Journal of general internal medicine
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Editorial
Closer to or Farther away from an Ideal Model of Care? Lessons Learned from Geographic Cohorting.
Geographic "cohorting," "co-location," "regionalization," or "localization" refers to the assignation of a hospitalist team to a specific inpatient unit. Its benefits may be related to the formation of a team and the additional interventions like interdisciplinary rounding that the enhanced proximity facilitates. However, cohorting is often adopted in isolation of the bundled approach within which it has proven beneficial. ⋯ Institutions and inpatient units should work in synergy to shape the day-to-day work which directly affects patient and clinician outcomes-and ultimately culminates in the success or failure of the parent organization. Such synergy can manifest in workflow design and metric selection. Attention to workloads and adopting the principles of continuous quality improvement are also crucial to developing models of care that deliver excellent care.
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Eliminating health disparities among different segments of the US population is an overarching goal of the US Healthy People 2020 objectives. ⋯ Educational and rural-urban disparities in premature mortality widened, whereas Black-White disparities narrowed in the USA between 2007 and 2017, though overall rates remained considerably higher in Black people.
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Serious illness often causes financial hardship for patients and families. Home-based palliative care (HBPC) may partly address this. ⋯ These findings highlight the importance and need for routine assessments of financial distress and for provision of social supports required to help families receiving palliative care services.
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Direct oral anticoagulants such as dabigatran are the preferred anticoagulant in treating atrial fibrillation (AF) patients due to their effectiveness and safety. Whether this applies to severely obese patients needs to be determined. ⋯ Among AF patients with a BMI >40kg/m2 or a weight >120kg in a real-world clinical setting, dabigatran was effective in reducing the risk of thromboembolism and mortality but was associated with an increased risk of bleeding when compared to warfarin. Dabigatran may be a reasonable option for AF patients with severe obesity.
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Despite substantial efforts to counter sexual assault and harassment in the military, both remain persistent in the Armed Services. In February 2021, President Biden directed the U. S. ⋯ Physical health impacts include greater chronic disease burden (e.g., hypertension), and impaired reproductive health and sexual functioning. Advances in treatment include evidence-based psychotherapies and novel approaches relying on mind-body interventions and peer support. Nonetheless, much work is needed to enhance detection, access, care, and support or even the best interventions will not be effective.