Field Of Pediatric Hospital Medicine Research Articles

Pediatric Hospital Medicine Needs More Randomized Controlled Trials.

Pediatric Hospital Medicine Needs More Randomized Controlled Trials.

Gender Distribution of Scholarship and Measures of National Recognition in Hospital Medicine.

Our specific aim was to assess the gender distribution of aspects of scholarly productivity and professional standing for pediatric hospital medicine over a 5-year period. We also evaluated for correlation between the makeup of editorial boards, conference planning committees, and chosen content. We reviewed scholarly publications, presentations, editorial boards, planning committees, awardees, and society leadership in pediatric hospital medicine from 2015 to 2019 and determined gender using published methods to assess for differences between observed proportions of women authors and presenters and the proportion of women in the field. The field of pediatric hospital medicine at large is 69% women (95% confidence internal [CI] 68%-71%), and an estimated 57% of senior members are women (95% CI 54%-60%). We evaluated 570 original science manuscripts and found 67% (95% CI 63%-71%) women first authors and 49% (95% CI 44%-53%) women senior authors. We evaluated 1093 presentations at national conferences and found 69% (95% CI 65%-72%) women presenters of submitted content and 44% (95% CI 37%-51%) women presenters of invited content. Senior authorship and invited speaking engagements demonstrated disproportionately low representation of women when compared with senior members of the field (senior authorship, P = .002; invited presenters, P < .001). Strong positive correlation between gender composition of conference planning committees and selected content was also noted (r = 0.94). Our study demonstrated representative gender distribution for some aspects of scholarly productivity in pediatric hospital medicine; however, a lack of gender parity exists in senior roles.

How Should Pediatric Residents Prepare for a Career in Pediatric Hospital Medicine?

How Should Pediatric Residents Prepare for a Career in Pediatric Hospital Medicine?

Reducing PICC Placement in Pediatric Osteomyelitis: A Diamond in the Deimplementation Rough?

Reducing PICC Placement in Pediatric Osteomyelitis: A Diamond in the Deimplementation Rough?

Going Virtual Amid a Pandemic: Perspectives on a Web-Based Hospital Medicine Conference.

In 2018, pediatric hospitalists at several New England institutions established a regional pediatric hospital medicine conference to facilitate collaboration and communication of advances in the field of pediatric hospital medicine. Planning committee members were recruited from pediatric hospital medicine programs from all six New England states, including multiple community sites, to ensure adequate representation and breadth of impact. The first conference was held in person in June 2019 in Boston, Massachusetts, and contained a full day of original content, including several concurrent lectures and workshops, a keynote address, a poster session, and a clinicopathological conference sponsored by Massachusetts General Hospital. Supported by favorable feedback from >100 attendees of the first conference, the planning committee decided to establish the New England Pediatric Hospital Medicine (NEPHM) conference thereafter as an annual event. While we were planning the NEPHM 2020 conference, the novel coronavirus disease 2019 (COVID-19) became a global pandemic. After surveying members of the planning committee and the conference speakers, we elected to change the format of the conference to an entirely Web-based platform. Various forms of virtual delivery have been successfully used in health care1,2 and medical education.3 Although there is some precedent for online health care conferences,4 organizing an entirely virtual forum was a novel and unfamiliar process for the planning committee. We describe here our experience with this transition and the challenges and opportunities it presented, including feedback from participants and presenters. By early 2020, the planning committee had already completed the call for lecture and workshop proposals, and a final schedule for the in-person conference …

Career Motivators for Community Pediatric Hospitalists.

Within the field of pediatric hospital medicine, physicians can choose to work at community-based or university-based centers. The factors that motivate pediatric hospitalists to work specifically at community sites have not yet been fully explored. Our objective with this study was to elucidate the motivators for pediatric hospitalists to begin and continue work at community sites. A qualitative study was performed via phone-based focus groups. Physicians were included if they were able to attend 1 of the offered group sessions and they self-identified as spending the majority of their time working as community-based pediatric hospitalists. Data were analyzed through a constant comparative analysis. Five themes emerged regarding factors that motivate pediatricians to begin and continue their careers as hospitalists in the community. The themes were (1) professional impact, (2) scope of practice, (3) personal and professional satisfaction, (4) community involvement, and (5) job availability. This study reveals the key factors that motivate community pediatric hospitalists to begin and continue working in the community.

The Creation of a Pediatric Hospital Medicine Dashboard: Performance Assessment for Improvement.

Leaders of pediatric hospital medicine (PHM) recommended a clinical dashboard to monitor clinical practice and make improvements. To date, however, no programs report implementing a dashboard including the proposed broad range of metrics across multiple sites. We sought to (1) develop and populate a clinical dashboard to demonstrate productivity, quality, group sustainability, and value added for an academic division of PHM across 4 inpatient sites; (2) share dashboard data with division members and administrations to improve performance and guide program development; and (3) revise the dashboard to optimize its utility. Division members proposed a dashboard based on PHM recommendations. We assessed feasibility of data collection and defined and modified metrics to enable collection of comparable data across sites. We gathered data and shared the results with division members and administrations. We collected quarterly and annual data from October 2011 to September 2013. We found comparable metrics across all sites for descriptive, productivity, group sustainability, and value-added domains; only 72% of all quality metrics were tracked in a comparable fashion. After sharing the data, we saw increased timeliness of nursery discharges and an increase in hospital committee participation and grant funding. PHM dashboards have the potential to guide program development, mobilize faculty to improve care, and demonstrate program value to stakeholders. Dashboard implementation at other institutions and data sharing across sites may help to better define and strengthen the field of PHM by creating benchmarks and help improve the quality of pediatric hospital care.

