Research, Quality Improvement, and Scholarship

    

Our research advances the scientific basis and clinical practice of hospital medicine. We also train, educate, and mentor the next generation of hospital medicine researchers who can advance our scientific mission into the future.

Research Projects

Many hospitalist faculty are actively involved in scholarly pursuits within the field of hospital medicine. Current work includes projects related to:

  • Appropriate use of urinary catheters and associated CAUTI.
  • Appropriate use of antibiotics in hospitalized medical patients.
  • Appropriate use of inpatient nebulizers at the VA.
  • Appropriate use of inpatient daily labs at the VA.
  • Geriatric/Palliative Care inter-professional rounding.
  • Hospitalist-Oncologist Communication.
  • Impact of early mobilization on functional outcomes in patients with severe sepsis who are admitted to the general medicine wards.
  • Improving the efficiency of hospital-based care.
  • Infection prevention and control in acute care hospitals.
  • Physician attire.
  • Less Lumens = Less Risk -multidisciplinary process targeting reducing unnecessary PICC lumens.

Also of note are the following, which are led by Michigan Medicine hospitalists:

Quality Improvement 

Quality Improvement Award

This award provides salary support to one hospitalist each year, to facilitate mentored quality improvement work.

2017-2018 QI Improvement Award Winner

Anupama Goyal, MD
Anupama Goyal, MD

Anupama Goyal, MD

Dr. Goyal's Summary of Work:  Patient satisfaction with medical care during hospitalization is a commonly measured assessment of quality of care and a key component of publicly reported surveys. Studies showing higher overall patient satisfaction have reported lower 30-day hospital readmissions, improved symptom resolution and overall health. Communication failure between patients and providers in hospital settings also lead to patient dissatisfaction. Low-cost interventions, (e.g., bedside whiteboards and face cards), have been used to enhance communication between patients, families and medical teams. Based on the findings of a recently completed systematic review, we found that certain visual tools (whiteboards, pictures of physicians, notepads and patient portals) improve patient recognition of providers and understanding of provider roles. Additionally, studies that examined patient-provider communication and patient satisfaction reported higher rates of both when visual tools were used. Importantly, picture-based tools and whiteboards are not only the most common visual tool used, but also the most promising. However, variability in the format, content and utilization use of these tools in published literature makes finding the “perfect” visual tool or design difficult. Furthermore, no studies have incorporated patient preferences on type of tool (picture vs whiteboards) or the content/template of these visual aids. At our institution, whiteboards are readily available in every inpatient room but are often either inadequately utilized by providers, contain erroneous information or are not made available to patients as a resource to facilitate communication. Improving these tools may not only augment patient-provider co

Our Quality Improvement Initiatives

  • Survey a convenience sample of our patient population (Patient and Family Centered Care has 400 patient advisers). Through this survey, we will answer three key questions:
    (a) do patients prefer to receive communication using visual tools;
    (b) what type of tool/s (e.g., whiteboards in patient room or pictures of providers) do patients prefer to use; and
    (c) what aspects of the tools’ design/content (e.g., name and picture of physician, nurses, goals of care, tests/procedures planned for the day) are most important to patients?
  • Survey hospitalists and nurses on their views regarding use/limitations of such visual tools (including frequency of use, beliefs about information presentation, content and accuracy, and willingness to use this tool as a format to communicate with patients).
  • Triangulate data from these surveys with our learning from the systematic review to develop a novel, patient-informed visual tool that will be pilot-tested on select units and assess influence on patient-provider communication and satisfaction with care. Patient-provider communication and satisfaction will be measured using standardized Likert scales.

Annals for Hospitalists

Since the summer of 2016, the Division has partnered with the Annals of Internal Medicine to create a special feature called “Annals for Hospitalists (AFH).” AFH highlights hospitalist-relevant content from Annals, and brings perspectives from leaders in the field to clinicians, policy-makers, and researchers to everyday hospitalists.

AFH screens Annals for relevant articles and provides succinct summaries tailored to a hospitalist’s perspective. It also points hospitalists to the most relevant ACP Journal Club summaries. Thus, hospitalists no longer need to skim the full table of contents of every Annals issue—AFH does this for them, and delivers exactly what they need, right to their e-mail.

The “crown jewel” of AFH is the Inpatient Notes feature. Inpatient Notes are monthly commentaries written by thought-leaders in the field on issues germane to hospital medicine.These invited commentaries provide readers with insights and views into issues that they might otherwise not fully appreciate or understand.

