Richard Quinn

Hospitalist Melissa Bartick, MD, MSc, became interested in breastfeeding some 10 years ago, as she was preparing for her first child. Her interest leaped to the national stage this month when several news outlets cited a study on which she is co-author and has implications for hospitalists treating lactating mothers.

"The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis” reported that if 90% of U.S. families fell in line with doctors’ recommendations to breastfeed newborns for six months, the country “would save $13 billion a year and prevent an excess 911 deaths, nearly all of which would be infants” (DOI: 10.1542/peds.2009-1616).

While breastfeeding isn’t a topic often mentioned by HM leaders, Dr. Bartick, a hospitalist at Cambridge Health Alliance in suburban Boston, points to its ties to preventing obesity, cardiovascular disease, and myocardial infarction (MI) incidences as reasons for hospitalists to keep a keener eye on the issue.

“Breastfeeding affects all kinds of diseases that we as hospitalists see every day,” Dr. Bartick adds. “It makes sense to study it.”

Dr. Bartick pushes physicians to think more about keeping lactating mothers and their infants connected during admissions. She also recommends increased usage of LactMed, a National Library of Medicine-sponsored database of drugs to which breastfeeding mothers might be exposed. Too many physicians, hospitalists included, will simply stop breastfeeding for hospitalized women just to stay on the safe side when a bit of research could eliminate complications.

“It’s important to be familiar with the physiology around lactation,” Dr. Bartick says. “It’s important to keep it going uninterrupted even if a woman is in the hospital. ... It’s not going an extra mile. It’s 20 seconds on the computer to go to LactMed.”

Hospitalist Melissa Bartick, MD, MSc, became interested in breastfeeding some 10 years ago, as she was preparing for her first child. Her interest leaped to the national stage this month when several news outlets cited a study on which she is co-author and has implications for hospitalists treating lactating mothers.

"The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis” reported that if 90% of U.S. families fell in line with doctors’ recommendations to breastfeed newborns for six months, the country “would save $13 billion a year and prevent an excess 911 deaths, nearly all of which would be infants” (DOI: 10.1542/peds.2009-1616).

While breastfeeding isn’t a topic often mentioned by HM leaders, Dr. Bartick, a hospitalist at Cambridge Health Alliance in suburban Boston, points to its ties to preventing obesity, cardiovascular disease, and myocardial infarction (MI) incidences as reasons for hospitalists to keep a keener eye on the issue.

“Breastfeeding affects all kinds of diseases that we as hospitalists see every day,” Dr. Bartick adds. “It makes sense to study it.”

Dr. Bartick pushes physicians to think more about keeping lactating mothers and their infants connected during admissions. She also recommends increased usage of LactMed, a National Library of Medicine-sponsored database of drugs to which breastfeeding mothers might be exposed. Too many physicians, hospitalists included, will simply stop breastfeeding for hospitalized women just to stay on the safe side when a bit of research could eliminate complications.

“It’s important to be familiar with the physiology around lactation,” Dr. Bartick says. “It’s important to keep it going uninterrupted even if a woman is in the hospital. ... It’s not going an extra mile. It’s 20 seconds on the computer to go to LactMed.”

Hospitalist Melissa Bartick, MD, MSc, became interested in breastfeeding some 10 years ago, as she was preparing for her first child. Her interest leaped to the national stage this month when several news outlets cited a study on which she is co-author and has implications for hospitalists treating lactating mothers.

"The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis” reported that if 90% of U.S. families fell in line with doctors’ recommendations to breastfeed newborns for six months, the country “would save $13 billion a year and prevent an excess 911 deaths, nearly all of which would be infants” (DOI: 10.1542/peds.2009-1616).

While breastfeeding isn’t a topic often mentioned by HM leaders, Dr. Bartick, a hospitalist at Cambridge Health Alliance in suburban Boston, points to its ties to preventing obesity, cardiovascular disease, and myocardial infarction (MI) incidences as reasons for hospitalists to keep a keener eye on the issue.

“Breastfeeding affects all kinds of diseases that we as hospitalists see every day,” Dr. Bartick adds. “It makes sense to study it.”

Dr. Bartick pushes physicians to think more about keeping lactating mothers and their infants connected during admissions. She also recommends increased usage of LactMed, a National Library of Medicine-sponsored database of drugs to which breastfeeding mothers might be exposed. Too many physicians, hospitalists included, will simply stop breastfeeding for hospitalized women just to stay on the safe side when a bit of research could eliminate complications.

“It’s important to be familiar with the physiology around lactation,” Dr. Bartick says. “It’s important to keep it going uninterrupted even if a woman is in the hospital. ... It’s not going an extra mile. It’s 20 seconds on the computer to go to LactMed.”

A review of 208 California hospitals shows the presence of hospitalists was associated with process improvements across three medical conditions—acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia—but the specific role HM played in those results remains murky, according to a study in this month’s Journal of Hospital Medicine.

The review, "Cross-Sectional Analysis of Hospitalist Prevalence and Quality of Care in California (PDF)” (2010;5(4);200-207), found that in the 170 subject hospitals with HM programs, every 10% increase in the estimated percentage of patients admitted by hospitalists was associated with 0.5% fewer (P<0.001) missed quality opportunities for AMI at admission. In addition, hospitalists were associated with 0.6% (P<0.001), 0.5% (P=0.004), and 1.5% (P=0.006) fewer missed quality opportunities for AMI, CHF, and pneumonia assessed at discharge, respectively.

“You can’t really see anything that’s causative, but … hospitals with hospitalists versus those who were without were definitely different,” says lead author Eduard Vasilevskis, MD, assistant professor of medicine in the Section of Hospital Medicine at Vanderbilt University and the Tennessee Valley-Nashville VA Hospital. “But it’s unclear if it’s the hospitalists themselves who are doing the improvements in quality initiatives, or is it more a hospital willing to invest in quality and hospitalists are part of that but there other investments going on?”

