Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Despite the proliferation of telehealth, uptake for acute inpatient services has been slower. Hospitalist shortages in rural and critical access hospitals as well as the COVID-19 pandemic have led to a renewed interest in telehealth to deliver acute inpatient services. Understanding current evidence is crucial for promoting uptake and developing evidence-based practices. ⋯ Telehealth services for hospital medicine were found to be effective, well received, and initial cost estimates appear favorable. A variety of services were described across programs with considerable benefit appreciated by rural and smaller hospitals. Additional work is needed to evaluate clinical outcomes and overall program costs.
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Multicenter Study
Child Opportunity Index 2.0 and acute care utilization among children with medical complexity.
Disproportionately high acute care utilization among children with medical complexity (CMC) is influenced by patient-level social complexity. ⋯ CMC from low opportunity ZIP codes utilize more acute care. They may benefit from hospital and community-based interventions aimed at equitably improving child health outcomes.
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The effects of extracranial hemorrhage (ECH), or bleeding outside the brain, are often considered transient. Yet, there are few data on the long-term and functional consequences of ECH. ⋯ In a cohort of 6719 subjects (mean age 77, 59% women) with average follow-up time of 8.3 years (55,767 person-years), 736 (11%) were hospitalized for ECH. ECH was associated with a 15% increase in ADL disability, 15% increase in IADL disability, 8% increase in nursing home stays, and 4% increase in mortality. After ECH, subjects became disabled and died at the same annual rate as pre-ECH but never recovered to pre-ECH levels of function. In conclusion, hospitalization for ECH was associated with significant and durable declines in independence and survival. Clinical and research efforts should incorporate the long-term harms of ECH into decision-making and strategies to mitigate these effects.