David Wesorick, MD and Vineet Chopra, MD, MS, serve as feature editors for AFH.

  • You can check out AFH, and sign up for monthly e-mail alerts here.
  • Interested in authoring an Inpatient Note? Pitch your ideas to Drs. Wesorick and Chopra here.

Society of Hospital Medicine 2017 Presentations

Invited Talks

Wednesday, May 3

  • 2:50-4:05 pm — Preventing Common Hospital Infections: A Hospitalist’s How-To Guide to Implementation. Saint S, Vaughn V.

Thursday, May 4

  • 7:40-8:35 am — The Next ‘Aha’ Moment in Hospital Medicine: Where & How to Find It. Gilmartin H, Saint S.
  • 8:20-8:55 am — What Went Wrong? Grant P.
  • 9-9:40 am — Take Your PICC: Choosing the Right Vascular Access. Chopra V.
  • 10-11:30 am — Hospitalists as Leaders in Patient Flow and Hospital Throughput. Kim C, Schleyer A, Berger G, Parekh V.
  • 10:55-11:50 am—Attributes and Behaviors Associated with Exemplary Inpatient Teaching: How Great Attending Physicians Do It. Houchens N, Saint S.
  • 11:15-11:50 am—Bleeding You Dry: Updates to Relieve Transfusion Confusion. Rohde J.

Oral Presentations - Research

Wednesday, May 3

  • 11-11:15 am—Excessive Antibiotic Duration for Pneumonia: Lessons and Opportunities. Vaughn V.
  • 11:30-11:45 am—Risk Score for PICC Venous Thromboembolism. Chopra V.

Poster Presentations - Innovations

Tuesday, May 2, 5:30-7:30 pm

  • Less Lumens = Less Risk. Bozaan DA, Tupps M, Brancaccio A, Arnold P, Friebe S, Skicki D, Paje D, Lopez A, Chopra V.
  • High-Reliability Academic Hospitalist Programs: A Lifecycle of Assessment and Feedback Integrating New and Veteran Faculty. Chang R, Rohde J, Khateeb R, Ward D, Paje D, Mack M.
  • Use of Electronic Tool to Reduce Errors in Inpatient Medication Reconciliation. Heidemann LA, Petrilli CM, Houchens N, Belanger K, Huang L, Lopez AN, Schildhouse RJ, Gupta A, Silver A, Granata J, Solomon G.
  • Electronic Medical Record Sign Out Tool Improvement Project: A Narrative Description of the Effectiveness of The University of Michigan’s House Office Quality and Safety Council. Levy K, Heidemann LA, Morrison RJ, Thompson M, Almendras EG, Chang R.
  • Impact of An Innovative Psychiatric Consultation Liaison Model on Provider Satisfaction When Caring for Behaviorally Complex Patients. Spital L, Goyal AA, Chang R.
  • Early Discharge from An Academic Hospitalist Service—Multiple Sustained Interventions are Necessary for Success. Chang R, Jacobs T, Barazsu K, Thielker J, Parker J, Desmond JS.
  • Trends in Incidence and Liability Costs from Diagnostic Error in Inpatient Settings: Insights from The National Practitioner Data Bank. Chopra V, Gupta A, Kachalia A, Snyder AM, Flanders SA, Saint S.
  • Do Users of Technology Differ from Non-Users in Peripherally Inserted Central Catheter Practice? An Analysis of the PICC1 Survey. Chopra V, Kuhn L, Ratz D, Winter S, Carr P, Paje D, Krein S.
  • Do Bedside Visual Tools Improve Patient and Caregiver Satisfaction? A Systematic Review of the Literature. Goyal AA, Tur K, Mann J, Townsend W, Flanders S, Chopra V.
  • A Contemporary Assessment of Mechanical Complication Rates and Trainee Perceptions of Central Venous Catheter Insertion. Heidemann LA, Chopra V, Sagana R, Heung M.
  • A Risk Tool to Predict Central Line-Associated Bloodstream Infection in Patients with PICCS. Herc E, Patel PK, Conlon A, Bernstein SJ, Flanders SA, Chopra V.
  • If You Build It, They Will Order It...Appropriately: Use of a Telemetry Order Set Improves Adherence to Evidence-Based Practice. Kataruka A, Heidemann LA, Schildhouse RJ, Petrilli CM.
  • Why Order Two When You Can Get One for Half the Price?: Evaluating the Reliability of Point of Care Arterial Blood Gas Electrolyte Measurements for Use in Standard Supplementation Protocols. Levy K, Petrilli CM, Heidemann LA, Chang R, Admon AJ, Schroeder LF.
  • Continuous Blood Collection: A Review of Current CBC Utilization, Provider Survey, and Pilot Intervention at a Large Academic Medical Center. McAleenan K, Shaya J, Smith E, Chen T, Kennedy J, Chang R, Heidemann LA, Johnson M, Durance P, Ellies T, Gosbee J, Petrilli CM.
  • Should We Modify Anticoagulant Venous Thromboembolism Prophylaxis for Underweight Patients? Paje D, Chopra V, Conlon A, Bernstein SJ, Flanders SA.
  • Patterns and Predictors of Short-Term Use of Peripherally Inserted Central Catheters, A Multi-Site Prospective Study. Paje D, Conlon A, Bernstein SJ, Flanders SA, Chopra V.
  • Preoperative Antibiotic Knowledge and Prescribing Practices: A Case for a Centrilized and Standardized Approach. Petrilli CM, Schildhouse RJ, Hausman M, Lake T, Patel PK, Wiseman S, Mack M.
  • Factors Associated with Excess Duration of Antibiotic Therapy for Patients Admitted with Pneumonia in Michigan Hospitals: A Cohort Study. Vaughn VM, Flanders SA, Conlon A, Chopra V, Nielsen D, Malani A, Thyagarajan R, Hsaiky L, Gandhi T.
  • Procalcitonin Utilization in Patients Hospitalized with Pneumonia in Michigan Hospitals: A Cohort Study. Vaughn VM, Gandhi T, Malani A, Thyagarajan R, Conlon A, Nielsen D, Chopra V, Flanders SA.

