Playing Music for Hospitalized Patients Enhances Mood and Reduces Perceptions of Pain.

OBJECTIVES: For most people, music serves as a calming influence or as a pleasurable stimulus that lifts their spirits. In an attempt to both distract and cheer up hospitalized patients, we designed a brief intervention that would bring music to their hospital rooms in attempt to enhance their mood and minimize their awareness of pain. METHODS: In this prospective study of adult patients on the general medicine ward at Johns Hopkins Hospital, we assessed the impact of self-selected music delivery on patients' mood and their perception of pain. Patients' mood and pain were assessed using the modified Hospital Anxiety and Depression Scale and the Verbal Numerical Rating Scale, a validated 10-point Likert pain scale. RESULTS: Of the 151 patients studied, their mean age was 57 years, 57% were women, and 65% were white. Ninety-seven percent of patients described listening to music regularly at home, but only 28% of patients reported that they had listened to any music since being in the hospital (P < 0.0001). The patients' modified Hospital Anxiety and Depression Scale score and pain score were decreased significantly (-4.99, standard error 0.45, P < 0.0001, and -0.72, standard error 1.51, P < 0.0001, respectively) after listening to a couple of their favorite songs. CONCLUSIONS: This study demonstrates that bringing music to hospitalized patients and encouraging them to listen to their favorite songs are genuinely appreciated. If this intervention can enhance moods and reduce pain for patients in the hospital, then directing resources to make it sustainable may be justified.

Association Between Radiologic Incidental Findings and Resource Utilization in Patients Admitted With Chest Pain in an Urban Medical Center.

BACKGROUND: Increasing use of testing among hospitalized patients has resulted in an increase in radiologic incidental findings (IFs), which challenge the provision of high-value care in the hospital setting. OBJECTIVE: To understand impact of radiologic incidental findings on resource utilization in patients hospitalized with chest pain. DESIGN: Retrospective observational cross sectional study. SETTING: Academic medical center. PARTICIPANTS: Adult patients hospitalized with principal diagnosis of chest pain. MEASUREMENTS: Demographic, imaging, and length of stay (LOS) data were abstracted from the medical charts. We used multiple logistic regression to evaluate factors associated with radiologic IFs and negative binomial regression to evaluate the association between radiologic IFs and LOS. RESULTS: 1811 consecutive admissions with chest pain were analyzed retrospectively over a period of 24 months; 376 patients were included in the study after exclusion criteria were applied and readmissions removed. Of these, 197 patients (52%) had 364 new radiologic IFs on imaging; most IFs were of minor (50%) or moderate clinical significance (42%), with only 7% of major significance. Odds of finding radiologic IFs increased with age (adjusted odds ratio, 1.04; 95% confidence interval [CI], 1.01-1.06) and was associated with a 26% increase in LOS (adjusted incidence rate ratio, 1.26; 95% CI, 1.07-1.49). CONCLUSION: Radiologic IFs were very common among patients hospitalized with chest pain of suspected cardiac origin and independently associated with an increase in the LOS. Interventions to address radiologic IFs may reduce LOS and, thereby, support high-value care. Journal of Hospital Medicine 2017;12:323-328.

Improving Breast Cancer Screening Adherence Among Hospitalized Women.

BACKGROUND: More than a third of hospitalized women are both overdue for breast cancer screening and at high risk for developing breast cancer. The purpose of the study was to evaluate if inpatient breast cancer screening education, scheduling an outpatient mammography appointment before hospital discharge at patients' convenience, phone call reminders, and a small monetary incentive ($10) would result in improved adherence with breast cancer screening for these patients. METHODS: A prospective intervention pilot study was conducted among 30 nonadherent women aged 50-75 years hospitalized to a general medicine service. Sociodemographic, reproductive history, family history for breast cancer, and medical comorbidity data were collected for all patients. Chi-square and unpaired t-tests were utilized to compare characteristics among women who did and did not get a screening mammogram at their prearranged appointments. RESULTS: Of the 30 women enrolled who were nonadherent to breast cancer screening, the mean age for the study population was 57.8 years (SD = 6), mean 5-year Gail risk score was 1.68 (SD = 0.67), and 57% of women were African American. Only one-third of the enrolled women (n = 10) went to their prearranged appointments for screening mammography. Not feeling well enough after the hospitalization and not having insurance were reported as main reasons for missing the appointments. Convenience of having an appointment scheduled was reported to be a facilitator of completing the screening test. CONCLUSION: This intervention was partially successful in enhancing breast cancer screening among hospitalized women who were overdue and at high risk. Future studies may need to evaluate the feasibility of inpatient screening mammography to improve adherence and overcome the significant barriers to compliance with screening.

