Pediatric Hospital Medicine Programs Research Articles

Impact of COVID-19 on the Sense of Job Security Among Community Pediatric Hospitalists.

The coronavirus disease 2019 (COVID-19) pandemic offers a prime opportunity to examine the ability of community pediatric hospital medicine programs to respond to external stressors. This study aims to characterize the impact of the COVID-19 pandemic on compensation and furlough among community pediatric hospitalists, as well as self-reported sense of job security. This study was part of a larger quantitative project investigating community pediatric hospitalists' career motivators. The survey was drafted through an iterative process by the authors. It was disseminated via e-mail to a convenience sample of community pediatric hospitalists obtained through direct contact with community pediatric hospital medicine programs. Data were collected on changes in compensation and furlough because of COVID-19, as well as worry about job security measured as self-reported worry about one's job being permanently terminated on a 5-point Likert scale. Data were collected from 31 hospitals across the United States with 126 completed surveys. Because of COVID-19, many community pediatric hospitalists experienced reduced base pay and benefits and a minority experienced furlough. Nearly two-thirds (64%) reported some worry about job security. Initial base pay reduction, working in suburban areas compared with rural areas, and affiliation with a university-based center or free-standing children's hospital were significantly associated with greater worry about job security. The initial response to the COVID-19 pandemic resulted in changes in compensation and furlough for some community pediatric hospitalists and many expressed concerns about job security. Future studies should identify protective factors for community pediatric hospitalists' job security.

Mind the Gap: Women in Pediatric Hospital Medicine.

Mind the Gap: Women in Pediatric Hospital Medicine.

Development of Goals and Objectives for Pediatric Hospital Medicine Fellowship Curricula.

Pediatric hospital medicine (PHM) has experienced incredible growth in the last 20 years, including the creation of >50 PHM fellowships since the first program in 2003. In 2013, a National Pediatric Hospital Medicine Leaders Conference concluded that the best path forward for the field would be subspecialty certification with a 2-year accredited fellowship.1 This process culminated in formal recognition of PHM as a subspecialty by the American Board of Medical Specialties in 2016 and the first American Board of Pediatrics (ABP) certification examination in 2019.2,3 Also, in 2019, the Accreditation Council for Graduate Medical Education (ACGME) published requirements for PHM fellowships and began accrediting programs.4 Established PHM fellowships and programs in development now need to implement standardized curricular components to improve the consistency and educational quality of training and be compliant with ACGME accreditation requirements. During the initial period of PHM fellowship expansion, before American Board of Medical Specialties recognition of PHM as a subspecialty, PHM fellowship program directors (PDs) mobilized and formed a national PHM Fellowship Directors’ Council to oversee the evolution of PHM fellowships and provide a community for collaboration and development of shared resources. In 2014, the council created subcommittees to address areas of need within PHM fellowship programs. These included the curriculum subcommittee, which was composed of both new and established PDs as well as 2 community hospitalist representatives, all with specific interest and skills in curriculum development. Between 2014 and 2016, the council, led by the curriculum subcommittee, created a standardized 2-year fellowship curricular framework to reflect the …

