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Biomedical subjects

Jeanne M Huddleston

Publications and source records attributed to Jeanne M Huddleston.

8 recordsLinked to original sources
PubMed2006

The status of hospital medicine groups in the United States.

BACKGROUND: Hospitalists, defined as hospital-based physicians who take responsibility for managing the medical needs of inpatients, represent a significant trend in physician specialization. However, only limited anecdotal data quantifying the status of hospital medicine groups around the country is available. OBJECTIVE: To better understand the extent and nature of the hospitalist movement, utilizing data from the 2003 Annual Survey of the American Hospital Association (AHA). STUDY POPULATION: 4895 acute care hospitals in the United States. MEASUREMENTS: Number and percentage of hospitals with hospital medicine groups; mean number of hospitalists per group; hospitalists per average daily census (ADC) of 100 patients; distribution of groups by employment model. DESCRIPTIVE VARIABLES: Census region; rural/urban status; number of beds; organizational control; teaching status. RESULTS: There are approximately 1415 hospital medicine groups and 11,159 hospitalists in the United States. The overall penetration of hospital medicine groups at hospitals is 29% (55% at hospitals with 200 or more beds), and the in-hospital impact at hospitals with hospital medicine groups is 3.93 hospitalists per 100 ADC. The average hospital medicine group has 7.9 hospitalists. There is a fairly equal distribution among the 3 major employment models for hospital medicine groups: hospital employees, independent provider groups, and physician groups. All these measures can vary substantially, depending on the characteristics of individual hospitals. CONCLUSIONS: Hospital medicine appears to have become part of the mainstream delivery of health care in the United States. No employment model of hospital medicine group appears to dominate this specialty. We expect there will continue to be growth and diversity in the implementation of hospital medicine groups.

Data Collection↗
PubMed2006

Effect of discharge instructions on readmission of hospitalised patients with heart failure: do all of the Joint Commission on Accreditation of Healthcare Organizations heart failure core measures reflect better care?

BACKGROUND: Most nationally standardised quality measures use widely accepted evidence-based processes as their foundation, but the discharge instruction component of the United States standards of Joint Commission on Accreditation of Healthcare Organizations heart failure core measure appears to be based on expert opinion alone. OBJECTIVE: To determine whether documentation of compliance with any or all of the six required discharge instructions is correlated with readmissions to hospital or mortality. RESEARCH DESIGN: A retrospective study at a single tertiary care hospital was conducted on randomly sampled patients hospitalised for heart failure from July 2002 to September 2003. PARTICIPANTS: Applying the Joint Commission on Accreditation of Healthcare Organizations criteria, 782 of 1121 patients were found eligible to receive discharge instructions. Eligibility was determined by age, principal diagnosis codes and discharge status codes. MEASURES: The primary outcome measures are time to death and time to readmission for heart failure or readmission for any cause and time to death. RESULTS: In all, 68% of patients received all instructions, whereas 6% received no instructions. Patients who received all instructions were significantly less likely to be readmitted for any cause (p = 0.003) and for heart failure (p = 0.035) than those who missed at least one type of instruction. Documentation of discharge instructions is correlated with reduced readmission rates. However, there was no association between documentation of discharge instructions and mortality (p = 0.521). CONCLUSIONS: Including discharge instructions among other evidence-based heart failure core measures appears justified.

Academic Medical Centers↗
PubMed2005

Effects of a hospitalist model on elderly patients with hip fracture.

BACKGROUND: Hospitalists' increased role in perioperative medicine allows for examination of their effects on surgical patients. This study examined the effects of a hospitalist service created to medically manage elderly patients with hip fracture. METHODS: During a 2-year historical cohort study of 466 patients 65 years or older admitted for surgical repair of hip fracture, we examined outcomes 1 year prior to and subsequent to the change from the standard to the hospitalist model. RESULTS: The mean (SD) time to surgery (38 [47] vs 25 [53] hours; P<.001), time from surgery to dismissal (9 [8] vs 7 [5] days; P = .04), and length of stay (10.6 [9] vs 8.4 [6] days; P<.001) were shorter in the hospitalist group. Predictors of shorter time to surgery were care by the hospitalist group (P = .002), older age (P = .01), and fall as the mechanism of fracture (P<.001), while American Society of Anesthesia scores of 3 and 4 were associated with increased time to surgery (P<.001). Receiving care by the hospitalist group (P<.001) and diagnosis of delirium (P<.001) were associated with increased chance of earlier dismissal, while admission to the intensive care unit decreased this chance (P<.001). Diagnosis of delirium was more frequent in the hospitalist group (74 [32.2%] of 230 vs 42 [17.8%] of 236; P<.001). There were no differences in inpatient deaths or 30-day readmission rates. CONCLUSION: In elderly patients with hip fracture, a hospitalist model decreased time to surgery, time from surgery to dismissal, and length of stay without adversely affecting inpatient deaths or 30-day readmission rates.