Developing a comportment and communication tool for use in hospital medicine.

BACKGROUND: An exceptional experience in a hospital is largely influenced by the quality and performance of the hospitalist physician. We set out to establish a metric that would comprehensively assess hospitalists' comportment and communication to establish norms and expectations. METHODS: The chiefs of hospital medicine divisions at 5 hospitals were asked to identify their "most clinically excellent" hospitalists. An investigator observed each hospitalist during a routine clinical shift and recorded behaviors believed to be associated with excellent comportment and communication using the hospital medicine comportment and communication tool (HMCCOT). Content, internal structure, and relation to other variables validity evidence were established. Analysis of the data for every single patient encounter allowed for the iterative revision of the HMCCOT and the calculation of scores. The mean HMCCOT score of each provider was compared to their Press Ganey (PG) scores. RESULTS: The mean age of the 26 participating physicians was 38 years, 13 (50%) were female, and 16 (62%) were of nonwhite race. The mean HMCCOT score was 61 (interquartile range = 37-80). HMCCOT score and PG were moderately correlated (adjusted Pearson correlation = 0.45, P = 0.047). CONCLUSIONS: This study represents a first step to specifically characterize comportment and communication in hospital medicine. Because hospitalists spend only a small proportion of their clinical time in direct patient care, it is imperative that excellent comportment and communication be established as a goal for every encounter. Journal of Hospital Medicine 2015;11:853-858. © 2015 Society of Hospital Medicine.

Communication of laboratory data and diagnostic test results to hospitalized patients: a study of preferences and recall.

OBJECTIVE: To assess patients' preferences with respect to different methods of receiving test results while they were hospitalized and to determine whether the different modes of communication of the test results were associated with better recall. METHODS: Five discrete test results were shared with adult inpatients on general medicine service (blood pressure, white blood cell count, hematocrit, creatinine, and chest X-ray). The information was delivered by a physician in one of three ways: 1) verbally, 2) explained with a print out of the results, or 3) described while showing results on a computer monitor (electronic). The same physician returned within 3 hours to assess recall and satisfaction with the way patients received their results. RESULTS: All the patients (100%) receiving their results in written format were satisfied with the mode of communication as compared to electronic format (86%) or verbally (79%) (P=0.02). Fifty percent of patients in the computer format group could recall four or more test results at the follow-up, as compared to 43% in printed group and 24% who were informed of their results verbally (P=0.35). CONCLUSION: Patients most appreciated receiving test results in written form while in the hospital, and this delivery method was as good as any other method with respect to recall.

Providing Feedback on Clinical Performance to Hospitalists: Experience Using a New Metric Tool to Assess Inpatient Satisfaction With Care From Hospitalists.

INTRODUCTION: Physicians have been shown to possess limited ability for accurate self-assessment; thus, effective feedback is crucial for their professional development. This study describes providers' reflections on their data and evaluates the hospitalist physicians' impressions about receiving this feedback derived from a new survey metric specifically designed to obtain patient assessment of their treating hospitalist provider coupled with reflective sessions. METHODS: Participants were 26 hospitalists from one institution. These physicians' data were used for the development and validation of a new metric, Tool to Assess Inpatient Satisfaction with Care from Hospitalists (TAISCH). Participants received a summary of ratings from patients for whom they were the primary provider. This was followed by a 15-minute semistructured telephone interview to discuss the data. Participants then completed an online survey to assess their perceptions about the data and the efficacy of the feedback. Both quantitative and qualitative results were analyzed. RESULTS: All 26 providers reviewed their evaluation data, participated in the discussion of results by phone, and completed the online survey. Most (54%) agreed that TAISCH was superior to Hospital Consumer Assessment of Healthcare Providers and Systems in providing hints on how to improve the quality of the care and in providing detailed information about the performance in specific areas (62%). After stratifying hospitalists according to their performance, it was observed that those who scored better responded more favorably to the data. The two main themes that emerged from the qualitative analysis were "reflection on one's performance" and "feedback using TAISCH." DISCUSSION: Most hospitalists in our study felt that TAISCH provided meaningful feedback.

