Ms. Suarez, a 48-year-old married Hispanic woman, came to her appointment at the outpatient psychiatry clinic asking for a second opinion. She told the admitting resident that she had had depression for years, and that nothing had helped. She said she had tried many medications and individual therapy, and she was feeling hopeless and frustrated. She worried that her husband would leave her. She was still working, but felt that the quality of her work was poor.

The psychiatric resident wondered whether to put her in the psychopharmacology clinic or in the psychotherapy clinic. What should the resident do? The American Psychiatric Association Symposium No. 81, from 9 a.m. to noon on May 8 in Philadelphia, will answer this question.

The symposium is called "Improving Quality of Care for Patients with Psychiatric Illness: Combining and Integrating Psychopharmacological, Individual, and Family Therapy." I will be presenting the symposium with Dr. Alan F. Schatzberg, Dr. Glen O. Gabbard, and Dr. Gabor I. Keitner as panelists, and Dr. Ira D. Glick as the discussant. We’ll be looking at the following topics:

• Dr. Schatzberg will discuss "Combining Pharmacotherapy With Other Modalities."

Psychopharmacology has become a major approach in the treatment of patients with psychiatric disorders. The discipline has evolved from its humble beginnings with a limited number of classes of agents that had a relatively narrow range of mechanisms of action, to the current host of classes and agents, many with disparate effects. This development demands considerable knowledge of the basic biology of the disorder, as well as the specific pharmacology of specific agents.

The development of this field, however, is not the only one in psychiatric treatment. Rather, parallel developments have taken place in the psychotherapies – as well as in devices – such that the practitioner needs to be able to incorporate advances in all of them to most optimally help his or her patient.

As models of other areas in psychiatry, recent developments in psychopharmacology and stimulatory device treatment of major depression will be reviewed, with data from studies on the biology of early abuse and cognitive deficits in depression and with an eye toward understanding how these various approaches can be integrated optimally to treating particular patients.

Early child abuse is associated with an increased risk for developing increased responsiveness to stress, as well as major depression in adulthood, and this risk interacts with specific genetic vulnerability. These patients might respond to medication, but do best when medications are combined with psychotherapy. Optimally, effective treatment outcomes will require the sophisticated application of knowledge of biology, pharmacology, and psychotherapy. In addition, training and education need to incorporate such approaches.

• Dr. Gabbard will discuss "Combining Individual Therapy With Other Modalities."

In the practice of general psychiatry, it inevitably becomes necessary to combine medication and psychotherapy techniques. However, this combination is undertheorized in our literature. In this presentation, the practice of combining individual therapy strategies and pharmacotherapy will be systematically considered from the standpoint of adherence, meanings of medication, enhancement of outcome, and different modes of therapeutic action. This presentation will address the practical matter of sequencing of the two modalities overall and within sessions.

• Dr. Keitner will discuss "Family Intervention by Psychiatrists as a Routine Component of Patient Care."

Illnesses begin and evolve in a social context, and affect friends and relatives of the ill person. The ways in which the patient’s significant others, in turn, deal with the illness influence its course and outcome.

It is necessary, therefore, to involve the families of patients in the assessment and treatment process. Family interventions can be stand-alone treatments or adjuncts to pharmacotherapy and psychotherapy. Numerous family-assessment and family-therapy models have been tested for use in many different illnesses. In general, family interventions have been found to be useful in the management of many chronic medical conditions as well as in major depression, bipolar disorder, anxiety disorders, schizophrenia, and substance abuse.

Most psychiatrists are not comfortable with or skilled in working with families, despite the evidence for its usefulness. This presentation will outline ways in which psychiatrists can systematically involve the families of patients in their assessment and treatment, and ways to combine and integrate family interventions with pharmacotherapy and psychotherapy.

For many decades, a biopsychosocial approach to patient care has meant a comprehensive assessment of the patient and the family environment. However, little discussion has occurred regarding what follows. What should follow is an extensive discussion with the patient and family about treatment. Clinical decision making should be done with the patient and the family, and should include a discussion of the biopsychosocial components that contribute to the illness, followed by a discussion of treatment options. The expected changes for each modality must be provided to the patient and family.

This symposium will address how to combine modalities, and how to discuss doing so with the patient and family. Each panelist will discuss how to combine modalities and will apply their expertise to Ms. Suarez’s situation.

Bring your clinical cases and questions, and pose them to the experts! See you there!

Ms. Suarez, a 48-year-old married Hispanic woman, came to her appointment at the outpatient psychiatry clinic asking for a second opinion. She told the admitting resident that she had had depression for years, and that nothing had helped. She said she had tried many medications and individual therapy, and she was feeling hopeless and frustrated. She worried that her husband would leave her. She was still working, but felt that the quality of her work was poor.

The psychiatric resident wondered whether to put her in the psychopharmacology clinic or in the psychotherapy clinic. What should the resident do? The American Psychiatric Association Symposium No. 81, from 9 a.m. to noon on May 8 in Philadelphia, will answer this question.

The symposium is called "Improving Quality of Care for Patients with Psychiatric Illness: Combining and Integrating Psychopharmacological, Individual, and Family Therapy." I will be presenting the symposium with Dr. Alan F. Schatzberg, Dr. Glen O. Gabbard, and Dr. Gabor I. Keitner as panelists, and Dr. Ira D. Glick as the discussant. We’ll be looking at the following topics:

• Dr. Schatzberg will discuss "Combining Pharmacotherapy With Other Modalities."

Psychopharmacology has become a major approach in the treatment of patients with psychiatric disorders. The discipline has evolved from its humble beginnings with a limited number of classes of agents that had a relatively narrow range of mechanisms of action, to the current host of classes and agents, many with disparate effects. This development demands considerable knowledge of the basic biology of the disorder, as well as the specific pharmacology of specific agents.

The development of this field, however, is not the only one in psychiatric treatment. Rather, parallel developments have taken place in the psychotherapies – as well as in devices – such that the practitioner needs to be able to incorporate advances in all of them to most optimally help his or her patient.

As models of other areas in psychiatry, recent developments in psychopharmacology and stimulatory device treatment of major depression will be reviewed, with data from studies on the biology of early abuse and cognitive deficits in depression and with an eye toward understanding how these various approaches can be integrated optimally to treating particular patients.

Early child abuse is associated with an increased risk for developing increased responsiveness to stress, as well as major depression in adulthood, and this risk interacts with specific genetic vulnerability. These patients might respond to medication, but do best when medications are combined with psychotherapy. Optimally, effective treatment outcomes will require the sophisticated application of knowledge of biology, pharmacology, and psychotherapy. In addition, training and education need to incorporate such approaches.