Dr. Vasilevskis’ team measured 16 publicly reported quality measures but could draw no conclusions as to HM’s direct role in the quality improvements. He suggests the next step in HM research will be to bridge the gap between defining the presence of hospitalists and qualitatively defining their impacts on respective institutions. Along that line, Dr. Vasilevskis notes that only 38 of the 208 hospitals in the review did not have HM programs, a trend that in time would eliminate the ability to study hospital performance without taking hospitalist care into account.

“Ten years from now, this study couldn’t be done any longer,” he says. “Given the evidence we know so far on length of stay, readmissions … that’s probably a good thing.”

A review of 208 California hospitals shows the presence of hospitalists was associated with process improvements across three medical conditions—acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia—but the specific role HM played in those results remains murky, according to a study in this month’s Journal of Hospital Medicine.

The review, "Cross-Sectional Analysis of Hospitalist Prevalence and Quality of Care in California (PDF)” (2010;5(4);200-207), found that in the 170 subject hospitals with HM programs, every 10% increase in the estimated percentage of patients admitted by hospitalists was associated with 0.5% fewer (P<0.001) missed quality opportunities for AMI at admission. In addition, hospitalists were associated with 0.6% (P<0.001), 0.5% (P=0.004), and 1.5% (P=0.006) fewer missed quality opportunities for AMI, CHF, and pneumonia assessed at discharge, respectively.

“You can’t really see anything that’s causative, but … hospitals with hospitalists versus those who were without were definitely different,” says lead author Eduard Vasilevskis, MD, assistant professor of medicine in the Section of Hospital Medicine at Vanderbilt University and the Tennessee Valley-Nashville VA Hospital. “But it’s unclear if it’s the hospitalists themselves who are doing the improvements in quality initiatives, or is it more a hospital willing to invest in quality and hospitalists are part of that but there other investments going on?”

Dr. Vasilevskis’ team measured 16 publicly reported quality measures but could draw no conclusions as to HM’s direct role in the quality improvements. He suggests the next step in HM research will be to bridge the gap between defining the presence of hospitalists and qualitatively defining their impacts on respective institutions. Along that line, Dr. Vasilevskis notes that only 38 of the 208 hospitals in the review did not have HM programs, a trend that in time would eliminate the ability to study hospital performance without taking hospitalist care into account.

“Ten years from now, this study couldn’t be done any longer,” he says. “Given the evidence we know so far on length of stay, readmissions … that’s probably a good thing.”

A review of 208 California hospitals shows the presence of hospitalists was associated with process improvements across three medical conditions—acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia—but the specific role HM played in those results remains murky, according to a study in this month’s Journal of Hospital Medicine.

The review, "Cross-Sectional Analysis of Hospitalist Prevalence and Quality of Care in California (PDF)” (2010;5(4);200-207), found that in the 170 subject hospitals with HM programs, every 10% increase in the estimated percentage of patients admitted by hospitalists was associated with 0.5% fewer (P<0.001) missed quality opportunities for AMI at admission. In addition, hospitalists were associated with 0.6% (P<0.001), 0.5% (P=0.004), and 1.5% (P=0.006) fewer missed quality opportunities for AMI, CHF, and pneumonia assessed at discharge, respectively.

“You can’t really see anything that’s causative, but … hospitals with hospitalists versus those who were without were definitely different,” says lead author Eduard Vasilevskis, MD, assistant professor of medicine in the Section of Hospital Medicine at Vanderbilt University and the Tennessee Valley-Nashville VA Hospital. “But it’s unclear if it’s the hospitalists themselves who are doing the improvements in quality initiatives, or is it more a hospital willing to invest in quality and hospitalists are part of that but there other investments going on?”

Dr. Vasilevskis’ team measured 16 publicly reported quality measures but could draw no conclusions as to HM’s direct role in the quality improvements. He suggests the next step in HM research will be to bridge the gap between defining the presence of hospitalists and qualitatively defining their impacts on respective institutions. Along that line, Dr. Vasilevskis notes that only 38 of the 208 hospitals in the review did not have HM programs, a trend that in time would eliminate the ability to study hospital performance without taking hospitalist care into account.

“Ten years from now, this study couldn’t be done any longer,” he says. “Given the evidence we know so far on length of stay, readmissions … that’s probably a good thing.”

NATIONAL HARBOR, Md. — The HM movement over the past two decades has matured into a defined specialty, but must now take charge of quality improvement (QI) in hospital settings if it hopes to “go to that next level,” the new SHM president declared at the annual meeting this morning.

“We’re at a stage as an organization that we need to continue to do the quality education efforts, but we need to start rising to that next level, which is the quality execution and solutions,” said President Jeffrey Wiese, MD, FACP, SFHM, associate professor of medicine at Tulane University Health Sciences Center in New Orleans.

Dr. Wiese said that within five years he expects SHM to have crafted an interactive database listing all HM-led QI projects. He envisions the information as a resource for hospitalists looking to lead projects, as well as a “grand menu of potential practice improvement modules” to satisfy the new Focused Practice in Hospital Medicine Maintenance of Certification through the American Board of Internal Medicine (ABIM).

“We have great heterogeneity in the society,” Dr. Wiese said after his address. “Some people are quality experts because they received great training from SHM, Intermountain Health, IHI, but then there are many members that are interested and really want to be that quality expert, but are to the left on the continuum, still learning how to do it."

The new president capped a morning of speechifying from outgoing President Scott Flanders, MD, SFHM, director of the hospitalist division, University of Michigan Health System, Ann Arbor, and SHM CEO Larry Wellikson, MD, SFHM. Both reveled in HM’s growth, but agreed that to sustain that momentum more of the estimated 30,000 hospitalists in the U.S. need to get more involved in promoting and pushing the practice.

“We really need to engage everybody," Dr. Flanders said. "We need all 60,000 hands on deck.”

NATIONAL HARBOR, Md. — The HM movement over the past two decades has matured into a defined specialty, but must now take charge of quality improvement (QI) in hospital settings if it hopes to “go to that next level,” the new SHM president declared at the annual meeting this morning.

“We’re at a stage as an organization that we need to continue to do the quality education efforts, but we need to start rising to that next level, which is the quality execution and solutions,” said President Jeffrey Wiese, MD, FACP, SFHM, associate professor of medicine at Tulane University Health Sciences Center in New Orleans.