Management of Cocaine-Induced Myocardial Infarction: 4-Year Experience at an Urban Medical Center.

OBJECTIVES: In 2008, the American Heart Association and the American College of Cardiology released guidelines for the management of cocaine-induced myocardial infarction (CIMI). We hypothesized that CIMI patients are likely to receive less invasive and more conservative management than patients with MI without history of cocaine use. METHODS: We conducted a retrospective analysis on patients younger than 65 years presenting with acute MI between April 1, 2008 and December 31, 2012. Patients were classified as cocaine-negative MI or CIMI based on either urine toxicology results or self-reported cocaine use. Categorical and continuous variables were compared using χ(2) or t test as appropriate. The primary outcome was cardiac catheterization or stress testing. The secondary outcome was a 30-day readmission rate for major adverse cardiovascular events. Multiple logistic regression models calculated odds ratios (ORs) for the primary outcomes adjusting for patient demographics and comorbidities. RESULTS: Of 378 MI patients, 4.2 % had CIMI. CIMI patients were younger (50 vs 54 years; P < 0.01) predominantly African American (56% vs 16%, P < 0.01), and mostly active smokers (88% vs 58%, P = 0.02). They were more likely to receive stress testing (adjusted OR 3.61, 95% confidence interval 1.04-12.53) and less likely to undergo cardiac catheterization (adjusted OR 0.12, 95% confidence interval 0.03-0.45). The 30-day readmission rate for major adverse cardiovascular events was higher in CIMI compared with cocaine-negative MI patients (38% vs 13%; P = 0.03). CONCLUSIONS: The use of cocaine in patients presenting with acute MI appears to impact management decisions of providers. Patient-centered postdischarge arrangements need better coordination for this patient group to optimize their follow-up care.

Pilot study aiming to support sleep quality and duration during hospitalizations.

BACKGROUND: Sleep is a vital part to healing and recovery, hence poor sleep during hospitalizations is highly undesirable. Few studies have assessed interventions to optimize sleep among hospitalized patients. OBJECTIVE: To assess the effect of sleep-promoting interventions on sleep quality and duration among hospitalized patients. DESIGN: Quasi-experimental prospective study. SETTING: Academic medical center. PARTICIPANTS: Adult patients on the general medicine ward. INTERVENTION: Nurse-delivered sleep-promoting interventions augmented by sleep hygiene education and environmental control to minimize sleep disruption. MEASUREMENTS: Objective and subjective measurement of sleep parameters using validated sleep questionnaires, daily sleep diary, and actigraphy monitor. RESULTS: Of the 112 patients studied, the mean age was 58 years, 55% were female, the mean body mass index was 32, and 43% were in the intervention group. Linear mixed models tested mean differences in 7 sleep measures and group differences in slopes representing nightly changes in sleep outcomes over the course of hospitalization between intervention and control groups. Only total sleep time, computed from sleep diaries, demonstrated significant overall mean difference of 49.6 minutes (standard error [SE] = 21.1, P < 0.05). However, significant differences in average slopes of subjective ratings of sleep quality (0.46, SE = 0.18, P < 0.05), refreshing sleep (0.54, SE = 0.19, P < 0.05), and sleep interruptions (-1.6, SE = 0.6, P < 0.05) indicated improvements during hospitalization within intervention patients compared to controls. CONCLUSION: This study demonstrated that there is an opportunity to identify patients not sleeping well in the hospital. Sleep-promoting initiatives, both at the unit level as well as individualized offerings, may improve sleep during hospitalizations, particularly over the course of the hospitalization. Journal of Hospital Medicine 2016;11:467-472. © 2016 Society of Hospital Medicine.

Hospitalists' utilization of weight loss resources with discharge texts and primary care contact: a feasibility study.