• Dr. Gabbard will discuss "Combining Individual Therapy With Other Modalities."

In the practice of general psychiatry, it inevitably becomes necessary to combine medication and psychotherapy techniques. However, this combination is undertheorized in our literature. In this presentation, the practice of combining individual therapy strategies and pharmacotherapy will be systematically considered from the standpoint of adherence, meanings of medication, enhancement of outcome, and different modes of therapeutic action. This presentation will address the practical matter of sequencing of the two modalities overall and within sessions.

• Dr. Keitner will discuss "Family Intervention by Psychiatrists as a Routine Component of Patient Care."

Illnesses begin and evolve in a social context, and affect friends and relatives of the ill person. The ways in which the patient’s significant others, in turn, deal with the illness influence its course and outcome.

It is necessary, therefore, to involve the families of patients in the assessment and treatment process. Family interventions can be stand-alone treatments or adjuncts to pharmacotherapy and psychotherapy. Numerous family-assessment and family-therapy models have been tested for use in many different illnesses. In general, family interventions have been found to be useful in the management of many chronic medical conditions as well as in major depression, bipolar disorder, anxiety disorders, schizophrenia, and substance abuse.

Most psychiatrists are not comfortable with or skilled in working with families, despite the evidence for its usefulness. This presentation will outline ways in which psychiatrists can systematically involve the families of patients in their assessment and treatment, and ways to combine and integrate family interventions with pharmacotherapy and psychotherapy.

For many decades, a biopsychosocial approach to patient care has meant a comprehensive assessment of the patient and the family environment. However, little discussion has occurred regarding what follows. What should follow is an extensive discussion with the patient and family about treatment. Clinical decision making should be done with the patient and the family, and should include a discussion of the biopsychosocial components that contribute to the illness, followed by a discussion of treatment options. The expected changes for each modality must be provided to the patient and family.

This symposium will address how to combine modalities, and how to discuss doing so with the patient and family. Each panelist will discuss how to combine modalities and will apply their expertise to Ms. Suarez’s situation.

Bring your clinical cases and questions, and pose them to the experts! See you there!

Ms. Suarez, a 48-year-old married Hispanic woman, came to her appointment at the outpatient psychiatry clinic asking for a second opinion. She told the admitting resident that she had had depression for years, and that nothing had helped. She said she had tried many medications and individual therapy, and she was feeling hopeless and frustrated. She worried that her husband would leave her. She was still working, but felt that the quality of her work was poor.

The psychiatric resident wondered whether to put her in the psychopharmacology clinic or in the psychotherapy clinic. What should the resident do? The American Psychiatric Association Symposium No. 81, from 9 a.m. to noon on May 8 in Philadelphia, will answer this question.

The symposium is called "Improving Quality of Care for Patients with Psychiatric Illness: Combining and Integrating Psychopharmacological, Individual, and Family Therapy." I will be presenting the symposium with Dr. Alan F. Schatzberg, Dr. Glen O. Gabbard, and Dr. Gabor I. Keitner as panelists, and Dr. Ira D. Glick as the discussant. We’ll be looking at the following topics:

• Dr. Schatzberg will discuss "Combining Pharmacotherapy With Other Modalities."

Psychopharmacology has become a major approach in the treatment of patients with psychiatric disorders. The discipline has evolved from its humble beginnings with a limited number of classes of agents that had a relatively narrow range of mechanisms of action, to the current host of classes and agents, many with disparate effects. This development demands considerable knowledge of the basic biology of the disorder, as well as the specific pharmacology of specific agents.

The development of this field, however, is not the only one in psychiatric treatment. Rather, parallel developments have taken place in the psychotherapies – as well as in devices – such that the practitioner needs to be able to incorporate advances in all of them to most optimally help his or her patient.

As models of other areas in psychiatry, recent developments in psychopharmacology and stimulatory device treatment of major depression will be reviewed, with data from studies on the biology of early abuse and cognitive deficits in depression and with an eye toward understanding how these various approaches can be integrated optimally to treating particular patients.

Early child abuse is associated with an increased risk for developing increased responsiveness to stress, as well as major depression in adulthood, and this risk interacts with specific genetic vulnerability. These patients might respond to medication, but do best when medications are combined with psychotherapy. Optimally, effective treatment outcomes will require the sophisticated application of knowledge of biology, pharmacology, and psychotherapy. In addition, training and education need to incorporate such approaches.

• Dr. Gabbard will discuss "Combining Individual Therapy With Other Modalities."

In the practice of general psychiatry, it inevitably becomes necessary to combine medication and psychotherapy techniques. However, this combination is undertheorized in our literature. In this presentation, the practice of combining individual therapy strategies and pharmacotherapy will be systematically considered from the standpoint of adherence, meanings of medication, enhancement of outcome, and different modes of therapeutic action. This presentation will address the practical matter of sequencing of the two modalities overall and within sessions.

• Dr. Keitner will discuss "Family Intervention by Psychiatrists as a Routine Component of Patient Care."

Illnesses begin and evolve in a social context, and affect friends and relatives of the ill person. The ways in which the patient’s significant others, in turn, deal with the illness influence its course and outcome.

It is necessary, therefore, to involve the families of patients in the assessment and treatment process. Family interventions can be stand-alone treatments or adjuncts to pharmacotherapy and psychotherapy. Numerous family-assessment and family-therapy models have been tested for use in many different illnesses. In general, family interventions have been found to be useful in the management of many chronic medical conditions as well as in major depression, bipolar disorder, anxiety disorders, schizophrenia, and substance abuse.

Most psychiatrists are not comfortable with or skilled in working with families, despite the evidence for its usefulness. This presentation will outline ways in which psychiatrists can systematically involve the families of patients in their assessment and treatment, and ways to combine and integrate family interventions with pharmacotherapy and psychotherapy.

For many decades, a biopsychosocial approach to patient care has meant a comprehensive assessment of the patient and the family environment. However, little discussion has occurred regarding what follows. What should follow is an extensive discussion with the patient and family about treatment. Clinical decision making should be done with the patient and the family, and should include a discussion of the biopsychosocial components that contribute to the illness, followed by a discussion of treatment options. The expected changes for each modality must be provided to the patient and family.

This symposium will address how to combine modalities, and how to discuss doing so with the patient and family. Each panelist will discuss how to combine modalities and will apply their expertise to Ms. Suarez’s situation.

Bring your clinical cases and questions, and pose them to the experts! See you there!

When Robert Wachter, MD, MHM, graduated from medical school in 1983, he thought he knew what a great doctor was. When he gave the penultimate address to a packed house at the Society of Hospital Medicine’s annual meeting in San Diego on Wednesday, he said that definition has changed—and will continue to evolve as hospitalists tackle the challenges of delivering high-value, cost-conscious care in an age of healthcare reform.