Dr. Wiese said that within five years he expects SHM to have crafted an interactive database listing all HM-led QI projects. He envisions the information as a resource for hospitalists looking to lead projects, as well as a “grand menu of potential practice improvement modules” to satisfy the new Focused Practice in Hospital Medicine Maintenance of Certification through the American Board of Internal Medicine (ABIM).

“We have great heterogeneity in the society,” Dr. Wiese said after his address. “Some people are quality experts because they received great training from SHM, Intermountain Health, IHI, but then there are many members that are interested and really want to be that quality expert, but are to the left on the continuum, still learning how to do it."

The new president capped a morning of speechifying from outgoing President Scott Flanders, MD, SFHM, director of the hospitalist division, University of Michigan Health System, Ann Arbor, and SHM CEO Larry Wellikson, MD, SFHM. Both reveled in HM’s growth, but agreed that to sustain that momentum more of the estimated 30,000 hospitalists in the U.S. need to get more involved in promoting and pushing the practice.

“We really need to engage everybody," Dr. Flanders said. "We need all 60,000 hands on deck.”

NATIONAL HARBOR, Md. — The HM movement over the past two decades has matured into a defined specialty, but must now take charge of quality improvement (QI) in hospital settings if it hopes to “go to that next level,” the new SHM president declared at the annual meeting this morning.

“We’re at a stage as an organization that we need to continue to do the quality education efforts, but we need to start rising to that next level, which is the quality execution and solutions,” said President Jeffrey Wiese, MD, FACP, SFHM, associate professor of medicine at Tulane University Health Sciences Center in New Orleans.

Dr. Wiese said that within five years he expects SHM to have crafted an interactive database listing all HM-led QI projects. He envisions the information as a resource for hospitalists looking to lead projects, as well as a “grand menu of potential practice improvement modules” to satisfy the new Focused Practice in Hospital Medicine Maintenance of Certification through the American Board of Internal Medicine (ABIM).

“We have great heterogeneity in the society,” Dr. Wiese said after his address. “Some people are quality experts because they received great training from SHM, Intermountain Health, IHI, but then there are many members that are interested and really want to be that quality expert, but are to the left on the continuum, still learning how to do it."

The new president capped a morning of speechifying from outgoing President Scott Flanders, MD, SFHM, director of the hospitalist division, University of Michigan Health System, Ann Arbor, and SHM CEO Larry Wellikson, MD, SFHM. Both reveled in HM’s growth, but agreed that to sustain that momentum more of the estimated 30,000 hospitalists in the U.S. need to get more involved in promoting and pushing the practice.

“We really need to engage everybody," Dr. Flanders said. "We need all 60,000 hands on deck.”

NATIONAL HARBOR, Md. – Hospitalists are poised to take the reins of implementing the landmark healthcare reform package signed into law two weeks ago.

“It creates challenges for us; it creates great opportunities for us,” Ron Greeno, MD, FCCP, SFHM, chief medical officer of Brentwood, Tenn.-based Cogent Healthcare, and a member of SHM’s Public Policy Committee, said during a panel discussion this morning at HM10. “Saddle up, because we’re going to be asked to do a lot of things.”

Just what the most meaningful healthcare legislation since Medicare was passed in 1965 will mean for hospitalists is murky. Eric Siegal, MD, SFHM, chair of SHM’s Public Policy Committee, noted that a skeptic can look at bundling payments as a negative influence on HM compensation, while a supporter might argue that a revised revenue methodology could streamline operations, align interests and eventually be a boon to the bottom line.

Either way, outgoing SHM President Scott Flanders, MD, SFHM, director of the hospitalist division at the University of Michigan Health System in Ann Arbor, wants all hospitalists to be prepared for inevitable discussions of how to improve quality of care and reduce costs.

“The timing couldn’t be more fortuitous,” Dr. Flanders said, referring to the fact the annual meeting is being held just miles from the Capitol. “We are about to experience some sea changes in healthcare in the United States.”

Leslie Norwalk, former acting administrator of the Centers for Medicare and Medicaid Services (CMS), noted that much of the reform would hinge on pay incentives and the ability to properly fund programs that encourage new ideas, particularly the proposed Council on Technology and Innovation. Without proper funding, many elements of the health reform legislation could go by the wayside, said Norwalk, now a lawyer in Washington.

“You get what you pay for,” she added. “If you stop paying for readmission—at least avoidable readmission…then I imagine that this trend would change.”

NATIONAL HARBOR, Md. – Hospitalists are poised to take the reins of implementing the landmark healthcare reform package signed into law two weeks ago.

“It creates challenges for us; it creates great opportunities for us,” Ron Greeno, MD, FCCP, SFHM, chief medical officer of Brentwood, Tenn.-based Cogent Healthcare, and a member of SHM’s Public Policy Committee, said during a panel discussion this morning at HM10. “Saddle up, because we’re going to be asked to do a lot of things.”

Just what the most meaningful healthcare legislation since Medicare was passed in 1965 will mean for hospitalists is murky. Eric Siegal, MD, SFHM, chair of SHM’s Public Policy Committee, noted that a skeptic can look at bundling payments as a negative influence on HM compensation, while a supporter might argue that a revised revenue methodology could streamline operations, align interests and eventually be a boon to the bottom line.

Either way, outgoing SHM President Scott Flanders, MD, SFHM, director of the hospitalist division at the University of Michigan Health System in Ann Arbor, wants all hospitalists to be prepared for inevitable discussions of how to improve quality of care and reduce costs.

“The timing couldn’t be more fortuitous,” Dr. Flanders said, referring to the fact the annual meeting is being held just miles from the Capitol. “We are about to experience some sea changes in healthcare in the United States.”

Leslie Norwalk, former acting administrator of the Centers for Medicare and Medicaid Services (CMS), noted that much of the reform would hinge on pay incentives and the ability to properly fund programs that encourage new ideas, particularly the proposed Council on Technology and Innovation. Without proper funding, many elements of the health reform legislation could go by the wayside, said Norwalk, now a lawyer in Washington.

“You get what you pay for,” she added. “If you stop paying for readmission—at least avoidable readmission…then I imagine that this trend would change.”