OBJECTIVES: Obesity affects a large proportion of the U.S. population, and hospitalizations may serve as an opportunity to promote weight loss. We sought to determine if multidisciplinary patient-centered inpatient weight loss intervention that included counseling, consults, post-discharge telephone text messages, and primary care follow up was feasible. METHODS: We conducted a feasibility study focusing on 25 obese hospitalized patients to understand the issues related to rolling out an intensive intervention. Actual weight loss was a secondary outcome and we compared these 25 patients to 28 control patients who were exposed to usual care; weight change was assessed at 1 and 6 months. RESULTS: Ninety-six percent (24/25) of nutritional consults and 92% (23/25) of physical therapy consults were submitted by hospital providers. All of these doctors were also reminded to counsel their patients about the detrimental health consequences. Fifty-two percent (13/25) and 40% (10/25) were actually seen and counseled by nutrition and physical therapy services respectively, before being discharged. Sixty-eight percent (17/25) received a motivational interviewing counseling session from the principal investigator. All patients were sent text messages and followed with their primary care provider after discharge who received the personalized weight loss discharge instructions that had been given to the patient. The feasibility group lost a mean of 3.0 kg at 6 months and the control group gained an average of 0.20 kg at 6 months post discharge (p = 0.03). CONCLUSION: Executing a multifaceted weight loss intervention for hospitalized obese patients is feasible, and there may be associated persistent improvements in weight status over time.

Comportment and Communication Patterns among Hospitalist Physicians: Insight Gleaned Through Observation.

OBJECTIVES: By 2014, there were more than 40,000 hospitalists delivering the majority of inpatient care in US hospitals. No empiric research has characterized hospitalist comportment and communication patterns as they care for patients. METHODS: The chiefs of hospital medicine at five different hospitals were asked to identify their best hospitalists. These hospitalists were watched during their routine clinical care of patients. An observation tool was developed that focused on elements believed to be associated with excellent comportment and communication. One observer watched the physicians, taking detailed quantitative and qualitative field notes. RESULTS: A total of 26 hospitalists were shadowed. The mean age of the physicians was 38 years, and their average experience in hospital medicine was 6 years. The hospitalists were observed for a mean of 5 hours, during which time they saw an average of 7 patients (patient encounters observed N = 181). Physicians spent an average of 11 minutes with each patient. There was large variation in the extent to which desirable behaviors were performed. For example, most physicians (76%) started encounters with an open-ended question, and relatively few (30%) attempted to integrate nonmedical content into conversation with patients. CONCLUSIONS: This study represents a first step in trying to characterize comportment and communication in hospital medicine. Because hospitalists spend only a small proportion of their clinical time in direct patient care, it is imperative that excellent comportment and communication are clearly defined and established as a goal for every encounter.

Hospitalized women's willingness to pay for an inpatient screening mammogram.

Lower rates for breast cancer screening persist among low income and uninsured women. Although Medicare and many other insurance plans would pay for screening mammograms done during hospital stays, breast cancer screening has not been part of usual hospital care. This study explores the mean amount of money that hospitalized women were willing to contribute towards the cost of a screening mammogram. Of the 193 enrolled patients, 72% were willing to pay a mean of $83.41 (95% CI, $71.51-$95.31) in advance towards inpatient screening mammogram costs. The study's findings suggest that hospitalized women value the prospect of screening mammography during the hospitalization. It may be wise policy to offer mammograms to nonadherent hospitalized women, especially those who are at high risk for developing breast cancer.

Development and validation of the tool to assess inpatient satisfaction with care from hospitalists.

OBJECTIVES: To develop and validate a new inpatient satisfaction metric to assess patients' perceptions of hospitalist performance. PATIENTS AND METHODS: We developed the Tool to Assess Inpatient Satisfaction with Care from Hospitalists (TAISCH) by building upon the theoretical underpinnings of the quality of care measures that the Society of Hospital Medicine endorses. TAISCH was completed by inpatients at an academic institution between September 2012 and December 2012 after they had been cared for by the same hospitalist provider for at least 2 consecutive days. Content, internal structure, and convergent/discriminant validity evidence were assessed for TAISCH. RESULTS: A total of 203 patients each rated 1 of our 29 hospitalists (patient response rate: 88%). Factor analyses resulted in a single factor with 15 items. Reliability of TAISCH was good (Cronbach's α = .88). The hospitalists' average TAISCH score ranged from 3.25 to 4.28 (mean [standard deviation] = 3.82 [0.24]; possible score range: 1-5). The relationship between TAISCH with a validated empathy scale and a global provider satisfaction question revealed significant positive associations (ß = 12.2, and ß = 11.2 respectively, both P < 0.001). At the provider level, no significant correlation was noted between the Press Ganey Physician score and TAISCH (r = 0.91, P = 0.51). CONCLUSION: TAISCH collects patient satisfaction data that are attributable to specific hospitalist providers. The timeliness of the TAISCH data collection also makes real-time service recovery possible, which is unachievable with other commonly used patient satisfaction metrics.

