Hospital System Research Articles

A Federated Interoperability Framework for Seamless Health Data Exchange Using FHIR Standards Across Multi-Hospital Systems

In the modern healthcare landscape, seamless and secure exchange of patient health data across disparate hospital systems remains a critical challenge. Existing infrastructures are often siloed, leading to data fragmentation, increased administrative burden, and compromised patient outcomes. This study proposes a Federated Interoperability Framework leveraging Fast Healthcare Interoperability Resources (FHIR) standards to enable seamless, standardized, and secure health data exchange across multi-hospital systems. The framework integrates federated learning principles with robust data governance and compliance mechanisms to maintain data privacy while facilitating real-time interoperability. The proposed architecture consists of modular components including an interoperability gateway, FHIR-based APIs, consent management modules, and distributed data repositories. These components work in harmony to ensure that data remains within its originating institution while enabling dynamic query and access across the network. A consensus-driven validation mechanism ensures the accuracy and consistency of exchanged data. The framework was tested using a simulated environment comprising three hospital systems with varying electronic health record (EHR) platforms. Performance metrics such as latency, data integrity, scalability, and compliance with HL7 FHIR standards were assessed. Results demonstrated over 95% success in data retrieval accuracy, reduced latency by 38% compared to conventional centralized systems, and full adherence to FHIR protocols. Moreover, the federated model significantly reduced the risk of data breaches, as no raw data was transferred. The study underscores the transformative potential of adopting federated interoperability models to advance health information exchange, particularly in large healthcare networks and regional health information organizations (RHIOs). By aligning with global interoperability standards and emphasizing patient-centric data control, the framework supports value-based care delivery, clinical decision support, and population health management. Future work includes real-world implementation across diverse healthcare settings and incorporating advanced security features such as blockchain and homomorphic encryption. This research contributes a scalable, secure, and standards-compliant blueprint for health data interoperability that can be replicated across jurisdictions, ultimately improving patient care and health system efficiency.

Managing the challenges of adolescence through improved family functioning

Adolescence can be a sensitive time encompassing significant, sometimes challenging, changes in an individual's physical, emotional, and social well‐being. This developmental stage can involve challenges for the collective family unit. Caregivers must adjust several aspects of parenting, as the rules and boundaries they established when their child was younger can be the same ones adolescents feel confined by as they continue to develop and mature. This period can be even more challenging for adolescents with mental health challenges. At Bradley Hospital, several programs for adolescents in distress include individual, family, and group outpatient programs, inpatient and partial levels of hospitalization, and intensive outpatient programs. Parents are encouraged to actively engage in treatment in all these modalities, often through family therapy. Family therapy is essential in ensuring sustainable long‐term changes outside the therapy environment. Themes of dysregulation or dysfunction in behavior, communication, and family relationships emerge in family therapy sessions. Understanding these themes and potential solutions can benefit families in and out of the Bradley Hospital system. While families have individual challenges and strengths, caregivers and adolescents identified that open communication and adolescent‐directed conversations support a high sense of family functioning (Bandura et al., 2011).

