Larry Beresford

Back to the Furture Past RIV winners talk about what the recognition meant for their careers By Larry Beresford

Twylla Tassava, MD

After winning SHM’s annual Research, Innovations, and Clinical Vignettes (RIV) scientific abstract and poster competition for an abstract illustrating a program that promoted flu vaccinations for families of neonatal patients, Shetal Shah, MD, FAAP, became a leading advocate for two laws mandating that New York hospitals offer vaccinations to families.

A poster that described a VTE prevention program led Gregory Maynard, MD, MSc, SFHM, to join SHM’s VTE Prevention Collaborative and, eventually, to become senior vice president of the society’s Center for Hospital Innovation and Improvement.

A prize-winning innovations poster for improving team communication by Vineet Chopra, MD, MS, FACP, FHM, and colleagues later took off as a new technology company.

Leonard Feldman, MD, FAAP, SFHM, won for a poster that explained online CME curriculum for hospitalists as consultants; the curriculum now resides on SHM’s website.

The evidence is clear: RIV abstracts are a vital part of hospital medicine.

Nearly 800 abstracts were submitted for HM13.

Awards are given in three categories:

• Research posters report clinical or basic science data, systematically review a clinical problem, or address efficiency, cost, or method of health-care delivery or medical decision-making;
• Innovations posters describe an existing innovative program in hospital medicine, often with preliminary data; and
• Clinical vignettes, either adult or pediatric, report on one or more cases illustrating a new disease entity, a prominent or unusual feature of an established disease, or an area of clinical controversy.

The Hospitalist asked 11 past RIV winners what the poster contest meant to their careers. Some added more data and analysis and went on to be published in such medical journals as the Journal of Hospital Medicine. Some used the recognition to launch or boost research-oriented careers; others saw their careers go in different directions.

“Winning a national poster competition gives you the confidence to continue to pursue your interest and take it to a higher level, like successfully competing for funding and publishing your line of inquiry,” says hospitalist and researcher Vineet Arora, MD, MPP, FHM, of the University of Chicago, who won the 2006 RIV research competition. “Sometimes, presenting posters can be lonely, but at SHM, you get a lot of traffic. You get a chance to practice your spiel, communicating science and research in a very concise way, which is an important skill to have.”

David Metzger, MD, PhD, also from the University of Chicago, who won the RIV research award in 2005, says recognition is a big deal, but “one of the biggest values of the RIV competition is just getting information out to colleagues, with the opportunity to talk with your peers. That’s the real prize.

“I’ve been involved in presenting posters at SHM every year that the society has been in existence,” he says. “I’ve met so many people and talked about what they’re doing. That’s what a medical society should do—bring people together like this.”

Twylla Tassava, MD

Title: Administrator, academic consult service; teaching staff physician

Institution: Saint Joseph Mercy Hospital, Ypsilanti, Mich.

Year: 2008

RIV: “A Case of Salty Voluminous Urine” (clinical vignette)

Dr. Tassava was honored two years in a row for topics drawn from her experience as a hospitalist working in the surgical ICU. Her HM08 entry won top poster, and her HM09 poster, “Permissive Hypernatremia: Co-Management of Intracranial Pressure in a Patient with Diabetes Insipidus,” was selected for an oral presentation.

The HM09 vignette described how the hypernatremia that occurs with diabetes insipidus could be used in a novel way to control intracranial pressure in a 17-year-old patient who had a traumatic brain injury from an auto accident.

“She had a beautiful outcome,” Dr. Tassava says. “She started college and she came back to our unit for a visit after her recovery.”

Dr. Tassava enjoyed the opportunity to explain to her peers how diabetes insipidus presented and how she managed the case. “I was a little surprised at how much discussion was generated by my case,” she says, “even though I knew this was an important and novel approach.”

When her hospital added intensivists, her work and research in the ICU ended and her career moved more toward hospitalist administration. She now runs the academic consult service at St. Joseph, serves as lead physician for the orthopedic surgery floor, instructs and mentors medical residents, and chairs the hospital’s Coagulation Collaborative Practice Team (Coagulation CPT). She credits the RIV honors with helping her to gain recognition as an academic hospitalist who was nominated for leadership roles. She has moved out of research for now but plans to pursue anticoagulation research in the future.

“I really appreciated the recognition for my curiosity and scientific approach, which was acknowledged by my surgical colleagues,” Dr. Tassava says. “I absolutely love the CPT. I am the hospital’s principal educator with regard to anticoagulation. Over the past year, I have given medicine and cardiology grand rounds, and have presented on the newest anticoagulants.”

Dr. Tassava still collaborates with her residents on abstracts, several of which have been submitted to SHM, the American College of Physicians, and other medical societies.

“I still love research,” she says. “I have a million ideas.”

Gregory Maynard, MD, MSc, SFHM

Title: Chief of the division of hospital medicine; senior vice president, SHM’s Center for Innovation and Improvement

Institution: University of California at San Diego (UCSD)

Year: 2008

RIV: “Prevention of Hospital-Acquired Venous Thromboembolism: Prospective Validation of a VTE Risk Assessment Model and Protocol” (research)

Citations: Maynard G, Stein J. Designing and implementing effective VTE prevention protocols: lessons from collaboratives. J Thromb Thrombolysis. 2010;29(2):159-166. Maynard G, Morris T, Jenkins I, et al. Optimizing prevention of hospital acquired venous thromboembolism: prospective validation of a VTE risk assessment model. J Hosp Med. 2010;5(1):10-18.

Dr. Maynard’s abstract described a project funded by the federal Agency for Healthcare Research and Quality to design and implement an organized, comprehensive protocol for VTE prevention within the hospital setting. The project also included a toolkit to help other hospitals do the same thing. The same group received SHM’s Award of Excellence for Teamwork.

This work, combined with similar efforts by Jason Stein, MD, and colleagues at Emory University in Atlanta and others, provided the foundation for SHM’s VTE resource room and the mentored implementation program of SHM’s VTE Prevention Collaborative, which had been launched in 2007 as one of the society’s first large-scale quality-improvement (QI) initiatives.

“SHM wanted to do something about VTE prevention, and when we got our AHRQ grant, I was interested in doing the same,” Dr. Maynard says. “We published our implementation guides on the AHRQ and SHM websites, along with a lot of valuable supporting materials.”

Dr. Maynard later took on leadership roles with SHM’s quality initiatives on glycemic control and care transitions, which made him the logical choice to become senior vice president of SHM’s Center for Hospital Innovation and Improvement.

He says the RIV honor lifted his profile not only within SHM, but also throughout the field, and it was instrumental in obtaining continued funding to advance the VTE initiative. “We did this tremendous work—with great results,” he says. “But I don’t think our local administrators appreciated it quite as much until we started to get external, national recognition.”

Dr. Maynard earned his master’s degree in biostatistics and clinical research design from the University of Michigan—skills he later brought to the academic setting at UCSD.

“It was a nice way for a hospitalist, who’s really a medical generalist, to become an expert in something,” he says. “I could never be more of an expert in cardiology than a cardiologist, or more of an expert in DVT than a hematologist or critical-care specialist. But I could help both of them do what they couldn’t do as effectively, which was to implement protocols reliably using a QI framework.”

Eduard E. Vasilevskis, MD

Title: Assistant professor of general internal medicine, hospital medicine, and public health

Institution: Vanderbilt University, Nashville, Tenn.

Year: 2009

RIV: “Predictors of Early Post-Discharge Mortality in Critically Ill Patients: Lessons for Quality Performance and Quality Assessment” (research)

Citation: Vasilevskis EE, Kuzniewicz MW, Cason BA, et al. Predictors of early post-discharge mortality in critically ill patients: a retrospective cohort study from the California Intensive Care Outcomes project. J Crit Care. 2011;26(1):65-75.

Dr. Vasilevskis has submitted abstracts to the RIV competition almost every year since 2007, when he was completing a fellowship at the University of California at San Francisco’s Institute for Health Policy Studies. He was honored in 2009 for a project based on the California Intensive Care Outcomes Project, which drew data from 35 hospitals to demonstrate that shortening ICU length of stay was predictive of early post-discharge mortality in the most severely ill patients.

He has continued to research quality and safety in the ICU, and he has published dozens of journal articles.

“My initial focus was on traditional mortality and length-of-stay outcomes,” he says. “I am now pursuing additional outcomes, most notably delirium in the ICU patient. I work with an amazing group of researchers that are trying to better measure, define, and treat delirium in the ICU—an outcome associated with a number of poor patient outcomes.”

Dr. Vasilevskis also is researching the causes of hospital readmissions and the development of novel ways to improve care transitions for elderly patients. He is pursuing a master’s of public health at Vanderbilt, and is co-principal investigator of an investigation of the Hospital Medicine Reengineering Network to improve transitions of care, supported by the Association of American Medical Colleges.

In addition to his 2009 win, he captured the HM10 and HM12 research categories. His HM12 poster, “Veterans Administration Acute Care 30-Day Mortality Model: Development, Validation and Performance Variation,” was singled out by the judging committee for its impressive sample size (1,114,327 patients in a retrospective cohort study of 131 VA hospitals), as well as for how it combined administrative and clinical risk models.

Dr. Vasilevskis says the opportunity to present his research at SHM and the recognition he received encouraged him to continue as a hospitalist engaged in medical research. He has been a member of SHM’s Research Committee since 2009, an RIV judge at HM11, and chaired the HM13 RIV competition subcommittee.

Vineet Chopra, MD, MS, FACP, FHM

Title: Assistant professor of medicine

Institution: University of Michigan Health System, Ann Arbor

Year: 2009

RIV: “MComm: Redefining Medical Communications in the 21st Century” (innovations)

Early in his career, Dr. Chopra was curious about how to improve the way patient care is delivered in the hospital setting. He was particularly interested in the inordinate amount of time hospitalists spend every day on communication.

“I saw one-way paging systems as a problem for communication between members of the medical team,” he says. “Doctors get paged and break off from what they’re doing to return the page—to someone who often isn’t there to take the call back. Sometimes the system gives us the wrong number or a cryptic message that makes no sense.”

A technological solution to this problem, which he and hospitalist Prasanth Gogineni, MD, conceived, designed, and created, then tested at the University of Michigan, is called MComm. Dr. Chopra describes it as a novel, uniform way of messaging for the entire medical team using wireless servers, PUSH technology, and iPhones. MComm was built around existing hospital workflow and patient-specific task lists, assigning priority to each message and documenting that it was delivered. The junior faculty members submitted an abstract about their innovative application, not really expecting it to get accepted. But when it won the poster competition and was selected for a plenary presentation, things got busy in a hurry. Specifically, the university hospital’s Office of Technology Transfer took a keen interest.

“We met with a number of people who had business experience in the health-care-technology space and found a CEO for the company we formed to develop MComm,” Dr. Chopra says. “I found myself getting pulled into it very quickly, with a lot of conversations about commercialization, revenue-sharing models, intellectual property, and the like.”

But running a company was not something Dr. Chopra wanted to do. Two years ago, that company, Synaptin, went one way and he went another—he stayed at Michigan as a medical researcher. He remains deeply interested in how care is delivered to hospitalized patients, but with a focus on such patient-safety questions as how to prevent negative outcomes from indwelling venous catheters.

“Winning the poster competition opened doors for me—there’s no doubt in my mind,” he says. “We demonstrated the ability to deliver a project of significance, from concept to prototype, without formal training in this area. If we didn’t have that recognition, I’m not sure I would have been ready to step into a research career as quickly. It helped me realize that medical research was what I wanted to do.”

Vineet Arora, MD, MPP, FHM

Title: Associate program director, internal-medicine residency; assistant dean of scholarship and discovery

Institution: Pritzker School of Medicine, University of Chicago

Year: 2006

RIV: “Measuring Quality of Hospital Care for Vulnerable Elders: Use of ACOVE Quality Indicators” (research)

Citation: Arora VM, Fish M, Basu A, et al. Relationship between quality of care of hospitalized vulnerable elders and postdischarge mortality. J Am Geriatrics. 2010;58:1642-1648.

David O. Meltzer, MD, PhD

Title: Associate professor, department of medicine; associate faculty member, Harris School and the Department of Economics

Institution: University of Chicago

Year: 2005

RIV: “Effects of Hospitalists on Outcomes and Costs in a Multicenter Trial of Academic Hospitalists” (research)

Dr. Meltzer was the lead author, with 11 other prominent hospitalists, of an abstract based on a multisite study of the cost and outcome implications of the hospitalist model—still a relatively new concept in 2001, when the research began. Although the study did not uncover large cost savings realized from the hospitalist model of care, as some advocates had hoped, important findings and implications for the emerging field were teased out of the data.

At the time, only a few randomly controlled, multisite studies of costs and outcomes for the hospitalist model had been performed. The study, Dr. Meltzer says, required a complicated analysis to discover that hospitalists, in fact, saved their facilities money, with their most important impact realized post-hospitalization, such as on nursing-home costs. It was important to control for spillover effect and the fact that hospitalists do a better job of teaching house staff, while a physician’s years of experience was another important variable, he says.

Dr. Meltzer was a medical researcher interested in medical specialization when the term “hospitalist” was first coined in 1996. “I thought, here was a chance to study a medical specialty in its formative stages,” he says.

He still works as a hospitalist, although with limited clinical time. In addition to his administrative work as division chief, he directs the Center for Health and the Social Sciences at the University of Chicago. His research interests include cost-effectiveness, technology assessment, and information research.

In 2010, his poster “Effects of Hospitalists on 1-Year Post-Discharge Resource Utilization by Medicare Beneficiaries” took the top prize in the HM10 research competition. In 2011, he was appointed to the methodology committee of the federal Patient-Centered Outcomes Research Institute (PCORI), which was created by the Affordable Care Act to advise the government on clinical-effectiveness research. He also sits on the Advisory Council to the National Institute of General Medical Sciences at the Institute of Medicine, and on the Congressional Budget Office’s panel of health advisors.

In a career full of recognition, Dr. Meltzer says it’s hard to pinpoint the impact of winning the poster contest. But he has continued to submit abstracts to SHM every year and appreciates the opportunities for interaction with peers at the poster exhibits.

Paul J. Grant, MD, FACP, SFHM

Title: Director of perioperative and consultative medicine

Institution: University of Michigan, Ann Arbor

Year: 2006

RIV: “Disseminated Histoplasmosis Presenting As Painful Oral Ulcers” (clinical vignettes)

Dr. Grant’s winning vignette presented a patient with a complex medical history, including heart disease and four months of painful oral ulcers, for which prior evaluations had been inconclusive, despite conducting biopsies. Following administration of high-dose corticosteroids, the patient’s condition worsened on multiple fronts. The vignette showed how the medical team was able to diagnose an unusual presentation of a fungal infection called histoplasmosis, which is prevalent in parts of the Midwest surrounding the Ohio and Mississippi river valleys.