What happens to the medication regimens of older adults during and after an acute hospitalization?

BACKGROUND: Hospitalized elderly patients are at risk for medication errors and nonadherence when discharged home. OBJECTIVE: To describe how older patients' medications change during and after hospitalizations and what patients ultimately take after discharge. METHODS: We conducted an observational cohort study of 95 patients aged 65 years and older admitted to Johns Hopkins Bayview Medical Center in 2007. Inclusion criteria included admissions longer than 24 hours and discharge to home. Medication lists from three periods were recorded: prehospitalization, day of discharge, and 3 days after discharge. In comparing lists, we characterized: new and discontinued medications, changes in dosage, and changes in frequency. RESULTS: Before admission, patients were taking a total of 701 medications (mean, 7 per patient). Upon discharge, 192 new medicines were started (2.0 per patient), 76 discontinued (0.8 per patient), 67 changed in frequency, (0.7 per patient), and 45 changed in dosage (0.5 per patient). Antibiotics and antihypertensives were the most commonly prescribed new medications. Antihypertensives were also most likely to be discontinued. At day 3 after discharge, patients were adherent with 98% (763/778) of medications. However, 25% of antihypertensives and 88% analgesics discontinued by hospitalists on the day of discharge were reinitiated by patients upon their return home. CONCLUSIONS: During hospitalizations, medications of older adults change substantially. Despite clear medication reconciliation efforts in the hospital environment, medication errors occur upon discharge to home. Because current standards are yielding suboptimal results, alternate methodologies for promoting medication adherence should also be considered, developed, and studied for effectiveness.

Receptivity to weight management interventions among hospitalized obese patients: an untapped opportunity.

OBJECTIVES: Hospitalized obese patients rarely receive counseling about weight loss. Specific patient preferences regarding inpatient weight loss interventions have not been systematically investigated. The objective of the study was to describe the preferences of hospitalized obese patients for weight loss interventions and to identify predictors of receptivity to such offerings. METHODS: A total of 204 individuals with a body mass index (BMI) ≥30 kg/m (mean BMI 38.1 kg/m) admitted to the hospital medicine service in spring 2011 were surveyed at bedside for this cross-sectional study. The study population was predominantly white (67%) and women (62%), and their mean age was 55 years. RESULTS: Although 82% expressed a desire for providers to discuss weight loss during hospitalization, nearly all (92%) of the patients reported that providers did not address this subject. Logistic regression analysis tested demographic variables and obesity-related health beliefs as predictors of receptivity to inpatient weight loss interventions. The recognition of their own obesity and belief that weight loss would prolong life were significantly associated with receptivity to specific interventions, over and above objectively measured BMI in adjusted models. CONCLUSIONS: Receptivity to inpatient weight loss interventions varies considerably among hospitalized obese patients. The most important determinants that predict the level of receptivity were related to weight-related beliefs and perceptions. Future inpatient weight loss interventions could be targeted to patients with truthful health beliefs and perceptions about obesity.

Breast cancer screening preferences among hospitalized women.