“We need to be great team players, but we also need to be great leaders,” said Dr. Wachter, professor and chief of the division of hospital medicine. chief of the medical service at the University of California San Francisco Medical Center and chair-elect for the American Board of Internal Medicine. “We need to embrace useful technology, but we can’t be slaves to it … improve systems of care, but welcome personal and group accountability. Strive for a balanced life but remember medicine is more a calling than a job. And think about the patients’ needs before our own. These are core and enduring values even as we move into this new era.”

Dr. Wachter’s plenary, titled “The Great Physician, Circa 2012: How Hospitalists Must Lead Efforts to Identify and Become This New Breed,” highlighted the balance HM practitioners must find in an increasingly complex healthcare system. He suggested hospitalists view themselves as technologically savvy “lifelong learners” whose reputation for systems improvement positions them perfectly to champion reform.

“We have big targets on us and I think they are appropriate,” said Dr. Wachter. “There are others who should have targets as well, but the main target has to be us. Change is impossible if we don’t embrace change.”

When Robert Wachter, MD, MHM, graduated from medical school in 1983, he thought he knew what a great doctor was. When he gave the penultimate address to a packed house at the Society of Hospital Medicine’s annual meeting in San Diego on Wednesday, he said that definition has changed—and will continue to evolve as hospitalists tackle the challenges of delivering high-value, cost-conscious care in an age of healthcare reform.

“We need to be great team players, but we also need to be great leaders,” said Dr. Wachter, professor and chief of the division of hospital medicine. chief of the medical service at the University of California San Francisco Medical Center and chair-elect for the American Board of Internal Medicine. “We need to embrace useful technology, but we can’t be slaves to it … improve systems of care, but welcome personal and group accountability. Strive for a balanced life but remember medicine is more a calling than a job. And think about the patients’ needs before our own. These are core and enduring values even as we move into this new era.”

Dr. Wachter’s plenary, titled “The Great Physician, Circa 2012: How Hospitalists Must Lead Efforts to Identify and Become This New Breed,” highlighted the balance HM practitioners must find in an increasingly complex healthcare system. He suggested hospitalists view themselves as technologically savvy “lifelong learners” whose reputation for systems improvement positions them perfectly to champion reform.

“We have big targets on us and I think they are appropriate,” said Dr. Wachter. “There are others who should have targets as well, but the main target has to be us. Change is impossible if we don’t embrace change.”

When Robert Wachter, MD, MHM, graduated from medical school in 1983, he thought he knew what a great doctor was. When he gave the penultimate address to a packed house at the Society of Hospital Medicine’s annual meeting in San Diego on Wednesday, he said that definition has changed—and will continue to evolve as hospitalists tackle the challenges of delivering high-value, cost-conscious care in an age of healthcare reform.

“We need to be great team players, but we also need to be great leaders,” said Dr. Wachter, professor and chief of the division of hospital medicine. chief of the medical service at the University of California San Francisco Medical Center and chair-elect for the American Board of Internal Medicine. “We need to embrace useful technology, but we can’t be slaves to it … improve systems of care, but welcome personal and group accountability. Strive for a balanced life but remember medicine is more a calling than a job. And think about the patients’ needs before our own. These are core and enduring values even as we move into this new era.”

Dr. Wachter’s plenary, titled “The Great Physician, Circa 2012: How Hospitalists Must Lead Efforts to Identify and Become This New Breed,” highlighted the balance HM practitioners must find in an increasingly complex healthcare system. He suggested hospitalists view themselves as technologically savvy “lifelong learners” whose reputation for systems improvement positions them perfectly to champion reform.

“We have big targets on us and I think they are appropriate,” said Dr. Wachter. “There are others who should have targets as well, but the main target has to be us. Change is impossible if we don’t embrace change.”

Could engineering processes and techniques help hospitalists with some of the inherent frustrations of their practice—scheduling, staffing, admission surges, prioritizing which patients to see first?

Jonathan Turner, PhD, an industrial engineer who works as a healthcare engineer with the division of hospital medicine at Northwestern University Medical Center in Chicago, led a workshop on applying techniques such as queuing principles to hospitalist practice on Wednesday morning at the Society of Hospital Medicine’s annual meeting, HM12.

One of those principles is Little's Law which, applied to hospitals, calculates length of stay as the hospital’s census divided by its admission rate, reflecting the rates in and out and waiting times within the hospital.

“A lot of hospital administrators talk about reducing lengths of stay, when what they really want to do is increase admissions without increasing beds,” said Dr. Turner. You could reduce length of stay without actually affecting admissions, he added, which would result in unused capacity. At the same time, as capacity approaches 100% percent, negative consequences such as longer wait times and reduced quality may dilute the gains in efficiency. A better target, he said, may be closer to 85% percent of capacity.

One workshop participant relayed how his hospital struggled with delays in processing admissions. He took Little’s Law to his administration and made the case for additional staffing. The administration agreed to an additional hospitalist FTE, since the alternative was back-ups, and shifts were adjusted to times of greatest need. Currently, on 85% of days at the hospital, there are no delays in admissions.

“We talked about how difficult it is to predict caseload,” said Turner at the end of the workshop. “We can look at spikes and seasonal differences, but it may be easier to see patterns if you start peeling off subsets of your patient population.”

Could engineering processes and techniques help hospitalists with some of the inherent frustrations of their practice—scheduling, staffing, admission surges, prioritizing which patients to see first?

Jonathan Turner, PhD, an industrial engineer who works as a healthcare engineer with the division of hospital medicine at Northwestern University Medical Center in Chicago, led a workshop on applying techniques such as queuing principles to hospitalist practice on Wednesday morning at the Society of Hospital Medicine’s annual meeting, HM12.

One of those principles is Little's Law which, applied to hospitals, calculates length of stay as the hospital’s census divided by its admission rate, reflecting the rates in and out and waiting times within the hospital.

“A lot of hospital administrators talk about reducing lengths of stay, when what they really want to do is increase admissions without increasing beds,” said Dr. Turner. You could reduce length of stay without actually affecting admissions, he added, which would result in unused capacity. At the same time, as capacity approaches 100% percent, negative consequences such as longer wait times and reduced quality may dilute the gains in efficiency. A better target, he said, may be closer to 85% percent of capacity.

One workshop participant relayed how his hospital struggled with delays in processing admissions. He took Little’s Law to his administration and made the case for additional staffing. The administration agreed to an additional hospitalist FTE, since the alternative was back-ups, and shifts were adjusted to times of greatest need. Currently, on 85% of days at the hospital, there are no delays in admissions.