NATIONAL HARBOR, Md. – Hospitalists are poised to take the reins of implementing the landmark healthcare reform package signed into law two weeks ago.

“It creates challenges for us; it creates great opportunities for us,” Ron Greeno, MD, FCCP, SFHM, chief medical officer of Brentwood, Tenn.-based Cogent Healthcare, and a member of SHM’s Public Policy Committee, said during a panel discussion this morning at HM10. “Saddle up, because we’re going to be asked to do a lot of things.”

Just what the most meaningful healthcare legislation since Medicare was passed in 1965 will mean for hospitalists is murky. Eric Siegal, MD, SFHM, chair of SHM’s Public Policy Committee, noted that a skeptic can look at bundling payments as a negative influence on HM compensation, while a supporter might argue that a revised revenue methodology could streamline operations, align interests and eventually be a boon to the bottom line.

Either way, outgoing SHM President Scott Flanders, MD, SFHM, director of the hospitalist division at the University of Michigan Health System in Ann Arbor, wants all hospitalists to be prepared for inevitable discussions of how to improve quality of care and reduce costs.

“The timing couldn’t be more fortuitous,” Dr. Flanders said, referring to the fact the annual meeting is being held just miles from the Capitol. “We are about to experience some sea changes in healthcare in the United States.”

Leslie Norwalk, former acting administrator of the Centers for Medicare and Medicaid Services (CMS), noted that much of the reform would hinge on pay incentives and the ability to properly fund programs that encourage new ideas, particularly the proposed Council on Technology and Innovation. Without proper funding, many elements of the health reform legislation could go by the wayside, said Norwalk, now a lawyer in Washington.

“You get what you pay for,” she added. “If you stop paying for readmission—at least avoidable readmission…then I imagine that this trend would change.”

NATIONAL HARBOR, Md. – The next cohort of sites for SHM’s transitional-care program will be 20 California hospitals and health centers.

The agreement to expand Project BOOST (Better Outcomes for Older Adults through Safer Transitions) was made public by society cofounder Win Whitcomb, MD, MHM, chief quality officer at Mercy Medical Center in Springfield, Mass., during an academic pre-course session Thursday at HM10 just outside Washington, D.C.

It’s the second major expansion of the program this year. In January, 15 sites in Michigan entered into a collaborative BOOST program to be comanaged by the University of Michigan and Blue Cross Blue Shield of Michigan. Although details are still pending for the California model, it will be a collaboration with the California HealthCare Foundation, an independent nonprofit focused on improving healthcare and reducing costs in the Golden State.

BOOST works by pairing mentors with hospitalists at select institutions to improve care via a discharge planning toolkit. BOOST debuted late in 2008 with six pilot sites. After the California additions, the platform will have expanded to 65 sites.

Dr. Whitcomb’s news was just one of the tidbits tossed out during the practice management pre-course, one of eight daylong courses for hospitalists. Two new pre-courses debuted this year: “Early Career Hospitalist: Skills for Success” and “Essential Neurology for the Hospitalist.”

“It’s a very good learning environment where you can sit down and focus,” said Julius Yang, MD, PhD, a hospitalist at Beth Israel Deaconess Medical Center in Boston and the course director for the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) learning session. “It allows you to really immerse yourself in the information.”

NATIONAL HARBOR, Md. – The next cohort of sites for SHM’s transitional-care program will be 20 California hospitals and health centers.

The agreement to expand Project BOOST (Better Outcomes for Older Adults through Safer Transitions) was made public by society cofounder Win Whitcomb, MD, MHM, chief quality officer at Mercy Medical Center in Springfield, Mass., during an academic pre-course session Thursday at HM10 just outside Washington, D.C.

It’s the second major expansion of the program this year. In January, 15 sites in Michigan entered into a collaborative BOOST program to be comanaged by the University of Michigan and Blue Cross Blue Shield of Michigan. Although details are still pending for the California model, it will be a collaboration with the California HealthCare Foundation, an independent nonprofit focused on improving healthcare and reducing costs in the Golden State.

BOOST works by pairing mentors with hospitalists at select institutions to improve care via a discharge planning toolkit. BOOST debuted late in 2008 with six pilot sites. After the California additions, the platform will have expanded to 65 sites.

Dr. Whitcomb’s news was just one of the tidbits tossed out during the practice management pre-course, one of eight daylong courses for hospitalists. Two new pre-courses debuted this year: “Early Career Hospitalist: Skills for Success” and “Essential Neurology for the Hospitalist.”

“It’s a very good learning environment where you can sit down and focus,” said Julius Yang, MD, PhD, a hospitalist at Beth Israel Deaconess Medical Center in Boston and the course director for the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) learning session. “It allows you to really immerse yourself in the information.”

NATIONAL HARBOR, Md. – The next cohort of sites for SHM’s transitional-care program will be 20 California hospitals and health centers.

The agreement to expand Project BOOST (Better Outcomes for Older Adults through Safer Transitions) was made public by society cofounder Win Whitcomb, MD, MHM, chief quality officer at Mercy Medical Center in Springfield, Mass., during an academic pre-course session Thursday at HM10 just outside Washington, D.C.

It’s the second major expansion of the program this year. In January, 15 sites in Michigan entered into a collaborative BOOST program to be comanaged by the University of Michigan and Blue Cross Blue Shield of Michigan. Although details are still pending for the California model, it will be a collaboration with the California HealthCare Foundation, an independent nonprofit focused on improving healthcare and reducing costs in the Golden State.

BOOST works by pairing mentors with hospitalists at select institutions to improve care via a discharge planning toolkit. BOOST debuted late in 2008 with six pilot sites. After the California additions, the platform will have expanded to 65 sites.

Dr. Whitcomb’s news was just one of the tidbits tossed out during the practice management pre-course, one of eight daylong courses for hospitalists. Two new pre-courses debuted this year: “Early Career Hospitalist: Skills for Success” and “Essential Neurology for the Hospitalist.”

“It’s a very good learning environment where you can sit down and focus,” said Julius Yang, MD, PhD, a hospitalist at Beth Israel Deaconess Medical Center in Boston and the course director for the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) learning session. “It allows you to really immerse yourself in the information.”