BACKGROUND: Efforts to increase mammographic screening for early detection of breast cancer among women of lower socioeconomic class and ethnic minorities have been largely unsuccessful. This study explores the receptivity of hospitalized women to inpatient mammography as a novel approach to enhance breast cancer screening. METHODS: A cross-sectional study was conducted among 210 hospitalized women, aged 50-75 years, admitted to the medicine services at Johns Hopkins Bayview Medical Center in early 2012. Unpaired t-test and Chi-square tests were used to compare characteristics, barriers, and receptivity to inpatient mammography among women adherent and non-adherent to screening guidelines. RESULTS: One-third of women enrolled were African American, and 60% of study participants reported an annual household income of <$20,000. Thirty-nine percent were overdue for screening, of which, 13% never had a mammogram and 28% were at high risk for breast cancer (Gail score ≥1.7%). The commonly reported barriers to screening mammograms were failure to remember appointments and lack of transportation. Most women (91%) believed that it is important for healthcare providers to discuss breast cancer screening while patients are in the hospital. Sixty-eight percent of non-adherent women would agree to have an inpatient screening mammogram if it was due and offered. CONCLUSIONS: A significant number of hospitalized women from lower socioeconomic class are at high risk of developing breast cancer and non-adherent to mammographic screening. Inpatient hospital stay may be a feasible time for screening and education to ensure adequate breast care and promote screening among these women.

Does sepsis treatment differ between primary and overflow intensive care units?

BACKGROUND: Sepsis is a major cause of death in hospitalized patients. Early goal-directed therapy is the standard of care. When primary intensive care units (ICUs) are full, sepsis patients are cared for in overflow ICUs. OBJECTIVE: To determine if process-of-care measures in the care of sepsis patients differed between primary and overflow ICUs at our institution. DESIGN: We conducted a retrospective study of all adult patients admitted with sepsis between July 2009 and February 2010 to either the primary ICU or the overflow ICU. MEASUREMENTS: Baseline patient characteristics and multiple process-of-care measures, including diagnostic and therapeutic interventions. RESULTS: There were 141 patients admitted with sepsis to our hospital; 100 were cared for in the primary ICU and 41 in the overflow ICU. Baseline acute physiology and chronic health evaluation (APACHE II) scores were similar. Patients received similar processes-of-care in the primary ICU and overflow ICU with the exception of deep vein thrombosis (DVT) and gastrointestinal (GI) prophylaxis within 24 hours of admission, which were better adhered to in the primary ICU (74% vs 49%, P = 0.004, and 68% vs 44%, P = 0.012, respectively). There were no significant differences in hospital and ICU length of stay between the 2 units (9.68 days vs 9.73 days, P = 0.98, and 4.78 days vs 4.92 days, P = 0.97, respectively). CONCLUSIONS: Patients with sepsis admitted to the primary ICU and overflow ICU at our institution were managed similarly. Overflowing sepsis patients to non-primary intensive care units may not affect guideline-concordant care delivery or length of stay.

Learning needs of physician assistants working in hospital medicine.

BACKGROUND: Hospital Medicine is growing rapidly, and the number of physician assistants (PAs) in this field is expected to grow. However, there is no available data related to the learning needs of PA hospitalists. OBJECTIVE: To conduct a needs assessment for PA hospitalists who may be embarking on a hospitalist career. DESIGN: Cross-sectional survey based on the Core Competencies in Hospital Medicine. SETTING/PARTICIPANTS: A sample of hospitalist PAs working in the United States. MEASUREMENTS: Amount of experience with core diagnoses and procedures, preferences for additional training that would have prepared them to function as hospitalist PAs. RESULTS: Sixty-nine PAs responded (response rate, 67%). Among the core clinical conditions, respondents had the most experience in managing diabetes and urinary tract infections and were least experienced with health care-associated pneumonias and sepsis syndrome. Over 90% rarely performed core competency procedures other than electrocardiogram and chest X-ray interpretations. The top 3 content areas that PA hospitalists believed would have helped to better prepare them to care for inpatients were palliative care (percent of PAs who agreed or strongly agreed: 85%), nutrition for hospitalized patients (84%), and consultations (64%). Almost all (91%) indicated that they would have been interested in formal postgraduate hospital medicine training even if it meant having a lower stipend during the first year on the job. CONCLUSIONS: This is the first national data on self-perceived learning needs of PA hospitalists. The results may prove helpful for both PAs entering hospitalist careers and for the physician groups looking to hire them.

Research in progress conference for hospitalists provides valuable peer mentoring.

