Commentary on “Impact of Consultation on Hospital Outcomes and Resource Utilization for Patients with Acute Congestive Heart Failure”

The rising cost of health care has been a problem in the United States for decades. As our population ages, healthcare costs continue to rise, becoming increasingly burdensome for...

Impact of Consultation on Hospital Outcomes and Resource Utilization for Patients with Acute Congestive Heart Failure

Objectives: Consultation is an important tool for acquiring subspecialty support when managing patients with acute congestive heart failure (CHF). The effect of consultation on hospital outcomes and resource utilization in CHF is unknown. The objectives of our study were to determine the effect of consultation on outcomes in CHF and to evaluate factors affecting the frequency of consultation. Methods: Our study was a retrospective cohort...

Can Computers Be Made to Respect the Art of Medicine?

To the Editor: One of the common criticisms of the application of automated medical decision pathways is that although they may yield the correct answer in the case of straightforward clinical presentations, they fail to capture the nuances of more complex scenarios in which human clinical judgment and the art of medicine become more...

Dissemination Approaches to Participating Primary Care Providers in a Quality Improvement Program Addressing Opioid Use in Central Appalachia

Objectives: Practice-based research networks (PBRNs) have been described as new clinical laboratories for primary care research and dissemination. PBRNs, however, have struggled to disseminate research results in a meaningful way to participating providers and clinics. Methods: The Central Appalachia Inter-Professional Pain Education Collaborative was developed to work with PBRN clinics using quality improvement methods, deliver statewide...

Physician Order Entry Clerical Support Improves Physician Satisfaction and Productivity

Objectives: To examine the impact of clerical support personnel for physician order entry on physician satisfaction, productivity, timeliness with electronic health record (EHR) documentation, and physician attitudes. Methods: All seven part-time physicians at an academic general internal medicine practice were included in this quasi-experimental (single group, pre- and postintervention) mixed-methods study. One full-time clerical support...

Hospital Readmissions from Patients’ Perspectives

Objectives: Healthcare expenditures in the United States have increased exponentially and hospital care accounts for one-third of these costs. Approximately 18% of hospitalized Medicare beneficiaries are being readmitted to the hospital within 30 days. Engaging patients in the discharge process can help better identify patients’ postdischarge needs and implement more effective readmission prevention strategies. The objective of our study was...

Standardized Physician-Administered Patient-Centered Discharge Protocol Improves Patients’ Comprehension

Objectives: Patients are 30% less likely to be readmitted or visit the emergency department if they have a clear understanding of their discharge instructions. A standardized approach to a hospital discharge plan has not been universally implemented, however. Our goal was to increase patients’ comprehension of discharge instructions by implementing a standardized patient-centered discharge planning protocol that uses a physician team member to...

Will the “Fixes” Fall Flat? Prospects for Quality Measures and Payment Incentives to Control Healthcare Spending

Payment systems in the US healthcare system have rewarded physicians for services and attempted to control healthcare spending, with rewards and penalties based upon projected goals for future spending. The incorporation of quality goals and alternatives to fee-for-service was introduced to replace the previous system of rewards and penalties. We describe the history of the US healthcare payment system, focusing on Medicare and the efforts to...

Commentary on “Will the ‘Fixes’ Fall Flat? Prospects for Quality Measures and Payment Incentives to Control Healthcare Spending”

In this issue of the Southern Medical Journal, Hauswald and Sklar et al explore the evolution of Medicare payment policies and the challenges faced by the quality-aligned payment incentives.1 After 50 years of various manipulations to a fee-for-service system, the Medicare Access and Children’s Health Insurance Program Reauthorization Act (MACRA) implemented new payment and incentive models based in part on quality...

Association Between Energy Prices and US Hospital Patient Outcomes

Objective: To evaluate associations between changing energy prices and US hospital patient outcomes. Methods: Generalized estimating equations were used to analyze relationships between changes in energy prices and subsequent changes in hospital patient outcomes measures for the years 2008 through 2014. Patient outcomes measures included 30-day acute myocardial infarction, heart failure, and pneumonia mortality rates, and 30-day acute...