A practical guide to manuscript writing with particular relevance to the field of pediatric hospital medicine.

Publishing manuscripts in peer-reviewed journals, such as Hospital Pediatrics, is critical for both the academic development of practitioners in pediatric hospital medicine and the scientific advancement of our field. Understanding the purpose of scientific writing and developing a structured approach to the writing process is essential. Doing so will improve the clarity of your work and likely the ease at which your research is published and disseminated throughout the scientific community. The purposes of this article are to detail the structure of a scientific manuscript, to highlight specific writing strategies, and to provide writing tips that may help or hinder publication. Our ultimate goal is to advance the field of pediatric hospital medicine and its growing membership by promoting the dissemination of high-quality research.

Pediatric hospitalists and medical education.

Pediatric hospital medicine (PHM) is moving toward becoming an American Board of Pediatrics (ABP) subspecialty, roughly a decade after its formal inception in 2003. Education has played a central role as the field has evolved. Hospitalists are needed to educate trainees, medical students, residents, fellows, and nurse practitioner and physician assistant students in inpatient pediatric practice. Continuous professional development is needed for hospitalists currently in practice to augment clinical skills, such as providing sedation and placing peripherally inserted central catheter lines, and nonclinical skills in areas such as quality improvement methodology, hospital administration, and health service research. To address the educational needs of the current and future state of PHM, additional training is now needed beyond residency training. Fellowship training will be essential to continue to advance the field of PHM as well as to petition the ABP for specialty accreditation. Training in using adult educational theory, curriculum, and assessment design are critical for pediatric hospitalists choosing to advance their careers as clinician-educators. Several venues are available for gaining advanced knowledge and skill as an educator. PHM clinician-educators are advancing the field of pediatric education as well as their own academic careers by virtue of the scholarly approach they have taken to designing and implementing curricula for unique PHM teaching situations. PHM educators are changing the educational paradigm to address challenges to traditional education strategies posed by duty hour restrictions and the increasing drive to shorten the duration of the hospitalization. By embracing learning with technology, such as simulation and e-learning with mobile devices, PHM educators can address these challenges as well as respond to learning preferences of millennial learners. The future for PHM education is bright.

Quality Improvement Research in Pediatric Hospital Medicine and the Role of the Pediatric Research in Inpatient Settings (PRIS) Network

Pediatric hospitalists care for many hospitalized children in community and academic settings, and they must partner with administrators, other inpatient care providers, and researchers to assure the reliable delivery of high-quality, safe, evidence-based, and cost-effective care within the complex inpatient setting. Paralleling the growth of the field of pediatric hospital medicine is the realization that innovations are needed to address some of the most common clinical questions. Some of the unique challenges facing pediatric hospitalists include the lack of evidence for treating common conditions, children with chronic complex conditions, compressed time frame for admissions, and the variety of settings in which hospitalists practice. Most pediatric hospitalists are engaged in some kind of quality improvement (QI) work as hospitals provide many opportunities for QI activity and innovation. There are multiple national efforts in the pediatric hospital medicine community to improve quality, including the Children’s Hospital Association (CHA) collaboratives and the Value in Pediatrics Network (VIP). Pediatric hospitalists are also challenged by the differences between QI and QI research; understanding that while improving local care is important, to provide consistent quality care to children we must study single-center and multicenter QI efforts by designing, developing, and evaluating interventions in a rigorous manner, and examine how systems variations impact implementation. The Pediatric Research in Inpatient Setting (PRIS) network is a leader in QI research and has several ongoing projects. The Prioritization project and Pediatric Health Information System Plus (PHIS+) have used administrative data to study variations in care, and the IIPE-PRIS Accelerating Safe Sign-outs (I-PASS) study highlights the potential for innovative QI research methods to improve care and clinical training. We address the importance, current state, accomplishments, and challenges of QI and QI research in pediatric hospital medicine; define the role of the PRIS Network in QI research; describe an exemplary QI research project, the I-PASS Study; address challenges for funding, training and mentorship, and publication; and identify future directions for QI research in pediatric hospital medicine.