Enterovirus D68–Associated Respiratory Illness in Children

Enterovirus D68 (EV-D68) typically causes mild to severe acute respiratory illness (ARI). Testing and surveillance for EV-D68 in the US are limited, and important epidemiologic gaps remain. To characterize the epidemiology and clinical severity of EV-D68 among US children seeking care for ARI from 2017 to 2022, using a multisite, active, systematic surveillance network. This cross-sectional study collected data from the New Vaccine Surveillance Network, an active, prospective, population-based surveillance system of emergency departments (EDs) and hospitals at 7 US academic medical centers. Children with ARI and EV-D68-positive results were enrolled during platform-wide EV-D68 testing periods (July to October 2017, July to November 2018, July to November 2020, and July 2021 to December 2022). Included children were aged younger than 18 years, reported 1 or more qualifying ARI symptoms, with a symptom duration less than 14 days at enrollment. Data were analyzed from in October 2024. Laboratory-confirmed EV-D68 infection, including overall infections or those without viral codetection. Trends and characteristics of EV-D68, including demographics, underlying conditions, and clinical severity by health care setting, were explored. Among hospitalized children with EV-D68-positive results without viral codetection, multivariable logistic regression was used to examine factors associated with receipt of (1) supplemental oxygen or (2) intensive care. From 2017 to 2022, 976 children with EV-D68-positive results were identified (median [IQR] age, 47 [18-63] months; 391 [40.1%] female); most were enrolled in 2018 (382 children) and 2022 (533 children). Among these, 856 had no viral codetection, of which 320 were discharged home from the ED (median [IQR] age, 33 [16-59] months; 180 male [56.3%]; 237 [74.1%] with no reported underlying conditions) and 536 were hospitalized (median [IQR] age, 40 [19-69] months; 330 male [61.6%]; 268 [50.0%] with no reported underlying conditions). Among those hospitalized, 199 (37.1%) reported a history of asthma or reactive airway disease (RAD) and 77 (14.4%) reported a condition other than asthma or RAD. Having an underlying condition other than asthma or RAD was associated with increased odds of receiving supplemental oxygen (adjusted odds ratio, 2.72; 95% CI, 1.43-5.18) or intensive care admission (adjusted odds ratio, 3.09; 95% CI, 1.72-5.56); neither age group nor history of asthma or RAD were associated with oxygen receipt or intensive care admission. In this cross-sectional study of children with medically attended EV-D68 infections, EV-D68 was associated with severe disease in otherwise healthy children of all ages, and children with nonasthma or RAD comorbidities were at higher risk for severe outcomes when hospitalized.

Impact of Weight-Based High-Flow Nasal Cannula Flow Limits on Intensive Care Unit Utilization in Bronchiolitis.

Background: High-flow nasal cannula (HFNC) is a common respiratory support device utilized in the management of children hospitalized with bronchiolitis. Early adoption in many pediatric wards was developed using age-based flow limits. However, age-based limits do not align with current evidence and potentially contribute to ICU admissions. To align with current evidence and improve ICU bed allocation, we implemented weight-based flow limits within our wards. The primary objective of this study was to evaluate the impact of these changes on ICU utilization. Methods: This retrospective study was conducted at Children's Medical Center in Plano, Texas, a free-standing, community-based hospital affiliated with an academic quaternary center. Subjects were patients < 2 years of age admitted for bronchiolitis and supported via HFNC in the 12 months before and after implementation of weight-based flow limits. Primary outcomes were ED disposition and ICU transfer rates. Secondary outcomes were evaluation of adverse respiratory events and stay. Results: A total of 1,207 subjects met inclusion criteria; 558 pre- and 649 post-implementation. There were no differences between groups in age, weight, or gender. Compared with the pre-implementation group, we observed an 8.6% absolute decrease in ICU admissions [92 (16.5%) vs 51 (7.9%), P < .001], a 3% absolute decrease in ward to ICU transfers [28 (6%) vs 19 (3%), P = .034], and no difference in escalation of respiratory support [6 (1.1%) vs 4 (0.6%), P = .38] or escalation within one hour of transfer [0 (0%) vs 2 (50%), P > .99]. Overall median stay decreased by 15.9 h in the post-implementation group, [59.4 (IQR 39.1- 85.9) vs 43.5 (IQR 26.9-67.2), P < .001]. Conclusions: These findings suggest that for hospital systems utilizing similar age-based HFNC flow limits, transitioning to weight-based flows, with safeguards in place, may improve ICU bed utilization while maintaining comparable patient outcomes.

Tragedy and Healing: The Impact of Two Black Surgeons in the Jim Crow South.

Tragedy and Healing: The Impact of Two Black Surgeons in the Jim Crow South.

Increasing Goals of Care Review and Fiscal Implications With an Embedded Palliative Care Specialist in the Emergency Department: A Quality Improvement Project at a Community-Based Hospital.

Patients with terminal illnesses presenting to the emergency department (ED) may be admitted to the hospital receiving aggressive treatment that will not reverse the dying process and is not aligned with their wishes. Misdirected, incongruous care negatively impacts the comfort of the patient and increases health care costs. This project aimed to determine if embedding a palliative care nurse practitioner in the ED at a community-based hospital is a meaningful method for addressing goals of care early in the preadmission period, with the potential secondary benefit of improved fiscal health of the system. A preintervention and postintervention EPIC (electronic medical record) review was done to evaluate change in readmission rates, hospice and palliative care referrals, and advance care planning sessions. The target population was adults presenting to the ED with an expected mortality within 6 months. An EPIC-generated report compared how many similar patients, during the same month, 1 year prior (November 2022), explored goals of care in the ED (as evidenced by above measures). Exploring goals of care in the ED for patients with terminal illnesses may lead to a more comfortable death and result in better utilization of resources, reduced unnecessary admissions, and cost savings to the hospital system.