“We talked about how difficult it is to predict caseload,” said Turner at the end of the workshop. “We can look at spikes and seasonal differences, but it may be easier to see patterns if you start peeling off subsets of your patient population.”

Could engineering processes and techniques help hospitalists with some of the inherent frustrations of their practice—scheduling, staffing, admission surges, prioritizing which patients to see first?

Jonathan Turner, PhD, an industrial engineer who works as a healthcare engineer with the division of hospital medicine at Northwestern University Medical Center in Chicago, led a workshop on applying techniques such as queuing principles to hospitalist practice on Wednesday morning at the Society of Hospital Medicine’s annual meeting, HM12.

One of those principles is Little's Law which, applied to hospitals, calculates length of stay as the hospital’s census divided by its admission rate, reflecting the rates in and out and waiting times within the hospital.

“A lot of hospital administrators talk about reducing lengths of stay, when what they really want to do is increase admissions without increasing beds,” said Dr. Turner. You could reduce length of stay without actually affecting admissions, he added, which would result in unused capacity. At the same time, as capacity approaches 100% percent, negative consequences such as longer wait times and reduced quality may dilute the gains in efficiency. A better target, he said, may be closer to 85% percent of capacity.

One workshop participant relayed how his hospital struggled with delays in processing admissions. He took Little’s Law to his administration and made the case for additional staffing. The administration agreed to an additional hospitalist FTE, since the alternative was back-ups, and shifts were adjusted to times of greatest need. Currently, on 85% of days at the hospital, there are no delays in admissions.

“We talked about how difficult it is to predict caseload,” said Turner at the end of the workshop. “We can look at spikes and seasonal differences, but it may be easier to see patterns if you start peeling off subsets of your patient population.”

Clinical decision support (CDS) can be defined very broadly as “a process for enhancing health-related decisions and actions with pertinent, organized clinical knowledge and patient information to improve health and healthcare delivery.” However, it's important to remember that simply deploying CDS does not automatically equate to performance improvement (PI), said Jerome Osheroff, MD, during a Wednesday morning session at HM12.

Dr. Osheroff is a leader in CDS and a key editor of the new HIMSS publication "Improving Outcomes with CDS: An Implementer's Guide." SHM co-sponsored the publication, and hospitalist Kendall Rogers was an editor.

Dr. Osheroff advised hospitalists to keep in mind the five "rights" of CDS: the right information, to the right people, in the right intervention formats, through the right channels, and at the right points in workflow. He also stressed the importance of workflow analysis, solid governance and management, and strategic plan development when initiating a hospital-based CDS program.

He finished the discussion by stressing the importance of collaboration, and described the "CDS/PI Collaborative," a multi-stakeholder national movement bringing CDS tools to caregivers and healthcare organizations.

"The screws are getting tighter and tighter" in healthcare, he said, and CDS collaboration needs to act as the screwdriver. In a show of hands during the session, the majority of attendees would participate in this approach, especially with SHM support.

Takeaways

• Apply the "CDS Five Rights" when implementing the CDS process.
• CDS deployment does not equate to performance improvement.
• The CDS/PI Collaborative can provide tools to healthcare organizations.
• Consider the Zen saying: A poor farmer produces weeds, a good farmer produces crops, a wise farmer produces soil.

Clinical decision support (CDS) can be defined very broadly as “a process for enhancing health-related decisions and actions with pertinent, organized clinical knowledge and patient information to improve health and healthcare delivery.” However, it's important to remember that simply deploying CDS does not automatically equate to performance improvement (PI), said Jerome Osheroff, MD, during a Wednesday morning session at HM12.

Dr. Osheroff is a leader in CDS and a key editor of the new HIMSS publication "Improving Outcomes with CDS: An Implementer's Guide." SHM co-sponsored the publication, and hospitalist Kendall Rogers was an editor.

Dr. Osheroff advised hospitalists to keep in mind the five "rights" of CDS: the right information, to the right people, in the right intervention formats, through the right channels, and at the right points in workflow. He also stressed the importance of workflow analysis, solid governance and management, and strategic plan development when initiating a hospital-based CDS program.

He finished the discussion by stressing the importance of collaboration, and described the "CDS/PI Collaborative," a multi-stakeholder national movement bringing CDS tools to caregivers and healthcare organizations.

"The screws are getting tighter and tighter" in healthcare, he said, and CDS collaboration needs to act as the screwdriver. In a show of hands during the session, the majority of attendees would participate in this approach, especially with SHM support.

Takeaways

• Apply the "CDS Five Rights" when implementing the CDS process.
• CDS deployment does not equate to performance improvement.
• The CDS/PI Collaborative can provide tools to healthcare organizations.
• Consider the Zen saying: A poor farmer produces weeds, a good farmer produces crops, a wise farmer produces soil.

Clinical decision support (CDS) can be defined very broadly as “a process for enhancing health-related decisions and actions with pertinent, organized clinical knowledge and patient information to improve health and healthcare delivery.” However, it's important to remember that simply deploying CDS does not automatically equate to performance improvement (PI), said Jerome Osheroff, MD, during a Wednesday morning session at HM12.

Dr. Osheroff is a leader in CDS and a key editor of the new HIMSS publication "Improving Outcomes with CDS: An Implementer's Guide." SHM co-sponsored the publication, and hospitalist Kendall Rogers was an editor.

Dr. Osheroff advised hospitalists to keep in mind the five "rights" of CDS: the right information, to the right people, in the right intervention formats, through the right channels, and at the right points in workflow. He also stressed the importance of workflow analysis, solid governance and management, and strategic plan development when initiating a hospital-based CDS program.

He finished the discussion by stressing the importance of collaboration, and described the "CDS/PI Collaborative," a multi-stakeholder national movement bringing CDS tools to caregivers and healthcare organizations.

"The screws are getting tighter and tighter" in healthcare, he said, and CDS collaboration needs to act as the screwdriver. In a show of hands during the session, the majority of attendees would participate in this approach, especially with SHM support.

Takeaways

• Apply the "CDS Five Rights" when implementing the CDS process.
• CDS deployment does not equate to performance improvement.
• The CDS/PI Collaborative can provide tools to healthcare organizations.
• Consider the Zen saying: A poor farmer produces weeds, a good farmer produces crops, a wise farmer produces soil.

Four hospitalist research teams were announced as winners of the 2012 Research, Innovation, and Clinical Vignette poster competition at HM12 in San Diego. More than 500 posters were judged this year, the most in competition history.