A report that associates lower ICU mortality rates with multidisciplinary team rounding has one thought leader envisioning hospitalists as a key part of future collaborations.

The Feb. 22 study, "The Effect of Multidisciplinary Care Teams on Intensive Care Unit Mortality," included 107,324 patients at 112 hospitals (Arch Intern Med. 2010;170(4):369-376). Overall 30-day mortality was 18.3%. After making adjustments for patient and hospital characteristics, the team reported that multidisciplinary care was associated with significant reductions in the odds of death (odds ratio [OR], 0.84%; 95% confidence interval [CI], 0.76-0.93 [P=0.01]).

J. Perren Cobb, MD, of Massachusetts General Hospital in Boston wrote an accompanying editorial calling for physicians to see quality improvement (QI) projects tied to collaborative care as stepping stones to what he calls "health engineering." He defines the term as the "application of systems science to study how staff, patient, data, and equipment interactions can be engineered to optimize patient outcomes."

Dr. Cobb explains, for example, that hospitalists and intensivists can provide 24/7 care. "Hospitalists can bridge the care of the patient from the ICU to the non-ICU setting," he says.

Dr. Cobb wants competing factions in hospitals to share a "common vision" that studies patient care from both macro and micro perspectives. That encompasses everything from patient handoffs that require brief conversations between shifts to streamlining electronic medical records. His editorial focuses on the potential improvements in ICUs, but he notes that the "engineering of healthcare" can improve efficiency and efficacy across the continuum of care.

"The components are all there; they’ve been there for a long time," Dr. Cobb adds. "But what we're seeing in medicine is we’re evolving from 'seeing one patient at a time' to managing systems."

A report that associates lower ICU mortality rates with multidisciplinary team rounding has one thought leader envisioning hospitalists as a key part of future collaborations.

The Feb. 22 study, "The Effect of Multidisciplinary Care Teams on Intensive Care Unit Mortality," included 107,324 patients at 112 hospitals (Arch Intern Med. 2010;170(4):369-376). Overall 30-day mortality was 18.3%. After making adjustments for patient and hospital characteristics, the team reported that multidisciplinary care was associated with significant reductions in the odds of death (odds ratio [OR], 0.84%; 95% confidence interval [CI], 0.76-0.93 [P=0.01]).

J. Perren Cobb, MD, of Massachusetts General Hospital in Boston wrote an accompanying editorial calling for physicians to see quality improvement (QI) projects tied to collaborative care as stepping stones to what he calls "health engineering." He defines the term as the "application of systems science to study how staff, patient, data, and equipment interactions can be engineered to optimize patient outcomes."

Dr. Cobb explains, for example, that hospitalists and intensivists can provide 24/7 care. "Hospitalists can bridge the care of the patient from the ICU to the non-ICU setting," he says.

Dr. Cobb wants competing factions in hospitals to share a "common vision" that studies patient care from both macro and micro perspectives. That encompasses everything from patient handoffs that require brief conversations between shifts to streamlining electronic medical records. His editorial focuses on the potential improvements in ICUs, but he notes that the "engineering of healthcare" can improve efficiency and efficacy across the continuum of care.

"The components are all there; they’ve been there for a long time," Dr. Cobb adds. "But what we're seeing in medicine is we’re evolving from 'seeing one patient at a time' to managing systems."

A report that associates lower ICU mortality rates with multidisciplinary team rounding has one thought leader envisioning hospitalists as a key part of future collaborations.

The Feb. 22 study, "The Effect of Multidisciplinary Care Teams on Intensive Care Unit Mortality," included 107,324 patients at 112 hospitals (Arch Intern Med. 2010;170(4):369-376). Overall 30-day mortality was 18.3%. After making adjustments for patient and hospital characteristics, the team reported that multidisciplinary care was associated with significant reductions in the odds of death (odds ratio [OR], 0.84%; 95% confidence interval [CI], 0.76-0.93 [P=0.01]).

J. Perren Cobb, MD, of Massachusetts General Hospital in Boston wrote an accompanying editorial calling for physicians to see quality improvement (QI) projects tied to collaborative care as stepping stones to what he calls "health engineering." He defines the term as the "application of systems science to study how staff, patient, data, and equipment interactions can be engineered to optimize patient outcomes."

Dr. Cobb explains, for example, that hospitalists and intensivists can provide 24/7 care. "Hospitalists can bridge the care of the patient from the ICU to the non-ICU setting," he says.

Dr. Cobb wants competing factions in hospitals to share a "common vision" that studies patient care from both macro and micro perspectives. That encompasses everything from patient handoffs that require brief conversations between shifts to streamlining electronic medical records. His editorial focuses on the potential improvements in ICUs, but he notes that the "engineering of healthcare" can improve efficiency and efficacy across the continuum of care.

"The components are all there; they’ve been there for a long time," Dr. Cobb adds. "But what we're seeing in medicine is we’re evolving from 'seeing one patient at a time' to managing systems."

The cost of healthcare varies widely from hospital to hospital and doesn't appear to be inherently linked to the quality of patient care, according to a study in the Archives of Internal Medicine.

"It's particularly perplexing because the differences in cost are quite substantial," says Mitchell Katz, MD, director of San Francisco's public-health program and the author of an accompanying editorial calling for more research.

The Feb. 22 report found wide disparities in the costs of care but no strong correlation in the context of patient care or the risk of death within 30 days. The nationwide study by researchers at the University of Michigan reviewed some 3,150 hospitals that discharged Medicare patients admitted for congestive heart failure or pneumonia in 2006. Data were studied in association with variables including readmission rates and quality scores.

Compared with hospitals in the lowest-cost quartile for congestive heart failure care, the researchers found that hospitals in the highest-cost quartile had higher quality-of-care scores (89.9% vs. 85.5%) and lower mortality for congestive heart failure (9.8% vs. 10.8%). For pneumonia, however, the converse was true. Compared with lower-cost hospitals, high-cost hospitals had lower quality-of-care scores (85.7% vs. 86.6%) and higher mortality (11.7% vs. 10.9%).