Poster Presentations - Vignettes

Wednesday, May 3, 12:00-1:30 pm

  • A Drug Interaction Involving Red Yeast Rice. Cho, D.
  • Anchors Away! Fevers in an Immunosuppressed TPN Dependent Patient. Kochhar S, Rohde J.
  • Whoosh! (There it is). Petrilli CM, Bozaan DA, Chopra V.
  • Profound Type B Insulin Resistance. Thanaporn P, Wargo JJ.
  • Antibody Negative Interferon-Induced Autoimmune Hepatitis. Wargo JJ.
  • A Robust and Varied Presentation of Lichen Planus. Wargo JJ, Berg A.
  • Not a Routine Case of Recurrent Cellulitis, Well’s Syndrome. Wargo JJ, McQuillan M.
  • Micturition-Associated Hypertension—A Different Kind of Hypertensive Urgency. Wilson S, Kozlansky G, Schuler EP, Chang R.
  • Pylephlebitis: The Clinical Complexities and Call for Collaboration. Xiong T.

Other Publications

  • Arain MA et al. Sepsis Trial of Early Physical Therapy Outside the ICU (STEP TO IT). Healthcare Administration Scholars Program Graduation Banquet, 4/2017
  • Liss, D, Michael Mullins, Mitchell McGill, Evan Schwarz, Kurt Eifling, and Anna Arroyo-Plasencia. "False Positive Cocaine Immunoassay Screen in a Patient Taking Levomilnacipran." In CLINICAL TOXICOLOGY, vol. 54, no. 8, pp. 722-722
  • Wesorick, D. H., Brotman, D. J., Jaffe, C., Berg, A., Chan, M. P. and Houchens, N. (2016), Painful losses. J. Hosp. Med., 11: 730–734. doi: 10.1002/jhm.2610
  • Gilliam M, Krein SL, Belanger K, Fowler KE, Dimcheff DE, Solomon G. Novel combined patient instruction and discharge summary tool improves timeliness of documentation and outpatient provider satisfaction. SAGE Open Med. 2017 Mar 29
  • Emmer BT, Ginsburg D, and Desch KC. VWF and ADAMTS13: Too much or too little of a good thing? Arteriosclerosis, Thrombosis, and Vascular Biology, 36:2281-2282 (2016)
  • Cohn SL, Dutta S, Slawski BA, Grant PJ, Smetana GW. Update in Perioperative Cardiac Medicine. Cleveland Clinic Journal of Medicine. 2016;83(10):723-730
  • Petrilli CHeidemann L, Durance P, Mack MChopra V. Things We Do For No Reason: Inpatient Thrombophilia Testing. J Hosp Med, 2016. 11(11): p.801-4
  • Petrilli CMHeidemann LMack M, Durance P, Chopra V, Inherited Thrombophilia Testing. J. Hosp. Med 2016;11;801-804. doi:10.1002/jhm.2616
  • Kurlander JE, Kolbe M, Scheiman JM, Weissman A, Piette JD, Rubenstein JH, Waljee AK. The Right Idea for the Wrong Patient: Results of a National Survey on Stopping PPIs. Saini SD Clin Gastroenterol Hepatol 2017
  • Nichani S, Fitterman N, Lukela M, Crocker J. The Core Competencies in Hospital Medicine 2017 Revisions. Introduction, Sections 1, 2 & 3. J Hosp Med. 2017 Apr;12(4 Suppl 1): 283-287, S1-S82.
  • Chopra, V., Kuhn, L., Ratz, D., Winter, S., Carr, P.J., Paje, D. and S.L. Krein. Variation in use of technology among vascular access specialists: an analysis of the PICC1 survey. J Vasc Access 2017