External Validation of the Clinical Obstetric Comorbidity Index across a Diverse Health System.

The clinically-modified obstetric comorbidity index (OB-CMI) is a comorbidity-based scoring system that has been validated to predict severe maternal morbidity (SMM) in a single tertiary, academic hospital using an internal SMM definition. We aimed to validate the OB-CMI for the prediction of SMM as defined by the CDC during delivery admissions across a diverse health system.This is a retrospective cohort study evaluating all deliveries in a large health system encompassing academic and community hospitals. Data from 2019 to 2021 were extracted from the electronic health record (EHR) and validated with chart review. An OB-CMI score was calculated for each patient using established diagnosis codes and EHR data. The primary outcome was nontransfusion SMM (defined by the CDC) during the delivery admission. Patient characteristics were evaluated by the hospital, and hospital-specific receiver-operator characteristic (ROC) curves were constructed and compared.In total, 42,130 deliveries were included with significant differences in all demographic, clinical, and obstetric characteristics across the hospitals including age, BMI, race/ethnicity, insurance type, preterm birth, and preeclampsia rates. Median OB-CMI score and rate of elevated OB-CMI score (≥6) were also significantly different. ROC curves for OB-CMI and SMM for each hospital are noted in the figure with an area under the curve range from 0.77 to 0.83, and no significant differences across hospitals (p = 0.32).In a large cohort of patients delivering across a diverse hospital system, the clinical OB-CMI score similarly predicted SMM despite differences in demographic and clinical characteristics among the hospitals. This validation of the OB-CMI supports the use of this scoring system in variegated clinical settings, which can inform widescale uptake and clinical integration of OB-CMI scoring to improve obstetric risk stratification. · The clinically-modified OB-CMI consistently predicted nontransfusion SMM across multiple hospitals.. · This OB-CMI can be used for obstetric risk stratification across different clinical settings.. · Future research should explore the impact of using the OB-CMI to mitigate risk in clinical practice..

Physician Perspectives on Z Codes for Social Determinants of Health Screening.

Health settings are increasingly assessing and addressing health-related social needs. ICD-10 Z codes are billing codes for social determinants of health (SDOH), but represent a novel opportunity to document social needs given their ubiquity; yet they are seldom used. Little work has explored physician perspectives on the utility of Z codes for social needs documentation. To elucidate physician understandings of Z codes and their perspectives on Z codes' utility in documenting patients' health-related social needs. Semi-structured qualitative interviews. Physicians at high Z-coding hospitals in New Jersey (n = 18). Deductive and inductive thematic content and cross-case analysis. Physicians assessed social needs. History taking and physician specialty influenced when needs were identified and documented. Needs most often came up in discharge planning. Physicians recognized their important role in ensuring social needs would be documented, but were unsure of what to do when a patient identified these needs. Physicians lacked explicit knowledge about Z codes and often would accidentally use them by "diagnosing" health-related social needs in the problem list. Hospital systems, SDOH screening, and reimbursement all influenced Z-coding; participants could not describe a systematic screening or documentation process at any hospital. Ultimately, Z codes were viewed as a tool to connote complexity and seek higher reimbursement. Z codes are ubiquitous across electronic medical records and represent an opportunity to document health-related social needs across settings. Physicians reported using them primarily as billing codes to document complex medical planning in the context of social risk and to drive higher reimbursement. Future work could consider these codes for other initiatives, such as integrating them into screening practices or using this reimbursement to fund social health programs.

Bacteriological Profile and Antibiotic Susceptibility Patterns of Late-Onset Neonatal Sepsis in Level III and Level IV Neonatal Intensive Care Units.