Research

Title: Veterans Administration Acute Care 30-Day Mortality Model: Development, Validation, and Performance Variation

Team: Eduard Vasilevskis, MD, Annette Christianson, MS, James Deddens, PhD, Siva Sivaganesin, PhD3, Ron Freyberg, MS, Timothy Hofer, MD, MSc, Peter Almenoff, MD, Marta Render, MD; VA Tennessee Valley Healthcare System, Nashville, Tenn.; Department of Veterans Affairs, Cincinnati, University of Cincinnati, Cincinnati, Ohio, Department of Veterans Affairs, Ann Arbor, Mich., Veterans Affairs Medical Center, Kansas City, Mo.

Click here to view the abstract.

Innovation

Title: Accountable Care Unit on a Medical Ward in a Teaching Hospital: A New Care Model Designed To Improve Patient and Hospital Outcomes

Team: Christina Payne, MD, Dapo Odetoyinbo, MD, Bryan Castle, RN, MBA, Amanda Methvin, MD, John Vazquez, MD, Molly Burleson, RN, Dustin Smith, MD, Daniel Dressler, MD, MSc, Jason Stein, MD; Emory University Hospital, Atlanta, Ga., Veterans’ Affairs Medical Center, Atlanta, Ga.

Click here to view the abstract.

Clinical Vignette – Adult

Title: Moo Is the Clue

Team: Rafina Khateeb, MD, Min Jiang, MD, Tejal Gandhi, MD; University of Michigan Health System, Ann Arbor, Mich

Click here to view the abstract.

Clinical Vignette - Pediatric

Title: Rare Cause of Lack of Expected Weight Gain in an Infant

Team: Jonathan Chiles, MD, Christrine Hrach, MD; Washington University, St. Louis, Mo.

Click here to view the abstract.

View all of the 2012 RIV abstracts via the HM12 at Hand app.

Jason Carris is editor of The Hospitalist.

Four hospitalist research teams were announced as winners of the 2012 Research, Innovation, and Clinical Vignette poster competition at HM12 in San Diego. More than 500 posters were judged this year, the most in competition history.

Research

Title: Veterans Administration Acute Care 30-Day Mortality Model: Development, Validation, and Performance Variation

Team: Eduard Vasilevskis, MD, Annette Christianson, MS, James Deddens, PhD, Siva Sivaganesin, PhD3, Ron Freyberg, MS, Timothy Hofer, MD, MSc, Peter Almenoff, MD, Marta Render, MD; VA Tennessee Valley Healthcare System, Nashville, Tenn.; Department of Veterans Affairs, Cincinnati, University of Cincinnati, Cincinnati, Ohio, Department of Veterans Affairs, Ann Arbor, Mich., Veterans Affairs Medical Center, Kansas City, Mo.

Click here to view the abstract.

Innovation

Title: Accountable Care Unit on a Medical Ward in a Teaching Hospital: A New Care Model Designed To Improve Patient and Hospital Outcomes

Team: Christina Payne, MD, Dapo Odetoyinbo, MD, Bryan Castle, RN, MBA, Amanda Methvin, MD, John Vazquez, MD, Molly Burleson, RN, Dustin Smith, MD, Daniel Dressler, MD, MSc, Jason Stein, MD; Emory University Hospital, Atlanta, Ga., Veterans’ Affairs Medical Center, Atlanta, Ga.

Click here to view the abstract.

Clinical Vignette – Adult

Title: Moo Is the Clue

Team: Rafina Khateeb, MD, Min Jiang, MD, Tejal Gandhi, MD; University of Michigan Health System, Ann Arbor, Mich

Click here to view the abstract.

Clinical Vignette - Pediatric

Title: Rare Cause of Lack of Expected Weight Gain in an Infant

Team: Jonathan Chiles, MD, Christrine Hrach, MD; Washington University, St. Louis, Mo.

Click here to view the abstract.

View all of the 2012 RIV abstracts via the HM12 at Hand app.

Jason Carris is editor of The Hospitalist.

Four hospitalist research teams were announced as winners of the 2012 Research, Innovation, and Clinical Vignette poster competition at HM12 in San Diego. More than 500 posters were judged this year, the most in competition history.

Research

Title: Veterans Administration Acute Care 30-Day Mortality Model: Development, Validation, and Performance Variation

Team: Eduard Vasilevskis, MD, Annette Christianson, MS, James Deddens, PhD, Siva Sivaganesin, PhD3, Ron Freyberg, MS, Timothy Hofer, MD, MSc, Peter Almenoff, MD, Marta Render, MD; VA Tennessee Valley Healthcare System, Nashville, Tenn.; Department of Veterans Affairs, Cincinnati, University of Cincinnati, Cincinnati, Ohio, Department of Veterans Affairs, Ann Arbor, Mich., Veterans Affairs Medical Center, Kansas City, Mo.

Click here to view the abstract.

Innovation

Title: Accountable Care Unit on a Medical Ward in a Teaching Hospital: A New Care Model Designed To Improve Patient and Hospital Outcomes

Team: Christina Payne, MD, Dapo Odetoyinbo, MD, Bryan Castle, RN, MBA, Amanda Methvin, MD, John Vazquez, MD, Molly Burleson, RN, Dustin Smith, MD, Daniel Dressler, MD, MSc, Jason Stein, MD; Emory University Hospital, Atlanta, Ga., Veterans’ Affairs Medical Center, Atlanta, Ga.

Click here to view the abstract.

Clinical Vignette – Adult

Title: Moo Is the Clue

Team: Rafina Khateeb, MD, Min Jiang, MD, Tejal Gandhi, MD; University of Michigan Health System, Ann Arbor, Mich

Click here to view the abstract.

Clinical Vignette - Pediatric

Title: Rare Cause of Lack of Expected Weight Gain in an Infant

Team: Jonathan Chiles, MD, Christrine Hrach, MD; Washington University, St. Louis, Mo.

Click here to view the abstract.

View all of the 2012 RIV abstracts via the HM12 at Hand app.

Jason Carris is editor of The Hospitalist.

ORLANDO – A slowed, rate-controlled infusion of rituximab during a desensitization protocol significantly reduced the number of hypersensitivity reactions compared with faster, standard-rate desensitization infusions.

"The safety of rituximab desensitization was improved using rate-controlled protocols," said Dr. Caroline L. Sokol, who discussed a review of 16 patients who underwent 103 desensitizations at a single U.S. center. The findings prompted her division to switch to rate-controlled infusions for all rituximab desensitization protocols, said Dr. Sokol of the division of allergy and immunology at Massachusetts General Hospital, Boston (J. Allergy Clin. Immunol. 2012;129[suppl.]:AB371).