The Strategic Planning Committee Report: The First Step in a Journey to Recognize Pediatric Hospital Medicine as a Distinct Discipline

The field of pediatric hospital medicine (PHM) has experienced phenomenal growth over the past decade. Academic contributions by pediatric hospitalists include the creation of PHM core competencies,1 national collaborative PHM networks for both research (the Pediatric Research in Inpatient Settings network2) and quality improvement (the Value in Inpatient Pediatrics network3), a robust and well-attended annual scientific meeting,4 and an increasing number of divisions or sections of PHM in pediatric departments across the country. Many pediatricians are choosing to pursue careers in PHM,5,6 and several postgraduate training programs for PHM have emerged.7 Similar to other generalist pediatric fields,8–11 the question as to how best for PHM to evolve as a distinct discipline has arisen. Several training and/or certification options are feasible and have been examined by the pediatric hospitalists who constitute the Strategic Planning (STP) Committee. The objectives of this commentary are to (1) describe the work done to investigate these options to date, (2) provide a framework for evaluating them, and (3) describe next steps. This commentary will neither justify subspecialty status for PHM, which is currently still debated within the field, nor will it compare the development of PHM as a subspecialty with other generalist fields because such a comparison is premature. In an effort to achieve adequate representation among a highly diverse community, a group of hospitalist leaders12 requested volunteers from the PHM community to join the STP Committee in September 2010. In December 2010, STP Committee cochairs were selected from the volunteers. Cochair selection was achieved by consensus among 1 representative from each of the 3 societies of PHM: the American Academy of Pediatrics Section on Hospital Medicine (AAP SOHM), Academic Pediatric Association (APA), and the Society of Hospital Medicine (SHM). The goal of the …

Research in Pediatric Hospital Medicine: How Research Will Impact Clinical Care

Hospitalist medicine has enjoyed a period of rapid growth over the past 10 years and research within this domain is no exception. This article will describe the initial research conducted within the world of pediatric hospital medicine, what the future of research will hold and how this will impact the clinical practice of hospitalists who care for children. This is a review of pertinent literature that represents key progress within the emerging field of pediatric hospital medicine. Research within pediatric hospital medicine has progressed from initial studies defining the emerging field and single-center studies to widely expanding national research networks which aim to prioritize the research needs of the field and use data from multiple centers to enrich the body of evidence that guides clinical practice. The field of pediatric hospital medicine has grown rapidly over the past decade and has an exciting trajectory of ongoing growth and research.

Pediatric Hospitalists in Medical Education: Current Roles and Future Directions

As the field of pediatric hospital medicine has evolved, pediatric hospitalists have become increasingly involved in medical student and resident education--providing direct education during clinical rotations, developing novel curricula to meet the demands of the new educational environment, occupying leadership roles in medical education, and more. The literature suggests that hospitalists possess the essential skills for teaching effectively, yet most hospitalists feel that additional training beyond residency is necessary to refine their knowledge and skills in education and in other essential domains. Several pediatric hospital medicine fellowships and continuing medical education activities have been developed in the last decade to meet this growing need. The recent publication of the Pediatric Hospital Medicine Core Competencies will help define the roles and expectations of practicing pediatric hospitalists, and will serve as a framework for future curriculum development in both graduate and continuing medical education.

Pediatric Hospital Medicine and Children with Medical Complexity: Past, Present, and Future

Children with medical complexity, regardless of underlying diagnoses, share similar functional and resource use consequences, including: intensive service needs, reliance on technology, polypharmacy, and/or home care or congregate care to maintain a basic quality of life, high health resource utilization, and, an elevated need for care coordination. The emerging field of complex care is focused on the holistic medical care of these children, which requires both broad general pediatrics skills and specific expertise in care coordination and communication with patients, families, and other medical and non-medical care providers. Many pediatric hospitalists have developed an interest in care coordination for CMC, and pediatric hospitalists are in an ideal location to embrace complex care. As a result of these factors, complex care has emerged as a field with many pediatric hospitalists at the helm, in arenas ranging from clinical care of these patients, research into their care, and education of future providers. The objective of this section of the review article is to outline the past, present, and possible future of children with medical complexity within several arenas in the field of pediatric hospital medicine, including practice management, clinical care, research, education, and quality improvement.

Pediatric hospital medicine: A strategic planning roundtable to chart the future

Given the growing field of Pediatric Hospital Medicine (PHM) and the need to define strategic direction, the Society of Hospital Medicine, the American Academy of Pediatrics, and the Academic Pediatric Association sponsored a roundtable to discuss the future of the field. Twenty-one leaders were invited plus a facilitator utilizing established health care strategic planning methods. A "vision statement" was developed. Specific initiatives in 4 domains (clinical practice, quality of care, research, and workforce) were identified that would advance PHM with a plan to complete each initiative. Review of the current issues demonstrated gaps between the current state of affairs and the full vision of the potential impact of PHM. Clinical initiatives were to develop an educational plan supporting the PHM Core Competencies and a clinical practice monitoring dashboard template. Quality initiatives included an environmental assessment of PHM participation on key committees, societies, and agencies to ensure appropriate PHM representation. Three QI collaboratives are underway. A Research Leadership Task Force was created and the Pediatric Research in Inpatient Settings (PRIS) network was refocused, defining a strategic framework for PRIS, and developing a funding strategy. Workforce initiatives were to develop a descriptive statement that can be used by any PHM physician, a communications tool describing "value added" of PHM; and a tool to assess career satisfaction among PHM physicians. We believe the Roundtable was successful in describing the current state of PHM and laying a course for the near future.