Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Despite nationally endorsed treatment guidelines and stewardship programs, variation and deviation from evidence-based antibiotic prescribing occur, contributing to inappropriate use and medication-related adverse events. Measures of antibiotic prescribing variability can aid in quantifying this problem but are not adequate. ⋯ We developed and applied a novel metric to quantify diversity in antibiotic prescribing that permits comparisons across hospitals and can be leveraged to identify high-priority areas for local and national stewardship interventions.
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Few rural hospital medicine programs include workforce development training that provides social and professional support for interdisciplinary teams. Even fewer include training that creates supportive learning environments that result in higher staff satisfaction, lower burnout, and reduced turnover. The Acute Inpatient Medicine-High Reliability, Learning Environment, and Workforce Development Initiative (AIM-HI) aims to create supportive learning environments in Veterans Health Administration (VA) rural hospital medicine teams. ⋯ The anticipated impact of AIM-HI is to evaluate the utility of the implementation strategies and assess trends in Playbook intervention outcomes. The Playbook has strong face validity; however, before large-scale adoption across the VA enterprise, it is essential to establish the acceptability, appropriateness, and feasibility of the Playbook and implementation strategies, as well as to gather data on AIM-HI effectiveness.
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Hospital at Home (HaH) programs are used throughout the United States and are beneficial in both providing patients care in environments most comfortable to them and freeing up inpatient beds. Better informing patients about HaH programs, while promoting shared decision-making (SDM), should be prioritized by health systems. SDM apps may promote increased patient agency and understanding of complex HaH care decisions. We previously developed, usability tested, and refined a HaH SDM app. ⋯ SDM apps may better inform patients' HaH care decisions, allowing patients self-directed access to information and engagement with visual content, which may address challenges related to health literacy and navigating complex, time-sensitive decisions.