Hypersensitivity reactions to rituximab primarily occur among patients who receive the drug to treat cancer. Patients who receive rituximab for other indications, such as rheumatoid diseases, rarely have hypersensitivity reactions. The explanation for this difference isn’t clear, Dr. Sokol said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In the series she reviewed, 15 patients received rituximab for cancer and one patient received it to treat multiple sclerosis.

She and her associates also plan to assess the safety of rate-controlled infusions for desensitization to other drugs, including other types of monoclonal antibodies and platinum-containing cancer chemotherapy drugs.

They compared the safety of standard and rate-controlled infusions with rituximab because some cancer patients who receive the drug experience hypersensitivity reactions that are not controllable with antihistamine or steroid pretreatment. These patients must therefore undergo desensitization, a step that usually needs to be repeated every time they start a new course of the drug.

To compare the two infusion protocols, the researchers reviewed the Massachusetts General experience using the rate-control method during 2006-2008 as well as in 2011-2012. Those results were compared against the outcomes using a standard-infusion protocol during 2008-2011.

Among the 103 total rituximab desensitization procedures done on 16 patients during 2006-2012, 75 protocols used the rate-controlled method with a fixed infusion rate that delivered no more than 200 mg/hr of rituximab and 28 used a standard protocol that delivered a fixed fluid volume with varying rituximab concentrations that finished at 320 mg/hr. Most patients underwent desensitization with each of the two methods at some point during the 6 years included in the review. The average age of the 16 patients was 51 years, and they were equally split between men and women.

The 75 rate-controlled desensitizations resulted in 13 hypersensitivity reactions (17%), including 6 mild reactions, 5 moderate, and 2 severe. The 28 standard desensitizations produced eight reactions (29%), a statistically significant difference compared with the rate-control incidence, and included two mild, five moderate, and one severe reaction, Dr. Sokol reported.

The reaction rate was highest in three patients who converted from rituximab skin-test negative to skin-test positive during the course of their 28 desensitization protocols. Hypersensitivity reactions occurred in nine of these 28 protocols (32%). In contrast, the reaction rate was 19% in patients who remained skin-test negative throughout their desensitizations. Among those who remained consistently skin-test positive, the reaction rate was 16%, she said.

Dr. Sokol said that she had no disclosures.

ORLANDO – A slowed, rate-controlled infusion of rituximab during a desensitization protocol significantly reduced the number of hypersensitivity reactions compared with faster, standard-rate desensitization infusions.

"The safety of rituximab desensitization was improved using rate-controlled protocols," said Dr. Caroline L. Sokol, who discussed a review of 16 patients who underwent 103 desensitizations at a single U.S. center. The findings prompted her division to switch to rate-controlled infusions for all rituximab desensitization protocols, said Dr. Sokol of the division of allergy and immunology at Massachusetts General Hospital, Boston (J. Allergy Clin. Immunol. 2012;129[suppl.]:AB371).

Hypersensitivity reactions to rituximab primarily occur among patients who receive the drug to treat cancer. Patients who receive rituximab for other indications, such as rheumatoid diseases, rarely have hypersensitivity reactions. The explanation for this difference isn’t clear, Dr. Sokol said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In the series she reviewed, 15 patients received rituximab for cancer and one patient received it to treat multiple sclerosis.

She and her associates also plan to assess the safety of rate-controlled infusions for desensitization to other drugs, including other types of monoclonal antibodies and platinum-containing cancer chemotherapy drugs.

They compared the safety of standard and rate-controlled infusions with rituximab because some cancer patients who receive the drug experience hypersensitivity reactions that are not controllable with antihistamine or steroid pretreatment. These patients must therefore undergo desensitization, a step that usually needs to be repeated every time they start a new course of the drug.

To compare the two infusion protocols, the researchers reviewed the Massachusetts General experience using the rate-control method during 2006-2008 as well as in 2011-2012. Those results were compared against the outcomes using a standard-infusion protocol during 2008-2011.

Among the 103 total rituximab desensitization procedures done on 16 patients during 2006-2012, 75 protocols used the rate-controlled method with a fixed infusion rate that delivered no more than 200 mg/hr of rituximab and 28 used a standard protocol that delivered a fixed fluid volume with varying rituximab concentrations that finished at 320 mg/hr. Most patients underwent desensitization with each of the two methods at some point during the 6 years included in the review. The average age of the 16 patients was 51 years, and they were equally split between men and women.

The 75 rate-controlled desensitizations resulted in 13 hypersensitivity reactions (17%), including 6 mild reactions, 5 moderate, and 2 severe. The 28 standard desensitizations produced eight reactions (29%), a statistically significant difference compared with the rate-control incidence, and included two mild, five moderate, and one severe reaction, Dr. Sokol reported.

The reaction rate was highest in three patients who converted from rituximab skin-test negative to skin-test positive during the course of their 28 desensitization protocols. Hypersensitivity reactions occurred in nine of these 28 protocols (32%). In contrast, the reaction rate was 19% in patients who remained skin-test negative throughout their desensitizations. Among those who remained consistently skin-test positive, the reaction rate was 16%, she said.

Dr. Sokol said that she had no disclosures.

ORLANDO – A slowed, rate-controlled infusion of rituximab during a desensitization protocol significantly reduced the number of hypersensitivity reactions compared with faster, standard-rate desensitization infusions.

"The safety of rituximab desensitization was improved using rate-controlled protocols," said Dr. Caroline L. Sokol, who discussed a review of 16 patients who underwent 103 desensitizations at a single U.S. center. The findings prompted her division to switch to rate-controlled infusions for all rituximab desensitization protocols, said Dr. Sokol of the division of allergy and immunology at Massachusetts General Hospital, Boston (J. Allergy Clin. Immunol. 2012;129[suppl.]:AB371).

Hypersensitivity reactions to rituximab primarily occur among patients who receive the drug to treat cancer. Patients who receive rituximab for other indications, such as rheumatoid diseases, rarely have hypersensitivity reactions. The explanation for this difference isn’t clear, Dr. Sokol said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In the series she reviewed, 15 patients received rituximab for cancer and one patient received it to treat multiple sclerosis.

She and her associates also plan to assess the safety of rate-controlled infusions for desensitization to other drugs, including other types of monoclonal antibodies and platinum-containing cancer chemotherapy drugs.

They compared the safety of standard and rate-controlled infusions with rituximab because some cancer patients who receive the drug experience hypersensitivity reactions that are not controllable with antihistamine or steroid pretreatment. These patients must therefore undergo desensitization, a step that usually needs to be repeated every time they start a new course of the drug.

To compare the two infusion protocols, the researchers reviewed the Massachusetts General experience using the rate-control method during 2006-2008 as well as in 2011-2012. Those results were compared against the outcomes using a standard-infusion protocol during 2008-2011.