Background Late-onset sepsis (LOS), which occurs 72 hours after birth, remains an important cause of mortality and morbidity in the Neonatal Intensive Care Unit (NICU). Differences in infant populations and the complexity of care at various NICU levels may result in varying bacteriological profiles and antibiotic susceptibility patterns. The objective of the current study was to determine and compare the bacteriological profiles, antibiotic susceptibility, and risk factors for LOS in a Level III and Level IV NICU within a single hospital system. Study Design This was a retrospective study of infants with LOS and positive blood cultures, admitted to Level III and Level IV NICUs between 2012 and 2021. Results Of the 173 infants included in our study, 105 were admitted to the Level IV NICU and 68 to the Level III NICU. Infants in the Level III NICU had a lower gestational age and birth weight at the time of LOS. Seventy percent of the infants had a central line. Gram-positive organisms were responsible for the vast majority of infections (75%), with coagulase-negative Staphylococcus (CoNS) being the most common bacteria in both units. Gram-negative bacteria were more frequently isolated from the Level IV NICU (36.2%) compared to the Level III NICU (8.8%). Escherichia coli (E. coli) and Enterobacter sp. were the most frequently isolated Gram-negative bacteria. All Gram-positive bacteria were susceptible to vancomycin, and all Gram-negative bacteria were susceptible to meropenem. Conclusion The prevalent bacteriological profile and antibiotic susceptibility patterns in the NICU should guide the choice of empiric antibiotics for LOS. It is important to monitor sepsis and antimicrobial resistance patterns in the NICU and implement risk-specific strategies to reduce the burden of LOS.

Soft Tissue Infections of Streptococcal Etiology in the Purulent-Surgical Department of a Multidisciplinary Hospital

Purulent diseases of skin and soft tissues occupy the leading place among surgical infections in terms of frequency of occurrence and possible complications. The most significant etiological agents in surgical infections of soft tissues are group A streptococci (SGA), however, there are known cases of severe invasive infections caused by group B, C, G streptococci and pneumococci.Aim. To estimate the frequency and identify the features of soft tissue streptococcal infection in patients of the purulent-surgical department of a multidisciplinary hospital in Moscow.Materials and Methods. We conducted an epidemiological observational descriptive continuous retrospective study based on the analysis of data from case histories of purulent surgery patients with isolation of Streptococcus monocultures obtained from the unified medical information and analytical system (EMIAS) of a multidisciplinary hospital in Moscow for 2020–2022. Establishment of a case of invasive infection was based on the criteria proposed by the US Centers for Disease Control and Prevention (CDC), according to which a case of invasive infection is defined by the isolation of the pathogen from the sterile in normal conditions environment of the organism and laboratory confirmation of infection with clinical signs of invasive disease. Statistical processing and analysis of the study results were performed using Microsoft Excel 2010 and IBM SPSS Statistics 22.Results. During the study period, 235 cases of skin and soft tissue infections with isolation of Streptococcus monocultures were detected in the department of purulent surgery of a multidisciplinary hospital. The most frequent diagnoses were abscesses – 109 (37,59%), phlegmons – 61 (21,03%), infected wounds – 30 (10,34%), purulent destructive arthritis – 12 (4,14%). The comorbidities identified were hypertension (HD) 21.45%, diabetes mellitus (DM) 19.8%, coronary heart disease (CHD) 12.54%, and hepatitis 4.97%. The age median of all patients was 47 (IQR=20) years. On average, patients spent 9 days in hospital. In 9.79% of cases, the treatment of patients was rather long (&gt;21 days). Among the monocultures of streptococci isolated from patients, S. pyogenes (40.78%), S. agalactiae (22.75%), S. anginosus (13.33%) and S. constellatus (6.27%) were predominant. A total of 32 (13.62%) cases of invasive soft tissue infection were identified during the study period, of which 16 (50.0%) were associated with S. agalactiae monocultures, 9 (28.13%) with S. pyogenes, and the remaining 7 (21.88%) with other streptococcal species. Male patients (87.5%) predominated in the sex and age structure. During the analysed period, mortality in the invasive form of infection was 6.25%. According to the ROC-analysis, the development of the invasive form of infection was predicted in patients aged 52 years and older. The comorbidities most closely associated with the invasive form of infection were diabetes mellitus DM (OR = 4.2), GB (OR = 2.7), CHD (OR = 4.8) and gastrointestinal inflammatory disease (OR = 14.3).Conclusion. The study demonstrated a wide prevalence of soft tissue streptococcal infection in the department of purulent surgery of a multidisciplinary hospital with the predominance of S. pyogenes, S. agalactiae, S. anginosus and S. constellatus in the etiological structure and showed the possibility of developing invasive forms of the disease associated not only with group A streptococci, but also with other species of streptococci.