AAP Publications Reaffirmed or Retired

Policy Statement. Point-of-care ultrasonography by pediatric emergency medicine physicians. Pediatrics. 2015;135(4). Available at: www.pediatrics.org/cgi/content/full/135/4/e1097. Reaffirmed September 2019Technical Report. Point-of-care ultrasonography by pediatric emergency medicine physicians. Pediatrics. 2015;135(4). Available at: www.pediatrics.org/cgi/content/full/135/4/e1113. Reaffirmed September 2019Policy Statement. Consumption of raw or unpasteurized milk and milk products by pregnant women and children. Pediatrics. 2014;133(1):175–179. Available at: https://pediatrics.aappublications.org/content/133/1/175. Reaffirmed November 2019Policy Statement. Off-label drug use in children. Pediatrics. 2014;133(3):563–567. Available at: https://pediatrics.aappublications.org/content/133/3/563. Reaffirmed November 2020Technical report. Prevention of drowning. Pediatrics. 2010;126(1):e253–e262. Available at: https://pediatrics.aappublications.org/content/126/1/e253. Reaffirmed February 2019Clinical report. Child sex trafficking and commercial sexual exploitation: health care needs of victims. Pediatrics. 2015;135(3):566–574. Available at: https://pediatrics.aappublications.org/content/135/3/566. Reaffirmed October 2020Clinical report. Management of food allergy in the school setting. Pediatrics. 2010;126(6):1232–1239. Available at: https://pediatrics.aappublications.org/content/126/6/1232. Reaffirmed October 2020Policy statement. HIV testing and prophylaxis to prevent mother-to-child transmission in the United States. Pediatrics. 2008;122(5):1127–1134. Available at: https://pediatrics.aappublications.org/content/122/5/1127. Reaffirmed October 2020Clinical report. Suicide and suicide attempts in adolescents. Pediatrics. 2016;138(1):e20161420. Available at: https://pediatrics.aappublications.org/content/138/1/e20161420. Reaffirmed October 2020Technical report. SIDS and other sleep‐related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics. 2011;128(5):e1341–e1367. Available at: http://pediatrics.aappublications.org/content/128/5/e1341. Reaffirmed October 2020Policy statement. SIDS and other sleep‐related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics. 2011;128(5):1030–1039. Available at: http://pediatrics.aappublications.org/content/128/5/1030. Reaffirmed October 2020Policy statement. Pediatrician-family-patient relationships: managing the boundaries. Pediatrics. 2009;124(6):1685–1688. Available at: https://pediatrics.aappublications.org/content/124/6/1685. Reaffirmed October 2020Clinical report: Attention-deficit/hyperactivity disorder and substance abuse. Pediatrics. 2014;134(1):e293–e301. Available at: https://pediatrics.aappublications.org/content/134/1/e293.full. Reaffirmed October 2020Clinical report: Health supervision for children with sickle cell disease. Pediatrics. 2002;109(3):526–535. Available at: https://pediatrics.aappublications.org/content/109/3/526. Reaffirmed September 2020Policy statement. Postnatal corticosteroids to prevent or treat chronic lung disease following preterm birth Pediatrics. 2010;126(4):800–808. Available at: https://pediatrics.aappublications.org/content/126/4/800. Reaffirmed September 2020Policy statement. Children’s Health Insurance Program (CHIP): accomplishments, challenges, and policy recommendations. Pediatrics. 2013;133(3):e784–e793. Available at: https://pediatrics.aappublications.org/content/133/3/e784. Reaffirmed August 2020Policy statement. Guiding principles for pediatric hospital medicine programs. Pediatrics. 2013;132(4):782–786. Available at: https://pediatrics.aappublications.org/content/132/4/782. Retired August 2020

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 …

Gender Distribution in Pediatric Hospital Medicine Leadership.

Pediatric Hospital Medicine (PHM), a field early in its development and with a robust pipeline of women, is in a unique position to lead the way in gender equity. We describe the proportion of women in divisional and fellowship leadership positions at university-based PHM programs (n = 142). When compared with the PHM field at large, women appear to be underrepresented as PHM division/program leaders (70% vs 55%; P< .001) but not as fellowship directors (70% vs 66%; P > .05). Women appear proportionally represented in associate/assistant leadership roles when compared with the distribution of the PHM field at large. Tracking these trends overtime is essential to advancing the field.

Community Pediatric Hospitalist Workload: Results from a National Survey.

As a newly recognized subspecialty, understanding programmatic models for pediatric hospital medicine (PHM) programs is vital to lay the groundwork for a sustainable field. Although variability has been described within university-based PHM programs, there remains no national benchmark for community-based PHM programs. In this report, we describe the workload, clinical services, employment, and perception of sustainability of 70 community-based PHM programs in 29 states through a survey of community site leaders. The median hours for a full-time hospitalist was 1,882 hours/year with those employed by community hospitals working 8% more hours/year and viewing appropriate morning pediatric census as 20% higher than those employed by university institutions. Forty-three out of 70 (63%) site leaders perceived their programs as sustainable, with no significant difference by employer structure. Future studies should further explore root causes for workload discrepancies between community and academic employed programs along with establishing potential standards for PHM program development.