“We see a lot of cases in the hospital where there are different angles you could take to turn it into a clinical vignette or a nice poster with good teaching points,” Dr. Grant says. “In this case, just digging deeper into the actual diagnosis was important because the empiric use of steroids can be fatal for some patients. Steroids are given for a lot of good reasons, but in this patient they caused immune suppression, allowing a smoldering infection to become very active.”

Dr. Grant did not submit the vignette for publication. “That was probably a mistake on my part,” he says, acknowledging the common complaint of too little time and too many competing priorities. But his interest in research has continued.

“I became involved at a national level with issues of perioperative medicine and last August published a textbook on the subject,” he reports.¹ “VTE is another area of interest I have developed since my hospital medicine fellowship.”

He serves as the VTE resource expert on the Michigan Hospital Medicine Safety Consortium, a quality collaborative of more than 40 hospitals with Blue Cross/Blue Shield of Michigan. “It’s exciting to be able to look at the risk factors, what kinds of patients get VTEs, and whether they were appropriately prophylaxed in the hospital,” he says.

VTE is a national quality priority, and Dr. Grant expects abstracts to emerge from the consortium’s work.

He says he appreciates the opportunities that arise from participating in poster sessions at SHM, where medical students, residents, and working hospitalists talk to the presenters of interesting cases.

“It gives you a real back-and-forth, which is good for the person asking the question and for the presenter,” he says, noting hospitalists from other parts of the country were not as familiar with histoplasmosis.

He says winning the HM06 poster contest helped him “get his feet wet” and feel more prepared for a career in academic hospital medicine. “I’m sure the award solidified my employers’ satisfaction in hiring me—and in giving me more desirable academic roles and responsibilities,” he adds.

Leonard Feldman, MD, FACP, FAAP, SFHM

Title: Assistant professor of medicine pediatrics; director of the general internal-medicine comprehensive consultation service

Institution: Johns Hopkins Hospital, Baltimore

Year: 2009

RIV: “An Internet-Based Consult Curriculum for Hospitalists” (innovations)

Dr. Feldman’s poster described an online CME curriculum for hospitalists acting as medical consultants. The concept grew out of a perceived deficiency in his own medical education when, in 2004, he was asked to lead the consultation service at Johns Hopkins—just six months after finishing his residency.

“I had no idea what I was doing as a general-internal-medicine consultant,” he says. “I maybe received two weeks of experience as a consultant during my residency. I was willing to take it on, learning on the job and asking for help. But it occurred to me that I’m probably not alone in feeling unprepared.”

In his quest for self-education, Dr. Feldman wondered whether he should write a textbook on the subject. “But the information changes so quickly, I thought I’d have a better chance to reach people online,” he notes.

After talking to publishers and CME companies, he came up with the concept of learning modules on perioperative and consultative medicine topics, which could be taken online while earning CME credits. Johns Hopkins served as the CME certifier, and medical-education company Advanced Studies in Medicine joined as a partner. Once the project got off the ground, a medical advisory committee was convened.

“Winning the SHM poster competition is a great honor to have on a CV. It really helps to legitimize your name in the world of hospital medicine,” Dr. Feldman says. “It also provided confirmation that we were on the right track with the curriculum project. People valued what we were doing.”

Dr. Feldman and SHM have since become affiliated, and the “Consultative and Perioperative Medicine Essentials for Hospitalists” modules are available on SHM’s website (www.shmconsults.com). The site has 12,000 registered members completing 500 CME modules every month.

“I do a lot of the editing still,” Dr. Feldman says. “We update the modules every two years and are still creating new ones.”

Dr. Feldman also pursues a number of clinical-research interests, including resident education and costs of care.

Kristin Wise, MD, FHM

Title: Assistant professor of medicine

Institution: Medical University of South Carolina, Charleston

Year: 2009

RIV: “Intensivists versus Hospitalists in the ICU: A Prospective Cohort Study Comparing Mortality and Length of Stay Between Two Staffing Models” (research) Citation: Wise KR, Akopov VA, Williams BR, Ido MS, Leeper KV, Dressler DD. Hospitalists and intensivists in the medical ICU: a prospective and observational study comparing mortality and length of stay between two staffing models. J Hosp Med. 2012;7(3):183-189.

Dr. Wise was recognized for research that began while she worked at Emory University in Atlanta, comparing hospitalists and intensivists in such outcomes as length of stay and mortality rates for patients in the ICU. The study was one of the first statistically rigorous examinations of this critical quality question. With an eye toward improving patient safety, national quality advocates such as the Leapfrog Group have called for hospitals to employ intensivists (critical-care specialists) to manage the care of ICU patients. In reality, Dr. Wise says, there aren’t enough intensivists to meet the need.

“Hospitalists are in the ICU anyway,” she says. “We just don’t have enough data to answer how well they do [in comparison to intensivists].”

Through a prospective cohort study of more than 1,000 patients, Dr. Wise’s group found that there was essentially no statistical difference in mortality rates between patients treated by intensivist teams or hospitalist ICU teams.

“We were also able to look at some of the intermediate-acuity patients—fairly complicated but not requiring ventilators,” she explains. “Our study wasn’t sufficiently powered for this subgroup, but it was an interesting piece of data to raise the question: Where should we deploy this scarce resource of intensivists? Which pockets of patients?”

Presenting her abstract at SHM’s annual meeting was a “good experience.”

“I’d done public speaking before, but never with an audience of about 500 people,” she says. “To go out there and field their questions was a real professional growing experience. Several people interested in the topic sought me out at the conference, introduced themselves, and we have subsequently stayed in touch.”

The manuscript published in JHM has been cited four times, including in a position paper from SHM and the Society of Critical Care Medicine.³ Another outgrowth of the research was being asked to contribute a chapter on hospitalists’ role in the ICU to a textbook on hospital medicine. Based on her still-fresh HM presentation, Dr. Wise was one of the few publicly identified experts on the subject. The chapter, co-authored by fellow Emory hospitalist Michael Heisler, MD, MPH, “The Role of the Hospitalist in Critical Care” was included in Principles and Practices of Hospital Medicine.⁴

Shetal Shah, MD, FAAP

Title: Neonatal intensivist

Institution: Stony Brook University Hospital, Great Neck, N.Y.

Year: 2006

RIV: “Administration of Inactivated Trivalent Influenza Vaccine (TIV) to Parents of Infants in the Neonatal Intensive Care Unit (NICU): A Novel Strategy to Increase Vaccination Rates” (innovations)

Citation: Shah SI, Caprio M, Hendricks-Munoz K. Administration of inactivated trivalent influenza vaccine to parents of high-risk infants in the neonatal intensive care unit. Pediatrics. 2007;120;e617-e621.

Dr. Shah was in his final year of a fellowship in neonatology at New York University when he took on the challenge of improving immunization access to protect premature, highly vulnerable patients in the NICU from influenza infections. Because these children are too young to be vaccinated directly, the concept of cocooning them from infection involves extending protection to everyone around them.

“We came up with the idea of offering flu vaccinations 24/7 in the NICU to the children’s parents,” he says. “It worked well for us as a way to define an indicated therapy for a defined population, even if it was a little outside the box. By the end of the flu season, 95% of the parents were vaccinated.”

SHM recognized the project as the top RIV innovations poster at HM06, but that was just the beginning.

“When I moved to SUNY Stony Brook, I continued to study and advocate for these vaccinations,” Dr. Shah says. “We were giving 500 to 700 vaccinations a year. Then I wrote a national resolution for the American Academy of Pediatrics, which was significant because it meant AAP was behind the project.”

Dr. Shah later became chair of AAP’s Long Island Chapter Legislative Committee and joined a statewide pediatric advocacy group. In 2009, the New York legislature enacted the Neonatal Influenza Protection Act, which required hospitals in the state to offer parents the vaccine, with Dr. Shah’s research and advocacy providing an essential basis for its passage. He’s even been recognized for his research in congressional citations.

Based on that success with influenza vaccinations, Dr. Shah and his colleagues looked at other diseases, starting with pertussis, and then tetanus, diphtheria, and whooping cough.⁵ All the while, they continued tracking immunization rates. A second state law, passed in 2011, added pertussis to the vaccinations. Next on his advocacy agenda is a project to promote smoking-cessation interventions in the NICU.⁶

“These parents come to see us every day,” he says. “What can we do, through the parents, to promote the health and well-being of their high-risk newborns?”

Jason Morrow, MD, PhD

Title: Assistant professor of medicine; medical director of inpatient palliative-care consultation

Institution: University of Texas Health Sciences Center, San Antonio

Year: 2009

RIV: “When to Depend on the Kinins of Strangers: An Unusual Case of Abdominal Pain” (clinical vignettes)

Publication: An article on the ethics of determining code status for patients with advanced cancer and a book chapter on the “last hours of life” for a forthcoming book on palliative care and hospital medicine.

As a medical resident, Dr. Morrow met a 27-year-old woman who had chronic abdominal pain and had made multiple visits to the ED for this complaint. The patient had a history of substance abuse and requested dilaudid for her pain—making it easy for staff to consign her to the stereotype of the difficult patient.

“I met her after an interesting finding,” he says. “It turns out that on the previous emergency room visit, she received a CAT scan, which showed duodenal and small-bowel thickening consistent with hereditary angioedema, although with an unusual presentation. As it happened, we had onsite a world expert in angioedema.”

The expert was able to confirm the diagnosis, Dr. Morrow says.

“By giving her this ‘legitimate,’ organic diagnosis, it just changed the whole dynamic of her relationship with her doctors,” he says. “She knew that they knew something was really wrong. The residents were empowered to have something to hang their hats on. And we were able to get better control of her pain.”

Dr. Morrow says he came on the scene late in the discovery process, but he helped to solve the puzzle, and then put together the abstract and poster that told the story of making the diagnosis.

“In my previous job, I was hired as a hospitalist but helped to build the palliative-care program within the hospital-medicine service,” he says. “In my current job, I was brought in to build the inpatient palliative-care-consultation service, although I still moonlight as a hospitalist to stay sharp.”

Dr. Morrow says he enjoys sharing stories of difficult cases and submitting case studies about them to medical conferences, often with clever titles incorporating puns (e.g. the 2009 SHM poster citing kinins, polypeptides in the blood that cause inflammation). Another example is “The Angina Monologues,” a story of an 82-year-old patient with chronic angina pectoris and complex pain syndromes that were difficult to bring under control. Palliative care also emphasizes patients’ stories, he says, in order to understand the person behind the diagnosis.

Larry Beresford is a freelance writer in San Francisco. References available at www.the-hospitalist.org.

References

Back to the Furture Past RIV winners talk about what the recognition meant for their careers By Larry Beresford

Twylla Tassava, MD

After winning SHM’s annual Research, Innovations, and Clinical Vignettes (RIV) scientific abstract and poster competition for an abstract illustrating a program that promoted flu vaccinations for families of neonatal patients, Shetal Shah, MD, FAAP, became a leading advocate for two laws mandating that New York hospitals offer vaccinations to families.

A poster that described a VTE prevention program led Gregory Maynard, MD, MSc, SFHM, to join SHM’s VTE Prevention Collaborative and, eventually, to become senior vice president of the society’s Center for Hospital Innovation and Improvement.

A prize-winning innovations poster for improving team communication by Vineet Chopra, MD, MS, FACP, FHM, and colleagues later took off as a new technology company.

Leonard Feldman, MD, FAAP, SFHM, won for a poster that explained online CME curriculum for hospitalists as consultants; the curriculum now resides on SHM’s website.

The evidence is clear: RIV abstracts are a vital part of hospital medicine.

Nearly 800 abstracts were submitted for HM13.

Awards are given in three categories:

• Research posters report clinical or basic science data, systematically review a clinical problem, or address efficiency, cost, or method of health-care delivery or medical decision-making;
• Innovations posters describe an existing innovative program in hospital medicine, often with preliminary data; and
• Clinical vignettes, either adult or pediatric, report on one or more cases illustrating a new disease entity, a prominent or unusual feature of an established disease, or an area of clinical controversy.

The Hospitalist asked 11 past RIV winners what the poster contest meant to their careers. Some added more data and analysis and went on to be published in such medical journals as the Journal of Hospital Medicine. Some used the recognition to launch or boost research-oriented careers; others saw their careers go in different directions.

“Winning a national poster competition gives you the confidence to continue to pursue your interest and take it to a higher level, like successfully competing for funding and publishing your line of inquiry,” says hospitalist and researcher Vineet Arora, MD, MPP, FHM, of the University of Chicago, who won the 2006 RIV research competition. “Sometimes, presenting posters can be lonely, but at SHM, you get a lot of traffic. You get a chance to practice your spiel, communicating science and research in a very concise way, which is an important skill to have.”

David Metzger, MD, PhD, also from the University of Chicago, who won the RIV research award in 2005, says recognition is a big deal, but “one of the biggest values of the RIV competition is just getting information out to colleagues, with the opportunity to talk with your peers. That’s the real prize.

“I’ve been involved in presenting posters at SHM every year that the society has been in existence,” he says. “I’ve met so many people and talked about what they’re doing. That’s what a medical society should do—bring people together like this.”

Twylla Tassava, MD

Title: Administrator, academic consult service; teaching staff physician

Institution: Saint Joseph Mercy Hospital, Ypsilanti, Mich.

Year: 2008

RIV: “A Case of Salty Voluminous Urine” (clinical vignette)

Dr. Tassava was honored two years in a row for topics drawn from her experience as a hospitalist working in the surgical ICU. Her HM08 entry won top poster, and her HM09 poster, “Permissive Hypernatremia: Co-Management of Intracranial Pressure in a Patient with Diabetes Insipidus,” was selected for an oral presentation.

The HM09 vignette described how the hypernatremia that occurs with diabetes insipidus could be used in a novel way to control intracranial pressure in a 17-year-old patient who had a traumatic brain injury from an auto accident.

“She had a beautiful outcome,” Dr. Tassava says. “She started college and she came back to our unit for a visit after her recovery.”

Dr. Tassava enjoyed the opportunity to explain to her peers how diabetes insipidus presented and how she managed the case. “I was a little surprised at how much discussion was generated by my case,” she says, “even though I knew this was an important and novel approach.”

When her hospital added intensivists, her work and research in the ICU ended and her career moved more toward hospitalist administration. She now runs the academic consult service at St. Joseph, serves as lead physician for the orthopedic surgery floor, instructs and mentors medical residents, and chairs the hospital’s Coagulation Collaborative Practice Team (Coagulation CPT). She credits the RIV honors with helping her to gain recognition as an academic hospitalist who was nominated for leadership roles. She has moved out of research for now but plans to pursue anticoagulation research in the future.

“I really appreciated the recognition for my curiosity and scientific approach, which was acknowledged by my surgical colleagues,” Dr. Tassava says. “I absolutely love the CPT. I am the hospital’s principal educator with regard to anticoagulation. Over the past year, I have given medicine and cardiology grand rounds, and have presented on the newest anticoagulants.”

