

Background: Limited hospital capacity continues to be one of the major challenges to health care in hospitals in the US and the developed word. This problem manifests in a variety of ways in multiple settings starting with prolonged emergency room wait times and left without being seen rates, prolonged ED boarding time, and elective surgery [...]

Background: Obtaining blood work through venipuncture is an important part of the diagnosis and management of hospitalized patients. Through formal and informal patient complaints, we found that patients admitted to the University of Colorado Hospital (UCH) report an excessive number of venipunctures for laboratory blood sampling. This results in overuse of resources, excess patient discomfort, [...]

Background: Healthcare costs are a challenge; for the greatest impact, high-value care education should begin early in residency training. Routine lab ordering for hospitalized patients is a well-known cause of high costs. This study utilized multiple interventions to decrease the number of BMPs, CMPs and CBCs ordered by residents on the inpatient medicine service. The [...]

Background: Patients recurrently admitted to the hospital frequently experience fragmentation of care and poor health outcomes, with discontinuity between hospital admissions resulting in unnecessary testing, ineffective or inconsistent treatment plans, patient/provider frustration, and inability to address the underlying medical and psychosocial issues that drive repeat hospitalization. Purpose: For patients with the highest inpatient utilization on [...]

Background: The Choosing Wisely campaign aims to engage clinicians and public in addressing overuse in healthcare. Through adoption in 20 countries and 75 organizations, clinician engagement is largely successful. However, patient and public engagement remains a challenge, and there is concern that the impact of Choosing Wisely will be dampened if this is not achieved. [...]

Background: Appropriate use of consultation can improve mortality and decrease cost of care. However, inappropriate consultation may carry risks to patients. Little is known about the variability of inpatient consultation. We aim to describe patient-, admission-, and physician- level factors that influence the variability of inpatient consultation. Methods: We conducted a secondary analysis of 2011-2015 [...]

Background: High value healthcare has been increasingly emphasized during residency training. The Choosing Wisely campaign, an initiative of the American Board of Internal Medicine foundation and the Society of Hospital Medicine recommend against performing repetitive laboratory tests in the setting of clinical and laboratory stability. Unnecessary phlebotomy draws increase healthcare cost, decrease patient satisfaction, and [...]