  • Barnes, G.D. and D. Paje. Inpatient Notes: Oral Anticoagulation for the Hospitalist. Expanded Choices Improve Patient-Centered Care. Ann Intern Med 2016;165(6):HO2-HO3
  • Paje, D. Chapter 27: Anticoagulation. Textbook of Observation Medicine. Ed. Sharon Mace. Cambridge University Press, April 2017
  • Paje, D. Chapter 26: Acute Pulmonary Embolism. Textbook of Observation Medicine. Ed. Sharon Mace. Cambridge University Press, April 2017
  • Paje, D. and P. Watson. Chapter 10: Observation Medicine and the Hospitalist. Textbook of Observation Medicine. Ed. Sharon Mace. Cambridge University Press, April 2017
  • Petrilli CM, Del Valle J, Chopra V. Why July Matters. Acad Med. 2016 Jul;91(7):910-2
  • Levy KVoit JGupta APetrilli CMChopra VExamining the July Effect: A National Survey of Academic Leaders in Medicine.Am J Med. 2016 Jul;129(7):754.e1-5
  • Keefer P, Lehmann K, Shanley M, Woloszyk T, Khang E, Luckritz K, Saul D. Single-Center Experience Providing Palliative Care to Pediatric Patients with End-Stage Renal Disease. J Palliat Med 2017
  • Zhabenko O, Austic E, Conroy DA, Ehrlich P, Singh V, Epstein-Ngo Q, Cunningham RM, Walton MA. Substance Use as a Risk Factor for Sleep Problems Among Adolescents Presenting to the Emergency Department. Journal of Addiction Medicine, 2016 Sep-Oct;10(5):331-8
  • Woods CEShang CTaghavi FDowney PZalewski ARubio GRLiu JHomburger JRGrunwald ZQi WBollensdorff C, Thanaporn PAli ARiemer RKKohl PMochly-Rosen DGerstenfeld ELarge SAli ZAAshley EACirculation. 2016 Sep 27;134(13):961-77
  • Keefer P, Orringer K, Vredeveld J, Warrier K, Burrows H. Developing a quality improvement and patient safety toolbox: the curriculum. MedEdPORTAL Publications. 2016;12:10385
  • Booms S, Hill E, Kulhanek L, Vredeveld J, Gregg B. Case Reports of Voluntary Dietary Restrictions Causing Iodine Deficiency-Induced Hypothyroidism in the United States. Pediatrics. 2016 Jun;137(6)
  • Haque F, Daniel M, Clay M, Vredeveld J, Santen S, House JB. The Interprofessional Clinical Experience: introduction to interprofessional education through early immersion in health care teams. MedEdPORTAL Publications. 2017;13:10564
  • Pasquel F,  Gianchandani R, Rubin D,  Dungan K, Anzola I,  Gomez P, Peng L, Hodish I, Bodnar T,  Wesorick D, Balakrishnan V, Osei K, Umpierrez G. Efficacy of sitagliptin for the hospital management of general medicine and surgery patients with type 2 diabetes (Sita-Hospital): a multicentre, prospective, open-label, non-inferiority randomised trial. The Lancet Diabetes & Endocrinology , Volume 5 , Issue 2 , 125 - 133

 

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