Dr. Tassava still collaborates with her residents on abstracts, several of which have been submitted to SHM, the American College of Physicians, and other medical societies.

“I still love research,” she says. “I have a million ideas.”

Gregory Maynard, MD, MSc, SFHM

Title: Chief of the division of hospital medicine; senior vice president, SHM’s Center for Innovation and Improvement

Institution: University of California at San Diego (UCSD)

Year: 2008

RIV: “Prevention of Hospital-Acquired Venous Thromboembolism: Prospective Validation of a VTE Risk Assessment Model and Protocol” (research)

Citations: Maynard G, Stein J. Designing and implementing effective VTE prevention protocols: lessons from collaboratives. J Thromb Thrombolysis. 2010;29(2):159-166. Maynard G, Morris T, Jenkins I, et al. Optimizing prevention of hospital acquired venous thromboembolism: prospective validation of a VTE risk assessment model. J Hosp Med. 2010;5(1):10-18.

Dr. Maynard’s abstract described a project funded by the federal Agency for Healthcare Research and Quality to design and implement an organized, comprehensive protocol for VTE prevention within the hospital setting. The project also included a toolkit to help other hospitals do the same thing. The same group received SHM’s Award of Excellence for Teamwork.

This work, combined with similar efforts by Jason Stein, MD, and colleagues at Emory University in Atlanta and others, provided the foundation for SHM’s VTE resource room and the mentored implementation program of SHM’s VTE Prevention Collaborative, which had been launched in 2007 as one of the society’s first large-scale quality-improvement (QI) initiatives.

“SHM wanted to do something about VTE prevention, and when we got our AHRQ grant, I was interested in doing the same,” Dr. Maynard says. “We published our implementation guides on the AHRQ and SHM websites, along with a lot of valuable supporting materials.”

Dr. Maynard later took on leadership roles with SHM’s quality initiatives on glycemic control and care transitions, which made him the logical choice to become senior vice president of SHM’s Center for Hospital Innovation and Improvement.

He says the RIV honor lifted his profile not only within SHM, but also throughout the field, and it was instrumental in obtaining continued funding to advance the VTE initiative. “We did this tremendous work—with great results,” he says. “But I don’t think our local administrators appreciated it quite as much until we started to get external, national recognition.”

Dr. Maynard earned his master’s degree in biostatistics and clinical research design from the University of Michigan—skills he later brought to the academic setting at UCSD.

“It was a nice way for a hospitalist, who’s really a medical generalist, to become an expert in something,” he says. “I could never be more of an expert in cardiology than a cardiologist, or more of an expert in DVT than a hematologist or critical-care specialist. But I could help both of them do what they couldn’t do as effectively, which was to implement protocols reliably using a QI framework.”

Eduard E. Vasilevskis, MD

Title: Assistant professor of general internal medicine, hospital medicine, and public health

Institution: Vanderbilt University, Nashville, Tenn.

Year: 2009

RIV: “Predictors of Early Post-Discharge Mortality in Critically Ill Patients: Lessons for Quality Performance and Quality Assessment” (research)

Citation: Vasilevskis EE, Kuzniewicz MW, Cason BA, et al. Predictors of early post-discharge mortality in critically ill patients: a retrospective cohort study from the California Intensive Care Outcomes project. J Crit Care. 2011;26(1):65-75.

Dr. Vasilevskis has submitted abstracts to the RIV competition almost every year since 2007, when he was completing a fellowship at the University of California at San Francisco’s Institute for Health Policy Studies. He was honored in 2009 for a project based on the California Intensive Care Outcomes Project, which drew data from 35 hospitals to demonstrate that shortening ICU length of stay was predictive of early post-discharge mortality in the most severely ill patients.

He has continued to research quality and safety in the ICU, and he has published dozens of journal articles.

“My initial focus was on traditional mortality and length-of-stay outcomes,” he says. “I am now pursuing additional outcomes, most notably delirium in the ICU patient. I work with an amazing group of researchers that are trying to better measure, define, and treat delirium in the ICU—an outcome associated with a number of poor patient outcomes.”

Dr. Vasilevskis also is researching the causes of hospital readmissions and the development of novel ways to improve care transitions for elderly patients. He is pursuing a master’s of public health at Vanderbilt, and is co-principal investigator of an investigation of the Hospital Medicine Reengineering Network to improve transitions of care, supported by the Association of American Medical Colleges.

In addition to his 2009 win, he captured the HM10 and HM12 research categories. His HM12 poster, “Veterans Administration Acute Care 30-Day Mortality Model: Development, Validation and Performance Variation,” was singled out by the judging committee for its impressive sample size (1,114,327 patients in a retrospective cohort study of 131 VA hospitals), as well as for how it combined administrative and clinical risk models.

Dr. Vasilevskis says the opportunity to present his research at SHM and the recognition he received encouraged him to continue as a hospitalist engaged in medical research. He has been a member of SHM’s Research Committee since 2009, an RIV judge at HM11, and chaired the HM13 RIV competition subcommittee.

Vineet Chopra, MD, MS, FACP, FHM

Title: Assistant professor of medicine

Institution: University of Michigan Health System, Ann Arbor

Year: 2009

RIV: “MComm: Redefining Medical Communications in the 21st Century” (innovations)

Early in his career, Dr. Chopra was curious about how to improve the way patient care is delivered in the hospital setting. He was particularly interested in the inordinate amount of time hospitalists spend every day on communication.

“I saw one-way paging systems as a problem for communication between members of the medical team,” he says. “Doctors get paged and break off from what they’re doing to return the page—to someone who often isn’t there to take the call back. Sometimes the system gives us the wrong number or a cryptic message that makes no sense.”

A technological solution to this problem, which he and hospitalist Prasanth Gogineni, MD, conceived, designed, and created, then tested at the University of Michigan, is called MComm. Dr. Chopra describes it as a novel, uniform way of messaging for the entire medical team using wireless servers, PUSH technology, and iPhones. MComm was built around existing hospital workflow and patient-specific task lists, assigning priority to each message and documenting that it was delivered. The junior faculty members submitted an abstract about their innovative application, not really expecting it to get accepted. But when it won the poster competition and was selected for a plenary presentation, things got busy in a hurry. Specifically, the university hospital’s Office of Technology Transfer took a keen interest.

“We met with a number of people who had business experience in the health-care-technology space and found a CEO for the company we formed to develop MComm,” Dr. Chopra says. “I found myself getting pulled into it very quickly, with a lot of conversations about commercialization, revenue-sharing models, intellectual property, and the like.”

But running a company was not something Dr. Chopra wanted to do. Two years ago, that company, Synaptin, went one way and he went another—he stayed at Michigan as a medical researcher. He remains deeply interested in how care is delivered to hospitalized patients, but with a focus on such patient-safety questions as how to prevent negative outcomes from indwelling venous catheters.

“Winning the poster competition opened doors for me—there’s no doubt in my mind,” he says. “We demonstrated the ability to deliver a project of significance, from concept to prototype, without formal training in this area. If we didn’t have that recognition, I’m not sure I would have been ready to step into a research career as quickly. It helped me realize that medical research was what I wanted to do.”

Vineet Arora, MD, MPP, FHM

Title: Associate program director, internal-medicine residency; assistant dean of scholarship and discovery

Institution: Pritzker School of Medicine, University of Chicago

Year: 2006

RIV: “Measuring Quality of Hospital Care for Vulnerable Elders: Use of ACOVE Quality Indicators” (research)

Citation: Arora VM, Fish M, Basu A, et al. Relationship between quality of care of hospitalized vulnerable elders and postdischarge mortality. J Am Geriatrics. 2010;58:1642-1648.

David O. Meltzer, MD, PhD

Title: Associate professor, department of medicine; associate faculty member, Harris School and the Department of Economics

Institution: University of Chicago

Year: 2005

RIV: “Effects of Hospitalists on Outcomes and Costs in a Multicenter Trial of Academic Hospitalists” (research)

Dr. Meltzer was the lead author, with 11 other prominent hospitalists, of an abstract based on a multisite study of the cost and outcome implications of the hospitalist model—still a relatively new concept in 2001, when the research began. Although the study did not uncover large cost savings realized from the hospitalist model of care, as some advocates had hoped, important findings and implications for the emerging field were teased out of the data.

At the time, only a few randomly controlled, multisite studies of costs and outcomes for the hospitalist model had been performed. The study, Dr. Meltzer says, required a complicated analysis to discover that hospitalists, in fact, saved their facilities money, with their most important impact realized post-hospitalization, such as on nursing-home costs. It was important to control for spillover effect and the fact that hospitalists do a better job of teaching house staff, while a physician’s years of experience was another important variable, he says.

Dr. Meltzer was a medical researcher interested in medical specialization when the term “hospitalist” was first coined in 1996. “I thought, here was a chance to study a medical specialty in its formative stages,” he says.

He still works as a hospitalist, although with limited clinical time. In addition to his administrative work as division chief, he directs the Center for Health and the Social Sciences at the University of Chicago. His research interests include cost-effectiveness, technology assessment, and information research.

In 2010, his poster “Effects of Hospitalists on 1-Year Post-Discharge Resource Utilization by Medicare Beneficiaries” took the top prize in the HM10 research competition. In 2011, he was appointed to the methodology committee of the federal Patient-Centered Outcomes Research Institute (PCORI), which was created by the Affordable Care Act to advise the government on clinical-effectiveness research. He also sits on the Advisory Council to the National Institute of General Medical Sciences at the Institute of Medicine, and on the Congressional Budget Office’s panel of health advisors.

In a career full of recognition, Dr. Meltzer says it’s hard to pinpoint the impact of winning the poster contest. But he has continued to submit abstracts to SHM every year and appreciates the opportunities for interaction with peers at the poster exhibits.

Paul J. Grant, MD, FACP, SFHM

Title: Director of perioperative and consultative medicine

Institution: University of Michigan, Ann Arbor

Year: 2006

RIV: “Disseminated Histoplasmosis Presenting As Painful Oral Ulcers” (clinical vignettes)

Dr. Grant’s winning vignette presented a patient with a complex medical history, including heart disease and four months of painful oral ulcers, for which prior evaluations had been inconclusive, despite conducting biopsies. Following administration of high-dose corticosteroids, the patient’s condition worsened on multiple fronts. The vignette showed how the medical team was able to diagnose an unusual presentation of a fungal infection called histoplasmosis, which is prevalent in parts of the Midwest surrounding the Ohio and Mississippi river valleys.

“We see a lot of cases in the hospital where there are different angles you could take to turn it into a clinical vignette or a nice poster with good teaching points,” Dr. Grant says. “In this case, just digging deeper into the actual diagnosis was important because the empiric use of steroids can be fatal for some patients. Steroids are given for a lot of good reasons, but in this patient they caused immune suppression, allowing a smoldering infection to become very active.”

Dr. Grant did not submit the vignette for publication. “That was probably a mistake on my part,” he says, acknowledging the common complaint of too little time and too many competing priorities. But his interest in research has continued.

“I became involved at a national level with issues of perioperative medicine and last August published a textbook on the subject,” he reports.¹ “VTE is another area of interest I have developed since my hospital medicine fellowship.”

He serves as the VTE resource expert on the Michigan Hospital Medicine Safety Consortium, a quality collaborative of more than 40 hospitals with Blue Cross/Blue Shield of Michigan. “It’s exciting to be able to look at the risk factors, what kinds of patients get VTEs, and whether they were appropriately prophylaxed in the hospital,” he says.

VTE is a national quality priority, and Dr. Grant expects abstracts to emerge from the consortium’s work.

He says he appreciates the opportunities that arise from participating in poster sessions at SHM, where medical students, residents, and working hospitalists talk to the presenters of interesting cases.

“It gives you a real back-and-forth, which is good for the person asking the question and for the presenter,” he says, noting hospitalists from other parts of the country were not as familiar with histoplasmosis.

He says winning the HM06 poster contest helped him “get his feet wet” and feel more prepared for a career in academic hospital medicine. “I’m sure the award solidified my employers’ satisfaction in hiring me—and in giving me more desirable academic roles and responsibilities,” he adds.

Leonard Feldman, MD, FACP, FAAP, SFHM

Title: Assistant professor of medicine pediatrics; director of the general internal-medicine comprehensive consultation service

Institution: Johns Hopkins Hospital, Baltimore

Year: 2009

RIV: “An Internet-Based Consult Curriculum for Hospitalists” (innovations)

Dr. Feldman’s poster described an online CME curriculum for hospitalists acting as medical consultants. The concept grew out of a perceived deficiency in his own medical education when, in 2004, he was asked to lead the consultation service at Johns Hopkins—just six months after finishing his residency.

“I had no idea what I was doing as a general-internal-medicine consultant,” he says. “I maybe received two weeks of experience as a consultant during my residency. I was willing to take it on, learning on the job and asking for help. But it occurred to me that I’m probably not alone in feeling unprepared.”

In his quest for self-education, Dr. Feldman wondered whether he should write a textbook on the subject. “But the information changes so quickly, I thought I’d have a better chance to reach people online,” he notes.

After talking to publishers and CME companies, he came up with the concept of learning modules on perioperative and consultative medicine topics, which could be taken online while earning CME credits. Johns Hopkins served as the CME certifier, and medical-education company Advanced Studies in Medicine joined as a partner. Once the project got off the ground, a medical advisory committee was convened.

“Winning the SHM poster competition is a great honor to have on a CV. It really helps to legitimize your name in the world of hospital medicine,” Dr. Feldman says. “It also provided confirmation that we were on the right track with the curriculum project. People valued what we were doing.”

Dr. Feldman and SHM have since become affiliated, and the “Consultative and Perioperative Medicine Essentials for Hospitalists” modules are available on SHM’s website (www.shmconsults.com). The site has 12,000 registered members completing 500 CME modules every month.

“I do a lot of the editing still,” Dr. Feldman says. “We update the modules every two years and are still creating new ones.”

Dr. Feldman also pursues a number of clinical-research interests, including resident education and costs of care.

Kristin Wise, MD, FHM

Title: Assistant professor of medicine

Institution: Medical University of South Carolina, Charleston

Year: 2009

RIV: “Intensivists versus Hospitalists in the ICU: A Prospective Cohort Study Comparing Mortality and Length of Stay Between Two Staffing Models” (research) Citation: Wise KR, Akopov VA, Williams BR, Ido MS, Leeper KV, Dressler DD. Hospitalists and intensivists in the medical ICU: a prospective and observational study comparing mortality and length of stay between two staffing models. J Hosp Med. 2012;7(3):183-189.

Dr. Wise was recognized for research that began while she worked at Emory University in Atlanta, comparing hospitalists and intensivists in such outcomes as length of stay and mortality rates for patients in the ICU. The study was one of the first statistically rigorous examinations of this critical quality question. With an eye toward improving patient safety, national quality advocates such as the Leapfrog Group have called for hospitals to employ intensivists (critical-care specialists) to manage the care of ICU patients. In reality, Dr. Wise says, there aren’t enough intensivists to meet the need.

