Processes and outcomes from a clinical genetics e-consultation service managed by a primary care physician champion.

Purpose: Timely access to clinical genetics consultations remains a barrier to timely genomic medicine services, which new service delivery models might help address.

Methods: We implemented a genetics electronic consultation (eConsult) service staffed by a primary care physician (PCP) champion, supervised by genetics specialists. Chart reviews from July 2018 to January 2022 examined categories of questions received, e-consultant's recommendations, and outcomes of any conventional genetics referrals.

Ambulatory Virtual Care During a Pandemic: Patient Safety Considerations.

Background: The COVID-19 pandemic prompted sudden and fundamental changes in health care, including a rapid rise in the utilization of telehealth services in the ambulatory setting. With the unprecedented and significant decline in traditional office-based visits and procedures, novel patient safety risks and challenges emerged.

Methods: The ambulatory practices at our quaternary care, academic medical center experienced a 200-fold increase in virtual visit volume between February and April 2020.

Association of Physician Characteristics With Early Adoption of Virtual Health Care.

Importance: The rapid transition to virtual health care has depended on physician and patient abilities to adopt new technology and workflows. Physicians transitioning more slowly or not at all could result in access challenges for their patients.

Objective: To identify physician characteristics associated with the transition to virtual health care in a large regional health care system.

Assessing the quality of shared decision making for elective orthopedic surgery across a large healthcare system: cross-sectional survey study.

Background: Clinical guidelines recommend engaging patients in shared decision making for common orthopedic procedures; however, limited work has assessed what is occurring in practice. This study assessed the quality of shared decision making for elective hip and knee replacement and spine surgery at four network-affiliated hospitals.

Methods: A cross-sectional sample of 875 adult patients undergoing total hip or knee joint replacement (TJR) for osteoarthritis or spine surgery for lumbar herniated disc or lumbar spinal stenosis was selected.

Virtual Team Rounding: A Cross-Specialty Inpatient Care Staffing Program to Manage COVID-19 Surges.

Problem: The SARS-CoV-2 (COVID-19) pandemic presented numerous challenges to inpatient care, including overtaxed inpatient medicine services, surges in patient censuses, disrupted patient care and educational activities for trainees, underused providers in certain specialties, and personal protective equipment shortages and new requirements for physical distancing. In March 2020, as the COVID-19 surge began, an interdisciplinary group of administrators, providers, and trainees at Brigham and Women's Hospital created an inpatient virtual staffing model called the Virtual Team Rounding Program (VTRP).

Approach: The conceptual framework guiding VTRP development was rapid-cycle innovation.

Patient characteristics associated with the successful transition to virtual care: Lessons learned from the first million patients.

Introduction: The increased use of telehealth to maintain ambulatory care during the COVID-19 pandemic had potential to exacerbate or diminish disparities in access to care.

Objective: The purpose of this study was to describe patient characteristics associated with successful transition from in-person to virtual care, and video vs audio-only participation.

Methods: This was a retrospective analysis of electronic health record data from all patients with ambulatory visits from 1 October 2019-30 September 2020 in a large integrated health system in the Northeast USA.

Telemedicine Use in Disasters: A Scoping Review.

Disasters have many deleterious effects and are becoming more frequent. From a health-care perspective, disasters may cause periods of stress for hospitals and health-care systems. Telemedicine is a rapidly growing technology that has been used to improve access to health-care during disasters.

A digital embrace to blunt the curve of COVID19 pandemic.

Digital health, virtual care, telehealth, and telemedicine are all terms often used interchangeably to refer to the practice of care delivered from a distance. Because virtual care collapses the barriers of time and distance, it is ideal for providing care that is patient-centered, lower cost, more convenient and at greater productivity. All these factors make virtual care tools indispensable elements in the COVID19 response.

Factors Associated With Increased Collection of Patient-Reported Outcomes Within a Large Health Care System.

Importance: The collection of patient-reported outcomes (PROs) has garnered intense interest, but dissemination of PRO programs has been limited, as have analyses of the factors associated with successful programs.

Objective: To identify factors associated with improving PRO collection rates within a large health care system using a centralized PRO infrastructure.