Among the 103 total rituximab desensitization procedures done on 16 patients during 2006-2012, 75 protocols used the rate-controlled method with a fixed infusion rate that delivered no more than 200 mg/hr of rituximab and 28 used a standard protocol that delivered a fixed fluid volume with varying rituximab concentrations that finished at 320 mg/hr. Most patients underwent desensitization with each of the two methods at some point during the 6 years included in the review. The average age of the 16 patients was 51 years, and they were equally split between men and women.

The 75 rate-controlled desensitizations resulted in 13 hypersensitivity reactions (17%), including 6 mild reactions, 5 moderate, and 2 severe. The 28 standard desensitizations produced eight reactions (29%), a statistically significant difference compared with the rate-control incidence, and included two mild, five moderate, and one severe reaction, Dr. Sokol reported.

The reaction rate was highest in three patients who converted from rituximab skin-test negative to skin-test positive during the course of their 28 desensitization protocols. Hypersensitivity reactions occurred in nine of these 28 protocols (32%). In contrast, the reaction rate was 19% in patients who remained skin-test negative throughout their desensitizations. Among those who remained consistently skin-test positive, the reaction rate was 16%, she said.

Dr. Sokol said that she had no disclosures.

All hospitalists have seen the phenomenon of "surgical signature," when different surgeons appear to have different rates of surgical intervention. Residents know different physicians often treat a single condition in varying ways. The losers in practice variation are the patients, learners, and the overall healthcare system.

Mark Shen, MD, the pediatric editor for The Hospitalist and presenter of this Tuesday afternoon session at HM12, said he has gone through the five stages of grief in the past when dealing with different care plans in a hospital setting, finally settling on acceptance. Now, he said it is important to move past acceptance and recognize variations in physician practice. Further, it's critical to understand the unintended consequences of unwarranted variation.

There are many factors in variation, said Dr. Shen. Examples include preference-sensitive care, in which a physician has a particular model that she or he follows that is specific to that physician, and supply-sensitive care, the trend where certain procedures are more frequently utilized when they are more readily available. A specific example of variation is the rate of tonsillectomy between surgeons.

Variation arises easily in medicine because of inherent uncertainty in medicine. Uncertainty arises because of the challenges of defining disease, making a diagnosis, selecting a procedure, observing outcomes, and assessing preferences.

Variation can be mitigated by formal protocols individualized to each patient. An example of successful protocols is modern pediatric oncology, which has dramatically improved patient outcomes.

Takeaways

• Hospitalists must recognize variation in care.
• Addressing variation improves patient care and offers improved utilization of limited healthcare resources.
• There are several approaches to mitigate variation, including practice guidelines.
• Shared decision making with the patient and family will also improve individual patient care.

All hospitalists have seen the phenomenon of "surgical signature," when different surgeons appear to have different rates of surgical intervention. Residents know different physicians often treat a single condition in varying ways. The losers in practice variation are the patients, learners, and the overall healthcare system.

Mark Shen, MD, the pediatric editor for The Hospitalist and presenter of this Tuesday afternoon session at HM12, said he has gone through the five stages of grief in the past when dealing with different care plans in a hospital setting, finally settling on acceptance. Now, he said it is important to move past acceptance and recognize variations in physician practice. Further, it's critical to understand the unintended consequences of unwarranted variation.

There are many factors in variation, said Dr. Shen. Examples include preference-sensitive care, in which a physician has a particular model that she or he follows that is specific to that physician, and supply-sensitive care, the trend where certain procedures are more frequently utilized when they are more readily available. A specific example of variation is the rate of tonsillectomy between surgeons.

Variation arises easily in medicine because of inherent uncertainty in medicine. Uncertainty arises because of the challenges of defining disease, making a diagnosis, selecting a procedure, observing outcomes, and assessing preferences.

Variation can be mitigated by formal protocols individualized to each patient. An example of successful protocols is modern pediatric oncology, which has dramatically improved patient outcomes.

Takeaways

• Hospitalists must recognize variation in care.
• Addressing variation improves patient care and offers improved utilization of limited healthcare resources.
• There are several approaches to mitigate variation, including practice guidelines.
• Shared decision making with the patient and family will also improve individual patient care.

All hospitalists have seen the phenomenon of "surgical signature," when different surgeons appear to have different rates of surgical intervention. Residents know different physicians often treat a single condition in varying ways. The losers in practice variation are the patients, learners, and the overall healthcare system.

Mark Shen, MD, the pediatric editor for The Hospitalist and presenter of this Tuesday afternoon session at HM12, said he has gone through the five stages of grief in the past when dealing with different care plans in a hospital setting, finally settling on acceptance. Now, he said it is important to move past acceptance and recognize variations in physician practice. Further, it's critical to understand the unintended consequences of unwarranted variation.

There are many factors in variation, said Dr. Shen. Examples include preference-sensitive care, in which a physician has a particular model that she or he follows that is specific to that physician, and supply-sensitive care, the trend where certain procedures are more frequently utilized when they are more readily available. A specific example of variation is the rate of tonsillectomy between surgeons.

Variation arises easily in medicine because of inherent uncertainty in medicine. Uncertainty arises because of the challenges of defining disease, making a diagnosis, selecting a procedure, observing outcomes, and assessing preferences.

Variation can be mitigated by formal protocols individualized to each patient. An example of successful protocols is modern pediatric oncology, which has dramatically improved patient outcomes.

Takeaways

• Hospitalists must recognize variation in care.
• Addressing variation improves patient care and offers improved utilization of limited healthcare resources.
• There are several approaches to mitigate variation, including practice guidelines.
• Shared decision making with the patient and family will also improve individual patient care.

The key word in the title of this Tuesday session at HM12 was "change." In 50 years, healthcare expenditures will consume 50% of the U.S. national GDP. Change in hospital medicine has to happen to accommodate this.

Robert Bessler, a former economics graduate, kept the talk interesting and simple enough even for a non-financial physician like myself. As everyone knows, the cost of health care is rapidly rising and will likely be unsustainable. Bressler described hospital medicine economic management as being made up of "three legs of a stool": These legs are the cost of healthcare, the quality of healthcare, and access to healthcare.

Two important occurrences that complicate quality are the aging baby boomers and the obesity epidemic hitting Americans. Access represents the second leg of the "stool," and it's extremely shaky. The demand for care will eventually exceed the professionals ability to provide it, as more patients become insured and some hospitals go bankrupt (an estimated 15% will do so in the next eight years), said Bressler.

Hospitalists will play a major role in the future in the financial health of medical institutions, the third leg of the stool. Bessler called hospitalists the "pit crew leaders" and our turf encompasses "accountable" acute-care episodes.