“Hospitalists are in the ICU anyway,” she says. “We just don’t have enough data to answer how well they do [in comparison to intensivists].”

Through a prospective cohort study of more than 1,000 patients, Dr. Wise’s group found that there was essentially no statistical difference in mortality rates between patients treated by intensivist teams or hospitalist ICU teams.

“We were also able to look at some of the intermediate-acuity patients—fairly complicated but not requiring ventilators,” she explains. “Our study wasn’t sufficiently powered for this subgroup, but it was an interesting piece of data to raise the question: Where should we deploy this scarce resource of intensivists? Which pockets of patients?”

Presenting her abstract at SHM’s annual meeting was a “good experience.”

“I’d done public speaking before, but never with an audience of about 500 people,” she says. “To go out there and field their questions was a real professional growing experience. Several people interested in the topic sought me out at the conference, introduced themselves, and we have subsequently stayed in touch.”

The manuscript published in JHM has been cited four times, including in a position paper from SHM and the Society of Critical Care Medicine.³ Another outgrowth of the research was being asked to contribute a chapter on hospitalists’ role in the ICU to a textbook on hospital medicine. Based on her still-fresh HM presentation, Dr. Wise was one of the few publicly identified experts on the subject. The chapter, co-authored by fellow Emory hospitalist Michael Heisler, MD, MPH, “The Role of the Hospitalist in Critical Care” was included in Principles and Practices of Hospital Medicine.⁴

Shetal Shah, MD, FAAP

Title: Neonatal intensivist

Institution: Stony Brook University Hospital, Great Neck, N.Y.

Year: 2006

RIV: “Administration of Inactivated Trivalent Influenza Vaccine (TIV) to Parents of Infants in the Neonatal Intensive Care Unit (NICU): A Novel Strategy to Increase Vaccination Rates” (innovations)

Citation: Shah SI, Caprio M, Hendricks-Munoz K. Administration of inactivated trivalent influenza vaccine to parents of high-risk infants in the neonatal intensive care unit. Pediatrics. 2007;120;e617-e621.

Dr. Shah was in his final year of a fellowship in neonatology at New York University when he took on the challenge of improving immunization access to protect premature, highly vulnerable patients in the NICU from influenza infections. Because these children are too young to be vaccinated directly, the concept of cocooning them from infection involves extending protection to everyone around them.

“We came up with the idea of offering flu vaccinations 24/7 in the NICU to the children’s parents,” he says. “It worked well for us as a way to define an indicated therapy for a defined population, even if it was a little outside the box. By the end of the flu season, 95% of the parents were vaccinated.”

SHM recognized the project as the top RIV innovations poster at HM06, but that was just the beginning.

“When I moved to SUNY Stony Brook, I continued to study and advocate for these vaccinations,” Dr. Shah says. “We were giving 500 to 700 vaccinations a year. Then I wrote a national resolution for the American Academy of Pediatrics, which was significant because it meant AAP was behind the project.”

Dr. Shah later became chair of AAP’s Long Island Chapter Legislative Committee and joined a statewide pediatric advocacy group. In 2009, the New York legislature enacted the Neonatal Influenza Protection Act, which required hospitals in the state to offer parents the vaccine, with Dr. Shah’s research and advocacy providing an essential basis for its passage. He’s even been recognized for his research in congressional citations.

Based on that success with influenza vaccinations, Dr. Shah and his colleagues looked at other diseases, starting with pertussis, and then tetanus, diphtheria, and whooping cough.⁵ All the while, they continued tracking immunization rates. A second state law, passed in 2011, added pertussis to the vaccinations. Next on his advocacy agenda is a project to promote smoking-cessation interventions in the NICU.⁶

“These parents come to see us every day,” he says. “What can we do, through the parents, to promote the health and well-being of their high-risk newborns?”

Jason Morrow, MD, PhD

Title: Assistant professor of medicine; medical director of inpatient palliative-care consultation

Institution: University of Texas Health Sciences Center, San Antonio

Year: 2009

RIV: “When to Depend on the Kinins of Strangers: An Unusual Case of Abdominal Pain” (clinical vignettes)

Publication: An article on the ethics of determining code status for patients with advanced cancer and a book chapter on the “last hours of life” for a forthcoming book on palliative care and hospital medicine.

As a medical resident, Dr. Morrow met a 27-year-old woman who had chronic abdominal pain and had made multiple visits to the ED for this complaint. The patient had a history of substance abuse and requested dilaudid for her pain—making it easy for staff to consign her to the stereotype of the difficult patient.

“I met her after an interesting finding,” he says. “It turns out that on the previous emergency room visit, she received a CAT scan, which showed duodenal and small-bowel thickening consistent with hereditary angioedema, although with an unusual presentation. As it happened, we had onsite a world expert in angioedema.”

The expert was able to confirm the diagnosis, Dr. Morrow says.

“By giving her this ‘legitimate,’ organic diagnosis, it just changed the whole dynamic of her relationship with her doctors,” he says. “She knew that they knew something was really wrong. The residents were empowered to have something to hang their hats on. And we were able to get better control of her pain.”

Dr. Morrow says he came on the scene late in the discovery process, but he helped to solve the puzzle, and then put together the abstract and poster that told the story of making the diagnosis.

“In my previous job, I was hired as a hospitalist but helped to build the palliative-care program within the hospital-medicine service,” he says. “In my current job, I was brought in to build the inpatient palliative-care-consultation service, although I still moonlight as a hospitalist to stay sharp.”

Dr. Morrow says he enjoys sharing stories of difficult cases and submitting case studies about them to medical conferences, often with clever titles incorporating puns (e.g. the 2009 SHM poster citing kinins, polypeptides in the blood that cause inflammation). Another example is “The Angina Monologues,” a story of an 82-year-old patient with chronic angina pectoris and complex pain syndromes that were difficult to bring under control. Palliative care also emphasizes patients’ stories, he says, in order to understand the person behind the diagnosis.

Larry Beresford is a freelance writer in San Francisco. References available at www.the-hospitalist.org.

References

Back to the Furture Past RIV winners talk about what the recognition meant for their careers By Larry Beresford

Twylla Tassava, MD

After winning SHM’s annual Research, Innovations, and Clinical Vignettes (RIV) scientific abstract and poster competition for an abstract illustrating a program that promoted flu vaccinations for families of neonatal patients, Shetal Shah, MD, FAAP, became a leading advocate for two laws mandating that New York hospitals offer vaccinations to families.

A poster that described a VTE prevention program led Gregory Maynard, MD, MSc, SFHM, to join SHM’s VTE Prevention Collaborative and, eventually, to become senior vice president of the society’s Center for Hospital Innovation and Improvement.

A prize-winning innovations poster for improving team communication by Vineet Chopra, MD, MS, FACP, FHM, and colleagues later took off as a new technology company.

Leonard Feldman, MD, FAAP, SFHM, won for a poster that explained online CME curriculum for hospitalists as consultants; the curriculum now resides on SHM’s website.

The evidence is clear: RIV abstracts are a vital part of hospital medicine.

Nearly 800 abstracts were submitted for HM13.

Awards are given in three categories:

• Research posters report clinical or basic science data, systematically review a clinical problem, or address efficiency, cost, or method of health-care delivery or medical decision-making;
• Innovations posters describe an existing innovative program in hospital medicine, often with preliminary data; and
• Clinical vignettes, either adult or pediatric, report on one or more cases illustrating a new disease entity, a prominent or unusual feature of an established disease, or an area of clinical controversy.

The Hospitalist asked 11 past RIV winners what the poster contest meant to their careers. Some added more data and analysis and went on to be published in such medical journals as the Journal of Hospital Medicine. Some used the recognition to launch or boost research-oriented careers; others saw their careers go in different directions.

“Winning a national poster competition gives you the confidence to continue to pursue your interest and take it to a higher level, like successfully competing for funding and publishing your line of inquiry,” says hospitalist and researcher Vineet Arora, MD, MPP, FHM, of the University of Chicago, who won the 2006 RIV research competition. “Sometimes, presenting posters can be lonely, but at SHM, you get a lot of traffic. You get a chance to practice your spiel, communicating science and research in a very concise way, which is an important skill to have.”

David Metzger, MD, PhD, also from the University of Chicago, who won the RIV research award in 2005, says recognition is a big deal, but “one of the biggest values of the RIV competition is just getting information out to colleagues, with the opportunity to talk with your peers. That’s the real prize.

“I’ve been involved in presenting posters at SHM every year that the society has been in existence,” he says. “I’ve met so many people and talked about what they’re doing. That’s what a medical society should do—bring people together like this.”

Twylla Tassava, MD

Title: Administrator, academic consult service; teaching staff physician

Institution: Saint Joseph Mercy Hospital, Ypsilanti, Mich.

Year: 2008

RIV: “A Case of Salty Voluminous Urine” (clinical vignette)

Dr. Tassava was honored two years in a row for topics drawn from her experience as a hospitalist working in the surgical ICU. Her HM08 entry won top poster, and her HM09 poster, “Permissive Hypernatremia: Co-Management of Intracranial Pressure in a Patient with Diabetes Insipidus,” was selected for an oral presentation.

The HM09 vignette described how the hypernatremia that occurs with diabetes insipidus could be used in a novel way to control intracranial pressure in a 17-year-old patient who had a traumatic brain injury from an auto accident.

“She had a beautiful outcome,” Dr. Tassava says. “She started college and she came back to our unit for a visit after her recovery.”

Dr. Tassava enjoyed the opportunity to explain to her peers how diabetes insipidus presented and how she managed the case. “I was a little surprised at how much discussion was generated by my case,” she says, “even though I knew this was an important and novel approach.”

When her hospital added intensivists, her work and research in the ICU ended and her career moved more toward hospitalist administration. She now runs the academic consult service at St. Joseph, serves as lead physician for the orthopedic surgery floor, instructs and mentors medical residents, and chairs the hospital’s Coagulation Collaborative Practice Team (Coagulation CPT). She credits the RIV honors with helping her to gain recognition as an academic hospitalist who was nominated for leadership roles. She has moved out of research for now but plans to pursue anticoagulation research in the future.

“I really appreciated the recognition for my curiosity and scientific approach, which was acknowledged by my surgical colleagues,” Dr. Tassava says. “I absolutely love the CPT. I am the hospital’s principal educator with regard to anticoagulation. Over the past year, I have given medicine and cardiology grand rounds, and have presented on the newest anticoagulants.”

Dr. Tassava still collaborates with her residents on abstracts, several of which have been submitted to SHM, the American College of Physicians, and other medical societies.

“I still love research,” she says. “I have a million ideas.”

Gregory Maynard, MD, MSc, SFHM

Title: Chief of the division of hospital medicine; senior vice president, SHM’s Center for Innovation and Improvement

Institution: University of California at San Diego (UCSD)

Year: 2008

RIV: “Prevention of Hospital-Acquired Venous Thromboembolism: Prospective Validation of a VTE Risk Assessment Model and Protocol” (research)

Citations: Maynard G, Stein J. Designing and implementing effective VTE prevention protocols: lessons from collaboratives. J Thromb Thrombolysis. 2010;29(2):159-166. Maynard G, Morris T, Jenkins I, et al. Optimizing prevention of hospital acquired venous thromboembolism: prospective validation of a VTE risk assessment model. J Hosp Med. 2010;5(1):10-18.

Dr. Maynard’s abstract described a project funded by the federal Agency for Healthcare Research and Quality to design and implement an organized, comprehensive protocol for VTE prevention within the hospital setting. The project also included a toolkit to help other hospitals do the same thing. The same group received SHM’s Award of Excellence for Teamwork.

This work, combined with similar efforts by Jason Stein, MD, and colleagues at Emory University in Atlanta and others, provided the foundation for SHM’s VTE resource room and the mentored implementation program of SHM’s VTE Prevention Collaborative, which had been launched in 2007 as one of the society’s first large-scale quality-improvement (QI) initiatives.

“SHM wanted to do something about VTE prevention, and when we got our AHRQ grant, I was interested in doing the same,” Dr. Maynard says. “We published our implementation guides on the AHRQ and SHM websites, along with a lot of valuable supporting materials.”

Dr. Maynard later took on leadership roles with SHM’s quality initiatives on glycemic control and care transitions, which made him the logical choice to become senior vice president of SHM’s Center for Hospital Innovation and Improvement.

He says the RIV honor lifted his profile not only within SHM, but also throughout the field, and it was instrumental in obtaining continued funding to advance the VTE initiative. “We did this tremendous work—with great results,” he says. “But I don’t think our local administrators appreciated it quite as much until we started to get external, national recognition.”

Dr. Maynard earned his master’s degree in biostatistics and clinical research design from the University of Michigan—skills he later brought to the academic setting at UCSD.

“It was a nice way for a hospitalist, who’s really a medical generalist, to become an expert in something,” he says. “I could never be more of an expert in cardiology than a cardiologist, or more of an expert in DVT than a hematologist or critical-care specialist. But I could help both of them do what they couldn’t do as effectively, which was to implement protocols reliably using a QI framework.”

Eduard E. Vasilevskis, MD

Title: Assistant professor of general internal medicine, hospital medicine, and public health

Institution: Vanderbilt University, Nashville, Tenn.

Year: 2009

RIV: “Predictors of Early Post-Discharge Mortality in Critically Ill Patients: Lessons for Quality Performance and Quality Assessment” (research)

Citation: Vasilevskis EE, Kuzniewicz MW, Cason BA, et al. Predictors of early post-discharge mortality in critically ill patients: a retrospective cohort study from the California Intensive Care Outcomes project. J Crit Care. 2011;26(1):65-75.

Dr. Vasilevskis has submitted abstracts to the RIV competition almost every year since 2007, when he was completing a fellowship at the University of California at San Francisco’s Institute for Health Policy Studies. He was honored in 2009 for a project based on the California Intensive Care Outcomes Project, which drew data from 35 hospitals to demonstrate that shortening ICU length of stay was predictive of early post-discharge mortality in the most severely ill patients.

He has continued to research quality and safety in the ICU, and he has published dozens of journal articles.

“My initial focus was on traditional mortality and length-of-stay outcomes,” he says. “I am now pursuing additional outcomes, most notably delirium in the ICU patient. I work with an amazing group of researchers that are trying to better measure, define, and treat delirium in the ICU—an outcome associated with a number of poor patient outcomes.”

Dr. Vasilevskis also is researching the causes of hospital readmissions and the development of novel ways to improve care transitions for elderly patients. He is pursuing a master’s of public health at Vanderbilt, and is co-principal investigator of an investigation of the Hospital Medicine Reengineering Network to improve transitions of care, supported by the Association of American Medical Colleges.

In addition to his 2009 win, he captured the HM10 and HM12 research categories. His HM12 poster, “Veterans Administration Acute Care 30-Day Mortality Model: Development, Validation and Performance Variation,” was singled out by the judging committee for its impressive sample size (1,114,327 patients in a retrospective cohort study of 131 VA hospitals), as well as for how it combined administrative and clinical risk models.