BACKGROUND: Many academic hospitalist units lack senior mentors. In such groups, peer mentoring may be valuable. To formalize collaboration, we instituted a research-in-progress conference at our institution, and this article describes the format and evaluation data. METHODS: The research-in-progress sessions were held every 3 to 4 weeks and followed a specific format. Evaluation forms were completed after each of the 15 sessions during the 2009 academic year. Attendees and presenters completed surveys at the end of the sessions. The projects presented were tracked for successful academic outcomes, namely, publication in a peer-reviewed journal or presentation at a national meeting. RESULTS: A mean of 9.6 persons were present at each session and completed the evaluations. All 15 presenters rated the climate of the sessions as extremely supportive, and 86% believed they were helpful in advancing their project. A total of 143 evaluations were completed by the attendees, 86% and 96% of whom found the sessions to be intellectually stimulating and to have satisfactorily kept them abreast of their colleagues' scholarly pursuits, respectively. To date, 10 of the 15 projects have translated into successful academic outcomes: 6 peer-reviewed publications and 4 other presentations presented at national meetings. CONCLUSIONS: The research-in-progress conference has been well received and has resulted in academic productivity within our hospitalist division. It is likely that such a conference will be most valuable for groups with limited access to senior mentors.

Patterns and predictors of proton pump inhibitor overuse among academic and non-academic hospitalists.

OBJECTIVE: In the hospital setting, several studies have reported proton pump inhibitor (PPI) overuse, a majority of which is continued after discharge. In addition to being expensive, PPIs are associated with an increased risk of infections, osteoporosis and serious drug interactions. We examined the trends and predictors of PPI guidelines non-compliance among academic and non-academic hospitalists in USA. METHODS AND PATIENTS: Oral PPI prescriptions initiated by 2 academic and 2 non-academic hospitalist groups were reviewed. Prescription indications were recorded when explicitly stated in the chart. Otherwise, qualified physicians reviewed the chart to make such determination. Indications were then compared to the published guidelines. Several variables were tested to determine independent predictors of initiation and post discharge continuation of guideline non-compliant prescriptions. RESULTS: Of the 400 PPI prescriptions 39% were guideline compliant. Academic hospitalists were significantly more compliant with PPI prescription guidelines (50 vs 29%). Gastrointestinal ulcer bleeding prophylaxis (GIP) for low risk patients was the most common indication for non-compliant prescriptions, while that of guideline compliant prescriptions was dyspepsia treatment. Independent predictors of the initiation of guideline non-compliant prescriptions were non-academic hospitalist group, PPI indication not documented in the chart, and GIP as part of the admission orderset. The latter was an independent predictor of those prescriptions continuation post-discharge (protective) in addition to non-academic hospitalists group. CONCLUSION: Hospitalists overprescribe PPI to a level comparable to that of the non-hospitalist providers in the literature. Understanding the determinants of increased compliance among academic groups is instrumental to design interventions aimed at increasing PPI prescription compliance.

Addressing obesity in the hospitalized patient: a needs assessment.

OBJECTIVE: To perform a needs assessment to determine the extent to which hospitalist providers recognize and intervene upon obese patients in the hospital setting. METHODS: A chart review was performed for patients admitted to the hospitalist service at Johns Hopkins Bayview Medical Center between September 1 and October 1, 2008. Patient charts were reviewed for documentation of obesity and treatment plans were ordered and implemented. Demographic data for patients and hospitalist providers was also collected. Providers were also surveyed about their documentation practices related to obesity and any perceived barriers. RESULTS: Forty-nine percent (136/276) of admitted patients were obese. Obesity was documented in 19% (26/136) of admission notes and a discrete plan was made to address obesity 7% (10/136) of the time. Hospitalist providers were more likely to document obesity in patients <60 years old (85% versus 55% respectively, P <0.007), and in patients with body mass indices (BMI) >or= 35 (77% versus 44% respectively, P < 0.004). Provider survey results suggest that providers do not document obesity because it is not considered to be an acute issue (67%), and they elect not to address obesity because they lack the time (63%), skill (37%), and they believe that their efforts will be unsuccessful (33%). CONCLUSION: Documentation of obesity by hospitalist providers is poor. Because an inpatient admission has been characterized as a teachable moment when patients are willing to reflect on behavior change, this may be an ideal time to counsel and educate obese patients.