Faculty Bibliography

RATIONALE/BACKGROUND:During the coronavirus disease pandemic, audio-only and video telehealth visits became more widely available, but the relative patient satisfaction between telehealth and in-person modalities is not well-described. AIMS AND OBJECTIVES/OBJECTIVE:Our objective was to compare patient satisfaction with audio-only, video, and in-person adult primary care visits at a large, urban public healthcare system. METHODS:In this cross-sectional study, we used aggregated data from Press Ganey patient satisfaction surveys at 17 primary care facilities at New York City Health + Hospitals for visits between 1 June 2021 to 30 November 2021. We compared mean scores for questions common to surveys for each modality in domains of Access, Care Provider, and Overall Assessment using pairwise comparisons with two-tailed t-tests. RESULTS:There were 7,183/79,562 (9.0%) respondents for in-person visits and 1,009/15,092 (6.7%) respondents for telehealth visits. Compared to respondents for in-person visits, respondents for telehealth visits were more likely to be aged 35-64 years, Asian, and speak English as their primary language, and less likely to be ≥65 years old, Black or other race, and speak Spanish or another language as their primary language (p < 0.001). Patients reported higher mean satisfaction for Access measures for telehealth visits than in-person visits (p < 0.001). For Care Provider satisfaction questions, video visits generally had higher mean scores than in-person and, in turn, audio-only visits. For Overall Assessment questions, video visits had higher mean scores than in-person and, subsequently, audio-only visits. CONCLUSION/CONCLUSIONS:Of the visit modalities, video visits had the highest mean satisfaction scores across all domains. Telehealth may improve experiences with access, but audio-only visits may provide poorer visit experiences.

BACKGROUND AND OBJECTIVES/OBJECTIVE:Contrast-associated AKI may result in higher morbidity and mortality. Intravenous fluid administration remains the mainstay for prevention. There is a lack of consensus on the optimal administration strategy. We studied the association of periprocedure fluid administration with contrast-associated AKI, defined as an increase in serum creatinine of at least 25% or 0.5 mg/dl from baseline at 3-5 days after angiography, and 90-day need for dialysis, death, or a 50% increase in serum creatinine. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS/METHODS:We conducted a secondary analysis of 4671 PRESERVE participants who underwent angiographic procedures. Although fluid type was randomized, strategy of administration was at the discretion of the clinician. We divided the study cohort into quartiles by total fluid volume. We performed multivariable logistic regression, adjusting for clinically important covariates. We tested for the interaction between fluid volume and duration of fluid administration, categorized as <6 or ≥6 hours. RESULTS:. The range of fluid administered was 89-882 ml in quartile 1 and 1258-2790 ml in quartile 4. Compared with the highest quartile (quartile 4) of fluid volume, we found a significantly higher risk of the primary outcome in quartile 1 (adjusted odds ratio, 1.58; 95% confidence interval, 1.06 to 2.38) but not in quartiles 2 and 3 compared with quartile 4. There was no difference in the incidence of contrast-associated AKI across the quartiles. The interaction between volume and duration was not significant for any of the outcomes. CONCLUSIONS:We found that administration of a total volume of 1000 ml, starting at least 1 hour before contrast injection and continuing postcontrast for a total of 6 hours, is associated with a similar risk of adverse outcomes as larger volumes of intravenous fluids administered for periods >6 hours. Mean fluid volumes <964 ml may be associated with a higher risk for the primary outcome, although residual confounding cannot be excluded.

BACKGROUND:Accurately identifying the number of practicing hospitalists across the United States continues to be a challenge. Characterizing the workforce is important in the context of healthcare reforms and public reporting. OBJECTIVE:We sought to estimate the number of adult hospitalists practicing in the United States over an 8-year period, to examine patterns in growth, and begin to explore billing patterns. DESIGN, SETTINGS, AND PARTICIPANTS/METHODS:Retrospective study using national Medicare Part B claims datasets. We applied a commonly used 90% threshold of billing hospital visit-associated Healthcare Common Procedure Coding System codes to identify adult hospitalists in publicly available Medicare Provider Utilization and Payment data for 2012-2019. We then analyzed billing patterns for those identified hospitalists. MAIN OUTCOMES AND MEASURES/METHODS:Identify trends in the number of identified adult hospitalists, including those self-identified. Compare hospitalists' billing to that of non-hospitalist Internal Medicine and Familiy Medicine physicians. RESULTS:We saw more than a 50% growth rate of practicing adult hospitalists between 2012 and 2019. In 2019, we identified 44,037 adult hospitalists. CONCLUSIONS:The number of adult hospitalists continued to grow at a consistent rate, such that hospitalists are in the top five largest physician specialties in the United States. In the absence of more formal identification and consistent use by hospitalists, a threshold continues to be a meaningful tool to characterize the workforce.

CONTEXT:As of 2015, an estimated 116000 New York City (NYC) residents had chronic hepatitis C, many of them undiagnosed. Although effective medications have been available since 2014 with the advent of direct-acting antivirals, provider-based barriers to treatment remain. The NYC Department of Health and Mental Hygiene (Health Department) coordinated the Hepatitis C Clinical Exchange Network (HepCX) from 2015 to 2019. The main goal of HepCX was to promote hepatitis C screening and treatment by hospital-based providers. PROGRAM:The Health Department recruited hepatitis C champions (Champions) from acute care hospitals (n = 40) to promote improved hepatitis C care at their institutions. The Health Department provided technical assistance for hospitals to improve electronic medical record (EMR) systems and implement reflex RNA testing, coordinated trainings to increase capacity to treat hepatitis C, and distributed dashboards containing facility-specific testing and treatment metrics. IMPLEMENTATION:By the end of the project period (2019), most hospitals (36/40; 90%) reported having a screening alert for baby boomers in their EMR system and 34 (85%) reported performing reflex RNA testing after a positive hepatitis C antibody test. The Health Department coordinated opportunities for Champions to share their work with providers from network hospitals at meetings and webinars and provided clinical education on hepatitis C treatment in partnership with a local nonprofit organization focused on liver health. Facility-specific dashboards were distributed annually to hospital leadership. RNA confirmation testing increased from an average of 57% in 2015 to 85% in 2018. Treatment initiation rates remained similar over 2 years, averaging 39% in 2017 and 38% in 2018. DISCUSSION:HepCX was a multipronged initiative designed to promote hepatitis C testing and treatment initiation among providers at NYC acute care hospitals. Improvements were observed in confirmatory testing rates; however, treatment initiation rates did not change. Further efforts should be targeted to hospitals in need of additional resources for linkage to care and treatment of hepatitis C.