Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Multicenter Study
Effectiveness of the rural transitions nurse program for Veterans: A multicenter implementation study.
Veterans are often transferred from rural areas to urban VA Medical Centers for care. The transition from hospital to home is vulnerable to postdischarge adverse events. ⋯ TNP was associated with increased postdischarge follow-up and a mortality reduction. Further investigation to understand the reduction in mortality is needed.
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Neighborhood disadvantage reflects historic and ongoing systemic injustices. Without addressing these upstream social determinants of health, hospitals may face different risk profiles for important quality metrics. Our objective was to assess differences in hospital characteristics where the proportion of patients residing in severely disadvantaged neighborhoods was high vs low. ⋯ We examined hospital characteristics by distribution of ADS and by risk-adjusted 30-day readmission. Hospitals in the highest decile cared for a higher proportion of Black patients, were more often located in rural areas, and had higher patient risk of 30-day readmission compared to all other deciles. Hospitals face unequal burdens of neighborhood disadvantage, a factor distinct from other social determinants such as rurality.
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Advanced practice providers (APPs) graduate from school with variable hospitalist experience. While hospitalist-specific onboarding is recommended for hospitalist APPs, no standard method currently exists to assess their readiness for practice. We created a 17-item instrument called the Cardin Hospitalist Advanced Practice Provider-Readiness Assessment (CHAPP-RA) to assess APPs'; readiness for practice using a milestones-based scale. ⋯ Supervisors rated novice APPs lower than more experienced APPs, p ≤ .001. CHAPP-RA ratings also correlated strongly with global ratings. CHAPP-RA is feasible to implement and has initial validity evidence.
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This survey study aimed to provide a contemporary appraisal of advanced practice provider (APP) practice and to summarize perceptions of the benefits and challenges of integrating APPs into adult academic hospital medicine (HM) groups. We surveyed leaders of academic HM groups. We received responses from 43 of 86 groups (50%) surveyed. ⋯ Reported challenges included training requirements and support for new hires. Further investigation is needed to determine which APP team structures deliver the highest quality care. There may be a role for expanding standardized competency-based postgraduate training for APPs planning to practice HM.