Pediatric Primary Care Providers' Perspectives Regarding Hospital Discharge Communication: A Mixed Methods Analysis

ObjectiveEffective communication between inpatient and outpatient providers may mitigate risks of adverse events associated with hospital discharge. However, there is an absence of pediatric literature defining effective discharge communication strategies at both freestanding children's hospitals and general hospitals. The objectives of this study were to assess associations between pediatric primary care providers' (PCPs) reported receipt of discharge communication and referral hospital type, and to describe PCPs' perspectives regarding effective discharge communication and areas for improvement. MethodsWe administered a questionnaire to PCPs referring to 16 pediatric hospital medicine programs nationally. Multivariable models were developed to assess associations between referral hospital type and receipt and completeness of discharge communication. Open-ended questions asked respondents to describe effective strategies and areas requiring improvement regarding discharge communication. Conventional qualitative content analysis was performed to identify emergent themes. ResultsResponses were received from 201 PCPs, for a response rate of 63%. Although there were no differences between referral hospital type and PCP-reported receipt of discharge communication (relative risk 1.61, 95% confidence interval 0.97–2.67), PCPs referring to general hospitals more frequently reported completeness of discharge communication relative to those referring to freestanding children's hospitals (relative risk 1.78, 95% confidence interval 1.26–2.51). Analysis of free text responses yielded 4 major themes: 1) structured discharge communication, 2) direct personal communication, 3) reliability and timeliness of communication, and 4) communication for effective postdischarge care. ConclusionsThis study highlights potential differences in the experiences of PCPs referring to general hospitals and freestanding children's hospitals, and presents valuable contextual data for future quality improvement initiatives.

The business of pediatric hospital medicine.

Pediatric hospital medicine (PHM) programs are mission driven, not margin driven. Very rarely do professional fee revenues exceed physician billing collections. In general, inpatient hospital care codes reimburse less than procedures, payer mix is poor, and pediatric inpatient care is inherently time-consuming. Using traditional accounting principles, almost all PHM programs will have a negative bottom line in the narrow sense of program costs and revenues generated. However, well-run PHM programs contribute positively to the bottom line of the system as a whole through the value-added services hospitalists provide and hospitalists' ability to improve overall system efficiency and productivity. This article provides an overview of the business of hospital medicine with emphasis on the basics of designing and maintaining a program that attends carefully to physician staffing (the major cost component of a program) and physician charges (the major revenue component of the program). Outside of these traditional calculations, resource stewardship is discussed as a way to reduce hospital costs in a capitated or diagnosis-related group reimbursement model and further improve profit-or at least limit losses. Shortening length of stay creates bed capacity for a program already running at capacity. The article concludes with a discussion of how hospitalists add value to the system by making other providers and other parts of the hospital more efficient and productive.

Guiding Principles for Pediatric Hospital Medicine Programs

Pediatric hospital medicine programs have an established place in pediatric medicine. This statement speaks to the expanded roles and responsibilities of pediatric hospitalists and their integrated role among the community of pediatricians who care for children within and outside of the hospital setting.

Survey of academic pediatric hospitalist programs in the US: Organizational, administrative, and financial factors

Many pediatric academic centers have hospital medicine programs. Anecdotal data suggest that variability exists in program structure. To provide a description of the organizational, administrative, and financial structures of academic pediatric hospital medicine (PHM). This online survey focused on the organizational, administrative, and financial aspects of academic PHM programs, which were defined as hospitalist programs at US institutions associated with accredited pediatric residency program (n = 246) and identified using the Accreditation Council for Graduate Medical Education (ACGME) Fellowship and Residency Electronic Interactive Database. PHM directors and/or residency directors were targeted by both mail and the American Academy of Pediatrics Section on Hospital Medicine LISTSERV. The overall response rate was 48.8% (120/246). 81.7% (98/120) of hospitals reported having an academic PHM program, and 9.1% (2/22) of hospitals without a program reported plans to start a program in the next 3 years. Over a quarter of programs provide coverage at multiple sites. Variability was identified in many program factors, including hospitalist workload and in-house coverage provided. Respondents reported planning increased in-house hospitalist coverage coinciding with the 2011 ACGME work-hour restrictions. Few programs reported having revenues greater than expenses (26% single site, 4% multiple site). PHM programs exist in the majority of academic centers, and there appears to be variability in many program factors. This study provides the most comprehensive data on academic PHM programs and can be used for benchmarking as well as program development.