Dr. Katz is heartened that the study found longer length-of-stay (LOS) at high-cost hospitals, suggesting that decreased LOS—a staple of HM's value-added services—will slash hospital costs. But he says more randomized, comparative-effectiveness studies need to be published. Hospitalists are in a natural position to author those examinations, he says. "One of the roles of a hospitalist can be to be advocates of 'Yes, we think it can be done,' " Dr. Katz says. "Because there are a lot of doctors who want to say, ‘No, it can’t be done.' "

The cost of healthcare varies widely from hospital to hospital and doesn't appear to be inherently linked to the quality of patient care, according to a study in the Archives of Internal Medicine.

"It's particularly perplexing because the differences in cost are quite substantial," says Mitchell Katz, MD, director of San Francisco's public-health program and the author of an accompanying editorial calling for more research.

The Feb. 22 report found wide disparities in the costs of care but no strong correlation in the context of patient care or the risk of death within 30 days. The nationwide study by researchers at the University of Michigan reviewed some 3,150 hospitals that discharged Medicare patients admitted for congestive heart failure or pneumonia in 2006. Data were studied in association with variables including readmission rates and quality scores.

Compared with hospitals in the lowest-cost quartile for congestive heart failure care, the researchers found that hospitals in the highest-cost quartile had higher quality-of-care scores (89.9% vs. 85.5%) and lower mortality for congestive heart failure (9.8% vs. 10.8%). For pneumonia, however, the converse was true. Compared with lower-cost hospitals, high-cost hospitals had lower quality-of-care scores (85.7% vs. 86.6%) and higher mortality (11.7% vs. 10.9%).

Dr. Katz is heartened that the study found longer length-of-stay (LOS) at high-cost hospitals, suggesting that decreased LOS—a staple of HM's value-added services—will slash hospital costs. But he says more randomized, comparative-effectiveness studies need to be published. Hospitalists are in a natural position to author those examinations, he says. "One of the roles of a hospitalist can be to be advocates of 'Yes, we think it can be done,' " Dr. Katz says. "Because there are a lot of doctors who want to say, ‘No, it can’t be done.' "

The cost of healthcare varies widely from hospital to hospital and doesn't appear to be inherently linked to the quality of patient care, according to a study in the Archives of Internal Medicine.

"It's particularly perplexing because the differences in cost are quite substantial," says Mitchell Katz, MD, director of San Francisco's public-health program and the author of an accompanying editorial calling for more research.

The Feb. 22 report found wide disparities in the costs of care but no strong correlation in the context of patient care or the risk of death within 30 days. The nationwide study by researchers at the University of Michigan reviewed some 3,150 hospitals that discharged Medicare patients admitted for congestive heart failure or pneumonia in 2006. Data were studied in association with variables including readmission rates and quality scores.

Compared with hospitals in the lowest-cost quartile for congestive heart failure care, the researchers found that hospitals in the highest-cost quartile had higher quality-of-care scores (89.9% vs. 85.5%) and lower mortality for congestive heart failure (9.8% vs. 10.8%). For pneumonia, however, the converse was true. Compared with lower-cost hospitals, high-cost hospitals had lower quality-of-care scores (85.7% vs. 86.6%) and higher mortality (11.7% vs. 10.9%).

Dr. Katz is heartened that the study found longer length-of-stay (LOS) at high-cost hospitals, suggesting that decreased LOS—a staple of HM's value-added services—will slash hospital costs. But he says more randomized, comparative-effectiveness studies need to be published. Hospitalists are in a natural position to author those examinations, he says. "One of the roles of a hospitalist can be to be advocates of 'Yes, we think it can be done,' " Dr. Katz says. "Because there are a lot of doctors who want to say, ‘No, it can’t be done.' "

Upper gastrointestinal hemorrhage (UGIH) patients attended by academic hospitalists and nonhospitalists exhibited similar outcomes and length of stay (LOS), but those cared for by the hospitalists required higher costs for care, according to a study published in this month's Journal of Hospital Medicine.

The report,"Do Hospitalists Affect Clinical Outcomes and Efficiency for Patients with Acute Upper Gastrointestinal Hemorrhage (UGIH)?" (2010;5(3):132-138), says "median LOS was similar for hospitalists and non-hospitalists (4 days; P=0.69), but patients cared for by hospitalists had higher median costs ($7,359 vs. $6,181; P

"Our hypothesis going into it was that the presence of a hospitalist may impact the efficiency of the quality of care for this type of condition," says senior author Peter Kaboli, MD, MS, FHM, a hospitalist at the Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP) at the VA Medical Center in Iowa City, Iowa. "But we weren't sure, because this condition is so dependent on subspecialty care that our thought was possibly the need for subspecialists would attenuate that potential hospitalist effect we see in many other studies."

Dr. Kaboli and colleagues could not draw a specific conclusion for why the disparity of costs existed. He suggests that the higher intensity of costs in HM models is one contributing factor, as is the co-management model that eliminates a hospitalist's ability to unilaterally—and more quickly—make decisions that affect care and costs.

Regardless, Dr. Kaboli is hopeful the study spurs more research into why the cost variation exists and encourages HM leaders to review their UGIH care standards.

"Look at lengths of stay. Look at time to endoscopy," Dr. Kaboli says. "Look to see what you can do to improve that efficiency and improve that coordination of care. And, frankly, because so much of what we do is on a DRG-based payment system, we all do better and patients do better if we have highly efficient care."

Upper gastrointestinal hemorrhage (UGIH) patients attended by academic hospitalists and nonhospitalists exhibited similar outcomes and length of stay (LOS), but those cared for by the hospitalists required higher costs for care, according to a study published in this month's Journal of Hospital Medicine.

The report,"Do Hospitalists Affect Clinical Outcomes and Efficiency for Patients with Acute Upper Gastrointestinal Hemorrhage (UGIH)?" (2010;5(3):132-138), says "median LOS was similar for hospitalists and non-hospitalists (4 days; P=0.69), but patients cared for by hospitalists had higher median costs ($7,359 vs. $6,181; P

"Our hypothesis going into it was that the presence of a hospitalist may impact the efficiency of the quality of care for this type of condition," says senior author Peter Kaboli, MD, MS, FHM, a hospitalist at the Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP) at the VA Medical Center in Iowa City, Iowa. "But we weren't sure, because this condition is so dependent on subspecialty care that our thought was possibly the need for subspecialists would attenuate that potential hospitalist effect we see in many other studies."

