Background: Hospital Medicine groups are often called upon to lead initiatives that require access to high-quality data from their local health system. These include quality and value improvement (QI) efforts as well as health services and outcomes research. Although these efforts can be important for clinical operations as well as academic advancement, clear mechanisms to [...]

Background: Despite years of intense focus, inpatient and observation readmission rates remain high and largely unchanged. Little robust evidence exists to guide hospitals in the selection of interventions effective at reducing 30 day readmissions in real-world settings. Our local healthcare system incorporated the most recent recommendations for preventing readmissions into a comprehensive program called Transition [...]

Background: Alcohol withdrawal is a common issue in hospitalized patients and is associated with significant morbidity and mortality. Alcohol withdrawal occurs when the gamma aminobutyric acid (GABA) stimulating effect of alcohol is removed, resulting in an excess of the excitatory neurotransmitter glutamate. Treatment typically consists of as needed benzodiazepines, which activate GABA. However, this reactive [...]

Background: Results from the recent SPRINT trial demonstrate lower rates of fatal and non-fatal major cardiovascular events and all-cause mortality in non-diabetics at high cardiovascular risk with intensive versus standard treatment, i.e., less than 120 versus less than 140 mmHg systolic, respectively. However, the long-term outcomes remain unknown.Methods: A validated state-transition model with multivariate risk [...]

Background: Esophageal varices with bleeding (EVB) are one of the most common causes of deaths in cirrhotic patients in the United States. Over the course of years, studies have reported an increase in the incidence of EVB and is associated with a high risk for morbidity and mortality. Data is lacking with regards to recent [...]

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: Chronic Obstructive Pulmonary Disease (COPD) is a lung disease characterized by chronic, irreversible airway obstruction that can precipitate into acute exacerbations (AECOPD) of cough, dyspnea and sputum production, often requiring hospitalization. Hospital systems aiming to improve outcomes for patients with AECOPD are testing innovative approaches to care in the acute care setting. To enroll [...]

Background: Sepsis research is limited by heterogeneity and inaccuracy of patient identification. An ideal identification algorithm would broadly define a population with suspected infection to optimize discrimination and provide real-time identification of high-risk populations for potential interventions. We combined clinical and administrative to identify a population of adults hospitalized with suspected infection and examined characteristics [...]

Background: The US healthcare system is under increasing pressure to improve value and affordability. Acute care is responsible for a large proportion of overall health costs, but the complexities and pace in this environment have left an evidence gap in value-based care transformation. Novel improvement and evaluation strategies are thus needed more than ever to [...]

Background: The 2016 Surviving Sepsis Campaign guidelines recommend antibiotic administration within 1 hour of emergency department (ED) presentation for patients with sepsis. While early antibiotics are associated with reduced mortality, the 1 hr policy has been criticized for its one-size-fits-all approach and risk for over-diagnosis and treatment. Clinicians and quality leaders have called, instead, for [...]