Dr. Vasilevskis says the opportunity to present his research at SHM and the recognition he received encouraged him to continue as a hospitalist engaged in medical research. He has been a member of SHM’s Research Committee since 2009, an RIV judge at HM11, and chaired the HM13 RIV competition subcommittee.

Vineet Chopra, MD, MS, FACP, FHM

Title: Assistant professor of medicine

Institution: University of Michigan Health System, Ann Arbor

Year: 2009

RIV: “MComm: Redefining Medical Communications in the 21st Century” (innovations)

Early in his career, Dr. Chopra was curious about how to improve the way patient care is delivered in the hospital setting. He was particularly interested in the inordinate amount of time hospitalists spend every day on communication.

“I saw one-way paging systems as a problem for communication between members of the medical team,” he says. “Doctors get paged and break off from what they’re doing to return the page—to someone who often isn’t there to take the call back. Sometimes the system gives us the wrong number or a cryptic message that makes no sense.”

A technological solution to this problem, which he and hospitalist Prasanth Gogineni, MD, conceived, designed, and created, then tested at the University of Michigan, is called MComm. Dr. Chopra describes it as a novel, uniform way of messaging for the entire medical team using wireless servers, PUSH technology, and iPhones. MComm was built around existing hospital workflow and patient-specific task lists, assigning priority to each message and documenting that it was delivered. The junior faculty members submitted an abstract about their innovative application, not really expecting it to get accepted. But when it won the poster competition and was selected for a plenary presentation, things got busy in a hurry. Specifically, the university hospital’s Office of Technology Transfer took a keen interest.

“We met with a number of people who had business experience in the health-care-technology space and found a CEO for the company we formed to develop MComm,” Dr. Chopra says. “I found myself getting pulled into it very quickly, with a lot of conversations about commercialization, revenue-sharing models, intellectual property, and the like.”

But running a company was not something Dr. Chopra wanted to do. Two years ago, that company, Synaptin, went one way and he went another—he stayed at Michigan as a medical researcher. He remains deeply interested in how care is delivered to hospitalized patients, but with a focus on such patient-safety questions as how to prevent negative outcomes from indwelling venous catheters.

“Winning the poster competition opened doors for me—there’s no doubt in my mind,” he says. “We demonstrated the ability to deliver a project of significance, from concept to prototype, without formal training in this area. If we didn’t have that recognition, I’m not sure I would have been ready to step into a research career as quickly. It helped me realize that medical research was what I wanted to do.”

Vineet Arora, MD, MPP, FHM

Title: Associate program director, internal-medicine residency; assistant dean of scholarship and discovery

Institution: Pritzker School of Medicine, University of Chicago

Year: 2006

RIV: “Measuring Quality of Hospital Care for Vulnerable Elders: Use of ACOVE Quality Indicators” (research)

Citation: Arora VM, Fish M, Basu A, et al. Relationship between quality of care of hospitalized vulnerable elders and postdischarge mortality. J Am Geriatrics. 2010;58:1642-1648.

David O. Meltzer, MD, PhD

Title: Associate professor, department of medicine; associate faculty member, Harris School and the Department of Economics

Institution: University of Chicago

Year: 2005

RIV: “Effects of Hospitalists on Outcomes and Costs in a Multicenter Trial of Academic Hospitalists” (research)

Dr. Meltzer was the lead author, with 11 other prominent hospitalists, of an abstract based on a multisite study of the cost and outcome implications of the hospitalist model—still a relatively new concept in 2001, when the research began. Although the study did not uncover large cost savings realized from the hospitalist model of care, as some advocates had hoped, important findings and implications for the emerging field were teased out of the data.

At the time, only a few randomly controlled, multisite studies of costs and outcomes for the hospitalist model had been performed. The study, Dr. Meltzer says, required a complicated analysis to discover that hospitalists, in fact, saved their facilities money, with their most important impact realized post-hospitalization, such as on nursing-home costs. It was important to control for spillover effect and the fact that hospitalists do a better job of teaching house staff, while a physician’s years of experience was another important variable, he says.

Dr. Meltzer was a medical researcher interested in medical specialization when the term “hospitalist” was first coined in 1996. “I thought, here was a chance to study a medical specialty in its formative stages,” he says.

He still works as a hospitalist, although with limited clinical time. In addition to his administrative work as division chief, he directs the Center for Health and the Social Sciences at the University of Chicago. His research interests include cost-effectiveness, technology assessment, and information research.

In 2010, his poster “Effects of Hospitalists on 1-Year Post-Discharge Resource Utilization by Medicare Beneficiaries” took the top prize in the HM10 research competition. In 2011, he was appointed to the methodology committee of the federal Patient-Centered Outcomes Research Institute (PCORI), which was created by the Affordable Care Act to advise the government on clinical-effectiveness research. He also sits on the Advisory Council to the National Institute of General Medical Sciences at the Institute of Medicine, and on the Congressional Budget Office’s panel of health advisors.

In a career full of recognition, Dr. Meltzer says it’s hard to pinpoint the impact of winning the poster contest. But he has continued to submit abstracts to SHM every year and appreciates the opportunities for interaction with peers at the poster exhibits.

Paul J. Grant, MD, FACP, SFHM

Title: Director of perioperative and consultative medicine

Institution: University of Michigan, Ann Arbor

Year: 2006

RIV: “Disseminated Histoplasmosis Presenting As Painful Oral Ulcers” (clinical vignettes)

Dr. Grant’s winning vignette presented a patient with a complex medical history, including heart disease and four months of painful oral ulcers, for which prior evaluations had been inconclusive, despite conducting biopsies. Following administration of high-dose corticosteroids, the patient’s condition worsened on multiple fronts. The vignette showed how the medical team was able to diagnose an unusual presentation of a fungal infection called histoplasmosis, which is prevalent in parts of the Midwest surrounding the Ohio and Mississippi river valleys.

“We see a lot of cases in the hospital where there are different angles you could take to turn it into a clinical vignette or a nice poster with good teaching points,” Dr. Grant says. “In this case, just digging deeper into the actual diagnosis was important because the empiric use of steroids can be fatal for some patients. Steroids are given for a lot of good reasons, but in this patient they caused immune suppression, allowing a smoldering infection to become very active.”

Dr. Grant did not submit the vignette for publication. “That was probably a mistake on my part,” he says, acknowledging the common complaint of too little time and too many competing priorities. But his interest in research has continued.

“I became involved at a national level with issues of perioperative medicine and last August published a textbook on the subject,” he reports.¹ “VTE is another area of interest I have developed since my hospital medicine fellowship.”

He serves as the VTE resource expert on the Michigan Hospital Medicine Safety Consortium, a quality collaborative of more than 40 hospitals with Blue Cross/Blue Shield of Michigan. “It’s exciting to be able to look at the risk factors, what kinds of patients get VTEs, and whether they were appropriately prophylaxed in the hospital,” he says.

VTE is a national quality priority, and Dr. Grant expects abstracts to emerge from the consortium’s work.

He says he appreciates the opportunities that arise from participating in poster sessions at SHM, where medical students, residents, and working hospitalists talk to the presenters of interesting cases.

“It gives you a real back-and-forth, which is good for the person asking the question and for the presenter,” he says, noting hospitalists from other parts of the country were not as familiar with histoplasmosis.

He says winning the HM06 poster contest helped him “get his feet wet” and feel more prepared for a career in academic hospital medicine. “I’m sure the award solidified my employers’ satisfaction in hiring me—and in giving me more desirable academic roles and responsibilities,” he adds.

Leonard Feldman, MD, FACP, FAAP, SFHM

Title: Assistant professor of medicine pediatrics; director of the general internal-medicine comprehensive consultation service

Institution: Johns Hopkins Hospital, Baltimore

Year: 2009

RIV: “An Internet-Based Consult Curriculum for Hospitalists” (innovations)

Dr. Feldman’s poster described an online CME curriculum for hospitalists acting as medical consultants. The concept grew out of a perceived deficiency in his own medical education when, in 2004, he was asked to lead the consultation service at Johns Hopkins—just six months after finishing his residency.

“I had no idea what I was doing as a general-internal-medicine consultant,” he says. “I maybe received two weeks of experience as a consultant during my residency. I was willing to take it on, learning on the job and asking for help. But it occurred to me that I’m probably not alone in feeling unprepared.”

In his quest for self-education, Dr. Feldman wondered whether he should write a textbook on the subject. “But the information changes so quickly, I thought I’d have a better chance to reach people online,” he notes.

After talking to publishers and CME companies, he came up with the concept of learning modules on perioperative and consultative medicine topics, which could be taken online while earning CME credits. Johns Hopkins served as the CME certifier, and medical-education company Advanced Studies in Medicine joined as a partner. Once the project got off the ground, a medical advisory committee was convened.

“Winning the SHM poster competition is a great honor to have on a CV. It really helps to legitimize your name in the world of hospital medicine,” Dr. Feldman says. “It also provided confirmation that we were on the right track with the curriculum project. People valued what we were doing.”

Dr. Feldman and SHM have since become affiliated, and the “Consultative and Perioperative Medicine Essentials for Hospitalists” modules are available on SHM’s website (www.shmconsults.com). The site has 12,000 registered members completing 500 CME modules every month.

“I do a lot of the editing still,” Dr. Feldman says. “We update the modules every two years and are still creating new ones.”

Dr. Feldman also pursues a number of clinical-research interests, including resident education and costs of care.

Kristin Wise, MD, FHM

Title: Assistant professor of medicine

Institution: Medical University of South Carolina, Charleston

Year: 2009

RIV: “Intensivists versus Hospitalists in the ICU: A Prospective Cohort Study Comparing Mortality and Length of Stay Between Two Staffing Models” (research) Citation: Wise KR, Akopov VA, Williams BR, Ido MS, Leeper KV, Dressler DD. Hospitalists and intensivists in the medical ICU: a prospective and observational study comparing mortality and length of stay between two staffing models. J Hosp Med. 2012;7(3):183-189.

Dr. Wise was recognized for research that began while she worked at Emory University in Atlanta, comparing hospitalists and intensivists in such outcomes as length of stay and mortality rates for patients in the ICU. The study was one of the first statistically rigorous examinations of this critical quality question. With an eye toward improving patient safety, national quality advocates such as the Leapfrog Group have called for hospitals to employ intensivists (critical-care specialists) to manage the care of ICU patients. In reality, Dr. Wise says, there aren’t enough intensivists to meet the need.

“Hospitalists are in the ICU anyway,” she says. “We just don’t have enough data to answer how well they do [in comparison to intensivists].”

Through a prospective cohort study of more than 1,000 patients, Dr. Wise’s group found that there was essentially no statistical difference in mortality rates between patients treated by intensivist teams or hospitalist ICU teams.

“We were also able to look at some of the intermediate-acuity patients—fairly complicated but not requiring ventilators,” she explains. “Our study wasn’t sufficiently powered for this subgroup, but it was an interesting piece of data to raise the question: Where should we deploy this scarce resource of intensivists? Which pockets of patients?”

Presenting her abstract at SHM’s annual meeting was a “good experience.”

“I’d done public speaking before, but never with an audience of about 500 people,” she says. “To go out there and field their questions was a real professional growing experience. Several people interested in the topic sought me out at the conference, introduced themselves, and we have subsequently stayed in touch.”

The manuscript published in JHM has been cited four times, including in a position paper from SHM and the Society of Critical Care Medicine.³ Another outgrowth of the research was being asked to contribute a chapter on hospitalists’ role in the ICU to a textbook on hospital medicine. Based on her still-fresh HM presentation, Dr. Wise was one of the few publicly identified experts on the subject. The chapter, co-authored by fellow Emory hospitalist Michael Heisler, MD, MPH, “The Role of the Hospitalist in Critical Care” was included in Principles and Practices of Hospital Medicine.⁴

Shetal Shah, MD, FAAP

Title: Neonatal intensivist

Institution: Stony Brook University Hospital, Great Neck, N.Y.

Year: 2006

RIV: “Administration of Inactivated Trivalent Influenza Vaccine (TIV) to Parents of Infants in the Neonatal Intensive Care Unit (NICU): A Novel Strategy to Increase Vaccination Rates” (innovations)

Citation: Shah SI, Caprio M, Hendricks-Munoz K. Administration of inactivated trivalent influenza vaccine to parents of high-risk infants in the neonatal intensive care unit. Pediatrics. 2007;120;e617-e621.

Dr. Shah was in his final year of a fellowship in neonatology at New York University when he took on the challenge of improving immunization access to protect premature, highly vulnerable patients in the NICU from influenza infections. Because these children are too young to be vaccinated directly, the concept of cocooning them from infection involves extending protection to everyone around them.

“We came up with the idea of offering flu vaccinations 24/7 in the NICU to the children’s parents,” he says. “It worked well for us as a way to define an indicated therapy for a defined population, even if it was a little outside the box. By the end of the flu season, 95% of the parents were vaccinated.”

SHM recognized the project as the top RIV innovations poster at HM06, but that was just the beginning.

“When I moved to SUNY Stony Brook, I continued to study and advocate for these vaccinations,” Dr. Shah says. “We were giving 500 to 700 vaccinations a year. Then I wrote a national resolution for the American Academy of Pediatrics, which was significant because it meant AAP was behind the project.”

Dr. Shah later became chair of AAP’s Long Island Chapter Legislative Committee and joined a statewide pediatric advocacy group. In 2009, the New York legislature enacted the Neonatal Influenza Protection Act, which required hospitals in the state to offer parents the vaccine, with Dr. Shah’s research and advocacy providing an essential basis for its passage. He’s even been recognized for his research in congressional citations.

Based on that success with influenza vaccinations, Dr. Shah and his colleagues looked at other diseases, starting with pertussis, and then tetanus, diphtheria, and whooping cough.⁵ All the while, they continued tracking immunization rates. A second state law, passed in 2011, added pertussis to the vaccinations. Next on his advocacy agenda is a project to promote smoking-cessation interventions in the NICU.⁶

“These parents come to see us every day,” he says. “What can we do, through the parents, to promote the health and well-being of their high-risk newborns?”

Jason Morrow, MD, PhD

Title: Assistant professor of medicine; medical director of inpatient palliative-care consultation

Institution: University of Texas Health Sciences Center, San Antonio

Year: 2009

RIV: “When to Depend on the Kinins of Strangers: An Unusual Case of Abdominal Pain” (clinical vignettes)

Publication: An article on the ethics of determining code status for patients with advanced cancer and a book chapter on the “last hours of life” for a forthcoming book on palliative care and hospital medicine.

As a medical resident, Dr. Morrow met a 27-year-old woman who had chronic abdominal pain and had made multiple visits to the ED for this complaint. The patient had a history of substance abuse and requested dilaudid for her pain—making it easy for staff to consign her to the stereotype of the difficult patient.