Holistic intelligence and smart organization affecting the performance of standard medical laboratory guidelines of medical technologists at community hospitals in Health Region 7

Background: Medical laboratories are vital components of healthcare systems in community hospitals, serving as frontline facilities in public healthcare. The development of laboratory quality standards requires comprehensive improvement in personnel and organizational aspects to ensure public confidence and safety in service delivery. Objective: This cross-sectional descriptive research aimed to study the effects of holistic intelligence and intelligent organization on medical laboratory standard practices among medical technologists in community hospitals within Health Region 7. Materials and methods: The sample consisted of 187 medical technologists from community hospitals in Health Region 7, selected through stratified random sampling proportionally by province, followed by simple random sampling within each province. Data were collected between November 13-23, 2024, using an online questionnaire validated for content by three experts, with an overall reliability coefficient of 0.988. Data analysis employed descriptive statistics, Pearson’s correlation coefficient, and stepwise multiple linear regression. Results: The results revealed that overall holistic intelligence was at a high level (Mean=4.12, SD=0.45), overall intelligent organization was at a high level (Mean=3.80, SD=0.65), and overall adherence to medical laboratory standards was at a high level (Mean=4.27, SD=0.49). Both holistic intelligence and intelligent organization showed statistically significant moderate positive correlations with medical laboratory standard practices (r=0.599, p&lt;0.001 and r=0.557,&gt;&lt;0.001 and r=0.557, p&lt;0.001 and r=0.557,&gt;&lt;0.001, respectively). Predictive factor analysis identified organizational learning system co-creation (B=0.266), moral and ethical intelligence (B=0.262), and emotional intelligence (B=0.213) as significant predictors, collectively explaining 47.2% of the variance in medical laboratory standard practices (R²adj=0.472). Conclusion: Based on these findings, relevant agencies should develop organizational learning systems through the establishment of learning centers and mentoring systems, enhance moral and ethical intelligence through training and knowledge exchange, and improve personnel emotional management skills to elevate the quality and safety standards of medical laboratory operations in community hospitals.

Leadership's role in conflict management during health information technology adoption decisions: qualitative study.

This study aims to explore how hospital leadership manages conflicts arising from the risks and complexities of adopting Health Information Technology (HIT). This qualitative study uses Yin's (2014) case study methodology, drawing on in-depth interviews with leaders from a research hospital system and a critical access hospital to develop a conceptual model of leadership's role in managing HIT-related conflicts. This study identifies 30 factors related to HIT-related conflicts. Critical access hospitals face higher risks due to resource constraints, though their impact on stakeholders is lower. Increased complexity, shaped by close-knit cultures and reliance on external networks, is offset by reduced bureaucracy, enabling quicker decision-making. Leadership in both settings uses servant leadership and similar conflict management strategies, including process, content and motivational controls. Furthermore, heightened HIT-related conflicts correlate with adoption and implementation delays, prompting proactive leadership interventions. This research fills a gap by examining how hospital leadership mediates conflicts during HIT adoption in a research hospital system and a critical access hospital.

Exploring challenges and policy considerations in point-of-care testing for hospital preparedness ahead of infectious disease emergencies: A qualitative study

Exploring challenges and policy considerations in point-of-care testing for hospital preparedness ahead of infectious disease emergencies: A qualitative study

Ferric carboxymaltose: A practical guide on the administration of iron infusions in general practice.

Despite having strong knowledge on iron deficiency, there is ongoing hesitancy among general practitioners (GPs) in providing iron infusions due to reduced confidence in the administration technique and concerns about adverse events. This article aims to prepare GPs, general practice registrars and other health providers with the knowledge to confidently and safely perform ferric carboxymaltose (FCM) infusions. It provides education around the use of parenteral iron, including indications, storage, administration, PBS (Pharmaceutical Benefits Scheme) subsidy, side effects, contraindications and benefits. It might also assist already seasoned GPs with supplementary information, or those not performing infusions, with information about pre- andpost-infusion care. GPs play a pivotal role in both detection and management of iron deficiency and are arguably best suited to facilitate iron infusions. The goal is to reduce the responsibility burden on the hospital system, as well as assist GPs to maintain advanced skills and provide holistic care.

