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"Wachter, Robert M."
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Zero to 50,000 — The 20th Anniversary of the Hospitalist
In the past 20 years, the number of hospitalists in the United States has grown from a few hundred to more than 50,000. Although challenges remain, many stars have aligned to enable the model to thrive and contribute to high-quality, efficient inpatient care.
Twenty years ago, we described the emergence of a new type of specialist that we called a “hospitalist.”
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Since then, the number of hospitalists has grown from a few hundred to more than 50,000 (see graph) — making this new field substantially larger than any subspecialty of internal medicine (the largest of which is cardiology, with 22,000 physicians), about the same size as pediatrics (55,000), and in fact larger than any specialty except general internal medicine (109,000) and family medicine (107,000). Approximately 75% of U.S. hospitals, including all highly ranked academic health centers, now have hospitalists. The field’s rapid growth . . .
Journal Article
Accountability Measures — Using Measurement to Promote Quality Improvement
The authors argue that quality measures in health care should be based on strong evidence that a care process directly improves outcomes, should capture the actual performance of a process, should address a process proximate to the desired outcome, and should not have unintended adverse consequences.
Measuring the quality of health care and using those measurements to promote improvements in the delivery of care, to influence payment for services, and to increase transparency are now commonplace. These activities, which now involve virtually all U.S. hospitals, are migrating to ambulatory and other care settings and are increasingly evident in health care systems worldwide. Many constituencies are pressing for continued expansion of programs that rely on quality measurement and reporting.
In this article, we review the origins of contemporary standardized quality measurement, with a focus on hospitals, where such programs have reached their most highly developed state. We . . .
Journal Article
Comparing frequency of booster vaccination to prevent severe COVID-19 by risk group in the United States
There is a public health need to understand how different frequencies of COVID-19 booster vaccines may mitigate the risk of severe COVID-19, while accounting for waning of protection and differential risk by age and immune status. By analyzing United States COVID-19 surveillance and seroprevalence data in a microsimulation model, here we show that more frequent COVID-19 booster vaccination (every 6–12 months) in older age groups and the immunocompromised population would effectively reduce the burden of severe COVID-19, while frequent boosters in the younger population may only provide modest benefit against severe disease. In persons 75+ years, the model estimated that annual boosters would reduce absolute annual risk of severe COVID-19 by 199 (uncertainty interval: 183–232) cases per 100,000 persons, compared to a one-time booster vaccination. In contrast, for persons 18–49 years, the model estimated that annual boosters would reduce this risk by 14 (10–19) cases per 100,000 persons. Those with prior infection had lower benefit of more frequent boosting, and immunocompromised persons had larger benefit. Scenarios with emerging variants with immune evasion increased the benefit of more frequent variant-targeted boosters. This study underscores the benefit of considering key risk factors to inform frequency of COVID-19 booster vaccines in public health guidance and ensuring at least annual boosters in high-risk populations.
The optimal frequency of COVID-19 booster vaccination is unclear. Here, the authors use a microsimulation model to assess the impact of different vaccine schedules on severe disease and show that regular boosters have large benefits for older and immunocompromised individuals but less so for younger age groups.
Journal Article
Access to Primary Care and Visits to Emergency Departments in England: A Cross-Sectional, Population-Based Study
The number of visits to hospital emergency departments (EDs) in England has increased by 20% since 2007-08, placing unsustainable pressure on the National Health Service (NHS). Some patients attend EDs because they are unable to access primary care services. This study examined the association between access to primary care and ED visits in England.
A cross-sectional, population-based analysis of patients registered with 7,856 general practices in England was conducted, for the time period April 2010 to March 2011. The outcome measure was the number of self-referred discharged ED visits by the registered population of a general practice. The predictor variables were measures of patient-reported access to general practice services; these were entered into a negative binomial regression model with variables to control for the characteristics of patient populations, supply of general practitioners and travel times to health services. MAIN RESULT AND CONCLUSION: General practices providing more timely access to primary care had fewer self-referred discharged ED visits per registered patient (for the most accessible quintile of practices, RR = 0.898; P<0.001). Policy makers should consider improving timely access to primary care when developing plans to reduce ED utilisation.
Journal Article
Revitalizing grand rounds in the time of COVID
COVID presented an opportunity to revolutionize the traditional format of Medical Grand Rounds (MGR). In this
Commentary
, we explore the educational ramifications of shifting MGR virtually with a focus on COVID-related content and its long-term sustainability. This transformation offers an inclusive interdisciplinary approach to sustain learner interest and improve education.
Journal Article
Patient Safety At Ten: Unmistakable Progress, Troubling Gaps
December 1, 2009, marks the tenth anniversary of the Institute of Medicine report on medical errors, To Err Is Human, which arguably launched the modern patient-safety movement. Over the past decade, a variety of pressures (such as more robust accreditation standards and increasing error-reporting requirements) have created a stronger business case for hospitals to focus on patient safety. Relatively few health care systems have fully implemented information technology, and we are finally grappling with balancing \"no blame\" and accountability. The research pipeline is maturing, but funding remains inadequate. Our limited ability to measure progress in safety is a substantial impediment. Overall, I give our safety efforts a grade of B-, a modest improvement since 2004. [PUBLICATION ABSTRACT]
Journal Article
The End Of The Beginning: Patient Safety Five Years After 'To Err Is Human'
The Institute of Medicine's 1999 report on medical errors galvanized the public and health professionals. Before then, providers, health care organizations, and policymakers lacked the understanding and incentives to generate the changes in culture, systems, training, and technology to improve safety. Since 1999 there has been progress, but it has been insufficient. Stronger regulation has helped, as have some early improvements in information technology and in workforce organization and training. Error-reporting systems have had little impact, and scant progress has been made in improving accountability. Five years after the report's publication, we appear to be at \"the end of the beginning.\" [PUBLICATION ABSTRACT]
Journal Article
Delayed Second Dose versus Standard Regimen for Covid-19 Vaccination
This interactive feature about administration of the second dose of Covid-19 vaccine either according to the standard schedule or delayed offers a case vignette accompanied by two essays, each of which recommends a different approach.
Journal Article