“I met her after an interesting finding,” he says. “It turns out that on the previous emergency room visit, she received a CAT scan, which showed duodenal and small-bowel thickening consistent with hereditary angioedema, although with an unusual presentation. As it happened, we had onsite a world expert in angioedema.”

The expert was able to confirm the diagnosis, Dr. Morrow says.

“By giving her this ‘legitimate,’ organic diagnosis, it just changed the whole dynamic of her relationship with her doctors,” he says. “She knew that they knew something was really wrong. The residents were empowered to have something to hang their hats on. And we were able to get better control of her pain.”

Dr. Morrow says he came on the scene late in the discovery process, but he helped to solve the puzzle, and then put together the abstract and poster that told the story of making the diagnosis.

“In my previous job, I was hired as a hospitalist but helped to build the palliative-care program within the hospital-medicine service,” he says. “In my current job, I was brought in to build the inpatient palliative-care-consultation service, although I still moonlight as a hospitalist to stay sharp.”

Dr. Morrow says he enjoys sharing stories of difficult cases and submitting case studies about them to medical conferences, often with clever titles incorporating puns (e.g. the 2009 SHM poster citing kinins, polypeptides in the blood that cause inflammation). Another example is “The Angina Monologues,” a story of an 82-year-old patient with chronic angina pectoris and complex pain syndromes that were difficult to bring under control. Palliative care also emphasizes patients’ stories, he says, in order to understand the person behind the diagnosis.

Larry Beresford is a freelance writer in San Francisco. References available at www.the-hospitalist.org.

References

A hospital in Portland, Ore., has received a $560,000 grant from the TKF Foundation to design and build a therapeutic 6,800-square-foot, four-seasons garden onsite, then measure stress levels among patients, family, visitors, and staff members who go to it.

Legacy Emanuel Medical Center was awarded one of six National Open Spaces Sacred Places grants last June. The center is part of the six-hospital Legacy Health system, which serves the greater Portland region and Vancouver, Wash., and has a history of innovative green spaces connected with its hospital and hospice facilities, explains Teresia Hazen, MEd, HTR, QMHP, a registered horticultural therapist, Legacy’s director of therapeutic gardens, and the grant’s project manager.

The garden will be built in an open-air terrace between the hospital's family birth center and cardiovascular ICU. Grant funding will support incorporating such design elements as portals and pathways, public spaces, and areas where visitors can have some privacy, reflecting therapeutic garden characteristics defined by the American Horticultural Therapy Association, Hazen says. Researchers will then monitor the stress levels and heart rates of expectant mothers and their babies in utero, family members visiting ICU patients, and hospital staff members who spend time in the hospital garden.

Isadora Roth, MD, a hospitalist at two Legacy Health hospitals, appreciates the availability of hospital gardens for her patients and herself. "I often see patients out there, and they seem happier, more relaxed, and less anxious," Dr. Roth says. "I really think it has therapeutic benefits."

The new garden is scheduled to be completed in December; data will start to be gathered next April, Hazen says. Legacy also is planning a Therapeutic Landscapes Symposium on April 4, 2014, in Portland.

Visit our website for more information on stress and hospitalists.

A hospital in Portland, Ore., has received a $560,000 grant from the TKF Foundation to design and build a therapeutic 6,800-square-foot, four-seasons garden onsite, then measure stress levels among patients, family, visitors, and staff members who go to it.

Legacy Emanuel Medical Center was awarded one of six National Open Spaces Sacred Places grants last June. The center is part of the six-hospital Legacy Health system, which serves the greater Portland region and Vancouver, Wash., and has a history of innovative green spaces connected with its hospital and hospice facilities, explains Teresia Hazen, MEd, HTR, QMHP, a registered horticultural therapist, Legacy’s director of therapeutic gardens, and the grant’s project manager.

The garden will be built in an open-air terrace between the hospital's family birth center and cardiovascular ICU. Grant funding will support incorporating such design elements as portals and pathways, public spaces, and areas where visitors can have some privacy, reflecting therapeutic garden characteristics defined by the American Horticultural Therapy Association, Hazen says. Researchers will then monitor the stress levels and heart rates of expectant mothers and their babies in utero, family members visiting ICU patients, and hospital staff members who spend time in the hospital garden.

Isadora Roth, MD, a hospitalist at two Legacy Health hospitals, appreciates the availability of hospital gardens for her patients and herself. "I often see patients out there, and they seem happier, more relaxed, and less anxious," Dr. Roth says. "I really think it has therapeutic benefits."

The new garden is scheduled to be completed in December; data will start to be gathered next April, Hazen says. Legacy also is planning a Therapeutic Landscapes Symposium on April 4, 2014, in Portland.

Visit our website for more information on stress and hospitalists.

A hospital in Portland, Ore., has received a $560,000 grant from the TKF Foundation to design and build a therapeutic 6,800-square-foot, four-seasons garden onsite, then measure stress levels among patients, family, visitors, and staff members who go to it.

Legacy Emanuel Medical Center was awarded one of six National Open Spaces Sacred Places grants last June. The center is part of the six-hospital Legacy Health system, which serves the greater Portland region and Vancouver, Wash., and has a history of innovative green spaces connected with its hospital and hospice facilities, explains Teresia Hazen, MEd, HTR, QMHP, a registered horticultural therapist, Legacy’s director of therapeutic gardens, and the grant’s project manager.

The garden will be built in an open-air terrace between the hospital's family birth center and cardiovascular ICU. Grant funding will support incorporating such design elements as portals and pathways, public spaces, and areas where visitors can have some privacy, reflecting therapeutic garden characteristics defined by the American Horticultural Therapy Association, Hazen says. Researchers will then monitor the stress levels and heart rates of expectant mothers and their babies in utero, family members visiting ICU patients, and hospital staff members who spend time in the hospital garden.

Isadora Roth, MD, a hospitalist at two Legacy Health hospitals, appreciates the availability of hospital gardens for her patients and herself. "I often see patients out there, and they seem happier, more relaxed, and less anxious," Dr. Roth says. "I really think it has therapeutic benefits."

The new garden is scheduled to be completed in December; data will start to be gathered next April, Hazen says. Legacy also is planning a Therapeutic Landscapes Symposium on April 4, 2014, in Portland.

Visit our website for more information on stress and hospitalists.

How can hospitalists know if the care-transition plans they’ve put in place to get their discharged patients back to their PCPs are working out? For the 18-member inpatient medicine group at Aultman Hospital in Canton, Ohio, the answer is simple: Ask the PCPs.

“It’s more important than ever for the transition from one service to the next to be smooth, with a very good handoff. That’s where our hospitalist group and what we are doing comes in,” says group leader O. George Mitri, MD, FACP, FHM.

Dr. Mitri, along with Lewis Humble, MD, the group’s designated outreach champion, and Katie Wright, MSN, RN, the group’s practice administrator, visit PCPs in their offices once or twice a month. They meet with the physicians and practice managers, sharing data and exchanging stories about care transitions.

They recently held a three-hour summit in a conference room in the hospital, where PCPs were treated to dinner and discussion about transitions of care. Annually, PCPs are sent a satisfaction survey, which, like the office visits, asks if they are getting the information they need, in the format they need, and the right amount of it in order to take care of their patients post-discharge.

“We’ve taken that feedback and implemented changes at our end to better meet the needs of the patients and PCPs,” Dr. Mitri says. “It’s a lost opportunity if you’re not visiting PCPs in their offices. You lose touch.”

Changes implemented by the hospitalist group include making the admitting hospitalist for the day responsible for forwarding to PCPs any test results for discharged patients that require immediate attention, as well as revising the group’s discharge report to include a cover sheet summarizing the most pertinent information, discharge medications, and an assessment of the patient’s risk of readmission using Project BOOST’s “8Ps” risk assessment tool.

The goal is to dictate the discharge summary within 24 hours and fax it to the PCP the next business day, Wright says. The group’s rounding nurses also schedule the patient’s first medical office visit before the discharge, even if that means finding a PCP for the patient or making an appointment with a local community clinic. Patients identified as at-risk, including those with congestive heart failure (CHF) or COPD, also get a post-discharge follow-up call.

Other hospitalist groups are employing similar techniques to close the loop with PCPs for discharged patients. Bronson Internal Medicine Hospitalist Specialist Group in Kalamazoo, Mich., just hired three phone nurses to help with care transitions, using Dr. Eric Coleman’s Care Transitions model, says practice manager Joshua Hill. The nurses also call the PCPs. Paying particular attention to new heart-failure cases, they will accompany patients to follow-up appointments with PCPs and specialists and will make home visits if needed.

“For every readmission within 60 days, we also call the PCP,” Hill says.

Listen to Dr. O. George Mitri and Katie Wright discuss improving communication with PCPs

At Aultman, the hospitalists and support staff, including nurse practitioners, rounding nurses and office staff, are employed by the health system, whereas the PCPs they work with mostly belong to small, independent groups. The changes described above mostly apply to patients managed in the hospital by the hospitalists. But if the metrics—such as a decline in readmissions to 11 percent from 13 percent since they started making follow-up appointments for patients—continue to show improvements, Dr. Mitri says they might become hospital standards.

“We’ve taken that feedback and implemented changes at our end to better meet the needs of the patients and PCPs. It’s a lost opportunity if you’re not visiting PCPs in their offices. You lose touch.”

—O. George Mitri, MD, FACP, FHM

Next on the quality hit list at Aultman is a greater focus on medication safety. “How do we get what happens in the hospital to the PCP and to the patient at home? Is it a nurse visit to address what really goes on in the home, including the shoebox full of medications in the closet?” he asks.

Wright adds that the hospitalist group has started meeting with partner specialist groups in the hospital, including cardiology, neurology, and general surgery, and is working on relationships with nursing homes. That might mean another set of regular sit-down meetings to talk about how to make transitions to post-acute care work better. TH

Larry Beresford is a freelance writer in Oakland, Calif.

How can hospitalists know if the care-transition plans they’ve put in place to get their discharged patients back to their PCPs are working out? For the 18-member inpatient medicine group at Aultman Hospital in Canton, Ohio, the answer is simple: Ask the PCPs.

“It’s more important than ever for the transition from one service to the next to be smooth, with a very good handoff. That’s where our hospitalist group and what we are doing comes in,” says group leader O. George Mitri, MD, FACP, FHM.

Dr. Mitri, along with Lewis Humble, MD, the group’s designated outreach champion, and Katie Wright, MSN, RN, the group’s practice administrator, visit PCPs in their offices once or twice a month. They meet with the physicians and practice managers, sharing data and exchanging stories about care transitions.

They recently held a three-hour summit in a conference room in the hospital, where PCPs were treated to dinner and discussion about transitions of care. Annually, PCPs are sent a satisfaction survey, which, like the office visits, asks if they are getting the information they need, in the format they need, and the right amount of it in order to take care of their patients post-discharge.

“We’ve taken that feedback and implemented changes at our end to better meet the needs of the patients and PCPs,” Dr. Mitri says. “It’s a lost opportunity if you’re not visiting PCPs in their offices. You lose touch.”

Changes implemented by the hospitalist group include making the admitting hospitalist for the day responsible for forwarding to PCPs any test results for discharged patients that require immediate attention, as well as revising the group’s discharge report to include a cover sheet summarizing the most pertinent information, discharge medications, and an assessment of the patient’s risk of readmission using Project BOOST’s “8Ps” risk assessment tool.

The goal is to dictate the discharge summary within 24 hours and fax it to the PCP the next business day, Wright says. The group’s rounding nurses also schedule the patient’s first medical office visit before the discharge, even if that means finding a PCP for the patient or making an appointment with a local community clinic. Patients identified as at-risk, including those with congestive heart failure (CHF) or COPD, also get a post-discharge follow-up call.

Other hospitalist groups are employing similar techniques to close the loop with PCPs for discharged patients. Bronson Internal Medicine Hospitalist Specialist Group in Kalamazoo, Mich., just hired three phone nurses to help with care transitions, using Dr. Eric Coleman’s Care Transitions model, says practice manager Joshua Hill. The nurses also call the PCPs. Paying particular attention to new heart-failure cases, they will accompany patients to follow-up appointments with PCPs and specialists and will make home visits if needed.

“For every readmission within 60 days, we also call the PCP,” Hill says.

Listen to Dr. O. George Mitri and Katie Wright discuss improving communication with PCPs

At Aultman, the hospitalists and support staff, including nurse practitioners, rounding nurses and office staff, are employed by the health system, whereas the PCPs they work with mostly belong to small, independent groups. The changes described above mostly apply to patients managed in the hospital by the hospitalists. But if the metrics—such as a decline in readmissions to 11 percent from 13 percent since they started making follow-up appointments for patients—continue to show improvements, Dr. Mitri says they might become hospital standards.

“We’ve taken that feedback and implemented changes at our end to better meet the needs of the patients and PCPs. It’s a lost opportunity if you’re not visiting PCPs in their offices. You lose touch.”

—O. George Mitri, MD, FACP, FHM

Next on the quality hit list at Aultman is a greater focus on medication safety. “How do we get what happens in the hospital to the PCP and to the patient at home? Is it a nurse visit to address what really goes on in the home, including the shoebox full of medications in the closet?” he asks.

Wright adds that the hospitalist group has started meeting with partner specialist groups in the hospital, including cardiology, neurology, and general surgery, and is working on relationships with nursing homes. That might mean another set of regular sit-down meetings to talk about how to make transitions to post-acute care work better. TH

Larry Beresford is a freelance writer in Oakland, Calif.

How can hospitalists know if the care-transition plans they’ve put in place to get their discharged patients back to their PCPs are working out? For the 18-member inpatient medicine group at Aultman Hospital in Canton, Ohio, the answer is simple: Ask the PCPs.

“It’s more important than ever for the transition from one service to the next to be smooth, with a very good handoff. That’s where our hospitalist group and what we are doing comes in,” says group leader O. George Mitri, MD, FACP, FHM.

Dr. Mitri, along with Lewis Humble, MD, the group’s designated outreach champion, and Katie Wright, MSN, RN, the group’s practice administrator, visit PCPs in their offices once or twice a month. They meet with the physicians and practice managers, sharing data and exchanging stories about care transitions.

They recently held a three-hour summit in a conference room in the hospital, where PCPs were treated to dinner and discussion about transitions of care. Annually, PCPs are sent a satisfaction survey, which, like the office visits, asks if they are getting the information they need, in the format they need, and the right amount of it in order to take care of their patients post-discharge.

“We’ve taken that feedback and implemented changes at our end to better meet the needs of the patients and PCPs,” Dr. Mitri says. “It’s a lost opportunity if you’re not visiting PCPs in their offices. You lose touch.”

Changes implemented by the hospitalist group include making the admitting hospitalist for the day responsible for forwarding to PCPs any test results for discharged patients that require immediate attention, as well as revising the group’s discharge report to include a cover sheet summarizing the most pertinent information, discharge medications, and an assessment of the patient’s risk of readmission using Project BOOST’s “8Ps” risk assessment tool.