Self-Report Study of Predictors of Physician Wellness, Burnout, and Quality of Patient Care

Objective: The goal of this self-report study was to examine the relation of work variables, self-rated health and mental health status, and perceived social support to physician wellness, physician burnout, and quality of patient care. Methods: We administered a demographics questionnaire, the Physician Wellness Inventory, the Maslach Burnout Inventory, and the Patient Care Scale to a random sample of full physician members of the American...

See ME Differently

Editor’s Note: In November 2016 at the Southern Medical Association’s (SMA) Annual Scientific Assembly, Randy Glick, SMA’s Executive Director, introduced the organization’s vision to “See ME Differently.” The following perspective details some of the shifts in the continuing medical education landscape and how the SMA is embracing the opportunities that these changes present. Throughout 2017, the Southern Medical Journal will...

Effectiveness of Pharmacist and Physician Collaboration in the Treatment of Type 2 Diabetes Mellitus With Severe Insulin Resistance Using U-500 Insulin

Objectives: To evaluate the effectiveness of pharmacist–physician collaboration in the treatment of type 2 diabetes mellitus (DM) with severe insulin resistance, using 500 U/mL concentrated regular insulin (U-500) in a primary care clinic that is not staffed by an endocrinologist. Methods: A retrospective chart review was conducted searching for patients who were prescribed U-500 insulin from January 1, 2008 through December 31, 2014....

Interprofessional Precision Care: Coming Together to Improve Outcomes

With the implementation of the Patient Protection and Affordable Care Act (PL 111–148), historically inconspicuous components of healthcare systems have gained more salience as healthcare spending and reimbursement shifts from individual, fee-for-service to population-based, pay-for-performance. The paradigm is to improve the health of populations and positively enhance patients’ experience while controlling per capita costs.1 Efficient and...

Frequency of Adverse Events Before, During, and After Hospital Admission

Objectives: Adverse events (AEs) are unintended physical injuries resulting from or contributed to by medical or surgical care. We determined the frequency and type of AEs before, during, and after hospital admission. Methods: We conducted a cohort study of 296 adult hospital patients. We used the standardized Institute for Healthcare Improvement Global Trigger Tool for Measuring Adverse Events to review the medical records of the hospital...

Commentary on “House Staff Participation in Patient Safety Reporting: Identification of Predominant Barriers and Implementation of a Pilot Program”

In his book Outliers: The Story of Success, Malcolm Gladwell describes a dark period in the history of Korean Air, which had experienced more crashes than almost any other airline.1 After investigation it was found that in many of these crashes, the copilot/first officer had grave concerns before the crash that often were disregarded, if they were voiced at all. Investigators posited that the barriers to communication in the cockpit many times...

Examining Invasive Bedside Procedure Performance at an Academic Medical Center

Objectives: Explore the performance patterns of invasive bedside procedures at an academic medical center, evaluate whether patient characteristics predict referral, and examine procedure outcomes. Methods: This was a prospective, observational, and retrospective chart review of adults admitted to a general medicine service who had a paracentesis, thoracentesis, or lumbar puncture between February 22, 2013 and February 21, 2014. Results:...

House Staff Participation in Patient Safety Reporting: Identification of Predominant Barriers and Implementation of a Pilot Program

Objectives: Patient safety event (PSE) reporting is a critical element for healthcare organizations that are striving for continuous quality improvement. Although resident physicians routinely provide the majority of direct patient care, the level of their participation in PSE reporting historically has been low. In addition, as part of the Accreditation Council for Graduate Medical Education’s Next Accreditation System, the Clinical Learning...

Commentary on “Examining Invasive Bedside Procedure Performance at an Academic Medical Center”

The decision to perform a procedure at the bedside or refer a patient to a radiologist rarely is based on the patient’s comorbidites and is largely discretionary.1 In this issue of the Southern Medical Journal, Kay and colleagues have shown that female patients and those with a higher body mass index were more commonly referred to radiology for procedures.2 The reason for more female patients being referred to radiology was unclear; however,...

Improving Interdisciplinary Provider Communication Through a Unified Paging System

Objectives: Interdisciplinary communication at a Veterans Affairs (VA) academic teaching hospital is largely dependent on alphanumeric paging, which has limitations as a result of one-way communication and lack of reliable physician identification. Adverse patient outcomes related to difficulty contacting the correct consulting provider in a timely manner have been reported. Methods: House officers were surveyed on the level of satisfaction...