Desire for death and risk of suicide: Covarying wish to die out of suicidal ideation.

Desire for death and risk of suicide: Covarying wish to die out of suicidal ideation.

Optimizing Pathological Examination Cost Control Through Process Management Information Systems: A Mixed-Methods Study.

This study aimed to investigate the effects of process management information systems used for consumable management in the Department of Pathology. Data, such as workload capacity of each work group from 2022 to 2023, consumable consumption, warehouse receiving and dispatching, and price of consumables, were extracted from the hospital information system (HIS) and the Goldisc Picture Archiving and Communication System (PACS) of West China Second University Hospital, Sichuan University. Chi-square test and 95% confidence interval (CI) analysis were performed to assess the effects of the systems in optimizing pathological examination cost control. The focus group interviews were conducted to investigate the advantages, limitations and optimization strategy of the systems. The workload capacities of the cellular pathology group, molecular pathology group, frozen section group, immunohistochemistry group, and routine pathological examination group increased by 20.17%, 22.72%, 24.10%, 24.28%, and 20.11%, respectively (P < 0.0001) (95% CI: 19.74%, 24.81%). The difference in the quantity of medical consumables received at the warehouse between 2022 and 2023 was 148,975 (P < 0.0001). The difference in the quantity of dispatched medical consumables between 2022 and 2023 was 150,282 (P < 0.0001). The overstock inventory of medical consumables decreased from 996,527.33 (Chinese Yuan) for 2022 to 832,401.60 (Chinese Yuan) for 2023. The quantity of waste in glass slides decreased from 17,244 for 2022 to 1,538 for 2023 (P < 0.0001). The timeliness rate of histopathological diagnosis in 2023 increased from 65.07% (data for 2022) to 95.46%. The timeliness rate of intraoperative pathological rapid diagnosis in 2023 increased from 67.34% (data for 2022) to 89.45%. Intelligent information management modules should be configured for medical consumables to optimize the allocation of medical resources and reduce the cost of pathological examinations. The process management information systems could significantly optimize pathological examination cost control.

Analyzing the implementation and use of incident reporting systems in German university hospitals: Results of a cross-sectional online survey

Analyzing the implementation and use of incident reporting systems in German university hospitals: Results of a cross-sectional online survey

Access to Care: The Role of Hospital-Based Violence Intervention Programs.

Limited access along the continuum of trauma care, at any point, may lead to significant health disparities. Trauma care begins with prevention and pre-hospital services and extends to inpatient care, post-hospital rehabilitation, and recovery. If looking at violent injuries, specifically, there are clear opportunities for hospital systems, trauma centers, and individual providers to promote awareness, provide education, engage with communities, embody trauma-informed care, and mitigate violence. These include community-focused initiatives like Stop the Bleed and hospital-based violence intervention programs. Failure to provide access to care poses a significant risk of increased incidence of violent injury and poor health. Therefore, policymakers and health care professionals alike should prioritize access to care and violence prevention to reduce the incidence of trauma and promote health, safety, and well-being for all communities.

Socioeconomic and Racial Disparities in Patients With Acute Exacerbations of Bronchiectasis: Insights From the New York City Public Hospital System

Socioeconomic and Racial Disparities in Patients With Acute Exacerbations of Bronchiectasis: Insights From the New York City Public Hospital System

Private Equity Strategies in Nonprofit Health Care.

Private equity firms exacerbate health inequity by driving hospital closures in historically underserved communities. Now nonprofit health systems seem to be adopting private equity practices to do the same. Drawing on a case study of one nonprofit hospital system that has adopted private equity business practices to acquire and close community hospitals, this article argues that nonprofit hospitals' adoption of private equity acquisition and closure practices sacrifices their missions, prioritizes profit, and works to the detriment of local communities. This article construes this set of practices as a breach of organizational ethics that must be addressed via policy changes, specifically by placing guardrails on closures and promoting responsible health care investments.