The goal is to dictate the discharge summary within 24 hours and fax it to the PCP the next business day, Wright says. The group’s rounding nurses also schedule the patient’s first medical office visit before the discharge, even if that means finding a PCP for the patient or making an appointment with a local community clinic. Patients identified as at-risk, including those with congestive heart failure (CHF) or COPD, also get a post-discharge follow-up call.

Other hospitalist groups are employing similar techniques to close the loop with PCPs for discharged patients. Bronson Internal Medicine Hospitalist Specialist Group in Kalamazoo, Mich., just hired three phone nurses to help with care transitions, using Dr. Eric Coleman’s Care Transitions model, says practice manager Joshua Hill. The nurses also call the PCPs. Paying particular attention to new heart-failure cases, they will accompany patients to follow-up appointments with PCPs and specialists and will make home visits if needed.

“For every readmission within 60 days, we also call the PCP,” Hill says.

Listen to Dr. O. George Mitri and Katie Wright discuss improving communication with PCPs

At Aultman, the hospitalists and support staff, including nurse practitioners, rounding nurses and office staff, are employed by the health system, whereas the PCPs they work with mostly belong to small, independent groups. The changes described above mostly apply to patients managed in the hospital by the hospitalists. But if the metrics—such as a decline in readmissions to 11 percent from 13 percent since they started making follow-up appointments for patients—continue to show improvements, Dr. Mitri says they might become hospital standards.

“We’ve taken that feedback and implemented changes at our end to better meet the needs of the patients and PCPs. It’s a lost opportunity if you’re not visiting PCPs in their offices. You lose touch.”

—O. George Mitri, MD, FACP, FHM

Next on the quality hit list at Aultman is a greater focus on medication safety. “How do we get what happens in the hospital to the PCP and to the patient at home? Is it a nurse visit to address what really goes on in the home, including the shoebox full of medications in the closet?” he asks.

Wright adds that the hospitalist group has started meeting with partner specialist groups in the hospital, including cardiology, neurology, and general surgery, and is working on relationships with nursing homes. That might mean another set of regular sit-down meetings to talk about how to make transitions to post-acute care work better. TH

Larry Beresford is a freelance writer in Oakland, Calif.

Click here to listen to our interview with Dr. Hansen

Click here to listen to our interview with Dr. Hansen

Click here to listen to our interview with Dr. Hansen

The Congressional Budget Office in May sharply lowered its projections for the next decade’s outlays on Medicare, Medicaid, and the extension of coverage for 25 million uninsured Americans under the Affordable Care Act.¹

“During the past several years, health-care spending has grown much more slowly, both nationally and for federal programs, than it did historically and more slowly than CBO had projected,” according to the CBO report.

Health-care spending in 2012 was 5% below the amount the nonpartisan budgetary analysts had estimated in a 2010 projection for 2012. If these trends continue, commentators note, that could lessen budgetary pressures and perhaps strengthen the economy, as well as reduce the urgency for Congress to achieve a “grand bargain” confronting national debt issues.

However, CBO notes, budgetary shortfalls are expected to increase later this decade under the pressures of an aging population, expanded federal subsidies for health insurance, and the resumption of health-care cost inflation.

Larry Beresford is a freelance writer in San Francisco.

Reference

1. Congressional Budget Office. Updated budget projections: fiscal years 2013 to 2023. Congressional Budget Office website. Available at: http://www.cbo.gov/publication/ 44172. Accessed June 15, 2013.

The Congressional Budget Office in May sharply lowered its projections for the next decade’s outlays on Medicare, Medicaid, and the extension of coverage for 25 million uninsured Americans under the Affordable Care Act.¹

“During the past several years, health-care spending has grown much more slowly, both nationally and for federal programs, than it did historically and more slowly than CBO had projected,” according to the CBO report.

Health-care spending in 2012 was 5% below the amount the nonpartisan budgetary analysts had estimated in a 2010 projection for 2012. If these trends continue, commentators note, that could lessen budgetary pressures and perhaps strengthen the economy, as well as reduce the urgency for Congress to achieve a “grand bargain” confronting national debt issues.

However, CBO notes, budgetary shortfalls are expected to increase later this decade under the pressures of an aging population, expanded federal subsidies for health insurance, and the resumption of health-care cost inflation.

Larry Beresford is a freelance writer in San Francisco.

Reference

1. Congressional Budget Office. Updated budget projections: fiscal years 2013 to 2023. Congressional Budget Office website. Available at: http://www.cbo.gov/publication/ 44172. Accessed June 15, 2013.

The Congressional Budget Office in May sharply lowered its projections for the next decade’s outlays on Medicare, Medicaid, and the extension of coverage for 25 million uninsured Americans under the Affordable Care Act.¹

“During the past several years, health-care spending has grown much more slowly, both nationally and for federal programs, than it did historically and more slowly than CBO had projected,” according to the CBO report.

Health-care spending in 2012 was 5% below the amount the nonpartisan budgetary analysts had estimated in a 2010 projection for 2012. If these trends continue, commentators note, that could lessen budgetary pressures and perhaps strengthen the economy, as well as reduce the urgency for Congress to achieve a “grand bargain” confronting national debt issues.

However, CBO notes, budgetary shortfalls are expected to increase later this decade under the pressures of an aging population, expanded federal subsidies for health insurance, and the resumption of health-care cost inflation.

Larry Beresford is a freelance writer in San Francisco.

Reference

1. Congressional Budget Office. Updated budget projections: fiscal years 2013 to 2023. Congressional Budget Office website. Available at: http://www.cbo.gov/publication/ 44172. Accessed June 15, 2013.

In June, the Robert Wood Johnson Foundation announced a national competition for technology developers to help consumers understand and utilize data for comparing the prices of hospital procedures. Winners of the foundation’s Hospital Price Transparency Challenge, to be announced later this year, will share $120,000 in prizes for intuitive, actionable tools leading to more transparent hospital pricing in two categories.

One category involves the creation of visual aids that would help consumers and others better understand the Centers for Medicare & Medicaid Services’ (CMS) hospital-cost data, which was released in May and compares widely variable hospital prices for 100 common inpatient procedures. The other category involves developing applications and tools that could help consumers price-shop.

The foundation is offering support and opportunities for submitters to interact with experts and technical innovators. The deadline for applications is Aug. 25.

In June, the Robert Wood Johnson Foundation announced a national competition for technology developers to help consumers understand and utilize data for comparing the prices of hospital procedures. Winners of the foundation’s Hospital Price Transparency Challenge, to be announced later this year, will share $120,000 in prizes for intuitive, actionable tools leading to more transparent hospital pricing in two categories.

One category involves the creation of visual aids that would help consumers and others better understand the Centers for Medicare & Medicaid Services’ (CMS) hospital-cost data, which was released in May and compares widely variable hospital prices for 100 common inpatient procedures. The other category involves developing applications and tools that could help consumers price-shop.

The foundation is offering support and opportunities for submitters to interact with experts and technical innovators. The deadline for applications is Aug. 25.

In June, the Robert Wood Johnson Foundation announced a national competition for technology developers to help consumers understand and utilize data for comparing the prices of hospital procedures. Winners of the foundation’s Hospital Price Transparency Challenge, to be announced later this year, will share $120,000 in prizes for intuitive, actionable tools leading to more transparent hospital pricing in two categories.

One category involves the creation of visual aids that would help consumers and others better understand the Centers for Medicare & Medicaid Services’ (CMS) hospital-cost data, which was released in May and compares widely variable hospital prices for 100 common inpatient procedures. The other category involves developing applications and tools that could help consumers price-shop.

The foundation is offering support and opportunities for submitters to interact with experts and technical innovators. The deadline for applications is Aug. 25.

A Joint Commission Sentinel Event Alert released this spring tackles “alarm fatigue” resulting from the constant beeping of medical-device alarms and information being broadcast from these devices. If not properly managed, the proliferation of alarms can put hospitalized patients at serious risk because the barrage of warning noises can desensitize professional caregivers or distract them from truly critical alarms. U.S. Food and Drug Administration data show that 566 hospital deaths from 2005 to 2008 were alarm-related, while the Joint Commission’s own sentinel-events database lists 80 alarm-related deaths in the same period.

The commission urges hospital leaders to look at this serious patient-safety issue. “By making alarm safety a priority, lives can be saved,” said Ana McKee, MD, the commission’s executive vice president and chief medical officer.

Among its recommendations:

• Ensure that there is a process for safe alarm management and response in high-risk areas;
• Prepare an inventory of alarm-equipped medical devices in these high-risk areas;
• Regularly inspect, check, and maintain the devices; and
• Establish guidelines for alarm settings, including situations in which alarm signals are not clinically necessary.

The commission, which participated in a 2011 summit of national safety and medical-technology organizations seeking solutions to the problem, is considering the possible promulgation of a national patient-safety goal on alarm fatigue, a draft of which was field-tested in February and released for public comment.

Larry Beresford is a freelance writer in San Francisco.

A Joint Commission Sentinel Event Alert released this spring tackles “alarm fatigue” resulting from the constant beeping of medical-device alarms and information being broadcast from these devices. If not properly managed, the proliferation of alarms can put hospitalized patients at serious risk because the barrage of warning noises can desensitize professional caregivers or distract them from truly critical alarms. U.S. Food and Drug Administration data show that 566 hospital deaths from 2005 to 2008 were alarm-related, while the Joint Commission’s own sentinel-events database lists 80 alarm-related deaths in the same period.

The commission urges hospital leaders to look at this serious patient-safety issue. “By making alarm safety a priority, lives can be saved,” said Ana McKee, MD, the commission’s executive vice president and chief medical officer.

Among its recommendations:

• Ensure that there is a process for safe alarm management and response in high-risk areas;
• Prepare an inventory of alarm-equipped medical devices in these high-risk areas;
• Regularly inspect, check, and maintain the devices; and
• Establish guidelines for alarm settings, including situations in which alarm signals are not clinically necessary.

The commission, which participated in a 2011 summit of national safety and medical-technology organizations seeking solutions to the problem, is considering the possible promulgation of a national patient-safety goal on alarm fatigue, a draft of which was field-tested in February and released for public comment.

Larry Beresford is a freelance writer in San Francisco.

A Joint Commission Sentinel Event Alert released this spring tackles “alarm fatigue” resulting from the constant beeping of medical-device alarms and information being broadcast from these devices. If not properly managed, the proliferation of alarms can put hospitalized patients at serious risk because the barrage of warning noises can desensitize professional caregivers or distract them from truly critical alarms. U.S. Food and Drug Administration data show that 566 hospital deaths from 2005 to 2008 were alarm-related, while the Joint Commission’s own sentinel-events database lists 80 alarm-related deaths in the same period.

The commission urges hospital leaders to look at this serious patient-safety issue. “By making alarm safety a priority, lives can be saved,” said Ana McKee, MD, the commission’s executive vice president and chief medical officer.

Among its recommendations:

• Ensure that there is a process for safe alarm management and response in high-risk areas;
• Prepare an inventory of alarm-equipped medical devices in these high-risk areas;
• Regularly inspect, check, and maintain the devices; and
• Establish guidelines for alarm settings, including situations in which alarm signals are not clinically necessary.

The commission, which participated in a 2011 summit of national safety and medical-technology organizations seeking solutions to the problem, is considering the possible promulgation of a national patient-safety goal on alarm fatigue, a draft of which was field-tested in February and released for public comment.

Larry Beresford is a freelance writer in San Francisco.

A common theme among abstracts presented at HM13 was the need for more leadership training, as current and future hospitalists take on bigger roles in their hospitalist groups and institutions.

In an oral abstract presentation at the annual meeting in May in National Harbor, Md., lead author Darlene Tad-y, MD, assistant professor of medicine at the University of Colorado School of Medicine in Aurora, described the Hospitalist Training Program Leaders Track (HTP-LT), which launched in 2012 for hospitalist residents interested in program-level leadership.¹ Dr. Tad-y notes that a generation ago, one-third of hospitals were led by physician CEOs; today, that figure is only 4%, even though quality metrics suggest that clinical outcomes might be better at physician-led facilities.

Faculty at the University of Colorado were inspired to create the program after learning that graduates of its nine-year-old hospitalist residency program were being thrust into clinical, operational, and quality-improvement (QI) leadership positions. Most were forced to learn how to be a leader on the fly.

“That got us thinking: We should be more deliberate about leadership training and the gap around the development of hospitalist leaders,” says co-author Read Pierce, MD, HTP-LT director. “We started asking those in medical leadership positions: How did you learn leadership and what would you teach to residents in the pipeline?”

HTP-LT guides residents through an intensive curriculum offering mentorship and opportunities to observe, practice, and reflect upon clinical leadership in real-world settings. It emphasizes hospital operations, finance, and change management within large, complex organizations. All HTP-LT residents complete a leadership project.

The same faculty also developed the Young Hospitalist Academy, a summer program for medical students from across the country; the goal of the academy is to spur interest in hospital medicine at an earlier stage of medical training.

“We thought it’s never too early for medical students to start thinking about what it means to be a hospitalist and to be a medical leader,” Dr. Tad-y says.

Larry Beresford is a freelance writer in San Francisco.

Reference

1. Tad-y D, Pierce R, Guthrie M, Glasheen J. Developing hospitalist leaders: the Hospitalist Training Program Leaders Track [abstract]. J Hosp Med. 2013;8(Suppl 1):540.

A common theme among abstracts presented at HM13 was the need for more leadership training, as current and future hospitalists take on bigger roles in their hospitalist groups and institutions.

In an oral abstract presentation at the annual meeting in May in National Harbor, Md., lead author Darlene Tad-y, MD, assistant professor of medicine at the University of Colorado School of Medicine in Aurora, described the Hospitalist Training Program Leaders Track (HTP-LT), which launched in 2012 for hospitalist residents interested in program-level leadership.¹ Dr. Tad-y notes that a generation ago, one-third of hospitals were led by physician CEOs; today, that figure is only 4%, even though quality metrics suggest that clinical outcomes might be better at physician-led facilities.

Faculty at the University of Colorado were inspired to create the program after learning that graduates of its nine-year-old hospitalist residency program were being thrust into clinical, operational, and quality-improvement (QI) leadership positions. Most were forced to learn how to be a leader on the fly.

“That got us thinking: We should be more deliberate about leadership training and the gap around the development of hospitalist leaders,” says co-author Read Pierce, MD, HTP-LT director. “We started asking those in medical leadership positions: How did you learn leadership and what would you teach to residents in the pipeline?”

HTP-LT guides residents through an intensive curriculum offering mentorship and opportunities to observe, practice, and reflect upon clinical leadership in real-world settings. It emphasizes hospital operations, finance, and change management within large, complex organizations. All HTP-LT residents complete a leadership project.

The same faculty also developed the Young Hospitalist Academy, a summer program for medical students from across the country; the goal of the academy is to spur interest in hospital medicine at an earlier stage of medical training.

