Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Observational Study
Association Between Radiologic Incidental Findings and Resource Utilization in Patients Admitted With Chest Pain in an Urban Medical Center.
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. ⋯ 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.
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Overuse of medical services is an increasingly recognized driver of poor-quality care and high cost. A practical framework is needed to guide clinical decisions and facilitate concrete actions that can reduce overuse and improve care. We used an iterative, expert-informed, evidence-based process to develop a framework for conceptualizing interventions to reduce medical overuse. ⋯ This interaction is influenced by other utilization drivers, including healthcare system factors, the practice environment, the culture of professional medicine, the culture of healthcare consumption, and individual patient and clinician factors. The variable strength of the evidence supporting these domains highlights important areas for further investigation. Journal of Hospital Medicine 2017;12:346-351.
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Pain management is a core competency of hospital medicine, and effective acute pain management should be a goal for all hospital medicine providers. The prevalence of opioid use in the United States, both therapeutic and non-medical in origin, has dramatically increased over the past decade. ⋯ In this review, we provide an evidence-based approach to appropriate and safe use of opioid analgesics in treating acute pain in hospitalized patients who are opioid-dependent. Journal of Hospital Medicine 2017;12:375-379.
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The United States is experiencing an epidemic of nonmedical opioid use and opioid overdose-related deaths. As a result, there have been a number of public health interventions aimed at addressing this epidemic. ⋯ In this review, we discuss the inpatient management of individuals with opioid use disorder, including the treatment of withdrawal, benefits of medication-assisted treatment, and application of harm-reduction strategies. Journal of Hospital Medicine 2017;12:369-374.
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Observational Study
Incidence, Predictors, and Outcomes of Hospital-Acquired Anemia.
Although hypothesized to be a hazard of hospitalization, it is unclear whether hospital-acquired anemia (HAA) is associated with increased adverse outcomes following discharge. ⋯ Severe HAA is associated with increased odds for 30-day mortality and readmission after discharge; however, it is uncertain whether severe HAA is preventable. Journal of Hospital Medicine 2017;12:317-322.