Aims: We aimed to improve screening and vaccination rates in hospitalized adults. Background: Com... more Aims: We aimed to improve screening and vaccination rates in hospitalized adults. Background: Community-acquired pneumonia is a serious respiratory tract infection that is a common reason for admission to the hospital. In the United States, pneumonia is the sixth leading cause of death and the primary cause of death from infectious diseases. The proper use of pneumococcal vaccination is up
OBJECTIVES: To study the feasibility and effectiveness of a discharge planning intervention.DESIG... more OBJECTIVES: To study the feasibility and effectiveness of a discharge planning intervention.DESIGN: Quasi-experimental pre–post study design.SETTING: General medicine wards at three hospitals: an academic medical center, a community teaching hospital, and a community-based nonteaching hospital.PARTICIPANTS: All patients aged 65 and older admitted to the hospitalist services.INTERVENTION: The intervention toolkit had five core elements: admission form with geriatric cues, facsimile to the primary care provider, interdisciplinary worksheet to identify barriers to discharge, pharmacist–physician collaborative medication reconciliation, and predischarge planning appointments.MEASUREMENTS: Thirty-day readmission and return to emergency department rates and patient satisfaction with discharge. Odds ratios were determined, and site effects were examined accordig to interaction terms and Breslow Day statistics.RESULTS: Two hundred thirty-seven patients were followed during the preintervention period, and 185 were exposed to the intervention. Patients characteristics were similar across the two time periods. The proportion of patients with high-quality transitions home, measured according to Coleman's Care Transition Measures, increased from 68% to 89% (odds ratio (OR)=3.49, 95% confidence interval (CI)=2.06–5.92). Return to the emergency department within 3 days of discharge was lower in the intervention period (10% vs 3%, OR=0.25, 95% CI=0.10–0.62). At 30 days, there was a lower rate of readmission (22% vs 14%, OR=0.59, 95% CI=0.34–0.97) and fewer visits to the emergency department (21% vs 14%, OR=0.61, 95% CI=0.36–1.03) (P=.06).CONCLUSION: When hospitalized elderly patients are treated with consideration of their specific needs, healthcare outcomes can be improved.
The policy of the American Osteopathic Association (AOA) on the approval of allopathic residency ... more The policy of the American Osteopathic Association (AOA) on the approval of allopathic residency training has evolved since the mid-1980s, when such a policy became necessary because of the low number of osteopathic medical residency positions compared with the number of students graduating from colleges of osteopathic medicine. Resolution 42 (A/2000), the Approval of ACGME (Accreditation Council on Graduate Medical Education) Training as an AOA-Approved Internship, requires that trainees justify a special circumstance requiring them to seek ACGME-accredited training, and complete all rotational requirements of an AOA-approved osteopathic internship.
Aims: We aimed to improve screening and vaccination rates in hospitalized adults. Background: Com... more Aims: We aimed to improve screening and vaccination rates in hospitalized adults. Background: Community-acquired pneumonia is a serious respiratory tract infection that is a common reason for admission to the hospital. In the United States, pneumonia is the sixth leading cause of death and the primary cause of death from infectious diseases. The proper use of pneumococcal vaccination is up
OBJECTIVES: To study the feasibility and effectiveness of a discharge planning intervention.DESIG... more OBJECTIVES: To study the feasibility and effectiveness of a discharge planning intervention.DESIGN: Quasi-experimental pre–post study design.SETTING: General medicine wards at three hospitals: an academic medical center, a community teaching hospital, and a community-based nonteaching hospital.PARTICIPANTS: All patients aged 65 and older admitted to the hospitalist services.INTERVENTION: The intervention toolkit had five core elements: admission form with geriatric cues, facsimile to the primary care provider, interdisciplinary worksheet to identify barriers to discharge, pharmacist–physician collaborative medication reconciliation, and predischarge planning appointments.MEASUREMENTS: Thirty-day readmission and return to emergency department rates and patient satisfaction with discharge. Odds ratios were determined, and site effects were examined accordig to interaction terms and Breslow Day statistics.RESULTS: Two hundred thirty-seven patients were followed during the preintervention period, and 185 were exposed to the intervention. Patients characteristics were similar across the two time periods. The proportion of patients with high-quality transitions home, measured according to Coleman's Care Transition Measures, increased from 68% to 89% (odds ratio (OR)=3.49, 95% confidence interval (CI)=2.06–5.92). Return to the emergency department within 3 days of discharge was lower in the intervention period (10% vs 3%, OR=0.25, 95% CI=0.10–0.62). At 30 days, there was a lower rate of readmission (22% vs 14%, OR=0.59, 95% CI=0.34–0.97) and fewer visits to the emergency department (21% vs 14%, OR=0.61, 95% CI=0.36–1.03) (P=.06).CONCLUSION: When hospitalized elderly patients are treated with consideration of their specific needs, healthcare outcomes can be improved.
The policy of the American Osteopathic Association (AOA) on the approval of allopathic residency ... more The policy of the American Osteopathic Association (AOA) on the approval of allopathic residency training has evolved since the mid-1980s, when such a policy became necessary because of the low number of osteopathic medical residency positions compared with the number of students graduating from colleges of osteopathic medicine. Resolution 42 (A/2000), the Approval of ACGME (Accreditation Council on Graduate Medical Education) Training as an AOA-Approved Internship, requires that trainees justify a special circumstance requiring them to seek ACGME-accredited training, and complete all rotational requirements of an AOA-approved osteopathic internship.
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Papers by John Bulger