“We thought it’s never too early for medical students to start thinking about what it means to be a hospitalist and to be a medical leader,” Dr. Tad-y says.

Larry Beresford is a freelance writer in San Francisco.

Reference

1. Tad-y D, Pierce R, Guthrie M, Glasheen J. Developing hospitalist leaders: the Hospitalist Training Program Leaders Track [abstract]. J Hosp Med. 2013;8(Suppl 1):540.

A common theme among abstracts presented at HM13 was the need for more leadership training, as current and future hospitalists take on bigger roles in their hospitalist groups and institutions.

In an oral abstract presentation at the annual meeting in May in National Harbor, Md., lead author Darlene Tad-y, MD, assistant professor of medicine at the University of Colorado School of Medicine in Aurora, described the Hospitalist Training Program Leaders Track (HTP-LT), which launched in 2012 for hospitalist residents interested in program-level leadership.¹ Dr. Tad-y notes that a generation ago, one-third of hospitals were led by physician CEOs; today, that figure is only 4%, even though quality metrics suggest that clinical outcomes might be better at physician-led facilities.

Faculty at the University of Colorado were inspired to create the program after learning that graduates of its nine-year-old hospitalist residency program were being thrust into clinical, operational, and quality-improvement (QI) leadership positions. Most were forced to learn how to be a leader on the fly.

“That got us thinking: We should be more deliberate about leadership training and the gap around the development of hospitalist leaders,” says co-author Read Pierce, MD, HTP-LT director. “We started asking those in medical leadership positions: How did you learn leadership and what would you teach to residents in the pipeline?”

HTP-LT guides residents through an intensive curriculum offering mentorship and opportunities to observe, practice, and reflect upon clinical leadership in real-world settings. It emphasizes hospital operations, finance, and change management within large, complex organizations. All HTP-LT residents complete a leadership project.

The same faculty also developed the Young Hospitalist Academy, a summer program for medical students from across the country; the goal of the academy is to spur interest in hospital medicine at an earlier stage of medical training.

“We thought it’s never too early for medical students to start thinking about what it means to be a hospitalist and to be a medical leader,” Dr. Tad-y says.

Larry Beresford is a freelance writer in San Francisco.

Reference

1. Tad-y D, Pierce R, Guthrie M, Glasheen J. Developing hospitalist leaders: the Hospitalist Training Program Leaders Track [abstract]. J Hosp Med. 2013;8(Suppl 1):540.

Initial outcomes data for SHM's Project BOOST show a reduction in 30-day hospital readmission rates to 12.7% from 14.7% among a select group of 11 participating hospitals.

Results were reported online July 22 in the Journal of Hospital Medicine. “Participation in Project BOOST appeared to be associated with a decrease in readmission rates,” the study authors cautiously observe, although two accompanying editorials label the results as "limited" and "disappointing."

The research compares outcomes data for clinical acute-care units at 11 of 30 hospitals in the first two BOOST cohorts, started in 2008 and 2009, with clinically matched non-BOOST control units for all-patient, 30-day readmissions. Each BOOST site adopted two or more of the recommended interventions from the program’s toolkit for improving care transitions, with the support of an expert mentor. Reporting clinical outcomes was voluntary and uncompensated, and 19 of the hospitals in the initial cohorts did not share their data—cited as a serious limitation by authors of the editorials.

"You can look at our study on a couple of different levels," says lead author and BOOST lead analyst Luke Hansen, MD, MHS, of the division of hospital medicine at Northwestern University Feinberg School of Medicine in Chicago. "One is the sites that gave us data, and in that group there were statistically significant results. But I think the more important question is: Will that be enough? What is the magnitude of the effect, and is it enough to give hospitals the impetus they need to prevent avoidable readmissions?"

Listen to more of our interview with Dr. Luke Hansen, Project BOOST's lead analyst.

Project BOOST is one of SHM's national QI programs aimed at improving care transitions through such strategies as readmission risk assessments, medication reconciliation, patient coaching, and post-discharge follow-up calls. For hospitals and HM groups searching for solutions to the 30-day readmission dilemma—and thereby avoid Medicare reimbursement penalties, clear answers remain elusive.

"BOOST is one of a number of care transitions improvement methodologies that have been applied to the problem of readmissions, each of which has evidence to support their effectiveness in their initial settings, but has proven difficult to translate to other sites," JHM Editor-in-Chief Andrew D. Auerbach, MD, MPH, SFHM, a professor of medicine in residence at the University of California at San Francisco's division of hospital medicine, and co-authors note in an accompanying editorial.

Dr. Auerbach notes in his editorial that research problems limited the study's robustness but that "the authors provide the necessary start down the road towards a fuller understanding of real-world efforts to reduce readmissions."

In the other editorial, Ashish K. Jha, MD, MPH, of the Harvard School of Public Health, Health Policy, and Management suggests that readmissions ultimately may be the wrong target. A better goal, Dr. Jha says, is to improve transitions of care and demonstrate better processes in achieving those results—even though that might not significantly alter readmission rates. "We need to get clearer on what we’re trying to achieve," he adds.

Visit our website for more information on hospital readmission studies.

Initial outcomes data for SHM's Project BOOST show a reduction in 30-day hospital readmission rates to 12.7% from 14.7% among a select group of 11 participating hospitals.

Results were reported online July 22 in the Journal of Hospital Medicine. “Participation in Project BOOST appeared to be associated with a decrease in readmission rates,” the study authors cautiously observe, although two accompanying editorials label the results as "limited" and "disappointing."

The research compares outcomes data for clinical acute-care units at 11 of 30 hospitals in the first two BOOST cohorts, started in 2008 and 2009, with clinically matched non-BOOST control units for all-patient, 30-day readmissions. Each BOOST site adopted two or more of the recommended interventions from the program’s toolkit for improving care transitions, with the support of an expert mentor. Reporting clinical outcomes was voluntary and uncompensated, and 19 of the hospitals in the initial cohorts did not share their data—cited as a serious limitation by authors of the editorials.

"You can look at our study on a couple of different levels," says lead author and BOOST lead analyst Luke Hansen, MD, MHS, of the division of hospital medicine at Northwestern University Feinberg School of Medicine in Chicago. "One is the sites that gave us data, and in that group there were statistically significant results. But I think the more important question is: Will that be enough? What is the magnitude of the effect, and is it enough to give hospitals the impetus they need to prevent avoidable readmissions?"

Listen to more of our interview with Dr. Luke Hansen, Project BOOST's lead analyst.

Project BOOST is one of SHM's national QI programs aimed at improving care transitions through such strategies as readmission risk assessments, medication reconciliation, patient coaching, and post-discharge follow-up calls. For hospitals and HM groups searching for solutions to the 30-day readmission dilemma—and thereby avoid Medicare reimbursement penalties, clear answers remain elusive.

"BOOST is one of a number of care transitions improvement methodologies that have been applied to the problem of readmissions, each of which has evidence to support their effectiveness in their initial settings, but has proven difficult to translate to other sites," JHM Editor-in-Chief Andrew D. Auerbach, MD, MPH, SFHM, a professor of medicine in residence at the University of California at San Francisco's division of hospital medicine, and co-authors note in an accompanying editorial.

Dr. Auerbach notes in his editorial that research problems limited the study's robustness but that "the authors provide the necessary start down the road towards a fuller understanding of real-world efforts to reduce readmissions."

In the other editorial, Ashish K. Jha, MD, MPH, of the Harvard School of Public Health, Health Policy, and Management suggests that readmissions ultimately may be the wrong target. A better goal, Dr. Jha says, is to improve transitions of care and demonstrate better processes in achieving those results—even though that might not significantly alter readmission rates. "We need to get clearer on what we’re trying to achieve," he adds.

Visit our website for more information on hospital readmission studies.

Initial outcomes data for SHM's Project BOOST show a reduction in 30-day hospital readmission rates to 12.7% from 14.7% among a select group of 11 participating hospitals.

Results were reported online July 22 in the Journal of Hospital Medicine. “Participation in Project BOOST appeared to be associated with a decrease in readmission rates,” the study authors cautiously observe, although two accompanying editorials label the results as "limited" and "disappointing."

The research compares outcomes data for clinical acute-care units at 11 of 30 hospitals in the first two BOOST cohorts, started in 2008 and 2009, with clinically matched non-BOOST control units for all-patient, 30-day readmissions. Each BOOST site adopted two or more of the recommended interventions from the program’s toolkit for improving care transitions, with the support of an expert mentor. Reporting clinical outcomes was voluntary and uncompensated, and 19 of the hospitals in the initial cohorts did not share their data—cited as a serious limitation by authors of the editorials.

"You can look at our study on a couple of different levels," says lead author and BOOST lead analyst Luke Hansen, MD, MHS, of the division of hospital medicine at Northwestern University Feinberg School of Medicine in Chicago. "One is the sites that gave us data, and in that group there were statistically significant results. But I think the more important question is: Will that be enough? What is the magnitude of the effect, and is it enough to give hospitals the impetus they need to prevent avoidable readmissions?"

Listen to more of our interview with Dr. Luke Hansen, Project BOOST's lead analyst.

Project BOOST is one of SHM's national QI programs aimed at improving care transitions through such strategies as readmission risk assessments, medication reconciliation, patient coaching, and post-discharge follow-up calls. For hospitals and HM groups searching for solutions to the 30-day readmission dilemma—and thereby avoid Medicare reimbursement penalties, clear answers remain elusive.

"BOOST is one of a number of care transitions improvement methodologies that have been applied to the problem of readmissions, each of which has evidence to support their effectiveness in their initial settings, but has proven difficult to translate to other sites," JHM Editor-in-Chief Andrew D. Auerbach, MD, MPH, SFHM, a professor of medicine in residence at the University of California at San Francisco's division of hospital medicine, and co-authors note in an accompanying editorial.

Dr. Auerbach notes in his editorial that research problems limited the study's robustness but that "the authors provide the necessary start down the road towards a fuller understanding of real-world efforts to reduce readmissions."

In the other editorial, Ashish K. Jha, MD, MPH, of the Harvard School of Public Health, Health Policy, and Management suggests that readmissions ultimately may be the wrong target. A better goal, Dr. Jha says, is to improve transitions of care and demonstrate better processes in achieving those results—even though that might not significantly alter readmission rates. "We need to get clearer on what we’re trying to achieve," he adds.

Visit our website for more information on hospital readmission studies.

The Center for Medicare & Medicaid Innovation's Rick Gilfillan, MD, will be leaving at the end of June, just as the organization prepares to start accepting round-two grant applications for up to $1 billion in Health Care Innovation Awards. Replacing him as acting director will be Patrick Conway, MD, MSc, FAAP, SFHM, a practicing pediatric hospitalist, former director of hospital medicine at Cincinnati Children's Hospital, and HM13 keynote speaker.

Dr. Conway will continue in his current role as CMS' chief medical officer.

"We applaud Patrick Conway's appointment to the Center for Medicare & Medicaid Innovation," says SHM President Eric Howell, MD, SFHM. "His work, compassion, and vision are tremendous validations of the hospitalist model as both a change agent and as a career path. Patients across the country will be the true beneficiaries of his new work.

"Hospitalists should continue to look toward the CMS Innovation Center as a leader in transforming healthcare."

The center was created by the 2010 Affordable Care Act to offer solutions to healthcare cost and delivery problems. Its first round of 107 innovations awards, averaging $8.4 million each over three years, was announced in 2012 and included several that focused on preventing hospitalizations, avoidable rehospitalizations, and ED visits. One award went to David Meltzer, MD, PhD, FHM, of the University of Chicago to test a model in which the same doctor would see selected high-risk patients both in and out of the hospital.

Round two "provides hospitalists—who have an exceptionally broad perspective—with a unique opportunity to share new approaches to delivering the best patient care at an affordable cost," Dr. Conway told The Hospitalist.

Visit our website for more information on CMS Innovation Center initiatives.

The Center for Medicare & Medicaid Innovation's Rick Gilfillan, MD, will be leaving at the end of June, just as the organization prepares to start accepting round-two grant applications for up to $1 billion in Health Care Innovation Awards. Replacing him as acting director will be Patrick Conway, MD, MSc, FAAP, SFHM, a practicing pediatric hospitalist, former director of hospital medicine at Cincinnati Children's Hospital, and HM13 keynote speaker.

Dr. Conway will continue in his current role as CMS' chief medical officer.

"We applaud Patrick Conway's appointment to the Center for Medicare & Medicaid Innovation," says SHM President Eric Howell, MD, SFHM. "His work, compassion, and vision are tremendous validations of the hospitalist model as both a change agent and as a career path. Patients across the country will be the true beneficiaries of his new work.

"Hospitalists should continue to look toward the CMS Innovation Center as a leader in transforming healthcare."

The center was created by the 2010 Affordable Care Act to offer solutions to healthcare cost and delivery problems. Its first round of 107 innovations awards, averaging $8.4 million each over three years, was announced in 2012 and included several that focused on preventing hospitalizations, avoidable rehospitalizations, and ED visits. One award went to David Meltzer, MD, PhD, FHM, of the University of Chicago to test a model in which the same doctor would see selected high-risk patients both in and out of the hospital.

Round two "provides hospitalists—who have an exceptionally broad perspective—with a unique opportunity to share new approaches to delivering the best patient care at an affordable cost," Dr. Conway told The Hospitalist.

Visit our website for more information on CMS Innovation Center initiatives.

The Center for Medicare & Medicaid Innovation's Rick Gilfillan, MD, will be leaving at the end of June, just as the organization prepares to start accepting round-two grant applications for up to $1 billion in Health Care Innovation Awards. Replacing him as acting director will be Patrick Conway, MD, MSc, FAAP, SFHM, a practicing pediatric hospitalist, former director of hospital medicine at Cincinnati Children's Hospital, and HM13 keynote speaker.

Dr. Conway will continue in his current role as CMS' chief medical officer.

"We applaud Patrick Conway's appointment to the Center for Medicare & Medicaid Innovation," says SHM President Eric Howell, MD, SFHM. "His work, compassion, and vision are tremendous validations of the hospitalist model as both a change agent and as a career path. Patients across the country will be the true beneficiaries of his new work.

"Hospitalists should continue to look toward the CMS Innovation Center as a leader in transforming healthcare."

The center was created by the 2010 Affordable Care Act to offer solutions to healthcare cost and delivery problems. Its first round of 107 innovations awards, averaging $8.4 million each over three years, was announced in 2012 and included several that focused on preventing hospitalizations, avoidable rehospitalizations, and ED visits. One award went to David Meltzer, MD, PhD, FHM, of the University of Chicago to test a model in which the same doctor would see selected high-risk patients both in and out of the hospital.

Round two "provides hospitalists—who have an exceptionally broad perspective—with a unique opportunity to share new approaches to delivering the best patient care at an affordable cost," Dr. Conway told The Hospitalist.

Visit our website for more information on CMS Innovation Center initiatives.