Dr. Kaboli and colleagues could not draw a specific conclusion for why the disparity of costs existed. He suggests that the higher intensity of costs in HM models is one contributing factor, as is the co-management model that eliminates a hospitalist's ability to unilaterally—and more quickly—make decisions that affect care and costs.

Regardless, Dr. Kaboli is hopeful the study spurs more research into why the cost variation exists and encourages HM leaders to review their UGIH care standards.

"Look at lengths of stay. Look at time to endoscopy," Dr. Kaboli says. "Look to see what you can do to improve that efficiency and improve that coordination of care. And, frankly, because so much of what we do is on a DRG-based payment system, we all do better and patients do better if we have highly efficient care."

Upper gastrointestinal hemorrhage (UGIH) patients attended by academic hospitalists and nonhospitalists exhibited similar outcomes and length of stay (LOS), but those cared for by the hospitalists required higher costs for care, according to a study published in this month's Journal of Hospital Medicine.

The report,"Do Hospitalists Affect Clinical Outcomes and Efficiency for Patients with Acute Upper Gastrointestinal Hemorrhage (UGIH)?" (2010;5(3):132-138), says "median LOS was similar for hospitalists and non-hospitalists (4 days; P=0.69), but patients cared for by hospitalists had higher median costs ($7,359 vs. $6,181; P

"Our hypothesis going into it was that the presence of a hospitalist may impact the efficiency of the quality of care for this type of condition," says senior author Peter Kaboli, MD, MS, FHM, a hospitalist at the Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP) at the VA Medical Center in Iowa City, Iowa. "But we weren't sure, because this condition is so dependent on subspecialty care that our thought was possibly the need for subspecialists would attenuate that potential hospitalist effect we see in many other studies."

Dr. Kaboli and colleagues could not draw a specific conclusion for why the disparity of costs existed. He suggests that the higher intensity of costs in HM models is one contributing factor, as is the co-management model that eliminates a hospitalist's ability to unilaterally—and more quickly—make decisions that affect care and costs.

Regardless, Dr. Kaboli is hopeful the study spurs more research into why the cost variation exists and encourages HM leaders to review their UGIH care standards.

"Look at lengths of stay. Look at time to endoscopy," Dr. Kaboli says. "Look to see what you can do to improve that efficiency and improve that coordination of care. And, frankly, because so much of what we do is on a DRG-based payment system, we all do better and patients do better if we have highly efficient care."

A national summit on the future of healthcare will take center stage in Washington, D.C., next month—but Congress won't be involved in this discussion. SHM's 13th annual meeting is April 8-11 at the Gaylord National Harbor Resort & Convention Center in National Harbor, Md. The four-day event is expected to draw more than 2,300 hospitalists.

"It's pretty exciting that we're coming to Washington this year with all the activity in healthcare reform," says Larry Wellikson, MD, FHM, CEO of SHM.

SHM leaders say HM10 will offer new features, including:

• Induction of the first classes of Senior Fellows in Hospital Medicine (SFHM) and Master in Hospital Medicine (MHM); 
• Two new pre-courses slated for April 8: "Essential Neurology for the Hospitalist" and "Early Career Hospitalist: Skills for Success";
• An expanded research and innovation platform that will include visiting professor Mark Zeidel, MD, chair of the Department of Medicine at Beth Israel Deaconess Medical Center in Boston; 
• A limited-seating workshop track; and
• A keynote address from Paul Levy, president and CEO of Beth Israel in Boston and a respected commentator in the arena of healthcare QI and patient safety. The speech is titled "The Hospitalist's Role in the Hospital of the Future."

 

SHM leaders say that despite the economic downturn, attendance at this year's conference is expected to significantly exceed the record crowd that trekked to Chicago last spring. "Even though there are travel-budget cuts and education-budget cuts, the one meeting that hospitalists continue to go to is SHM's annual conference," says Geri Barnes, SHM senior director of education and meetings. “That’s where they get their education and are able to network at the largest gathering of hospitalists every year."

Visit www.the-hospitalist.org for extensive meeting coverage.

A national summit on the future of healthcare will take center stage in Washington, D.C., next month—but Congress won't be involved in this discussion. SHM's 13th annual meeting is April 8-11 at the Gaylord National Harbor Resort & Convention Center in National Harbor, Md. The four-day event is expected to draw more than 2,300 hospitalists.

"It's pretty exciting that we're coming to Washington this year with all the activity in healthcare reform," says Larry Wellikson, MD, FHM, CEO of SHM.

SHM leaders say HM10 will offer new features, including:

• Induction of the first classes of Senior Fellows in Hospital Medicine (SFHM) and Master in Hospital Medicine (MHM); 
• Two new pre-courses slated for April 8: "Essential Neurology for the Hospitalist" and "Early Career Hospitalist: Skills for Success";
• An expanded research and innovation platform that will include visiting professor Mark Zeidel, MD, chair of the Department of Medicine at Beth Israel Deaconess Medical Center in Boston; 
• A limited-seating workshop track; and
• A keynote address from Paul Levy, president and CEO of Beth Israel in Boston and a respected commentator in the arena of healthcare QI and patient safety. The speech is titled "The Hospitalist's Role in the Hospital of the Future."

 

SHM leaders say that despite the economic downturn, attendance at this year's conference is expected to significantly exceed the record crowd that trekked to Chicago last spring. "Even though there are travel-budget cuts and education-budget cuts, the one meeting that hospitalists continue to go to is SHM's annual conference," says Geri Barnes, SHM senior director of education and meetings. “That’s where they get their education and are able to network at the largest gathering of hospitalists every year."

Visit www.the-hospitalist.org for extensive meeting coverage.

A national summit on the future of healthcare will take center stage in Washington, D.C., next month—but Congress won't be involved in this discussion. SHM's 13th annual meeting is April 8-11 at the Gaylord National Harbor Resort & Convention Center in National Harbor, Md. The four-day event is expected to draw more than 2,300 hospitalists.

