Journal of general internal medicine
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Hospitalization is a "reachable" moment to engage people in addiction care. Addiction consult services (ACSs) have been shown to improve outcomes for hospitalized patients with substance use disorders (SUDs). Despite this, most hospital systems do not provide hospital-based addiction care or have an ACS. ⋯ Barriers to ACS implementation are common and significant and the process of obtaining leadership support for implementation is often long and iterative. Broad adoption of ACSs will require support from hospital systems and policymakers including incentives, funding, and infrastructure to support clinical champions.
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Our purpose was to evaluate the characteristics of highly and poorly rated teachers as well as to assess the validity and reliability of those evaluations. ⋯ Most attendings received high ratings, while lower ratings were uncommon. Most teachers receiving lower ratings received more than one, suggesting that lower ratings may be a better discriminator of teaching effectiveness than outstanding ones. Teaching ratings had low inter-rater reliability, suggesting either low validity or that learners value different characteristics in teachers.
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Chronic lower respiratory disease, heart disease, and diabetes have a higher prevalence in rural areas. Previous studies raise concerns that a lower supply of physicians is associated with negative outcomes. ⋯ This study found higher PQI scores for chronic conditions than acute conditions, indicating the need for higher-quality outpatient care to prevent avoidable hospital admissions. Further, Appalachian counties had fewer other healthcare providers and many counties lacked specialist physicians, highlighting significant disparities in healthcare access in Appalachian Ohio.