Background: Inpatient margins and hospital reimbursement have become increasingly dependent upon improving key metrics, such as length of stay and 30-day readmissions. Hospitalists typically lack access to credible, timely, and insightful metrics that inform their practice. In addition, individualized metrics, when available, struggle to properly normalize for patient complexity, warranted variations in care, shared decision-making, [...]

Background: Mortality prediction models are increasingly being adopted in the clinical setting, both to retrospectively assess quality of care and to prospectively inform clinical practice. An open question is whether a particular hospital should employ a model trained using a diverse nationwide dataset or use a model developed primarily from local data. The Veterans Affairs [...]

Background: Ten to twenty percent of U.S. hospitalizations are avoidable, driven by clinical uncertainty, social factors, or lack of access to ambulatory care [1-3]. These unnecessary admissions result in significant human and financial costs, including in-hospital errors, wasteful spending, and medical debt [4-7]. With hospital occupancy reaching critical levels, we designed and launched the Olive [...]

Background: Inpatient margins and hospital reimbursement have become increasingly dependent upon improving key metrics, such as length of stay and 30-day readmissions. Hospitalists typically lack access to credible, timely, and insightful metrics that inform their practice. In addition, individualized metrics, when available, struggle to properly normalize for patient complexity, warranted variations in care, shared decision-making, [...]

Background: Assessing severity of illness using available electronic medical record (EMR) data on admission and predicting inpatient mortality is very challenging. Lacking standardized practices around end of life issues, hospitalists use their clinical judgment in making these crucial decisions. Prolonged discussions may be needed in medically complex patients to direct an optimal plan of care [...]

Background: Mortality prediction models are increasingly being adopted in the clinical setting, both to retrospectively assess quality of care and to prospectively inform clinical practice. An open question is whether a particular hospital should employ a model trained using a diverse nationwide dataset or use a model developed primarily from local data. The Veterans Affairs [...]

Background: Hospital readmissions among HIV positive patients are high, and reducing 30-day readmissions is a priority of health systems and payers. Improved communication in the hospital may help decrease readmissions. Our objective was to determine the association between satisfaction with provider communication and 30-day readmissions among HIV positive patients. Methods: We performed a cross-sectional analysis [...]

Background: Hospital at home (HaH) programs have shown efficacy as substitutes for high-cost, traditional hospitalization in patients who are primarily low-acuity and with a range of medical conditions, including community-acquired pneumonia (CAP) and urinary tract infection (UTI). However, wide-spread adoption is minimal as providers and patients are challenged to consider HaH at the time of [...]

Background: Prior exposure to antibiotics is associated with a subsequent risk for sepsis (Baggs et al., 2018). However, there are limited data on characteristics of patients readmitted with sepsis following previous antibiotic exposure during a non-sepsis related hospitalization. We sought to characterize factors associated with sepsis-related readmission (SRR) within 30 days of a non-sepsis index [...]

Background: Historically, patients transferred from one hospital to another are admitted through the emergency department and then placed on the desired unit at the accepting hospital. This practice creates delays for critically ill patients in need of continuous ICU care. A strategy known as the direct admission addresses this issue. With this strategy, transfer patients [...]