"It's pretty exciting that we're coming to Washington this year with all the activity in healthcare reform," says Larry Wellikson, MD, FHM, CEO of SHM.

SHM leaders say HM10 will offer new features, including:

• Induction of the first classes of Senior Fellows in Hospital Medicine (SFHM) and Master in Hospital Medicine (MHM); 
• Two new pre-courses slated for April 8: "Essential Neurology for the Hospitalist" and "Early Career Hospitalist: Skills for Success";
• An expanded research and innovation platform that will include visiting professor Mark Zeidel, MD, chair of the Department of Medicine at Beth Israel Deaconess Medical Center in Boston; 
• A limited-seating workshop track; and
• A keynote address from Paul Levy, president and CEO of Beth Israel in Boston and a respected commentator in the arena of healthcare QI and patient safety. The speech is titled "The Hospitalist's Role in the Hospital of the Future."

 

SHM leaders say that despite the economic downturn, attendance at this year's conference is expected to significantly exceed the record crowd that trekked to Chicago last spring. "Even though there are travel-budget cuts and education-budget cuts, the one meeting that hospitalists continue to go to is SHM's annual conference," says Geri Barnes, SHM senior director of education and meetings. “That’s where they get their education and are able to network at the largest gathering of hospitalists every year."

Visit www.the-hospitalist.org for extensive meeting coverage.

With prods from technological advancement and political pressure, the use of digital medicine is expected to take another leap forward this year—and hospitalists can be among those who benefit most, according to a presentation at an American College of Physicians meeting last month.

The workshop, "Wired and Wireless Health," held as part of the New Jersey Chapter regional meeting in Woodbridge, N.J., focused on three areas of health information technology (IT): social networking, applications and devices, and infrastructure. Steven Peskin, MD, MBA, FACP, says social networking Web sites like Sermo and Medscape Physician Connect offer portals for the "sharing of clinical insights and solutions to practical clinical problems in a way that promises to hone best practices."

As executive vice president and chief medical officer of Yardley, Pa.-based MediMedia USA, Dr. Peskin preaches the value of digital technology for inpatient care. Hospitalists, in particular, can use handheld devices and applications to deliver faster care and receive test results more quickly.

“There’s an app for that,” he quips, noting Modality and MedCalc. SHM is nearing launch of its new mobile resource center, which is supported by Epocrates and offers hospitalists exclusive commentary on the latest news and research in HM and hospitalist practice management.

Dr. Peskin, while an ardent supporter of the use of digital technology to improve patient care, is quick to caution that technology has its place. Privacy concerns, which are often associated with electronic health records (EHR), are a major consideration physicians should keep in mind when incorporating advances in iPhones, BlackBerrys, or other smartphones, he says.

"Digital medicine is not a substitute for clinical experience," Dr. Peskin says. "But it can improve clinical judgment and better clinical judgment. I like to say, 'Use computers for what they do well and use your brain for what it does well.'"

With prods from technological advancement and political pressure, the use of digital medicine is expected to take another leap forward this year—and hospitalists can be among those who benefit most, according to a presentation at an American College of Physicians meeting last month.

The workshop, "Wired and Wireless Health," held as part of the New Jersey Chapter regional meeting in Woodbridge, N.J., focused on three areas of health information technology (IT): social networking, applications and devices, and infrastructure. Steven Peskin, MD, MBA, FACP, says social networking Web sites like Sermo and Medscape Physician Connect offer portals for the "sharing of clinical insights and solutions to practical clinical problems in a way that promises to hone best practices."

As executive vice president and chief medical officer of Yardley, Pa.-based MediMedia USA, Dr. Peskin preaches the value of digital technology for inpatient care. Hospitalists, in particular, can use handheld devices and applications to deliver faster care and receive test results more quickly.

“There’s an app for that,” he quips, noting Modality and MedCalc. SHM is nearing launch of its new mobile resource center, which is supported by Epocrates and offers hospitalists exclusive commentary on the latest news and research in HM and hospitalist practice management.

Dr. Peskin, while an ardent supporter of the use of digital technology to improve patient care, is quick to caution that technology has its place. Privacy concerns, which are often associated with electronic health records (EHR), are a major consideration physicians should keep in mind when incorporating advances in iPhones, BlackBerrys, or other smartphones, he says.

"Digital medicine is not a substitute for clinical experience," Dr. Peskin says. "But it can improve clinical judgment and better clinical judgment. I like to say, 'Use computers for what they do well and use your brain for what it does well.'"

With prods from technological advancement and political pressure, the use of digital medicine is expected to take another leap forward this year—and hospitalists can be among those who benefit most, according to a presentation at an American College of Physicians meeting last month.

The workshop, "Wired and Wireless Health," held as part of the New Jersey Chapter regional meeting in Woodbridge, N.J., focused on three areas of health information technology (IT): social networking, applications and devices, and infrastructure. Steven Peskin, MD, MBA, FACP, says social networking Web sites like Sermo and Medscape Physician Connect offer portals for the "sharing of clinical insights and solutions to practical clinical problems in a way that promises to hone best practices."

As executive vice president and chief medical officer of Yardley, Pa.-based MediMedia USA, Dr. Peskin preaches the value of digital technology for inpatient care. Hospitalists, in particular, can use handheld devices and applications to deliver faster care and receive test results more quickly.

“There’s an app for that,” he quips, noting Modality and MedCalc. SHM is nearing launch of its new mobile resource center, which is supported by Epocrates and offers hospitalists exclusive commentary on the latest news and research in HM and hospitalist practice management.

Dr. Peskin, while an ardent supporter of the use of digital technology to improve patient care, is quick to caution that technology has its place. Privacy concerns, which are often associated with electronic health records (EHR), are a major consideration physicians should keep in mind when incorporating advances in iPhones, BlackBerrys, or other smartphones, he says.

"Digital medicine is not a substitute for clinical experience," Dr. Peskin says. "But it can improve clinical judgment and better clinical judgment. I like to say, 'Use computers for what they do well and use your brain for what it does well.'"