Takeaways

• The cost of healthcare is unsustainable.
• Quality will play a key role in decreasing costs.
• Access to healthcare will be constrained.
• Accountable acute-care episodes are on hospitalist "turf."

The key word in the title of this Tuesday session at HM12 was "change." In 50 years, healthcare expenditures will consume 50% of the U.S. national GDP. Change in hospital medicine has to happen to accommodate this.

Robert Bessler, a former economics graduate, kept the talk interesting and simple enough even for a non-financial physician like myself. As everyone knows, the cost of health care is rapidly rising and will likely be unsustainable. Bressler described hospital medicine economic management as being made up of "three legs of a stool": These legs are the cost of healthcare, the quality of healthcare, and access to healthcare.

Two important occurrences that complicate quality are the aging baby boomers and the obesity epidemic hitting Americans. Access represents the second leg of the "stool," and it's extremely shaky. The demand for care will eventually exceed the professionals ability to provide it, as more patients become insured and some hospitals go bankrupt (an estimated 15% will do so in the next eight years), said Bressler.

Hospitalists will play a major role in the future in the financial health of medical institutions, the third leg of the stool. Bessler called hospitalists the "pit crew leaders" and our turf encompasses "accountable" acute-care episodes.

Takeaways

• The cost of healthcare is unsustainable.
• Quality will play a key role in decreasing costs.
• Access to healthcare will be constrained.
• Accountable acute-care episodes are on hospitalist "turf."

The key word in the title of this Tuesday session at HM12 was "change." In 50 years, healthcare expenditures will consume 50% of the U.S. national GDP. Change in hospital medicine has to happen to accommodate this.

Robert Bessler, a former economics graduate, kept the talk interesting and simple enough even for a non-financial physician like myself. As everyone knows, the cost of health care is rapidly rising and will likely be unsustainable. Bressler described hospital medicine economic management as being made up of "three legs of a stool": These legs are the cost of healthcare, the quality of healthcare, and access to healthcare.

Two important occurrences that complicate quality are the aging baby boomers and the obesity epidemic hitting Americans. Access represents the second leg of the "stool," and it's extremely shaky. The demand for care will eventually exceed the professionals ability to provide it, as more patients become insured and some hospitals go bankrupt (an estimated 15% will do so in the next eight years), said Bressler.

Hospitalists will play a major role in the future in the financial health of medical institutions, the third leg of the stool. Bessler called hospitalists the "pit crew leaders" and our turf encompasses "accountable" acute-care episodes.

Takeaways

• The cost of healthcare is unsustainable.
• Quality will play a key role in decreasing costs.
• Access to healthcare will be constrained.
• Accountable acute-care episodes are on hospitalist "turf."

The future of hospital medicine is rooted in the accountability of its practitioners, the new SHM president said Tuesday morning at the Society of Hospital Medicine’s annual meeting.

Shaun Frost, MD, SFHM, FACP, chief medical officer for the Northeast region for Cogent HMG, used his inaugural address at the HM12 award ceremony as a clarion call for HM leaders to view personal and professional accountability as a challenge.

“Delivering genuine results is now what we definitely must do, because the train that is healthcare reform has clearly left the station,” he said. “If we don’t jump aboard this train by delivering tangible and measurable results through true quality performance improvements and honest cost containment, I’m afraid that the consequences could be disastrous for our hospitals, for our communities, for us individually, and for the profession of hospital medicine.”

Dr. Frost said that providing evidence-based improvements will solidify the specialty’s status as a “successful historical improvement to the practice of medicine.” HM leaders who have prided themselves on leading the push for quality have done an admirable job of becoming change agents at their institutions over the past 15 years, said Dr. Frost. And now, he added, the field's reputation is staked to the next wave of reform.

“It’s time for each of us to put our money where our mouths have been,” he said.

Adds outgoing society president Joseph Ming-Wah Li, MD, SFHM: “Expectations are higher than ever for hospital medicine and for SHM … can we meet those expectations? What’s the story that’s going to be told about hospital medicine and SHM five, 10 years from now?”

The future of hospital medicine is rooted in the accountability of its practitioners, the new SHM president said Tuesday morning at the Society of Hospital Medicine’s annual meeting.

Shaun Frost, MD, SFHM, FACP, chief medical officer for the Northeast region for Cogent HMG, used his inaugural address at the HM12 award ceremony as a clarion call for HM leaders to view personal and professional accountability as a challenge.

“Delivering genuine results is now what we definitely must do, because the train that is healthcare reform has clearly left the station,” he said. “If we don’t jump aboard this train by delivering tangible and measurable results through true quality performance improvements and honest cost containment, I’m afraid that the consequences could be disastrous for our hospitals, for our communities, for us individually, and for the profession of hospital medicine.”

Dr. Frost said that providing evidence-based improvements will solidify the specialty’s status as a “successful historical improvement to the practice of medicine.” HM leaders who have prided themselves on leading the push for quality have done an admirable job of becoming change agents at their institutions over the past 15 years, said Dr. Frost. And now, he added, the field's reputation is staked to the next wave of reform.

“It’s time for each of us to put our money where our mouths have been,” he said.

Adds outgoing society president Joseph Ming-Wah Li, MD, SFHM: “Expectations are higher than ever for hospital medicine and for SHM … can we meet those expectations? What’s the story that’s going to be told about hospital medicine and SHM five, 10 years from now?”

The future of hospital medicine is rooted in the accountability of its practitioners, the new SHM president said Tuesday morning at the Society of Hospital Medicine’s annual meeting.

Shaun Frost, MD, SFHM, FACP, chief medical officer for the Northeast region for Cogent HMG, used his inaugural address at the HM12 award ceremony as a clarion call for HM leaders to view personal and professional accountability as a challenge.

“Delivering genuine results is now what we definitely must do, because the train that is healthcare reform has clearly left the station,” he said. “If we don’t jump aboard this train by delivering tangible and measurable results through true quality performance improvements and honest cost containment, I’m afraid that the consequences could be disastrous for our hospitals, for our communities, for us individually, and for the profession of hospital medicine.”

Dr. Frost said that providing evidence-based improvements will solidify the specialty’s status as a “successful historical improvement to the practice of medicine.” HM leaders who have prided themselves on leading the push for quality have done an admirable job of becoming change agents at their institutions over the past 15 years, said Dr. Frost. And now, he added, the field's reputation is staked to the next wave of reform.

“It’s time for each of us to put our money where our mouths have been,” he said.

Adds outgoing society president Joseph Ming-Wah Li, MD, SFHM: “Expectations are higher than ever for hospital medicine and for SHM … can we meet those expectations? What’s the story that’s going to be told about hospital medicine and SHM five, 10 years from now?”