Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Little is known about the daily ethical conflicts encountered by hospitalists that do not prompt a formal clinical ethics consultation. We describe the frequencies of ethical issues identified during daily rounds on hospitalist teaching services at a metropolitan, tertiary-care, teaching hospital. Data were collected from September 2017 through May 2018 by two attending hospitalists from the ethics committee who were embedded on rounds. ⋯ These issues most frequently involved discussions about goals of care, treatment refusals, decision-making capacity, discharge planning, cardiopulmonary resuscitation status, and pain management. Only five formal consults were brought to the Hospital Ethics Committee for these 270 patients. Our data are the first prospective description of ethical issues arising on academic hospitalist teaching services and are an important step in the development of a targeted ethics curriculum for hospitalists.
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We examined whether hospitals participating in Medicare's Shared Saving Program increased the use of highly rated skilled nursing facilities (SNFs) or decreased the use of low-rated SNFs hospital-wide after initiation of their accountable care organization (ACO) contracts compared with non-ACO hospitals. Using a difference-in-differences design, we estimated the change in the probability of discharge to 5-star and 1-star SNFs among all beneficiaries discharged from ACO-participating hospitals after the hospital initiated ACO participation. ⋯ The probability of discharge from an ACO-participating hospital to low-quality SNFs did not change significantly compared with non-ACO-participating hospitals. Our findings indicate that ACO-participating hospitals were more likely to discharge patients to highly rated SNFs after they began their ACO contract but did not change the likelihood of discharge to lower rated SNFs in comparison with non-ACO hospitals.
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For more than 20 years, the Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center (EPC) Program has been identifying and synthesizing evidence to inform evidence-based healthcare. Recognizing that many healthcare settings continue to face challenges in disseminating and implementing evidence into practice, AHRQ's EPC program has also embarked on initiatives to facilitate the translation of evidence into practice and to measure and monitor how practice changes impact health outcomes. The program has structured its efforts around the three phases of the Learning Healthcare System cycle: knowledge, practice, and data. Here, we use a topic relevant to the field of hospital medicine-Clostridium difficile colitis prevention and treatment-as an exemplar of how the EPC program has used this framework to move evidence into practice and develop systems to facilitate continuous learning in healthcare systems.