Ruth Aguiar

Effect of Hospitalist Workload on the Quality and Efficiency of Care

IMPORTANCE Hospitalist physicians face increasing pressure to maximize productivity, which may undermine the efficiency and quality of care. OBJECTIVE To determine the association between hospitalist workload and the efficiency and quality of inpatient care. DESIGN, SETTING, AND PARTICIPANTS We conducted a retrospective cohort study of 20,241 admissions of inpatients cared for by a private hospitalist group at a large academic community hospital system between February 1, 2008, and January 31, 2011. EXPOSURES Daily hospitalist workload as measured by relative value units and patient encounters from the hospitalist billing records. MAIN OUTCOMES AND MEASURES The main outcomes were length of stay (LOS), cost, rapid response team activation, in-hospital mortality, patient satisfaction, and 30-day readmission rates. Key covariates included hospital occupancy and patient-level characteristics. RESULTS The LOS increased as workload increased, particularly at lower hospital occupancy. For hospital occupancies less than 75%, LOS increased from 5.5 to 7.5 days as workload increased. For occupancies of 75% to 85%, LOS increased exponentially above a daily relative value unit of approximately 25 and a census value of approximately 15. At high occupancy (>85%), LOS was J-shaped, with significant increases at higher ranges of workload. After controlling for LOS, cost increased by

Higher 30-day readmission rate for suspicion of ACS : effect of kidney function

111 for each 1-unit increase in relative value unit and

ELIMINATING CREATININE KINASE-MB (CKMB) IN RULING OUT ACUTE MYOCARDIAL INFARCTION (MI) WHEN TROPONIN (TN) IS AVAILABLE CAN LEAD TO SAVING HUNDREDS OF MILLIONS OF HEALTHCARE DOLLARS

205 for each 1-unit increase in census across the range of values. Changes in workload were not associated with the remaining outcomes. CONCLUSIONS AND RELEVANCE Increasing hospitalist workload is associated with clinically meaningful increases in LOS and cost. Although our findings should be validated in different clinical settings, our results suggest the need for methods to mitigate the potential negative effects of increased hospitalist workload on the efficiency and cost of care.

Usefulness of Pharmacy Claims for Medication Reconciliation in Primary Care

Current evidence suggests prolonged hospitalization for Acute Coronary Syndrome (ACS) in the setting of chronic kidney disease (CKD). What remains unclear is the impact of CKD on 30-day readmission rate for suspected ACS. All patients who came to the emergency department (ED) from 2004 to 2010 and

Using aggregated pharmacy claims to identify primary nonadherence.

According to the Joint ESC/ACC/AHA/WHF Task Force, Tn is the preferred biomarker for the diagnosis of acute MI. However, it is still common practice to order both serial CKMB and Tn to rule out acute MI. Our hypothesis is that most clinicians only use Tn and not CKMB in further management decisions