Design, Setting, And Participants: This cohort study included 205 medical and surgical clinics in the Partners Healthcare system in Massachusetts that implemented a PRO program between March 15, 2014, and December 31, 2018, using a standardized centralized infrastructure.

Utility, Appropriateness, and Content of Electronic Consultations Across Medical Subspecialties.

Background: Electronic consultations (e-consults) can facilitate patient access to specialists, minimize travel, and reduce unnecessary in-person visits. However, metrics to enable study of e-consults and their effect on processes and patient care are lacking.

Objective: To assess novel metrics of e-consult appropriateness and utility.

Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial.

Background: Hospitals are standard of care for acute illness, but hospitals can be unsafe, uncomfortable, and expensive. Providing substitutive hospital-level care in a patient's home potentially reduces cost while maintaining or improving quality, safety, and patient experience, although evidence from randomized controlled trials in the US is lacking.

Objective: Determine if home hospital care reduces cost while maintaining quality, safety, and patient experience.

A Scalable Program for Customized Patient Education Videos.

Problem Definition: Patients must make sense of increasingly complex information to navigate their health and the health care system, with limited opportunity to do so in clinical settings. Patient education videos may help to communicate key information, but they are often impersonal and cumbersome to produce or update with new evidence. To address these limitations, a program was developed to facilitate local video creation to deliver targeted information to patients.

Ten Years, Forty Decision Aids, And Thousands Of Patient Uses: Shared Decision Making At Massachusetts General Hospital.

Shared decision making is a core component of population health strategies aimed at improving patient engagement. Massachusetts General Hospital's integration of shared decision making into practice has focused on the following three elements: developing a culture receptive to, and health care providers skilled in, shared decision making conversations; using patient decision aids to help inform and engage patients; and providing infrastructure and resources to support the implementation of shared decision making in practice. In the period 2005-15, more than 900 clinicians and other staff members were trained in shared decision making, and more than 28,000 orders for one of about forty patient decision aids were placed to support informed patient-centered decisions.

An educational intervention to improve cost-effective care among medicine housestaff: a randomized controlled trial.

Purpose: High medical costs create significant burdens. Research indicates that doctors have little awareness of costs. This study tested whether a brief educational intervention could increase residents' awareness of cost-effectiveness and reduce costs without negatively affecting patient outcomes.

Renal ultrasonography in the evaluation of acute kidney injury: developing a risk stratification framework.

Background: In adult inpatients with acute kidney injury (AKI), clinicians routinely order a renal ultrasonography (RUS) study. It is unclear how often this test provides clinically useful information.

Methods: Cross-sectional study, including derivation and validation samples, of 997 US adults admitted to Yale-New Haven Hospital from January 2005 to May 2009, who were diagnosed as having AKI and who underwent RUS to evaluate elevated creatinine level.

The impact of disclosing financial ties in research and clinical care: a systematic review.

Background: Despite increased demand for disclosure of physician and researcher financial ties (FTs) to industry, little is known about patients', research participants', or journal readers' attitudes toward FTs.

Methods: We systematically reviewed original, quantitative studies of patients', research participants', or journal readers' views about FTs to pharmaceutical and medical device companies. The MEDLINE, Scopus, and Web of Knowledge databases were searched for English-language studies containing original, quantitative data on attitudes toward FTs.

Interpretation of head CT scans in the emergency department by fellows versus general staff non-neuroradiologists: a closer look at the effectiveness of a quality control program.

Prior studies have evaluated discordance rates among radiology residents in interpretation of head computed tomograms (CTs). To our knowledge, there has been no study to compare performance among first-year fellows and more experienced general staff radiologists. This study will compare performances of these groups and evaluate the effect of a redundant system as part of a quality control program.

Update on the diagnostic radiology employment market: findings through 2005.

Objective: The purpose of this study is to analyze and summarize the latest data describing the diagnostic radiologist employment market.

Materials And Methods: Three sources of data--vacancies in academic radiology departments as of July 1, 2005; the ratio of job listings to job seekers at a major placement service; and the number of positions advertised in the American Journal of Roentgenology and Radiology-are presented and compared with previous data.

Results: Vacancies in academic departments averaged 4.