Aged↗
PubMed2004

Medical and surgical comanagement after elective hip and knee arthroplasty: a randomized, controlled trial.

BACKGROUND: Hospitalists are assuming an increasing role in the care of surgical patients, but the impact of this model of care on postoperative outcomes is unknown. OBJECTIVE: To determine the impact of providing a collaborative, hospitalist-led model of care on postoperative outcomes and costs among patients having hip or knee arthroplasty. DESIGN: Randomized, controlled trial. SETTING: Academic medical center. PARTICIPANTS: 526 patients having elective orthopedic surgery who are at elevated risk for postoperative morbidity. MEASUREMENTS: Length of stay, inpatient postoperative medical complications, health care provider satisfaction, and inpatient costs. INTERVENTIONS: A comanagement medical Hospitalist-Orthopedic Team compared with standard postoperative care by orthopedic surgeons with medical consultation. RESULTS: More patients in the hospitalist group were discharged from the hospital with no complications (61.6% vs. 49.8%; difference, 11.8 percentage points [95% CI, 2.8 to 20.7 percentage points]). Fewer minor complications were observed among hospitalist patients (30.2% vs. 44.3%; difference, -14.1 percentage points [CI, -22.7 to -5.3 percentage points]). Observed length of stay was not statistically different between treatment groups. However, when adjusted for discharge delays, mean length of stay for patients in the hospitalist model of care was shorter (5.1 days vs. 5.6 days; difference, -0.5 day [CI, -0.8 to -0.1 day]). Total costs did not differ between groups. Orthopedic surgeons and nurses preferred the hospitalist model. LIMITATIONS: Care providers and patients were aware of intervention assignments, and the study could not capture all costs associated with the hospitalist model. CONCLUSIONS: The comanagement medical Hospitalist-Orthopedic Team model reduced minor postoperative complication rates with no statistically significant difference in length of stay or cost. The nurses and surgeons strongly preferred the comanagement hospitalist model. Additional research on the clinical and economic impact of the hospitalist model in other surgical populations is warranted.

Aged↗
PubMed2004

Increased faculty presence on inpatient teaching services.

OBJECTIVES: To determine whether the level of presence of faculty in the afternoon or evening influences residents' perception of learning, "autonomy," or satisfaction, and if so whether the effect is positive or negative. SUBJECTS AND METHODS: A survey of internal medicine residents was conducted from January 1 through June 30, 1999. Primary outcome was residents' satisfaction and its relationship to the degree of (resident-observed) faculty presence. RESULTS: A total of 156 (86.7%) of the 180 surveys distributed were returned. Residents rated the individual faculty members' frequency of afternoon or evening presence as "most/all of the time" (47%), "occasionally" (32%), or "never/rarely" (21%). Increased faculty presence was positively associated with higher resident "satisfaction with faculty" (P < .001), "educational value of time spent with the faculty member" (P = .001), "team dynamics" (P = .002), "(quality of) overall medical care provided" (P = .03), and "sufficient autonomy" (P = .04). Residents were less likely to report concerns (difficulties) with teaching (P < .001) and efficiency (P = .008) of faculty whose level of presence was increased. CONCLUSION: Contrary to some concerns expressed, increased faculty presence is associated with higher resident satisfaction and a more favorable learning experience.

Attitude of Health Personnel↗
PubMed2003

Effect of multiple freeze-thaw cycles on detection of measles, mumps, and rubella virus antibodies.

We investigated the effect of multiple freeze-thaw cycles on mumps, measles, and rubella virus serum antibody levels with whole-virus immunoglobulin G enzyme-linked immunoassays. Fresh serum samples from nine healthy adult volunteers were divided into six sets of five aliquots each. Samples were taken through a total of 10 freeze-thaw cycles and stored at 4 degrees C until assayed. Each assay measurement was done in replicates of five, and the mean value was reported. After completing 10 freeze-thaw cycles, we found no clinically or statistically significant effect on measured antibody levels and found no discernible detrimental effect on the ability to measure these antibodies by enzyme-linked immunoassays.

Adult↗